Medicare Primer for Mental Health Professionals

Mental health professionals who provide mental health services to older adults are likely to encounter Medicare as the primary insurer for most clients. This primer is provided to mental health professionals as an introduction to Medicare coverage in its many forms, and the regulations necessary to comply as a provider under Medicare.

It is important to note that Medicare coverage, guidance, and requirements are constantly evolving. Therefore, links to a variety of online information provided directly from the Centers for Medicare and Medicaid services, the federal department responsible for Medicare, are also provided for each section. As providers learn from the information provided here, they are also encouraged to refer to the online resources. Current information about Medicare coverage and guidance applying to Medicare beneficiaries and providers can be found in two online locations hosted by the federal government.

Medicare provides a range of basic information about Medicare coverage for those enrolled under Medicare coverage and those who provide services.

The Center for Medicare and Medicaid Services (CMS) provides guidance for those who administrate and participate as providers in Medicare.

What is Medicare?

Medicare is the federally funded insurance program provided to older adults and people living with disabilities. Medicare is administered by the Centers for Medicare and Medicaid (CMS). To be eligible for Medicare, one must be (1) 65 years old and greater, (2) permanently disabled, which is defined as at least two years of disability due to physical and/or mental illness, (3) diagnosed with End-stage renal disease, or (4) diagnosed with Amyotrophic Lateral Sclerosis (ALS).

Additional information about the Medicare program and eligibility requirements can be found HERE.

How is Medicare structured?

Medicare benefits are offered under four separate types of coverage.

• Medicare Part A –Hospital Insurance (Inpatient). Part A coverage is automatically available when a person turns 65 and most people receive Part A coverage at no additional cost because they paid into Medicare while working. For those who must pay for Part A coverage, the cost is published annually by CMS and is typically deducted from the beneficiary’s social security payment.
• Medicare Part B – Medical Insurance (Outpatient). Part B coverage must be opted into by the individual and is also available at age 65 or when other eligibility criteria are met. A premium is charged for Part B coverage and the cost is determined by annual income levels. The Part B premium costs are published annually by CMS.

When a beneficiary has a Traditional or Original Medicare plan, Medicare pays 80% of Part B services. Coverage for the remaining 20% is described in a later section.

• Medicare Part C – Advantage Plans. These plans are offered by private healthcare insurance companies that are contracted by CMS to provide coverage to Medicare beneficiaries. When an insurance provider agrees to offer an Advantage Plan under Medicare, they are obliged to offer specific benefits and follow standardized rules for management of benefits. Medicare beneficiaries must opt into the Advantage Plan of their choice, and when they do so, they then interact directly with that insurance company for all their insurance benefits and questions. Additional information about Advantage Plans is included later in this document.
• Medicare Part D – Prescription Plans. Medicare will also cover the cost of prescriptions, but to access this benefit each Medicare recipient must choose a Part D Medicare plan. For most people, there are additional costs for Part D coverage, including the monthly premium and the annual deductible and co-payments required by the plan depending on their medications. Pharmacists and Medicare insurance specialists can help a beneficiary select a plan to maximize their covered medications annually. Plans can be selected based on the costs under each plan and the array of prescriptions covered by that plan, known as the formulary. However, plans can only be chosen during open enrollment, but the person’s prescriptions and the insurance formulary can change during the year.

Additional information about Part D Medicare plans and coverage is HERE.

Medicare coverage is funded in part by federal monies, but most beneficiaries also pay for their coverage. The individual’s financial liability is limited to an annual deductible, monthly premiums (often deducted from their social security payment), and their co-payments (coinsurance).

More about the different Medicare programs and the coverage they offer is HERE.

How are Medicare requirements determined and communicated?

