A Plain-Language Guide
Medicare & mental health coverage
What Medicare covers for mental health and substance use care, who can provide it, how telehealth works, and the details most people never get explained. Written in plain language, sourced directly from Medicare.
In a crisis? Anyone experiencing a mental health or substance use crisis, or thoughts of suicide, can get confidential support 24/7 by calling or texting 988, or visiting 988lifeline.org.
What’s Covered
Mental health services Medicare may cover
Medicare-covered behavioral health services, typically known as mental health and substance use services: can affect a person’s overall well-being. Medicare may cover the following, when medically reasonable and necessary:
Alcohol misuse screening & counseling. For adults who misuse alcohol but aren’t dependent, up to 4 brief, face-to-face counseling sessions per year.
Alcohol treatment. Behavior modification, detoxification, outpatient hospital treatment, and rehabilitative services, including inpatient stays.
Annual wellness visit (AWV). To build or update a personalized prevention plan, including a depression screening and, where indicated, a cognitive assessment.
Advance care planning. To discuss a patient’s health care wishes, including an advance directive.
Behavioral health integration (BHI). Clinical staff assess, monitor, and plan care, including psychiatric collaborative care that uses a psychiatric consultant to support primary care.
Caregiver training services. When a clinician provides them as part of the patient’s treatment plan, available by telehealth.
Caregiver-focused behavioral health risk assessment. Assessing a caregiver’s own behavior and health risks where it benefits the patient.
Community health integration (CHI). Helping patients connect with clinical and social supports for upstream drivers that affect their care.
Chronic care management (CCM). For patients with multiple chronic conditions, including chronic pain management.
Cognitive assessment & care planning. A comprehensive evaluation of a patient with cognitive impairment to establish or confirm a diagnosis and severity (CPT 99483).
Depression screening. Up to 15 minutes annually with staff-assisted depression care supports, available by telehealth.
Digital mental health treatment (DMHT) devices. FDA-cleared devices used “incident to” professional behavioral health services, under a treatment plan of care (HCPCS G0552).
Electroconvulsive therapy (ECT). To treat major depressive disorder and other clinical conditions.
Health & behavioral assessment and intervention. Identifies or treats factors important to managing a physical health issue.
Hypnotherapy. As a covered behavioral health service.
Initial preventive physical exam. Reviews medical and social health history with preventive education, counseling, and referral.
Intensive outpatient program (IOP). Structured, organized intensive ambulatory treatment (see Outpatient programs below).
Medication for opioid use disorder (MOUD). Management when a patient agrees to a medication trial and effectiveness is monitored.
Medications for substance use disorders. Including medications for alcohol use disorder and OUD when used with counseling and behavioral therapy.
Narcosynthesis. Administered only by an MD or DO to relax a patient and ease discussion of difficult subjects.
Opioid treatment programs (OTPs). SAMHSA-certified programs providing counseling and MOUD (methadone, buprenorphine, naltrexone, nalmefene).
Partial hospitalization program (PHP). Structured, intensive outpatient psychiatric care as an alternative to inpatient care (no overnight stay).
Physical activity & nutrition risk assessment. Provided with an E/M visit, AWV, or behavioral health visit (HCPCS G0136).
Principal illness navigation (PIN). Helping patients with high-risk conditions connect with clinical and social supports, including PIN-peer support.
Psychiatric evaluation. To create a treatment plan based on a psychiatric disorder’s causes, symptoms, and course.
Psychoanalysis. Treating mental disorders by investigating conscious and unconscious elements.
Psychological & neuropsychological testing. As medically reasonable and necessary.
Psychotherapy. Family (with or without the patient present), individual and group, interactive, and psychotherapy for crisis.
Safety planning & post-discharge follow-up. Safety planning intervention (SPI) and follow-up contacts intervention (FCI), see below.
Screening, brief intervention & referral (SBIRT). Early interventions and treatment for people with, or at risk of, substance use disorders.
Substance use disorder (SUD) treatment. Including OUD treatment in an office setting (HCPCS G2086-G2088) and via telehealth.
Telehealth. Two-way, interactive audio-video to diagnose, evaluate, or treat mental health or SUDs from the patient’s home, on a permanent basis.
Therapeutic activities. Such as occupational therapy, recreational therapy, and milieu therapy that can improve the patient’s condition.
Tobacco use cessation counseling. Two cessation attempts per year (up to 8 sessions per year), available by telehealth.
Transcranial magnetic stimulation. For treating severe major depressive disorder.
Transitional care management. Within 30 days of an inpatient hospital discharge.
