• Home
  • /
  • Blog
  • /
  • Medicare and Licensed Mental Health Services



   Medicare, the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease, is a crucial resource for millions of Americans.

   For family therapists, understanding what Medicare covers, especially in relation to licensed mental health services, is integral to providing comprehensive care to patients. This article aims to provide a guide for family therapists, outlining the key aspects of Medicare coverage for mental health services and how to navigate them. In turn this will help Medicare beneficiaries because they will better understand what professional need from them.

Understanding Medicare Coverage for Family Therapy

   Medicare Part B (Medical Insurance) generally covers mental health services, including family therapy, when they are provided by a healthcare provider who accepts assignment.

   It covers outpatient therapy, including family counseling, if the primary purpose is to help treat a medical condition. Medicare typically pays 80% of the Medicare-approved amount for outpatient mental health services after the beneficiary meets the yearly Part B deductible.

   Family therapists should note that Medicare does not pay for all types of therapy. For instance, it does not cover marriage counseling or therapy for couples unless it’s necessary to treat a medical condition.

   Similarly, Medicare does not pay for therapy that is not considered medically necessary, such as therapy for personal growth or for coping with occupational stress. Therefore, it is critical to understand and explain to patients about what services are covered and which ones are not.

Navigating Licensed Mental Health Services with Medicare

   Licensed mental health professionals such as psychologists, clinical social workers, psychiatric nurses, and psychiatrists can provide mental health services under Medicare.

    Therapists can bill Medicare for psychotherapy services using a variety of codes, depending on the specific type and length of therapy provided. It’s important for therapists to understand the billing codes and use them correctly to ensure that they are properly reimbursed and to avoid potential allegations of fraud or abuse.

   In addition to understanding the billing codes, therapists should also be aware of the Medicare mental health services documentation requirements. Medicare requires that the records for each service provided include the date, length of time, and a description of the patient's condition, the goals and progress of therapy, and the specific therapeutic interventions used. The records should also include documentation of the necessity for the service, which is crucial for obtaining reimbursement.

   Family therapists providing mental health services to Medicare beneficiaries must understand the specifics of Medicare coverage for these services. This includes being aware of what types of therapy are covered, who can provide and bill for these services, and what documentation is required.

   With this understanding, family therapists can more effectively navigate the Medicare system, ensuring that they provide their patients with the necessary care and receive appropriate reimbursement for their services. It's always beneficial for therapists to stay updated with Medicare's coverage details to ensure they’re providing the best possible care for their patients. This knowledge will also help Medicare beneficiaries receive the help they need. Beneficiaries can better equip themselves to navigate the Medicare system by helping licensed therapist use/take Medicare Insurance.


Related Articles

Become an EDL Member Today!

Learn About The Benefits of Membership and More