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Does Medicare Pay For Licensed Professional Counselors

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Does Medicare Cover Counseling

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by Ethan Bynon, November 17, 2021 fact checkedA qualified researcher has reviewed the content on this page to ensure it is factually accurate, meets current industry standards, and helps readers achieve a better understanding of Medicare health insurance and Medicare coverage topics…. by Andrew Bynon

Medicare covers counseling and other mental health services provided by a licensed and certified mental health professional. This includes counseling during inpatient careInpatient care refers to care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition…., such as substance abuse counseling during a period of inpatient treatment. However, Medicare does not cover pastoral counseling, marriage counseling, or counseling over the phone, among other services.

Does Medicare Cover Other Types Of Counseling

There are other specific situations in which Medicare may cover specialized counseling services. For example:

  • Grief and loss counseling for hospice patients and their families.
  • High-intensity behavioral counseling about sexually transmitted infections for at-risk sexually active adults.
  • Behavioral counseling to help you lose weight if you meet certain medical requirements.
  • Counseling sessions to help you quit smoking.
  • Alcohol misuse counseling if its provided in a doctors office or other primary care setting.

These specialized types of counseling are usually limited to a certain number of sessions per year. Ask your health care provider for details if he or she recommends these counseling services.

Are Resources Available If Im Uninsured And Struggling To Find Help

If you need grief or trauma counseling and youre uninsured there are resources available for free or low cost. Among them:

  • Some counselors offer discounts on their fees for those in need. If you find a counselor or therapy group youd like to try but dont have insurance, ask about lower cost sliding scale options.

  • The Department of Veterans Affairs has developed a free mental health and self-care app called COVID Coach. Its available for anyone to use.

  • The National Alliance on Mental Illness has more than 600 chapters across the country, many of which offer free support and education programs.

  • Community health centers can provide or direct you to local low-cost mental health care on a sliding fee scale. Find a health center near you.

  • If you have a low income, you can apply for state health insurance called Medicaid. Medicaid offers assistance with healthcare, mental health programs, education, food benefits, and more. Visit the programs site to find links to assistance in your state.

  • If youre employed, check with your human resources department to see if they offer an employee assistance program . An EAP provides free and confidential emotional well-being services such as grief counseling.

Several mental health hotlines can also provide support and help you find other resources in your community:

Theres no reason to postpone treatment for grief, trauma, or PTSD. Its OK to ask for help, especially during this time of crisis.

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What Can I Expect When I Go To Grief Counseling And Are There Any Specialized Groups

Counseling offers a safe space for you to work through your difficult thoughts and feelings with a trusted mental health professional.

In one-on-one grief counseling, your counselor will listen and offer support and coping strategies so you can move forward in a positive way. If you have medical issues as a result of your grief, such as sleeplessness or depression, you may be referred to another provider for treatment of those issues.

If youre more comfortable in a group therapy setting, you can find grief support groups online or by contacting local hospitals and churches. In a group setting, youll share your experience with others who are also grieving.

Group members take turns talking as a counselor moderates the discussion. Group therapy sessions are usually held once or twice a week. Insurance coverage is similar for both group and individual therapy, but check your plan for details.

There are also specific support networks to help you find a counselor who best fits your needs. Here are some examples:

Medicaid Billing To Remain Available For Licensed Professional Counselors

When Medicare Won

UPDATE: The Louisiana Department of Health said Monday it received the requested guidance from the Centers for Medicare and Medicare Services that it was seeking. Based on the feedback of CMS, LDH says it’s able to allow Federally Qualified Health Centers to bill for services provided by Licensed Professional Counselors. The state says it plans to notify the Medicaid health plans so they can resume working with LPC’s in the FQHC’s.

BATON ROUGE – There’s been a change to Medicaid and it could be affecting your school-aged children.

Earlier this year, the Louisiana Department of Health says it was made aware of a change effective July 1, 2019, affecting Licensed Professional Counselors working for a Federally Qualified Health Center . The state is citing a federal requirement ) from 2014 and says it’s waiting on guidance about what to do next.

LPC’s have been working in schools state-wide for years. They were brought in to help fill a need and assist counselors already in schools. Certain parishes do not employ guidance counselors and fully rely on non-profit agencies to provide behavioral health services. Some schools don’t have enough counselors to fill the need.

LPC’s working for FQHC’s have been able to bill Medicaid and receive reimbursement for their services — but not anymore. With this change, dozens of LPC’s and thousands of students seeking counseling services at school are left wondering what’s next.

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Medicare Part D Coverage

Your doctor may prescribe medications as part of your treatment. Keep in mind that Original Medicare, Part A and Part B, includes only limited prescription drug coverage, although Part B covers certain prescription drugs you get in an outpatient setting, such as medications you cant give yourself. For most other prescription needs, youll need to enroll in a stand-alone Medicare Part D Prescription Drug Plan if you have Original Medicare.