What’s Not Covered
Services Medicare generally doesn’t cover
Same-Day Care
Mental health and primary care on the same day
Medicare Part B pays for reasonable and necessary integrated health care services provided on the same day, to the same patient, by the same or different professionals in the same or different locations. That includes primary care, mental health care (including substance use treatment), and alcohol/substance use screening and intervention (SBIRT), billed under one of these codes:
- G2011: structured assessment (e.g., AUDIT, DAST) and brief intervention, 5-14 minutes
- G0396: structured assessment and brief intervention, 15-30 minutes
- G0397: structured assessment and intervention, greater than 30 minutes
AUDIT = Alcohol Use Disorders Identification Test · DAST = Drug Abuse Screen Test
Crisis Support
Safety planning & follow-up after a crisis
Safety planning intervention (SPI)
A patient works with a clinician to build a personalized list of coping strategies and sources of support to use if they have thoughts of harming themselves or others. It’s used to reduce the risk of suicide or overdose for people at elevated risk. Billed under HCPCS code G0560.
Follow-up contacts intervention (FCI)
A series of phone contacts, up to 4 calls per month, in the weeks (sometimes months) after a patient is discharged from a crisis encounter, such as an emergency department or psychiatric inpatient stay. Calls are typically 10-20 minutes and encourage use of the safety plan, offer psychosocial support, and encourage follow-up care. Billed under HCPCS code G0544.
Medications
Prescription drug coverage (Part D)
Medicare Parts A and B generally don’t cover prescription drugs. However, Part B covers certain medications a patient can’t self-administer, like drugs that must be given by a health care provider. For broader prescription coverage, patients enroll in a Medicare drug plan (Part D).
Part D must cover certain protected drug classes, including antipsychotics, antidepressants, and anticonvulsants. Drug plans must cover most medications in these classes, with some exceptions.
Medicare Advantage
Medicare Advantage plans
Medicare Advantage (Part C) enrollees get Part A, Part B, and often Part D benefits under a single plan. These plans provide the Part B, covered mental health services and may offer extra benefits, for example, additional telehealth, beyond what Part B pays for. Some plans also provide supplemental mental health benefits that Original Medicare doesn’t cover, such as help coping with life changes, conflict resolution, or grief counseling.
From Home
Telehealth for mental health
Medicare covers telehealth for behavioral and mental health on a permanent basis. Telehealth is two-way, interactive, audio-video technology used to diagnose, evaluate, or treat certain mental health or substance use disorders when the patient is in their home. Practitioners must be able to provide real-time audio-video, but may use audio-only technology given a patient’s technological limitations, abilities, or preferences.
Three hospital outpatient (OPPS-specific) telehealth codes describe remotely delivered services when the patient is at home:
| Service | HCPCS code |
|---|---|
| Diagnosis, evaluation, or treatment of a mental health or substance use disorder, 15-29 minutes (patient at home) | C7900 |
| Same, 30-60 minutes | C7901 |
| Same, each additional 15 minutes | C7902 |
Who Can Provide Care
Eligible mental health professionals
These Part B providers may deliver diagnostic and therapeutic mental health services allowed under state law. Each must meet all qualification and coverage requirements. Note that marriage and family therapists and mental health counselors can enroll in Medicare and bill independently since January 1, 2024.
| Provider | Key qualifications | Medicare pays |
|---|---|---|
| Physician (MD/DO) | Licensed to practice medicine; psychiatrists especially. | 100% of the Physician Fee Schedule (PFS). |
| Clinical psychologist (CP) | Doctoral degree; licensed/certified at the independent level. | 100% of PFS (if they accept assignment). |
| Clinical social worker (CSW) | Master’s or doctoral degree; 2 years supervised experience. | 75% of the PFS amount for psychologists. |
| Clinical nurse specialist (CNS) | RN licensed; doctoral or master’s degree; CNS-certified. | 85% of the physician PFS amount. |
| Nurse practitioner (NP) | RN licensed and state-authorized as an NP; certified. | 85% of the physician PFS amount. |
| Physician assistant (PA) | State-licensed; accredited program; national certification. | 85% of the physician PFS amount. |
| Certified nurse-midwife (CNM) | RN authorized as a nurse-midwife; accredited program; certified. | 100% of the physician PFS amount. |
| Independently practicing psychologist (IPP) | Psychologist (not a CP) practicing independently. | 100% of PFS for diagnostic tests. |
| Certified registered nurse anesthetist (CRNA) | Licensed RN; accredited program; certified. | 100% of PFS (by level of supervision). |
| Marriage & family therapist (MFT) | Master’s/doctoral degree; licensed; supervised experience. Eligible to enroll since Jan 1, 2024. | 75% of the PFS amount for psychologists. |
| Mental health counselor (MHC) | Master’s/doctoral degree; licensed (incl. addiction/drug counselors). Eligible to enroll since Jan 1, 2024. | 75% of the PFS amount for psychologists. |
PFS = Physician Fee Schedule. Most non-physician providers must accept assignment.
“Incident To”
Services provided “incident to” a clinician
Physicians and certain non-physician practitioners can bill for integral but incidental services and supplies that auxiliary personnel provide, as if they provided them themselves, when all “incident to” requirements are met: the services are integral to the treatment course, the clinician stays actively involved, and the services are commonly provided in the office.
Importantly, Medicare exempts behavioral health services from the usual direct supervision requirement. Incident-to behavioral health services can be provided under general supervision: the clinician may be contacted by phone if needed, and doesn’t have to be physically present during the service.