The rules that govern Medicare coverage are determined by federal regulation and CMS. CMS is responsible for administrating and overseeing the implementation of Medicare, but uses private insurance compa­nies, known as Medicare Administrative Contractors (MACs), to enroll providers, process claims, reimburse providers, handle claim appeals, answer beneficiary and provider inquiries, and detect and prevent fraud and abuse. To provide guidance to the MACs, CMS has both national coverage determinations (NCD) and local coverage determinations (LCD). These documents provide detailed guidance regarding coverage for specific procedure codes and diagnoses, documentation standards, reimbursement criteria, and administrative processes. It should also be noted that NCDs and LCDs are periodically updated by CMS. When this occurs, the dates of the revision to the document are noted at the top of the NCD or LCD. Mental health professionals are encouraged to be familiar with the limited number of NCDs and LCDs that apply to the provision of mental health services and to review these documents periodically to ensure that your understanding of current regulations is up to date. Links to specific NCDs and LCDs are provided below.

CMS hosts all current Medicare Coverage Determination notices online (i.e., NCDs and LCDs), stating Medicare regulations and requirements. This site allows you to look up the Medicare guidance you are seeking by typing in key words or procedure codes.

As a provider of Medicare reimbursed services, mental health professionals will want to understand the guidance provided by CMS and administrated through their local MAC.  Each MAC has a website which has valuable information, including educational videos and webinars, necessary forms, and a portal. Annually, CMS determines the reimbursement amounts which are then posted, according to geographical area and procedure code in the “Medicare Physician Fee Schedules” (MPFS). The portal allows a provider to verify a beneficiary’s eligibility and benefits, check their reimbursements, etc.  Learn more about the role and function of MACs and find the MAC that administers Medicare coverage in your region HERE.

How is Medicare different from Medicaid?

Whereas Medicare is a federal program available to all Americans who meet eligibility requirements, Medicaid is the health care insurance program offered specifically to low-income individuals. Medicaid programs are sponsored by and administrated by the State in which they are offered, but each State Medicaid program is also subject to the guidance of the Center for Medicare and Medicaid Services (CMS). CMS provides standardized structure and criteria for the operation of all Medicaid programs and provides a monetary contribution to each State Medicaid program. Nonetheless, the requirements for coverage, the benefits are offered, and how the program is administrated varies greatly based on state laws and funding.

When a person receives coverage under both Medicare and Medicaid, it is referred to as “dual eligible” or “Medi/Medi.” It’s important for providers to know if their state will pay for the 20% co-pay for individuals who are dual eligible under Medicare and Medicaid.  If Medicaid does not cover the 20% co-pay in your state, you may be able to enroll as a Medicaid provider to receive the additional reimbursement. If neither option is available, as a provider you must decide whether you will work with dual eligible clients and accept 80% reimbursement paid by Medicare as your full fee.

Learn more about Medical Assistance or about Medicaid coverage in your state HERE.

What is Medicare Supplemental coverage?

Even when an individual subscribes to Traditional Medicare Parts A and B and purchases prescription coverage through a Part D plan, they are still responsible for an annual deductible, co-pays, and any uncovered services. Therefore, most people also choose to subscribe to Medicare Supplemental insurance, also known as Medigap plans. There are a number of supplemental plans that vary greatly in the benefits they provide and cost of the premiums. However, all these plans conform to the requirements set by Medicare related to the benefits they provide and how they operate.

It is important to note that if a Medicare beneficiary opts into a supplemental plan at the time they accept Part B coverage, there is no health assessment necessary for coverage. However, if an individual purchases their supplemental plan more than 2 months after they turn 65, retire, or lose their private health insurance, the person is subject to medical review before coverage is provided. This means that if a person has developed significant health issues, they may not be eligible for coverage by a Supplemental plan of their choice.

When a client has a Supplemental plan in addition to their Part A and B Medicare coverage, it is likely that their co-pay for mental health services will be covered by the Supplemental plan. Moreover, the charges for deductible, co-pays or other uncovered fees are generally forwarded automatically by Medicare to the supplemental plan carrier, which is known as “crossover.” This reduces the paperwork for the clinician.  However, it is important to keep copies of all forms of insurance on record in case the crossover doesn’t occur.

