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Marriage and family therapist (MFT)
Last Modified: 3/7/2024
Location: FL, PR, USVI
Business: Part A, Part B
Effective January 1, 2024, Medicare covers services furnished by MFTs. An MFT is defined in CFR § 410.53(a)(1)-(3) as an individual who:
1. Possesses a master's or doctor's degree which qualifies for licensure or certification as a MFT pursuant to state law of the state in which such individual furnishes the services defined as MFT services
2. After obtaining such degree, has performed at least two years or 3,000 hours of post-master’s degree clinical supervised experience in marriage and family therapy in an appropriate setting such as a hospital, SNF, private practice, or clinic
3. Is licensed or certified as an MFT by the state in which the services are performed
Note: To expedite the processing of your provider enrollment application, you may use the internet-based
PECOS 
, which will automatically select the appropriate form and allow you to complete the application process online.
• Signed and dated certification statement -- all signatures must be original and signed in ink (blue ink preferred). Stamped, faxed, or copied signatures will not be accepted.
Note: If you submitted your application through internet-based PECOS, you may sign the application electronically or you must submit your paper certification statement within 15 days of your electronic submission.
Note: If a provider or supplier already receives payments electronically and is not making a change to his or her banking information, the CMS-588 is not required. In addition, physicians and non-physician practitioners who are reassigning their benefits to another entity are not required to submit the CMS-588.
Include copies of the following supporting documents:
• A notarized copy or a certified “true copy” of the practitioner’s state medical license
• A notarized copy must include the stamp that states “official seal” and the name of the notary public as well as the state, county, and date the notary’s commission expires
• A certified “true copy” of an original document has a raised seal that identifies the state and county in which it originated or is stored
Note: A provider or supplier located in Puerto Rico or U.S. Virgin Islands must include a copy of his or her Letter of Good Standing. The letters for Puerto Rico providers and suppliers will be considered valid if it was issued within 12 months of First Coast’s receipt of the enrollment application. The letters for U.S. Virgin Islands providers and suppliers will be considered valid if it was issued within six months of First Coast’s receipt of the enrollment application.
• Documentation to demonstrate that at least two years or 3,000 hours of post-master’s degree clinical supervised experience in marriage and family therapy in an appropriate setting. The document must be on letterhead, signed by an authorized individual, and confirm that the year or hour requirement was met. If the year or hour requirement was met at multiple facilities, multiple documents can be submitted.
Medicare may require additional documentation, when applicable, to validate key information contained within the enrollment application (e.g., name change, tax identification number, proof of citizenship) or to address specific issues that could adversely affect a practitioner’s potential eligibility for enrollment (e.g., adverse legal actions, financial relationships).
• Driver’s license
• Social Security card
• Marriage license
• U.S. passport
• NPI verification from National Plan and Provider Enumeration System (NPPES) -- only durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers are required to submit this type of documentation
• Written confirmation from the IRS verifying provider’s TIN is associated with the provider’s legal business name (e.g., IRS CP 575)
• Final adverse action documentation: Please include copies of legal documents associated with any final adverse action(s) taken against the provider as well as copies of any the legal documents showing its resolution (e.g., notifications, reinstatement letters).
Note: Documents containing a summary of the adverse actions taken or their resolution will not be accepted.
• Statement in writing from the practitioner’s bank (or other financial institution) -- if Medicare payments will be sent to a practitioner’s bank with which he or she has a lending relationship (i.e., any type of loan), then the practitioner must provide a statement in writing from the bank -- which must be specified in the loan agreement -- that the lender has agreed to waive its right of offset for Medicare receivables.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
and associated documentation (e.g., copy of a voided check or a deposit slip). Please click here for more information.
