Frequently Asked Questions: Medicare Mental Health Billing
Who Can Bill Medicare for Mental Health Services: Provider Reference
Medicare allows a broad range of licensed mental health providers to bill Part B directly, provided they are enrolled in Medicare, hold an active NPI, and provide services within their state’s scope of practice. The 2024 expansion added LPCs and LMFTs for the first time. For the full Medicare credentialing overview, see our Medicare credentialing guide.
Psychiatrist (MD/DO)
Full scope — psychotherapy, medication management, diagnostic evaluation, inpatient and outpatient. Highest reimbursement rate of all mental health providers.
Psychologist (PhD/PsyD)
Psychological evaluation, testing, individual/group/family psychotherapy. Bills under own NPI. Cannot prescribe medication (except in a few states).
Licensed Clinical Social Worker (LCSW)
Individual, family, and group psychotherapy. Must have MSW + 2 years supervised clinical experience + Medicare enrollment. Cannot bill for diagnostic evaluation or testing.
Nurse Practitioner (NP)
Psychotherapy, medication management, psychiatric evaluation, health behavior assessment. Scope varies by state. Bills independently in full-practice-authority states.
Clinical Nurse Specialist (CNS)
Same scope as NPs for mental health services. Must be enrolled in Medicare and practice within state CNS scope of practice.
Physician Assistant (PA)
Can provide and bill for mental health services under physician supervision as required by state law. Bills at 85% of physician fee schedule.
Licensed Professional Counselor (LPC)
Newly eligible as of January 1, 2024 under the Consolidated Appropriations Act. Must enroll in Medicare as a provider to bill directly. Previously could only bill under a supervising physician.
Licensed Marriage & Family Therapist (LMFT)
Newly eligible as of January 1, 2024 under the Consolidated Appropriations Act. Must complete Medicare enrollment and hold active NPI to bill directly.
Licensed Social Worker (non-LCSW)
Only clinical social workers with the LCSW credential can bill Medicare. General social workers without clinical licensure are not eligible.
Unlicensed Counselor / Life Coach
Medicare does not reimburse services from unlicensed mental health workers or life coaches, regardless of the setting or the supervising provider.
Mental Health Services Covered by Medicare
Medicare’s mental health coverage spans all three major parts, covering everything from an emergency inpatient psychiatric stay to a weekly therapy session to a monthly prescription refill.
Inpatient psychiatric care in a hospital or psychiatric facility. Covers room, board, nursing care, and related medications during the inpatient stay. Cost-sharing applies based on the benefit period.
Outpatient mental health services: psychotherapy, psychiatric evaluations, psychological testing, medication management, and preventive mental health screenings. Medicare pays 80% after the deductible.
Prescription medications for mental health conditions including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. Coverage and formulary vary by plan.
Medicare Advantage plans (Part C) must cover all Part A and B mental health benefits, and many offer additional mental health benefits beyond original Medicare.
Medicare Billing Codes for Mental Health Services (CPT)
Medicare uses Current Procedural Terminology (CPT) codes to process and reimburse mental health claims. Accurate coding is critical — the wrong code or missing modifier results in denial or reduced payment.
| CPT Code | Description | Who Can Bill | Notes |
|---|---|---|---|
| 90791 | Psychiatric Diagnostic Evaluation | Psychiatrist, Psychologist, NP, CNS, PA | Typically 1 per rolling year per patient. LCSWs cannot bill this code. |
| 90832 | Psychotherapy, 30 min | All eligible providers | Use when session is 16–37 minutes of psychotherapy time. |
| 90834 | Psychotherapy, 45 min | All eligible providers | Use when session is 38–52 minutes of psychotherapy time. |
| 90837 | Psychotherapy, 60 min | All eligible providers | Use when session is 53+ minutes of psychotherapy time. Most frequently billed code. |
| 90839 | Psychotherapy for Crisis, 60 min | All eligible providers | First 60 minutes of crisis intervention. Requires documentation of crisis state. |
| 90840 | Psychotherapy for Crisis, add-on | All eligible providers | Each additional 30 minutes beyond 90839. Add-on code only. |
| 90846 | Family Psychotherapy (without patient) | All eligible providers | Family session without the identified patient present. |
| 90847 | Family Psychotherapy (with patient) | All eligible providers | Family session with the identified patient present. |
| 90853 | Group Psychotherapy | All eligible providers | Bill per patient, per session. Document all group members separately. |
| 90785 | Interactive Complexity (add-on) | All eligible providers | Add-on to psychotherapy codes. Use when communication difficulties are present. |
| 96130–96133 | Psychological Testing | Psychologist, Psychiatrist | Cognitive, personality, neuropsychological testing. Requires clinical interpretation report. |
| 99213–99215 | E&M (Medication Management) | Psychiatrist, NP, CNS, PA, Physician | Used for medication management visits without psychotherapy. Select level based on complexity. |
How to Bill Medicare for Mental Health Services: Step by Step
Verify Patient Eligibility
Confirm Medicare enrollment, active Part B, whether deductible has been met, and whether prior authorization is required for the service.
Provide & Document the Service
Render the mental health service. Document diagnosis (ICD-10 code), CPT code, session duration, clinical notes, and treatment plan. Medicare audits documentation heavily.
Select the Correct CPT Code
Choose the CPT code based on the type of service and actual time spent. Use the correct time-based code for psychotherapy — billing 90837 for a 30-minute session is upcoding. See our PMHNP billing and CPT code guide for psychiatric prescribers.
Submit the Claim Electronically
Submit via a clearinghouse or billing software using your NPI and Medicare provider number. Include the correct Place of Service (POS) code: 11 for office, 02 for telehealth, 10 for telehealth from patient’s home.