A provider does not have to be “in-network” with a supplement insurance company to get paid the full amount due if the plan is a PPO (preferred provider organization) plan. If the person has an HMO (health maintenance organization) supplement, it’s important to check with the insurance company to find out if they will be reimbursed the 20%.  Sometimes past or current employers provide a Medicare supplemental insurance plan as an employee benefit. These plans may not cover the full 20% co-pay. A provider may charge the client the difference.

Learn more about supplemental coverage HERE.

What should a mental health professional know about Medicare Advantage Plans (Part C)?

Historically, Medicare coverage was provided only through Parts A and B plans; the combination of these plans is often called “Traditional” Medicare or “Original” Medicare.  The benefit of working with Traditional coverage plans is that healthcare insurance is provided directly through Medicare in a standardized manner. Studies have shown that Medicare both provides good healthcare insurance coverage and that most Traditional Medicare beneficiaries are very satisfied with their coverage.

In 1999 legislation was passed to allow Medicare beneficiaries more choice in their healthcare coverage. Medicare Advantage plans are offered by private insurance companies under a contract to Medicare. These plans are funded with Medicare dollars under a capitated system, meaning that the insurance companies provide a certain amount of money for each person covered by their plan. To ensure that all required benefits are provided to beneficiaries and the company makes a profit providing the coverage, Part C plans are carefully managed. This is in contrast to Traditional Medicare, which, per Congress, must legally be budget neutral.

Beneficiaries who choose Advantage plans generally pay lower monthly premiums than Medicare and receive additional benefits. Most Advantage plans provide coverage for the benefits offered under Medicare Parts A, B and D. Many plans also offer additional coverage for vision hearing, dental, and wellness services, such as gym memberships.   Advantage plans either operate like HMOs and the enrollees are limited to providers within the plan or like PPOs and the enrollees are allowed to see any Medicare provider.

While there may be advantages to Part C plans, they can also be problematic, particularly for individuals with significant healthcare needs. These plans often limit the providers who can be seen and aggressively manage benefits in a manner that limits access to necessary services.

For mental health professionals, Medicare Advantage plans can be difficult to work with.  Providers typically must enroll on the panel of each individual Part C plan in order to be an approved provider. In addition, Part C plans may require additional documentation to support services and require that providers use their unique forms and systems to provide billing and documentation. Moreover, because of the aggressive management of benefits, some clinicians may encounter challenges in collecting fees for services already provided.

When a mental health professional is contacted by a potential client who “has Medicare,” it is important to discuss details about the person’s coverage, preferably during the initial phone contact and certainly during the first session. If your client is covered by a Medicare Advantage plan, you will want to ensure that you are either already enrolled as a provider under that plan or you understand the out of network benefits provided to your client.

Learn more about Medicare Part C at the Health and Human Services website HERE.

Which mental health specialties are allowed to provide services under Medicare?

Medicare credentials the following specialties to provide mental health services:

• Psychiatrists and other physicians
• Nurse practitioners and clinical nurse specialists
• Physician Associates
• Clinical psychologists, defined as those who hold a doctoral degree and are licensed as psychologists in their state
• Mental Health Counselors (MHC) and Marriage and Family Therapists (MFT), defined as those who hold a master’s degree, are credentialed by their state as mental health providers and demonstrate at least two years of supervised clinical experience.
• Licensed Clinical Social Workers (LCSW)

Among these credentialed specialties, physicians, advance practice nurses, physician associates, and clinical psychologists are allowed to bill for services provided in an inpatient hospital setting. MHCs, MFTs, and LCSWs are not allowed to bill for mental health services in an inpatient setting.

Medicare began credentialling licensed Marriage and Family Therapists (MFTs) and Mental Health Counselors MHCs) in 2024. Additional guidance regarding enrollment in Medicare by MFTs and MHCs can be found at the following sites:

FAQ document regarding therapists with these degrees is available HERE.