Another option is to sign up for a Medicare Advantage Prescription Drug plan, which includes both health and drug benefits. These plans must provide at least the same level of coverage as Medicare Part A and Part B, but may include additional coverage, including drug benefits, routine vision and dental, and more. You need to continue paying your Medicare Part B premium along with any plan premium. There are only certain times when you can enroll in a Medicare Advantage plan.

Keep in mind that prescription costs may vary by plan, even for the same medications. One way to minimize your costs is to compare plans and find a Medicare Part D Prescription Drug Plan that covers your prescriptions with low cost-sharing. Remember, costs to consider include not only premiums and copayments or coinsurance, but also deductibles and out-of-pocket maximum limits.

To browse plans in your area, simply enter your zip code where indicated on this page.

To learn about Medicare plans you may be eligible for, you can:

Does Medicare Cover Marriage Counseling

Medicare only covers services linked to a primary psychiatric diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders . Medicare has only started reimbursing marriage and family therapists starting in 2019, and only for services for people with a primary substance use disorder diagnosis. It won’t cover any kind of marriage or family therapy from any kind of provider if it isn’t required to treat a mental health condition. This means that if you want to see a social worker or psychologist to address communication or other relationship issues that aren’t directly related to a mental health diagnosis, Medicare won’t cover it.

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Medicare Coverage Of Preventive Mental Health Services

Medicare Part B covers preventive services that address your mental health, including screenings to identify your risk for depression or substance abuse. You generally need to get these services from a Medicare-assigned health provider in a Medicare-enrolled facility to make sure Part B covers them.

Preventive benefits related to mental health coverage include:

  • Depression screening: All Medicare Part B beneficiaries are covered for one depression screening every year at no cost, so long as the doctor accepts Medicare assignment.
  • Alcohol misuse screening: All Medicare Part B beneficiaries who arent alcohol-dependent are covered for one alcohol misuse screening every year. If your doctor determines you misuse alcohol, you may qualify for up to four counseling sessions per year.
  • Welcome to Medicare visit: This one-time preventive exam includes a review of your overall health and includes an evaluation of your risk for depression. The visit is completely covered if you have the visit within the first year of having Medicare Part B.
  • Wellness visit: After the introductory visit, all Medicare Part B enrollees are covered for one preventive visit every year. If you have any questions or concerns about your mental well-being, youll have the chance to speak with your doctor during this exam. Your doctor may discuss treatment options or refer you for additional care.

Does Medicare Cover Counseling If You Have Medicare Advantage

Behavioral Health Treatments & Services in an FQHC

Medicare Advantage is private insurance, which means that your coverage may be different depending on the specific plan you choose. At a minimum, Medicare Advantage must provide the same level of counseling and therapy coverage as Original Medicare.

Your Medicare Advantage plan may charge a flat copayment for counseling and therapy services instead of a percentage-based coinsurance. You may also need to get counseling from providers in the plans approved network of providers.

Also noteworthy, some Medicare Advantage plans require referrals and prior authorization for therapy and counseling services.

If you have a Medicare Advantage plan, check your plan brochure for specific information about mental health coverage. You can also call your plans Member Services department for further help.

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Medicare Advantage Plans Also Cover Counseling

Medicare Advantage plans are required to provide at least the same minimum coverage as Medicare Part A and Part B .

This means that a Medicare Advantage plan will cover your Medicare-eligible counseling and therapy services in the same way that Original Medicare would.

Many Medicare Advantage plans also offer additional benefits not covered by Original Medicare. These benefits can include prescription drug coverage, vision and hearing coverage and other potential benefits that support your counseling and therapy needs.

Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports:

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.

Medicare Inpatient Mental Health Services

If you do need inpatient care as part of your treatment, Medicare Part A covers services during an inpatient hospital or psychiatric hospital stay. Theres a limit to Medicare coverage if you stay at a psychiatric hospital thats dedicated to treating mental health patients, as opposed to a general hospital. Medicare Part A pays for up to 190 days of psychiatric hospital care in your lifetime.

Even during inpatient stays, Medicare Part B still covers certain mental health benefits, such as physician services.

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What Is S 1830

In short, S. 1830 is a bill that seeks to amend title XVIII of the Social Security Act under Medicare Part B. If passed, this bill will grant licensed marriage and family counselors and licensed professional counselors the ability to see Medicare Part B beneficiaries. Licensed professional counselors will also be able to bill and receive reimbursement by Medicare Part B for their services.

Currently, Medicare Part B only covers psychologists and licensed clinical social workers but not licensed counselors.

This bill was originally introduced and sponsored by Sen. Barrasso, John on July 22, 2015. Since then, the bill has received bipartisan support from the following 13 cosponsors :

Sen. Stabenow, Debbie *

Sen. Franken, Al

Sen. Carper, Thomas R.

Sen. Gillibrand, Kirsten E.

Sen. Schumer, Charles E.

Sen. Collins, Susan M.

Sen. King, Angus S., Jr.

Sen. Blumenthal, Richard

Sen. Bennet, Michael F.