Medicare Adjudicates the Claim
Medicare reviews the claim for accuracy, coverage, and medical necessity. Clean electronic claims are typically processed within 14–30 days.
Receive Payment & Review EOB
Medicare pays 80% of the approved amount directly to the provider (if you accept assignment). Review the Explanation of Benefits (EOB/EOMB) and collect the patient’s 20% co-insurance.
Can a Physician Bill Medicare for Mental Health Services?
Yes. Physicians (MD/DO) are one of the primary provider types authorized to bill Medicare for mental health services under Part B. This includes psychiatrists as well as primary care physicians and other specialists who provide mental health services within their scope. Services reimbursable under Medicare Part B include outpatient psychiatric evaluations, individual and group psychotherapy, and medication management.
Physicians bill at the full physician fee schedule rate — the highest reimbursement tier among mental health providers. A non-participating physician can charge up to 15% above Medicare’s approved amount; a participating physician accepts the approved amount as payment in full.
Can a Licensed Clinical Social Worker (LCSW) Bill Medicare?
Yes. Licensed clinical social workers are recognized by Medicare as independent mental health providers and can bill Part B directly for a defined set of services. To bill Medicare, an LCSW must hold a master’s degree in social work, have completed at least two years of post-degree supervised clinical experience, hold state LCSW licensure, and be enrolled in Medicare as a provider.
Services LCSWs Can Bill Medicare For
- Individual psychotherapy (CPT 90832, 90834, 90837)
- Family psychotherapy (CPT 90846, 90847)
- Group psychotherapy (CPT 90853)
- Crisis psychotherapy (CPT 90839, 90840)
- Interactive complexity add-on (CPT 90785)
Can a Nurse Practitioner (NP) Bill Medicare for Mental Health?
Yes. Nurse practitioners can bill Medicare for a full range of mental health services including psychotherapy, medication management, psychiatric evaluations, and health and behavior assessment. NPs bill at 85% of the physician fee schedule rate. In states that grant full practice authority to NPs, they can bill entirely independently without physician supervision.
| Service | Description |
|---|---|
| Psychotherapy | Individual, family, group, and crisis psychotherapy (CPT 90832–90853). Includes interactive complexity add-on (90785). |
| Psychiatric Evaluation | Psychiatric diagnostic evaluation (CPT 90791). Typically limited to once per year per patient. |
| Medication Management | E&M codes (99213–99215) for medication visits. NPs with prescribing authority can manage psychiatric medications. |
| Health Behavior Assessment | Assessment and intervention for behavioral factors affecting physical health (CPT 96156–96171). |
Can a Psychologist Bill Medicare for Mental Health Services?
Yes. Psychologists (PhD/PsyD) are fully authorized to bill Medicare Part B independently for psychological evaluation, testing, and psychotherapy services. Psychologists must be enrolled in Medicare and accept assignment to bill directly. They bill under their own NPI and receive reimbursement at the psychologist fee schedule rate.
Services Psychologists Can Bill Medicare For
- Psychiatric diagnostic evaluation (CPT 90791)
- Individual, family, and group psychotherapy (CPT 90832–90853)
- Psychological testing and evaluation (CPT 96130–96133)
- Neuropsychological testing (CPT 96132–96133)
- Health and behavior assessment and intervention (CPT 96156–96171)
Medicare Telehealth Coverage for Mental Health Services
Medicare covers telehealth mental health services with reimbursement at parity with in-person visits. Following the CARES Act expansions and subsequent legislation, telehealth mental health coverage became permanent for many services. Key billing rules for telehealth:
- POS 02 — when the provider is at a non-patient-home location (office, clinic)
- POS 10 — when the patient receives telehealth from their home
- Modifier 95 — synchronous real-time audio-video telehealth
- Modifier GT — interactive audio/video (still required by some Medicare contractors)
- Document: session duration, platform used, that it was real-time two-way audio-video communication
- Audio-only telehealth has more limited coverage — verify with your Medicare contractor
Mental health providers can also now prescribe controlled substances via telehealth without an in-person visit requirement under extended DEA rules, subject to state law and DEA registration requirements.
Common Challenges in Medicare Mental Health Billing
Incorrect CPT Code Selection
Time-based psychotherapy codes (90832/90834/90837) require documentation of actual face-to-face time. Billing 90837 for a 40-minute session is upcoding — a compliance risk.
Missing Medical Necessity Documentation
Medicare requires documentation justifying medical necessity for every session. A progress note that doesn’t reflect the patient’s ongoing need for treatment is grounds for denial or recoupment.
Wrong Place of Service Code
Using POS 11 (office) for a telehealth session results in underpayment or denial. Always match your POS code to where the service was actually delivered.
Not Verifying Eligibility First
Medicare patients can lose Part B coverage, have Medicare Advantage plans that require different billing, or be in their deductible period. Verify eligibility before every session, not just the first.
Billing Frequency Violations
Certain codes like 90791 (psychiatric evaluation) are limited to once per year. Duplicate billing triggers automatic claim denials and can flag the provider for audit.
LPC/LMFT Not Yet Enrolled
LPCs and LMFTs have been eligible since Jan 2024 but must complete Medicare enrollment (CMS 855i via PECOS) before billing. Claims submitted before enrollment is effective will be denied.
Need Help Enrolling in Medicare as a Mental Health Provider?
Whether you’re an LPC newly eligible to bill Medicare, an LCSW getting your first panel, or a group practice managing multiple provider enrollments — our team handles the full CMS 855i process from start to finish.