CMS information regarding MFT and MHC services is available HERE.

Mental health professionals who supervise master’s level clinicians and bill services “incident to” their own license should be familiar with all the requirements of the incident to provisions under Medicare. Failure to follow the guidance of this provision may be considered a fraudulent billing practice and can result in serious repercussions. In order to bill services under the “Incident to” provisions, the supervised provider must be directly supervised by mental health professionals (or other Medicare providers allowed to provide mental health services). The supervisor must be available (such as in the same office suite and not just via telephone) when the services are provided. Note that the supervised provider must be independently licensed – trainees and psychological assistants are not allowed to be billed for as “incident to.”

Guidance on billing incident-to services is provided in the CMS LCD # L34539, titled Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians.

Medicare provides an educational resource that outlines mental health service coverage and defines the specific provider specialties that are reimbursed under Medicare.

How does a mental health professional become a Medicare provider?

Federal law requires that all healthcare professionals who work with Medicare beneficiaries either enroll in or officially opt-out. Most mental health professionals who specialize in working with older adults choose to enroll in Medicare. Enrollment as a Medicare provider allows you to bill Medicare for your services and to be reimbursed by Medicare at the allowable rate. It also permits you to charge your client for any deductible or co-pay that is allowed under Medicare. Moreover, as a Medicare provider, when you bill Medicare under Part A or B for your services, any remaining amount due should be automatically forwarded to any supplemental Medicare insurance provider your client has subscribed to, assuming that they have Traditional Medicare.

To enroll as a Medicare provider or to opt out of Medicare, you must complete an application and submit it to Medicare, through your MAC, for review and approval. It is important to note that there is a specific process to be followed to opt out of Medicare.  Your local Medicare MAC can answer questions and provides the necessary forms to either enroll in or opt out of Medicare.

Learn more about enrolling in or opting out of Medicare HERE.

What mental health services are covered under Medicare?

Medicare essentially covers two broad categories of mental health services: assessment and intervention. While other providers are permitted to bill Medicare for supplemental services such as case management, consultation with other providers or care partners, these kinds of services are not billable by mental health providers.  Incidentally, the ability to be reimbursed for such services are currently being advocated for by the American Psychological Association and other groups representing mental health providers.

Medicare covers initial diagnostic evaluations, individual, group and family psychotherapy, health and behavioral (H&B) interventions and assessment batteries, such as neuropsychological evaluations. There are no restrictions on treatment orientation or modality. All services must meet criteria for “medical necessity” and the specific indicator of medical necessity varies somewhat by procedure code and diagnosis.

In addition to the assessment and intervention services that have traditionally been allowed under Medicare, three additional services were made accessible to mental health professionals effective in October 2023. These additional procedure codes billable by mental health professionals represent an extension of traditional psychological services under Medicare and expand the scope of practice in meaningful ways. It is worth noting that the availability of these new procedure codes represents tireless advocacy by APA and mental health professionals across the country. Since this is new information, it is strongly recommended to go to the appropriate links to learn more about each service.

• Behavioral Health Integration (BHI) Services: This is a model of collaborative care team. There are two types of BHI: (1) Psychiatric Collaborative Care Model (CoCM) and (2) General BHI Services. A booklet with the details can be found HERE.
• Psychotherapy for Crisis: For years CMS has had specific codes for crisis situations, yet they have been updated and there is now increased reimbursement when these services are in certain locations other than the provider’s offices. Additional guidance can be found HERE.
• Opioid Use Disorder Screening & Treatment (OUD): These services are designed to provide an early intervention approach to people with “non-dependent substance use” before they require more specialized treatment. Additional guidance can be found HERE.

Information regarding psychological and neuropsychological assessment services is included in a later section.

How does Medicare determine that billed services are approved for payment? 

