Does Medicare Cover Telepsychiatry?

Are you or a loved one struggling with mental health issues? If so, then, unfortunately, you are far from being alone.

The number of people suffering from mental health issues is snowballing. In fact, many mental health experts claim that we are in the midst of a worldwide mental health crisis.

And more and more people are realizing that addressing these issues is just as important as taking care of our physical well-being.

First, please know that you are never alone or helpless. And one of the ways to get help is by contacting telehealth providers. Getting help from a professional without leaving the comfort of your home can be an excellent option for many.

If seeking out this sort of help is something you are considering, then you likely have the question, “Does Medicare cover telepsychiatry?” In this article, we answer the question in clear, plain English.

Does Medicare Cover Telepsychiatry?

The short answer is yes. For the most part, Medicare will cover the cost of telepsychiatry. But this does not apply 100% of the time.

As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your telepsychiatry. Let’s examine what these conditions are so you know what to expect.

Original Medicare Coverage of Telepsychiatry

Original Medicare (Medicare Part A and Part B) provides coverage for telepsychiatry. This plan provides coverage for your telepsychiatry if considered medically necessary.

Also, the telepsychiatry visit will have to be with a licensed mental health professional in order for Medicare to cover it.

Examples of mental health services that are covered include the following:

Family counseling
Group psychotherapy
Individual psychotherapy
Lab tests
Psychiatric evaluation
Partial hospitalization
Medication management
Annual depression screenings

Is Telepsychiatry Covered by Part A or Part B?

Telepsychiatry is provided by Medicare Part B. This is because it often takes place in an outpatient setting. Medicare Part B considers telemedicine appointments as something similar to in-person outpatient appointments. For that reason, Medicare Part B provides coverage for telemedicine appointments.

Once approved, Medicare Part B covers 80 percent of the costs of telepsychiatry. You will pay for the remaining 20 percent.

How Does a Telehealth Consultation Work?

There are various services that you may receive in a telehealth consultation. Some of the services that you may receive in a telemedicine appointment may include:

Office visits
Consultations
Psychotherapy (Telepsychiatry)

Certain healthcare providers can provide a telemedicine appointment. These professionals may include the following:

Doctors
Physician assistants
Nurse practitioners
Clinical social workers
Nurse anesthetists
Licensed nutritionists
Licensed dieticians

Finally, you can receive a telehealth service in two ways. You can either accept it in your home without ever going out. Or an alternative would be you can go to a healthcare facility and have it there.

Medicare Advantage Coverage of Telepsychiatry

Medicare Advantage plans (Medicare Part C) also provide coverage for telepsychiatry. They cover everything Original Medicare covers – they have to. It’s the law!

But these plans also provide coverage for some things that Original Medicare does not. What a plan covers and how much the out-of-pocket costs are will depend on your plan.

Plans that include prescription drugs will also provide coverage for medications your healthcare provider will prescribe you, such as antidepressants.

Medicare Part D plans provide coverage for mental health medications such as antidepressants. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.