In March 2012, CMS published a general summary of Mental Health Coverage topics. This summary includes information that impacts Medicare provider enrollment and covered services.
COVERED MENTAL HEALTH SERVICES
The mental health services that may be covered under the Medicare Program include:
- Psychiatric diagnostic interviews;
- Individual psychotherapy;
- Interactive psychotherapy;
- Family psychotherapy (with the patient present and the primary purpose of which is treatment of the individual’s condition);
- Family psychotherapy (without the patient present that is medically reasonable and necessary and the primary purpose of which is treatment of the individual’s condition);
- Group psychotherapy;
- Pharmacologic management;
- Electroconvulsive therapy (ECT);
- Diagnostic psychological and neuropsychological tests;
- Biofeedback therapy; and
- Individualized activity therapy (as part of a Partial Hospitalization Program [PHP] and that is not primarily recreational or diversionary).
MENTAL HEALTH SERVICES THAT ARE NOT COVERED
The mental health services that are not covered under the Medicare Program are:
- Environmental intervention;
- Geriatric day care programs;
- Individual psychophysiological therapy that incorporates biofeedback training (any modality);
- Marriage counseling;
- Pastoral counseling;
- Report preparation;
- Interpretation or explanation of results or data;
- Transportation and meals; and
- Telephone services.
The following are recognized as being eligible under Part B of the Medicare Program to provide diagnostic and/or therapeutic treatment for mental, psychoneurotic, and personality disorders to the extent permitted under State law:
- Physicians ( [MD] and doctors of osteopathy Physicians medical doctors [DO]), particularly psychiatrists;
- Clinical psychologists (CP);
- Clinical social workers (CSW);
- Clinical nurse specialists (CNS);
- Nurse practitioners (NP);
- Physician assistants (PA);
- Certified nurse-midwives (CNM); and
- Independently Practicing Psychologists (IPP)
For more information about Medicare mental health services, refer to the following:
- Chapters 2, 6, and 15 of the “Medicare Benefit Policy Manual” (Publication 100-02) and Chapters 3 and 4 of the “Medicare Claims Processing Manual” (Publication 100-04) located at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html on the Centers for Medicare & Medicaid Services (CMS) website;
- The Medicare Learning Network® (MLN) publication titled “Inpatient Psychiatric Facility Prospective Payment System” located at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/InpatientPsychFac.pdf on the CMS website; and
- The section for your provider type in the MLN publication titled “MLN Guided Pathways to Medicare Resources Provider Specific” booklet located at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/Guided_Pathways_Provider_Specific_Booklet.pdf on the CMS website.
For more information about inpatient psychiatric hospital services, visit http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/InpatientPsychFacilPPS on the CMS website. To find the compilation of Social Security laws, visit http://www.ssa.gov/OP_Home/ssact/title18/1800.htm on the U.S. Social Security Administration website. To find Medicare information for beneficiaries (e.g., Medicare basics, managing health, and resources), visit http://www.medicare.gov on the CMS website.
For the complete Medicare Mental Health Coverage summary, visit:
nCred can assist your Mental Health practice with Medicare provider enrollment. For more information about our services, visit our information page here or call our office today at 423.443.3840