Many Medicare Advantage Plans Offer Additional Benefits
Medicare Advantage plans are sold by private insurance companies. They cover everything that Original Medicare covers. So, if your telemedicine services would be covered by Original Medicare, they would also be covered by Medicare Advantage.
Some Medicare Advantage plans offer additional telemedicine services, such as a 24/7 nursing advice line.
A licensed insurance agent can help you find Medicare Advantage plans in your area that cover telemedicine.
Reliable & Dedicated To Customer Service
Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy.
We understand that it’s important to actually be able to speak to someone about your billing. Every provider we work with is assigned an admin as a point of contact. You’ll always be able to get in touch.
Telemedicine Coding Billing And Rates
For commercial members non-facility telemedicine claims must use POS 02 or POS 10 with the GT or 95 modifier. Fee schedules have been updated so claims with approved telemedicine CPT codes and modifiers with POS 02 or POS 10 will be reimbursed at the same rate as an equal office visit. For example, a telemedicine service 99213 GT with POS 02 or POS 10 will reimburse the same as a face-to-face in-office visit 99213. Urgent Care Centers should continue to use POS 20. All other facilities should continue to use their respective POS CPTs and the telemedicine modifiers must be noted on the UB-04 and HCFA 1500 forms as the Rev Code will not be sufficient.
For Medicare members, POS 02 or POS 11, or the POS equal to what it would have been had the service been furnished in-person, along with the 95 modifier indicating that the service rendered was actually performed via telehealth, may be utilized and will reimburse at the same rate.
Aetna will cover appropriate evaluation and management codes with a wellness diagnosis for those aspects of the visit done via telehealth. Preventative visit codes should be reserved for such time when routine in-office visits resume and the remaining parts of the well visit can be completed. Both services will be fully reimbursed, and the patient will not incur a cost share.
Yes. In or out of network benefit levels will apply, depending on the providers network participation status.
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Does Medicare Cover Mental Health Therapy
Yes, Medicare covers mental health care, which includes counseling or therapy. Depending on your needs, mental health care can be provided in a variety of settings. The goal is to get the right kind of support when you need it.
Mental health pertains to our emotional, psychological, and social well-being. Our mental health can impact how we think, feel, and act. From a holistic, whole-person perspective, mental health plays a big part in our general overall health. Just as Medicare helps cover physical ailments, it also offers various benefits to support emotional, psychological, and social health.
Mental health concerns include anxiety and depression, substance abuse, eating and stress disorders, schizophrenia, and attention-deficit/hyperactivity disorders. These concerns can range from mild to severe and can be addressed on an outpatient or inpatient basis.
You can access mental health benefits through Original Medicare or Medicare Advantage plans, an alternative to Original Medicare. MA plans offer the same services, follow the same Medicare rules as Original Medicare, and generally require in-network providers, referrals, and prior authorization to receive benefits.
Avoiding The Cliff: Medicare Coverage Of Telemental Health And The End Of The Phe
Joanne Haynes, a nurse practitioner at the University of Mississippi Medical Center, meets virtually with a patient on Sept. 17, 2021. Without further action, telemental health services will decrease once the public health emergency ends. Photo: Imani Khayyam/The New York Times via Redux
Joanne Haynes, a nurse practitioner at the University of Mississippi Medical Center, meets virtually with a patient on Sept. 17, 2021. Without further action, telemental health services will decrease once the public health emergency ends. Photo: Imani Khayyam/The New York Times via Redux
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Policy Director, Wynne Health Group
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Policy Director, Wynne Health Group
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What will happen to Medicare coverage of telemental health services once the COVID-19 public health emergency ends?
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Extending the telehealth flexibilities set to expire at the end of the public health emergency would give policymakers time to study the long-term effects of telehealth coverage and help shape broader telehealth reform
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Does Medicare Pay For Therapy Services
As part of Medicares mental health care benefits, therapy, or counseling is typically covered under Part B as an outpatient service with Original Medicare. MA plans provide the same benefits as Part B does. Therapy generally can be for an individual or a group. Family therapy is covered if it is to support the Medicare beneficiarys mental health treatment goals.
As with all mental health services, you must receive therapy from a provider that accepts assignment for Original Medicare or is in-network with your MA plan. The provider must be licensed in your state. Copay or coinsurance and deductibles apply.
In 2022, for instance, for outpatient mental health care through a UnitedHealthcare MA HMO plan, you pay $25 copay for each Medicare-covered individual therapy session and $15 copay for group therapy. For a similar type of plan with Humana, you pay a $20 copay for mental health services received from a specialist, an outpatient hospital, or intensive therapy that is part of the day program in a hospital. For a similar plan with BCBS/Anthem, you pay $40 for each Medicare-covered visit, group, or individual.
