Does Medicare Cover Outpatient Behavioral Health Care Services?

Medicare Part B covers outpatient behavioral health care, including the following services:

  • Individual and group therapy
  • Substance use disorder treatment
  • Tests to make sure you are getting the right care
  • Occupational therapy
  • Activity therapies such as art, dance, or music therapy
  • Training and education (such as training on how to inject a needed medication or education about your condition)
  • Family counseling to help with your treatment
  • Laboratory tests
  • Prescription drugs that you cannot self-administer, such as injections that a doctor must give you
  • An annual depression screening that you receive in a primary care setting. You should speak to your doctor or primary care provider for more information.
    • The depression screening is considered a preventive service and Medicare covers depression screenings at 100% of the Medicare-approved amount.

Medicare Part B covers care you receive through an outpatient hospital program, at a doctor’s or therapist’s office, or at a clinic. You may receive services from the following types of providers:

  • General practitioners
  • Nurse practitioners
  • Physician’s assistants
  • Psychiatrists
  • Clinical psychologists
  • Clinical social workers
  • Clinical nurse specialists

You should make sure that any provider you see accepts assignment, meaning that they accept Medicare’s approved amount as full payment for a service, to avoid paying more. If you see a nonmedical doctor (such as a psychologist or clinical social worker), it is especially important to make sure that your provider is Medicare-certified and takes the assignment. Medicare will only pay for the services of non-medical providers if they take assignments.

Note: Psychiatrists are more likely than any other type of provider to opt-out of Medicare. An opt-out provider does not accept Medicare payment and has signed an agreement to be excluded from the Medicare program. You should be sure to ask any provider if they take your Medicare insurance before you begin receiving services. If you see an opt-out provider, the provider must have you sign a private contract. The contract states that your doctor does not accept Medicare payment and that you must pay the full cost of the service. Medicare will not reimburse you if you see an opt-out provider. If an opt-out provider does not present you with a private contract, you are not responsible for the cost of the services.

Read More: Does Medicare Cover Partial Hospitalization for Mental Health Treatments?
Learn About: Does Medicare Cover Addiction Recovery Services?
Return to: Medicare In-Depth

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