Medicare payment assumes that the services are necessary, appropriate to the identified needs of the client, and effective. Under Medicare law and in most other healthcare insurance settings, this standard is referred to as “Medical Necessity.” CMS defines “Medical Necessity” from SSA Title XVIII, the Health Insurance for the Aged and Disabled Act:

“No payment shall be made for items or services that ‘are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” 

Although this language doesn’t seem to apply to psychological services, it means that there is (a) an evaluation and documentation of symptoms necessitating treatment, (b) an appropriate diagnosis, with evidence that the patient meets diagnostic criteria, (c) a treatment plan that addresses the symptoms, therapeutic modalities and/or techniques intended to use, and (d) goals of treatment.

Documented progress towards goals is one criterion that must be met for most mental health procedures. Medicare also recognizes that importance of services to maintain progress and/or prevent decompensation.

When conducting an initial evaluation, one might find that the client doesn’t meet the criteria for medical necessity or cannot benefit from psychotherapy. This is to be documented in the initial evaluation report and no additional services are provided under Medicare. To be reimbursed for the evaluation, it is important to include the diagnosis you were assessing for on the billing form.

The CMS Local Coverage Determination related to Psychology and Psychiatry provides a summary of the procedure codes that are considered billable by each mental health specialty, descriptions of each covered procedure, and any limitations of coverage for each procedure.

The LCD titled Psychiatry and Psychology services (LCD #L33632) allowed under Medicare can be found HERE.

How does Medicare reimburse mental health services?

Health care professionals enrolled as Medicare providers are required to accept the reimbursement allowed under Medicare, which is called “accepting assignment.” It means they must accept the Medicare allowed charge as full payment for their services. Medicare providers are legally required to (1) bill Medicare directly for services to clients who are Medicare beneficiaries, even if a person offers to be pay privately; and (2) not bill or accept any additional payment beyond the allowed amount set by the MAC.

The specific fee for each procedure code allowed under Medicare is determined annually and varies by the license of the practitioner, the location where services are provided, and the region where the client lives. The fee schedule is published annually and can be looked up via this online tool provided by CMS referenced below. To look up a specific fee, one must know the procedure code. This information may also be available on your local MAC website.

Knowing a potential client’s type of coverage is important regarding reimbursement and billing for psychological services. Traditional Medicare pays 80% of the allowed charge for all medical services. The remaining 20%, which is referred to as the coinsurance or “co-pay” is paid by: (a) a Supplemental or Secondary Plan; (b) Medicaid but only in some states; or (c) the client, except when there is severe financial need, which generally includes having Medicaid. The supplement plans should be set up to “crossover” so after Medicare reimburses the 80%, the claim is automatically forwarded to the supplement.

Mental health professionals should be aware that some Supplemental plans offer the benefit of covering the annual Medicare deductible. If the supplement plan doesn’t pay it, a provider is allowed to collect the deductible directly from the client.

Look up the fee schedule for a specific procedure code HERE.

How does a mental health professional bill for Medicare services?

Services are billed using the HCFA 1500 claim form. Traditional Medicare allows claims to be accepted up to one year after the date of service, but one is encouraged to bill sooner. Any problems with the coverage of either Medicare or the supplemental plan will often only be found when the claim is processed. An Advantage Plan might have different requirements about when to submit claims.

Medicare strongly encourages providers to submit billing electronically. The 80% portion of the allowed fee paid by Traditional Medicare is paid via electronic funds transfer within 15 days, as required by federal law. At the time of enrollment, a separate form for electronic funds transfer is completed with the provider’s bank information. It is strongly recommended that one have a bank account that is solely for business, although not limited to Medicare reimbursement, opened prior to enrollment.

The Administrative Simplification Compliance Act prohibits payment of services if a provider did not bill Medicare electronically. However, among the exceptions to this requirement is billing by a “small provider” which is defined as having fewer than 10 full-time employees who are Medicare providers in one’s practice. Thus, solo practitioners could submit a paper claim but there are several disadvantages: (a) the claim must be entered on a HCFA 1500 form which must be purchased, (b) the information has to be entered each time, (c) there is no check for errors prior to submission, (d) the paper claim is scanned by a computer and if the form is not legible for this system, the claim will be returned, and (e) the claim will take approximately 30 days to be reimbursed.

