Outpatient Mental Health

Medicare Part B (Medical Insurance) will help cover certain outpatient mental health services including services that are usually provided outside a hospital such as:

  • A doctor’s or other health care provider’s office
  • A hospital outpatient department
  • A community mental health center

What is it?

Mental health services help with conditions like depression, anxiety and substance abuse often referred to as counseling or therapy.

What's included?

Outpatient mental health services include the following:

  • One depression screening per year. The screening must be done in a primary care physician’s office or primary care clinic that can provide follow-up treatment and referrals.
  • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services.
  • Family counseling if the main purpose is to help with your treatment.
  • Testing to find out if you’re getting the services you need and if your current treatment is helping you.
  • Psychiatric evaluation
  • Medication management
  • Certain prescription drugs that aren’t usually “self administered” (drugs you would normally take on your own), like some injections.
  • Diagnostic tests
  • Partial hospitalization
  • A one-time “Welcome to Medicare” preventive care visit including a review of your possible risk factors for depression.
  • A yearly “Wellness” visit

What are my costs?

  • You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
  • You pay 20% of the Medicare-approved amount for visits to your doctor or other health care provider to diagnose or treat your condition including the Part B deductible.
  • If you get your services in a hospital outpatient clinic or hospital outpatient department you may have to pay an additional copayment or coinsurance amount to the hospital.

Important notes

Medicare only covers the visits when they’re provided by a health care provider who accepts assignment, and will cover mental health services from the following types of providers:

  • Psychiatrist or other doctor
  • Clinical psychologist
  • Clinical social worker
  • Clinical nurse specialist
  • Nurse practitioner
  • Physician assistant

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