Does Medicare Cover Teletherapy?
- The COVID-19 pandemic has changed the health care industry, and this presents a common concern. Does Medicare cover teletherapy? Here's what you need to know.
Medicare Part B does cover teletherapy in certain scenarios, but it's important that you review your plan to determine what is and is not covered. Telehealth services are in high demand due to the COVID-19 pandemic, so if you have a justified need to conduct your appointments in this manner, your doctor may be able to gain approval through Medicare to have your telehealth services covered.
Medicare Advantage (Medicare Part C) plans are required to provide the same coverage you receive through Medicare Part B, and some plans may even cover more services than traditional Medicare would.
If you're approved for telehealth services, your coverage will be the same as if you were to schedule a regular appointment with your doctor in person. You will be responsible for 20% of your bills through Medicare Part B.
If you have an Advantage plan, you would pay whatever copayment your insurance provider requires through your specific policy.
Compare Medicare Advantage plans where you live that cover teletherapy and find out if they cover your doctor, cover your prescription drugs or offer other additional benefits you can't get from Original Medicare (Part A and Part B).
Special Medicare Telehealth Coverage Due to COVID-19
As of March 2020, there are many telehealth services that were previously uncovered by Medicare that are now covered. As long as the purpose for your appointment is deemed medically reasonable, you are covered under Medicare Part B.
Some health care services are even choosing to reduce their fees or waive them entirely throughout the pandemic.
Does Medicare Pay for Online Counseling?
Counseling is one of the services you may be able to receive coverage for. As with most services covered by Medicare, you will need to obtain documentation that shows your need for treatment.
You will also need to make sure that the health care provider you work with is approved by Medicare or your Advantage plan so you avoid being rejected for coverage.
Does Medicare Cover Teletherapy for Mental Health?
Medicare covers a broad range of mental health services, including treatment of neurological disorders, mental health disorders and treatment for substance abuse.
As long as you work through a Medicare-approved provider, you will be responsible only for your copayment. This is also true if you have an Advantage plan, but the amount of coverage you receive and approved physicians might vary based on your policy.
What Other Telehealth Services Are Covered by Medicare?
If you suffer from end-stage renal disease, you can receive coverage through Medicare for home dialysis and any telehealth services that are aimed at monitoring your progress, diagnosing your condition and providing treatment. The cost of treating an acute stroke via teletherapy is also covered, including the use of a mobile stroke unit.
These are only a couple of examples, and with industry-wide changes to telehealth services due to the COVID-19 pandemic, nobody knows whether the recent exceptions to the traditional rules will become permanent.
How Do I Bill Medicare for Telehealth?
Because these forms are often very complicated and require knowing which codes to provide that classify what type of treatment you are receiving, the best way to address this is to review everything with your physician to ensure accuracy. If you're receiving treatment via telehealth, you can bill Medicare by submitting form CMS-1500. This is a medical claim form that seeks reimbursement for the cost of your medical treatment.
If you're having difficulty with this, most health care providers will help you with the paperwork. Many will even submit it on your behalf. If you have a Medicare Advantage plan, review your policy to check how you would submit a claim.