Your copays vary depending on your MA plan. To find out what your out-of-pocket costs will be and precisely what your plan will cover based on Medicare rules, talk with your plans administrator, review your EOC, and talk with your healthcare provider. Allow for the time it takes to get a referral and prior authorization.
Using The Medicare Helpline
Medicare gives you special rights and resources for protecting them. These include:
- The Medicare Beneficiary Ombudsman
- The Competitive Acquisition Ombudsman
- The Beneficiary and Family Centered Care-Quality Improvement Organization
These resources provide information and advice to make informed healthcare decisions that best meet your needs and situation. They can also help you address and work through grievances with Medicare providers.
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What Services Can Medicare Beneficiaries Receive Through Telehealth
Before the public health emergency, Medicare covered about 100 services that could be administered through telehealth, including office visits, psychotherapy, and preventive health screenings, among other services. During the public health emergency, the list of allowable telehealth services covered under Medicare has expanded to include emergency department visits, physical and occupational therapy, and certain other services. Some evaluation and management, behavioral health, and patient education services can be provided to patients via audio-only telephone.
In the 2022 physician fee schedule final rule, the Centers for Medicare & Medicaid Services temporarily extended coverage for a subset of the expanded telehealth services through December 31, 2023 to give both CMS and stakeholders time to evaluate whether they should be permanently included as Medicare-covered telehealth services. These services include physical and occupational therapy, end-stage renal disease visits, emergency department visits, critical care services, and others.
The Centers For Medicare & Medicaid Services Is Making It Easier For Healthcare Providers To Use Telehealth Including The Telephone To Deliver Mental Health And Substance Abuse Care To Patients In Their Homes
The Centers for Medicare & Medicaid Services is expanding coverage for the use of telehealth technology in underserved areas and for the delivery of mental health services.
In its final rule for the 2022 Physician Fee Schedule, released this week, the agency has amended its rules to allow beneficiaries to receive care in their homes “for the purposes of diagnosis, evaluation, or treatment of a mental health disorder.” This ends the long-debated practice of excluding a patient’s home from the list of originating sites for telehealth services, and gives providers the opportunity to craft telehealth programs that reach patient where they live.
As part of that service, CMS is mandating that the provider and patient must meet in person at least six months prior to adopting virtual visits, and that an in-person exam be conducted at least once every 12 months thereafter, with some exception allowed due to “beneficiary circumstances.”
The agency is also changing its definition of telehealth to include audio-only platforms, the most common of which is the telephone, for these home-based telehealth visit for mental health services. The move reflects a surge in telephone use during the pandemic, when providers were replacing in-person care with telehealth visits and patients were looking for easier ways to access careespecially in dealing with stress, depression, anxiety and substance abuse.
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.
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What Does Medicare Part C Cover
Medicare Part C is also referred to as Medicare Advantage. Private insurance companies sell Part C plans. Part C includes the same coverage as original Medicare but may also include additional benefits.
In 2020, changes were made to Part C that may allow it to offer more telehealth benefits than original Medicare. These changes include increased access to telehealth benefits from home instead of requiring a visit to a healthcare facility.
Additional benefits can vary based on your Part C plan. Check your specific plan to see what type of telehealth benefits are offered.
When should i use telehealth?
Below are some examples of when telehealth might be used:
- training or education, such as learning techniques for diabetes monitoring
- care planning for a chronic medical condition
- getting a consultation with a specialist whos not in your area
How To Choose Mental Health Insurance Companies For Credentialing
Choosing which companies to apply to depends on a number of factors but can fall cleanly into three buckets:
For the best possible guidance, try to pick only two of these three possible options and weight their significance to you in your current private practice.
Are you looking to increase the number of sessions you do? Work with lower paying but higher supplying networks like Medicaid.
Want higher income per client? Look at the Blue Card network .
And if you dont even know what Blue Card programs apply to your state or you need a free customized quote thats specific to your needs, we are happy to help. You can reach out about that at our mental health credentialing services page.
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Medicare And Mental Health Coverage
When a person first enrolls in Medicare, they receive a Welcome to Medicare preventive visit. During this visit, a doctor reviews risks of depression.
Yearly wellness visits can then include discussions with a persons doctor on any changes to mental health that may have occurred since the last visit.
In addition to the wellness visits, Medicare covers certain mental health services both inside and outside of a hospital.
What To Expect During Online Therapy
Your online therapy sessions will work just like a face-to-face therapy session would. Youll be connected to your mental health professional in a video chat. You can normally do this online or by using an app on your phone.
Youll be able to talk with your therapist as soon as the session begins. Theyll ask you questions and help you manage your mental health, just like they would in person.