Outpatient Programs
Outpatient psychiatric programs
Hospitals can offer a wide range of outpatient psychiatric services, from a few individual services to comprehensive, full-day programs. Covered outpatient services are generally provided under an individualized, written plan of care and supervised by a physician, including individual and group psychotherapy, occupational and activity therapies that are part of a program, family counseling, patient education, and other medically necessary services.
Partial hospitalization program (PHP)
A distinct, structured program of intensive outpatient psychiatric care (less than 24 hours a day) as an alternative to inpatient care, covered in hospital outpatient departments and community mental health centers (CMHCs). A physician must certify the patient needs a minimum of 20 hours per week and recertify at least every 30 days.
Intensive outpatient program (IOP)
A distinct, organized intensive ambulatory treatment service offering less than 24-hour daily care, in a setting other than the home or an inpatient/residential setting. A physician prescribes an IOP for someone who needs a minimum of 9 hours per week of these services, under an individualized written treatment plan.
Community mental health centers (CMHCs)
Medicare covers Part B partial hospitalization services CMHCs provide. CMHCs must be appropriately licensed and provide outpatient services, 24-hour emergency care, day treatment/PHP/IOP, and other services to their community.
Behavioral health integration (BHI)
Integrating behavioral health with primary care helps improve outcomes. Medicare separately pays physicians and NPPs for BHI services over a calendar month, and CPs, CSWs, MFTs, and MHCs can bill the general BHI code (G0323) when they personally perform and are the focal point of care integration.
Opioid treatment programs (OTPs)
Medicare pays SAMHSA-certified OTPs through bundled, weekly Part B payments for opioid use disorder (OUD) treatment. Covered items include FDA-approved medications for OUD (methadone, buprenorphine, naltrexone, nalmefene), dispensing and administration, substance use counseling, individual and group therapy, toxicology testing, intake and periodic assessments, care coordination, patient navigation, and peer recovery support, and many of these can be provided by audio-video (or, where needed, audio-only) telehealth.
Inpatient Care
Inpatient psychiatric facility services
Inpatient psychiatric facilities (IPFs) include freestanding certified psychiatric hospitals and psychiatric units in acute care hospitals. Medicare covers inpatient psychiatric services under the IPF Prospective Payment System when the facility is certified and the patient needs intensive, active treatment in that setting. Covered services include a semi-private room, meals, general nursing, drugs (including methadone to treat OUD), and other inpatient treatment services and supplies. Deductible and coinsurance apply.
Important: the 190-day limit
Medicare covers IPF services for 90 days per illness, with a 60-day lifetime reserve, and a lifetime maximum of 190 days of care in freestanding psychiatric hospitals. After using 190 days, the patient gets no more benefits for psychiatric hospital care. (This 190-day lifetime limit doesn’t apply to certified psychiatric units within general hospitals.)
For Reference
Commonly used billing codes
A reference of common mental health, related HCPCS/CPT codes. For the authoritative, complete list and billing rules, see the CMS source linked below.
| Service category | HCPCS/CPT code |
|---|---|
| Cognitive assessment & care planning | 99483 |
| Interactive complexity | 90785 |
| Psychiatric diagnostic evaluation | 90791, 90792 |
| Psychotherapy with patient | 90832, 90833, 90834, 90836, 90837, 90838 |
| Psychotherapy for crisis | 90839, 90840 |
| Psychotherapy for crisis (applicable site of service) | G0017, G0018 |
| Psychoanalysis | 90845 |
| Family psychotherapy | 90846, 90847 |
| Multiple-family group psychotherapy | 90849 |
| Group psychotherapy | 90853 |
| Electroconvulsive therapy (ECT) | 90870 |
| Hypnotherapy | 90880 |
| Neurobehavioral status exam | 96116, 96121 |
| Psychological testing evaluation | 96130, 96131 |
| Neuropsychological testing evaluation | 96132, 96133 |
| Health behavior assessment & intervention | 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171 |
| Caregiver training | 97550-97552, G0539-G0543 |
| Post-discharge follow-up contacts (FCI) | G0544 |
| Supply of DMHT device + onboarding | G0552 |
| Monthly management of DMHT device | G0553, G0554 |
| Physical activity & nutrition assessment | G0136 |
| Safety planning interventions (SPI) | G0560 |
| MOUD initiation in the ED | G2213 |
CPT codes, descriptions, and data are copyright 2025 American Medical Association. All rights reserved.
Source & Disclaimer
Where this comes from
This guide summarizes the official Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network booklet, “Medicare & Mental Health Coverage” (MLN1986542, March 2026). It’s provided for general educational purposes and isn’t medical, legal, or billing advice. Coverage depends on your individual plan and eligibility.
Read the full CMS booklet (PDF)Total Life is not affiliated with, endorsed by, or part of Medicare, CMS, or any government agency. We are a private telehealth company and a Medicare provider. We accept Medicare and Medicare Advantage plans for payment.
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