Providers can electronically submit their claims several ways, including a MAC’s portal system, through an electronic health record system, using a billing clearinghouse, or a professional biller. Some professional billers have a monthly flat rate while others charge according to a percentage of the reimbursement; the latter can be expensive.

For more information, see the LCD titled Billing and Coding for Psychiatric Diagnostic Evaluation and Psychotherapy Services (LCD #A57520).

What additional requirements guide the billing of mental health services under Medicare?

CMS provides an LCD to guide all aspects of billing mental health services under Medicare (LCD #56937) titled Billing and Coding: Psychiatry and Psychology Services (see link below). This document outlines the mental health related service codes that are reimbursed under Medicare, the diagnoses for which this procedure is considered appropriate, documentation standards, and any limitations in coverage. This is an important resource to understand the regulations and verify the procedure codes and certain specific rules. For example, there is an add-on code, Interactive Complexity, if there are specific communication difficulties during psychotherapeutic services; details of the appropriate use of this code are in this article.

CMS also provides very specific guidance on how services must be documented in order to support the medical necessity of the services and ensure eligibility for payment.  CMS guidance regarding documentation standards for psychological services can be found in LCD #33252, titled Psychiatric Diagnostic Evaluation and Psychotherapy Services (see link below).

It is critical that the billing codes are consistent with the services provided and for individual psychotherapy as per the CMS guidelines. The exact start and end time of the session should be documented in the clinical notes and should support the procedure code utilized in the billing. If the billing code indicates a longer session than the time documented on the session note, it is an error called “Upcoding.” “Downcoding” occurs if a session is billed as shorter than what is documented in the record. “Miscoding” occurs when no time is documented for an individual therapy session or when the billing code does not match the actual service provided, such as billing for individual therapy but providing group psychotherapy. Care and accuracy in billing and coding for Medicare services is essential, as errors of any kind may result in legal action against the provider.

General guidance on billing and coding for mental health services can be found in LCD #56937, titled Billing and Coding:  Psychology and Psychiatry.

Additional guidance on documentation can be found in the CMS document titled Psychiatric Diagnostic Evaluation and Psychotherapeutic Services (LCD 33252).

Does Medicare reimburse mental health services delivered via telehealth?

Historically, telehealth services were limited to rural areas and the client had to go to an approved Medicare location. However, due to the COVID Public Health Emergency (PHE) these restrictions were eliminated in March 2020. Subsequently, Medicare patients can receive telehealth services for behavioral health care in their homes and in any part of the country. This includes most behavioral health services, such as counseling, psychotherapy, and psychiatric evaluations.

As telehealth services become more common and services expand, the regulations governing its reimbursement under Medicare continue to evolve. Currently, there is no requirement for an in-person evaluation prior to utilization of telehealth services.  However, an in-person visit requirement has been delayed through December 31, 2024.  Please be sure to check with CMS and your local MAC and/or consult with the Practice Directorate at APA to determine the current rules and requirements related to telehealth for psychology.

More information about behavioral health telehealth services under Medicare is HERE.   

Are psychological and neuropsychological assessment services covered under Medicare?

Medicare reimburses psychological and neuropsychological assessment services. As with all specialized services, CMS provides guidance on which diagnoses are considered appropriate for these evaluation services and provides guidance on medical necessity and documentation standards. This information can be found in the LCD on Psychological and Neuropsychological Evaluations.

The procedure codes and guidance for these services were changed in January, 2019. To guide clinicians in compliance with the new standards, the APA Practice Organization produced a webinar detailing these issues, which was presented by Dr. Antonio Puente, APA’s 2017 President, and Dr. Neil Pliskin. The webinar is titled Getting Reimbursed: Testing Code Changes Are Here. Both the webinar and the slides are available HERE.