Some providers also let you talk with your therapist over the phone without a video call. This can be even more convenient in many cases.
If youre using Talkspace or Betterhealth, you can also send messages to your mental health professional throughout the day. Youll get an answer once or twice a day, Monday through Friday. This can be a great way to manage your mental health on the go.
When you have an online therapy visit, its important to be in a private location. Your therapist will be in an office, so your privacy will be protected just like it would during an in-person appointment. However, your location can have a big impact on privacy.
If youre at home during your session and live alone, you dont need to take any other steps. If you live with other people, its a good idea to go into a bedroom or other space where you can close a door.
If you have your therapy session at work or another public location, you should go somewhere private. Find a room with a door and use headphones during your session.
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Caring For Someone With A Mental Health Disorder
Caring for someone with a mental health issue can be challenging emotionally and financially.
Centrelink offers support through:
- Carer Payment – an income support payment if you give constant care to someone
- Carer Supplement – an extra yearly payment for some carers
- Carer Adjustment Payment – a one-off payment for carers of children under 7 with severe illness or major disability.
You can use the Carer Gateway website to find other kinds of support. This includes practical, social, and emotional help.
How Is Telehealth Covered Under Medicare For Beneficiaries And Providers Participating In Alternative Payment Models
Like all other traditional Medicare beneficiaries, beneficiaries who receive care through an alternative payment model can access expanded telehealth benefits during the public health emergency. Separate from the time-limited expanded availability of telehealth services, CMS has granted providers participating in some alternative payments models, including Medicare Shared Savings Program ACOs, greater flexibility to provide care through telehealth, including billing for telehealth services provided to both urban and rural beneficiaries and to beneficiaries when they are at home.
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Summary Of Insurance Reimbursement Rates For Psychotherapy
Mental health reimbursement rates vary dramatically. They depend on your:
- license,
- your location,
- and the service map for each insurance company youre applying to.
Your reimbursement rates are most dramatically influenced by your education and license, baring living in a few locations that are dying for more mental health providers .
Strategically speaking, your first big decision is your level of licensing and continued education you have sought or will seek. Next will be picking an area that is undeserved to the best of your estimation. Finally, consider choosing a specialization that fills in a service gap that is regularly sought after.
From there, pick which insurance companies youre most interested in working with depending on the demographic you aim to serve. Some companies may pay less but provide you a higher inbound flow of clients , whereas others might be very challenging to get in-network with but pay much higher .
For specific recommendations for credentialing in your state, feel free to reach out to us at TheraThink for help.
How Can I Find Out Whether An Online Mental Health Professional Takes My Insurance
You can start by looking at the website of the mental health professional youd like to use. Most online platforms will have a link you can click to see which insurance companies they work with.
There might even be a form you can use that will check your coverage for you. Youll just need to provide your plan name, your name, and your policy number to see whether youre covered.
Its always a good idea to call the office of any therapist youre considering and verify whether they accept your specific insurance plan for online therapy.
Another option is to start by calling your insurance company. The company can let you know whether you have coverage for online therapy and what copayments or coinsurance costs youll have. They can also point you in the direction of therapists who are in-network and the specific therapy platforms they work with.
Heres a top-level glance at what some of the major insurance providers offer, but youll still want to call and confirm whats covered in your exact plan:
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Mental Health Treatment Plans
If you have a mental health disorder, you and your doctor can create a plan to treat it.
Your mental health treatment plan will have goals agreed by you and your doctor. Itll also have:
- treatment options
- support services available.
Keep in mind your health information and treatment plan will be private. Doctors cant share your information unless you agree to it.
What Can Stakeholders Do Now
Providers, technology companies, and virtual care entrepreneurs interested in Medicare coverage of audio-only telehealth services should consider providing comments to the proposed rule. CMS specifically asked for comments on the following:
- Should all mental health telehealth service codes be allowed to use audio-only communication?
- What, if any, additional documentation should be required in the patients medical record to support the clinical appropriateness of providing audio-only telehealth services for mental health in the event of an audit or claims denial?
- Should CMS disallow audio-only for certain higher-level services, such as level 4 or 5 E/M visit codes, when furnished alongside add-on codes for psychotherapy, or codes that describe psychotherapy with crisis?
CMS is soliciting comments on the proposed rule until 5:00 p.m. on September 13, 2021. Anyone may submit comments anonymously or otherwise via electronic submission at this link. When commenting, refer to file code CMS-1751-P in your submission. Alternatively, commenters may submit comments by mail to:
- Regular Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1751-P, P.O. Box 8016, Baltimore, MD 21244-8016.
- Express Overnight Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1751-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850
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