Sen. Brown, Sherrod

Sen. Shaheen, Jeanne

Mental Health Provider Demand Effecting Reimbursement Rates For Therapy

Does Medicare Cover Outpatient Mental Health Services ...

The sad truth is some of the best panels are totally full and their network map of mental health providers is saturated. Theres nothing you can do when a company like Florida Blue hasnt accepted mental health providers in years.

The amount of contracted providers per insurance company will have a larger influence on your ability to get in that network or not than it will on what youll be paid.

But on the other hand, if a company is easy to get accepted into their network, odds are higher they do not reimburse as much. Again, this is a case by case situation youll need to research and address.

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Medicare Outpatient Mental Health Services

Medicare Part B covers outpatient mental health services, such as care youd get in a health clinic or doctors office. Youll generally pay 20% of the Medicare-approved cost for outpatient care delivered by providers that accept Medicare assignment.

Medicare covers the following types of psychotherapy :

  • Psychiatric assessment
  • Family counseling, when the primary goal is to treat your condition
  • Alcohol misuse counseling, up to four sessions

You may need to meet other criteria to be eligible for therapy coverage, and the doctor, psychologist, or other health-care professional must accept Medicare assignment. Medicare doesnt cover certain types of therapy, such as pastoral counseling or marriage counseling.

If you need more structured or frequent treatment, Medicare Part B also covers partial hospitalization programs, which are outpatient mental health programs where treatment is provided throughout the day and doesnt require an overnight, inpatient stay. The programs are usually run through a community mental health center or a hospitals outpatient department. Services may include therapy with a mental health professional, diagnostic services, and occupational therapy . These programs dont cover meals or transportation to the facility.

Is There Anything Else I Should Know About Medicare And Medical Nutrition Therapy

Its important to note that Original Medicare benefits may change each year. If you are enrolled in a Medicare Advantage plan, you may also have access to additional wellness benefits that may work alongside your medical nutrition therapy services. Consult your individual plan booklet or customer service department for more information. While all Medicare Advantage plans must offer the same benefits as Original Medicare , many include additional benefits such as prescription drug coverage and wellness programs copayments, annual benefit caps, or coinsurance amounts may apply.

Wondering what benefits, including medical nutrition therapy, are available under Medicare Advantage plan options? I am available to answer your questions. If youd like an email with information prepared just for you, or would prefer to schedule a phone call at your convenience, click one of the links below. You can also view a list of plans in your area you may qualify for by clicking the Compare Plans button. To find out more about me, click the View profile link below.

New To Medicare?

Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

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Medicare And Counselors: Frequently Asked Questions

Scott Barstow, Christopher Campbell and Brian Altman January 7, 2006

At presstime, Congress was still considering budget reconciliation legislation that included language establishing Medicare coverage of state-licensed professional counselors. American Counseling Association members are strongly encouraged to check www.counseling.org/publicpolicy for updates on the status of this legislation and the possible need for grass-roots support for this provision. This website and the related website at http://capwiz.com/

counseling will include information regarding members of Congress to contact and suggested messages for discussing the issue.

To help familiarize counselors with both Medicare and the legislative process involved in working to gain recognition of counselors under this program, ACAs Office of Public Policy and Legislation offers a list of frequently asked questions .

Q: What is Medicare? Who are Medicares beneficiaries?

Q: How do I get a Medicare provider number?

A: Right now, you cant. Currently, psychologists and clinical social workers are the only nonphysician mental health professionals covered under the program. Congress writes Medicares benefit package. At presstime, Congress had yet to pass legislation establishing Medicare coverage of licensed professional counselors.

Q: Since Medicare coverage of counselors has passed the Senate, does this mean its going to become law in a certain amount of time?

Q: What groups are opposing this provision?

When Your Client Has Medicare And Another Policy

Beginners Guide to Mental Health Billing for Mental Health Providers

When a client is covered by two insurance policies, normally you would determine which is the primary plan and bill them first. A claim could then be sent to the secondary plan with a copy of the Explanation of Benefits from the primary plan, showing how the claim was paid.

When a client has Medicare coverage as well as private health insurance, Medicare is the primary payer and the other plan is secondary. So you should always bill Medicare first, right? Not necessarily. Things get messy if you are one of the many providers not eligible to participate in Medicare, including Marriage and Family Therapists and Licensed Professional Counselors.

If you are a NOT a Medicare-eligible provider, the secondary plan essentially becomes the primary payer. But theres a catch.In the past, plans required providers or patients to submit denial letters from Medicare before the plans would pay out as a second party payer, writes Catherine Atkins, JD, Deputy Executive Director of the California Assn. of Marriage and Family Therapists .1 However, Medicare changed its policy and no longer sends denial letters for services to Medicare patients, says Atkins. Because providers were unable to garner denial letters from Medicare for the treatment, they were unable to submit the claim to the secondary plan for processing and payment.

Bottom Line: Contact the secondary plan you are working with to find out their policies and the best way to handle this situation.

References:

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