How do mental health professionals utilize Health and Behavior Codes under Medicare?

Health and Behavior Codes (H&B) have been allowed by CMS since 2002. The treatment focuses on the psychological factors that influence and/or interfere with physical functioning and recovery. Thus, the diagnosis is a medical diagnosis, and not a psychiatric diagnosis. The goal of the treatment is to improve physical health and wellbeing with the focus on the bio-psycho-social factors of a newly diagnosed physical illness or an exacerbation of established illness.

Additional guidance is available in LCD L37638, titled Billing and Coding:  Health and Behavior Assessment/Intervention

Are mental health services covered for people diagnosed with dementia under Medicare? 

Psychotherapy providers sometimes report that their claims are denied if there is a diagnosis of dementia. However, intervention with a client with mild or even moderate dementia is often for depression, anxiety, or an adjustment disorder. Thus, it is strongly recommended to diagnosis, treat and bill accordingly. Psychotherapeutic treatments are not designed to treat dementia; rather, they are designed to treat concomitant disorders. It is important, both legally and ethically, that the client can benefit from services. The provider should terminate with a client when the dementia progresses to the level that the person can no longer meet this requirement.

The Medicare Learning Network provides educational resources for service providers.  This resource provides education regarding services to people living with dementia.

CMS also provides guidance on cognitive assessment of clients with cognitive impairment. Curiously, these codes are not billable by mental health professionals, but rather only medical providers can provide this care.

Are mental health services covered for people receiving Hospice care?

Psychotherapy can continue when a patient enters hospice if it is “for a condition completely unrelated to the terminal condition for which hospice was elected.” The diagnosis must differ from the ones used by the hospice group. The documentation should indicate medical necessity and that the client can benefit from the services. When billing, include the modifier “GW” on the HCFA 1500 claim form.

Can a mental health professional charge a Medicare client for a missed appointment?

Yes. As of October 2007, providers may charge a Medicare beneficiary directly for missed appointments, if they “equally charge” non-Medicare clients. Similar to most insurance plans, Medicare does not pay for missed appointment fees and thus any charges to clients for missed appointments should not be billed to Medicare.

The guidance related to billing for missed appointments can be found HERE.

Additional Resources:

Medicare provides a range of basic information about Medicare coverage for those enrolled under Medicare coverage and those who provide services.

The Center for Medicare and Medicaid Services (CMS) provides guidance for those who administrate and participate as providers in Medicare.

Center for Medicare and Medicaid (CMS) Fee Schedule Look-Up:  Fee schedules for specific procedures code can be found HERE.

CMS hosts all current Medicare Coverage Determination notices online (i.e., NCDs and LCDs), reflecting Medicare regulations and requirements.  This site allows you to look up the Medicare guidance you are seeking by typing in key words or procedure codes.

Medicare Learning Network:  This CMS sponsored site provides education for professionals interacting with Medicare.  Topics related to billing, new procedure codes, proper documentation, and emerging best practices can be found HERE.

The Center for Medicare Advocacy is a national, non-profit, law organization that works to advance access to comprehensive Medicare coverage, health equity, and quality health care for older people and people with disabilities by providing legal analysis, education, and advocacy.

The E4 Center of Excellence for Behavioral Health Disparities in Aging recently published Building and Sustaining Effective Behavioral Health Care for Older Adults: Strategies and Considerations, a toolkit that includes curated information regarding Medicare and Medicaid, along with other funding options for services.

Medicare Interactive: This non-profit entity provides information to Medicare recipients and providers in support of access, utilization, and the protection of rights.  For providers, there is a helpful interactive tool to provide information about all aspects of the Medicare program.

American Psychological Association Guidelines for Psychological Practice with Older Adults were just updated in 2024.

American Psychological Association Guidelines for the Evaluation of Dementia and Age Related Cognitive Changes

Written by Amy Rosett, Ph.D. and Kelly O’Shea Carney, Ph.D.