Key terms on this page (6)
- Credentialing
- Applying to an insurer to join its network, so you can bill it at the rates in its contract.
- NPI
- National Provider Identifier: a free, permanent ten-digit number from the federal NPPES system that goes on every claim.
- CAQH ProView
- A free online profile most commercial insurers read when they credential you, so you fill in your details once.
- CPT code
- The five-digit code on a claim that says what service you provided, such as 90837 for about an hour of psychotherapy.
- Sliding scale
- Fees reduced by a written policy, usually by income, applied the same way to everyone who qualifies.
- Good faith estimate
- The written estimate of expected charges that federal law requires for uninsured and self-pay clients.
The main settings
The setting matters most in your associate years, when you need a supervisor and someone to bill for your work. After the license, most clinicians move between settings at least once.
Community agency
Associates and new licenseesClinics and nonprofits, often funded by Medicaid and county contracts. Large caseloads and lots of paperwork, but built-in supervision and a wide range of clients. Nonprofit and government jobs can count toward Public Service Loan Forgiveness.
Group practice
Associates in some states; licenseesA practice that handles intake, billing and credentialing while you see clients. You are paid by the session or a split of what you bring in, sometimes as an employee, sometimes as a contractor.
Private practice
Licensed cliniciansYour own business: your fee, your hours, your rent, your liability insurance and your billing. Usually possible only once fully licensed; associates in most states cannot practice independently.
Hospitals and health systems
Often LCSWs and psychologistsInpatient units, emergency departments, primary care teams. Salaried, with benefits. Social workers are widely hired here.
Schools
Varies by stateSchool-based therapy through districts or agencies. Many districts also want a separate school credential from the state education agency.
Government and telehealth employers
VariesFederal and state agencies, corrections, military family programs, and companies employing clinicians for video sessions. Check where the client must be located, and your license’s reach.
Whether associates can work in a private or group practice at all, and under what supervision, varies by state. California, for example, requires associates to work as employees or volunteers, not as independent contractors, and to document their hours with W-2s or a volunteer letter. Check your state’s requirements and the associate years page before you accept an offer.
The pay, honestly
No national survey publishes associate pay, and job postings vary widely by city and setting. The Bureau of Labor Statistics publishes medians for the licensed occupations, which include associates in some cases and experienced clinicians in all of them:
- Mental health counselors
- $59,350
Median, May 2025 (with substance use and behavioral disorder counselors). Hospitals $63,310; outpatient centers $58,750.
- Mental health social workers
- $60,280
Median, May 2025, for mental health and substance abuse social workers. Healthcare social workers $67,880.
- Marriage and family therapists
- $66,940
Median, May 2025. Outpatient care centers $75,560; individual and family services $61,060.
- Clinical and counseling psychologists
- $100,580
Median, May 2025.
Associates are commonly paid per session or by the hour, and in some settings only for sessions that happen. Ask every employer three questions: am I paid for no-shows, am I paid for notes and meetings, and who pays for my supervision? Then do the math below with the real numbers.
Session math
A per-session rate sounds bigger than it is. Put in an offer, or your own fee, and see what it becomes over a year.
Example figures. Change any of them to your own.
Your fee, or the insurer’s contracted rate.
Client hours, not hours at work.
After vacation, holidays and sick days.
Late cancellations, no-shows, denied claims.
Rent, records system, insurance, fees. Zero if employed.
- Paid sessions a year
- 846
- Collected in total
- $101,568
- Yours, before tax
- $101,568
- $120 per paid session
Getting paid by insurance
Once you are licensed and want to see clients through their insurance, the steps are roughly the same everywhere:
- Get an NPI from NPPES. It is free, and individual clinicians need the Type 1 number. Many associates get one early, because employers bill with it.
- Buy professional liability insurance if your employer does not cover you. Insurers ask for proof.
- Build your CAQH ProView profile, upload your license and insurance, and keep re-attesting it on schedule. A stale profile stalls applications.
- Apply to each insurer you want to join, then read the contract and its fee schedule before you sign. Expect it to take months, so start before you need the income.
- Bill with the right codes, document medical necessity, and keep notes that support every claim.
| Code | What it is |
|---|---|
| 90791 | Psychiatric diagnostic evaluation, usually the first session. Not timed. |
| 90832 | Psychotherapy, about 30 minutes (16 to 37). |
| 90834 | Psychotherapy, about 45 minutes (38 to 52). |
| 90837 | Psychotherapy, about 60 minutes (53 or more). |
| 90846 / 90847 | Family psychotherapy, without or with the client present. |
| 90853 | Group psychotherapy. |
Medicare
Medicare matters if you want to see older adults or people with disabilities, and since 2024 it is open to every license on this path. Marriage and family therapists and mental health counselors (a category that includes many licensed professional counselors, and addiction counselors who meet the same requirements) can enroll if they:
- hold a master’s or doctorate that qualifies for their state license;
- are fully licensed in the state where they see the client (associates cannot enroll); and
- have at least two years or 3,000 hours of post-master’s supervised clinical experience.
