Practice
Applying to become a Medicare provider
Following the procedures and using the correct terminology will speed your application process.
Step 1: Obtain an NPI
Psychologists seeking to become Medicare providers must obtain a National Provider Identifier (NPI) before attempting to enroll in Medicare. NPI applications can be completed and submitted online. Alternatively, an NPI application can be downloaded (PDF, 156 KB). Once completed, mail the application to the NPI Enumerator address listed on the form. Psychologists who cannot access the NPI application form online should call (800) 465-3203 to request a paper copy. For more information, see Choosing a taxonomy code in applying for your National Provider Identifier: Guidance from the APA Practice Organization.
Step 2: Complete the Medicare Enrollment Application
Once a psychologist has an NPI, the next step is to complete the Medicare Enrollment Application. Complete the application through Medicare’s online enrollment system known as the Provider Enrollment, Chain, and Ownership System (PECOS). Although PECOS is designed to be paperless, providers can print a copy of the application for their records. PECOS will indicate if additional documentation is needed and includes the name and address of the Medicare Administrative Contractor (MAC) that should receive the documentation.
Paper copies of the Medicare provider application forms are available on the website for the Centers for Medicare and Medicaid Services (CMS). To bill Medicare directly, complete Form CMS-855l (PDF, 495KB). To reassign benefits to another entity, use Form CMS-855R (PDF, 90KB).
Medicare does not charge an application fee for psychologists to enroll.
Step 3: Select a Specialty Designation
Psychologists applying for a Medicare provider number must choose a specialty from the two psychologist designations used by CMS. Psychologists may apply as an "independently practicing psychologist" (specialty code 62) or “clinical psychologist” (specialty code 68). Independently practicing psychologists can only furnish diagnostic testing services, whereas clinical psychologists can provide diagnostic and therapeutic services. The vast majority of psychologists in the Medicare program are designated as clinical psychologists. For more information, see Medicare Learning Network MLN Guided Pathways (PDF, 2.44MB).
Clinical psychologist
A clinical psychologist in Medicare is an individual who:
- Holds a doctoral degree in psychology.
- Is licensed or certified, on the basis of the doctoral degree in psychology, by the State in which he or she practices, at the independent practice level of psychology to furnish diagnostic, assessment, preventive, and therapeutic services directly to individuals.
Clinical psychologists can perform diagnostic psychological and neuropsychological tests without a physician or authorized non-physician practitioner’s order. Clinical psychologists, in addition to physicians, are also authorized to supervise diagnostic psychological and neuropsychological tests. An individual applying to be a clinical psychologist in Medicare must agree to consult with their patient’s primary care or attending physician.
It is important to understand that the term clinical psychologist in Medicare does not mean that your degree must specifically be in clinical psychology. What matters is that you have the appropriate clinical training and are licensed to provide direct services independently. Many counseling psychologists, health psychologists and school psychologists are Medicare providers under the clinical psychologist designation.
Independently practicing psychologist
To be considered an independently practicing psychologist you must:
- Be responsible for rendering your own services, meaning you are not an employee of a physician, institution or agency.
- Treat your own patients.
- Have the right to bill directly, collect and retain the fee for your services.
An independently practicing psychologist in Medicare can provide only diagnostic testing services if a physician orders such testing.
Medicare covers diagnostic testing as an outpatient service if furnished by an independently practicing psychologist who is licensed or certified to practice psychology in the State or jurisdiction where he or she is furnishing services. For jurisdictions that do not issue licenses, such as some of the trust territories, any practicing psychologist may furnish services as an independently practicing psychologist. Individuals enrolled as independently practicing psychologists often hold terminal masters’ degrees.