Medicare pays MFTs, mental health counselors and clinical social workers at 75% of what it pays a clinical psychologist for the same service, and all must accept Medicare’s amount as payment in full.
Self-pay and sliding scale
Many clinicians see some or all clients who pay directly. It is simpler billing and more freedom over the work, at the price of a smaller pool of clients who can afford it.
- Good faith estimates. Federal law requires a written estimate of expected charges for uninsured clients and for insured clients who choose not to use their insurance, and notice that they can ask for one.
- Sliding scale. Write the policy down, base it on something you can apply consistently (usually income), and apply it the same way to everyone who qualifies.
- Superbills. A detailed receipt with codes and your NPI lets clients ask their insurer for out-of-network reimbursement.
Three first jobs
Invented composites, not real people.
Kenji
28, associate MFT
Community agencyWeekly supervision on site, a caseload of families on Medicaid, and a nonprofit employer that counts toward loan forgiveness. Hard work, and the hours came fast.
Bri
32, associate counselor
Group practicePaid per session. She asked about no-shows before signing, ran the numbers, and negotiated paid time for notes.
Omar
40, newly licensed LCSW
Hospital, then practiceA salaried hospital job for the benefits, and two evenings a week of private practice once his insurance contracts came through.
Myths worth dropping
Myth
“A high per-session rate means a high income.”
Actually
No-shows, unpaid notes, weeks off and overhead all come out of it. Do the math.
Myth
“Associates can bill Medicare under supervision.”
Actually
Medicare enrolls fully licensed clinicians only, and an MFT, counselor or social worker cannot bill an associate’s work “incident to” their own services.
Myth
“Self-pay means no paperwork.”
Actually
Good faith estimates, receipts and notes still apply. It is less paperwork, not none.
Next · Step 23
Specialties and lifelong learning
The license is not the end of learning. Certifications worth the money, the continuing education every state requires, and keeping the license you worked for.
Questions people ask
Can associates bill insurance?
Usually not under their own name with commercial insurers, most of which credential only fully licensed clinicians. Some plans, and some state Medicaid programs, allow supervised associates to provide covered services under rules that vary by state and plan. Medicare does not enroll associates at all. Associates are most often paid by the agency or practice that employs them.
Can LMFTs and counselors bill Medicare?
Yes, since 1 January 2024. Marriage and family therapists and mental health counselors can enroll once fully licensed and with at least two years or 3,000 hours of post-master’s supervised clinical experience. Medicare pays them, like clinical social workers, at 75% of the clinical psychologist rate, and they must accept Medicare’s amount as payment in full.
What is the difference between CPT 90834 and 90837?
Both are individual psychotherapy codes, chosen by time spent in therapy: 90834 for about 45 minutes (38 to 52), 90837 for about 60 (53 or more). 90832 covers about 30 minutes, and 90791 is the diagnostic evaluation, usually the first session. Insurers pay more for 90837 and some review it more closely.
Do I need to give self-pay clients a good faith estimate?
Yes. Under the federal No Surprises Act, providers must give uninsured clients, and insured clients who choose not to use their insurance, a written good faith estimate of expected charges, and tell them it is available.
Sources
Checked 28 October 2026. Medicare and insurer rules change every year; check CMS and each payer before you rely on them.
- CMS, Marriage and family therapists and mental health counselors — Medicare enrollment from 1 January 2024; degree, licensure, and 2 years or 3,000 hours of post-master’s supervised experience; payment at 75% of the clinical psychologist rate; addiction counselors who meet the MHC requirements.
- CMS, Medicare & Mental Health Coverage (MLN1986542, March 2026) — Qualifications and payment for each provider type, including clinical social workers at 75% of the psychologist amount, mandatory assignment, and no payment for services incident to an MFT’s, MHC’s or CSW’s own; the psychotherapy codes 90791, 90832–90838, 90846, 90847 and 90853.
- BLS, Occupational Outlook Handbook — May 2025 medians for mental health counselors, social workers, marriage and family therapists and psychologists, and by industry.
- CMS, Good faith estimates for uninsured or self-pay individuals — Who must receive a good faith estimate, and the patient-provider dispute process.
- NPPES (CMS) — Applying for a National Provider Identifier.
- CAQH ProView — The provider profile most commercial insurers use for credentialing.
- studentaid.gov, Public Service Loan Forgiveness — Qualifying employers: government and 501(c)(3) nonprofits.
- California Board of Behavioral Sciences, Statutes and Regulations (2026) — Associates work only as employees or volunteers, not independent contractors (BPC §§4980.43.3, 4996.23.2, 4999.46.3), and document hours with W-2s or a volunteer letter.