Does Medicare Cover Therapy? What Independent Therapists and Patients Need to Know

Medicare coverage of mental health therapy has expanded significantly. Here’s the current state of what’s covered, who can provide it, and where the gaps remain.

Medicare covers mental health therapy, and the scope of that coverage has expanded meaningfully in recent years. With the addition of Licensed Marriage and Family Therapists (LMFTs) and Mental Health Counselors (including LPCs) as Medicare providers on January 1, 2024, more patients now have access to therapy under Medicare than at any point in the program’s history.

That said, Medicare coverage of therapy is conditioned on medical necessity, a covered diagnosis, and service from an eligible provider. This guide walks through what is covered, what isn’t, and what has changed.

What Medicare covers for mental health

Under current Medicare rules, the following mental health services are generally covered when medically necessary:

• Psychiatric diagnostic evaluation (90791 or 90792)
• Individual psychotherapy (90832, 90834, 90837)
• Family psychotherapy (90846, 90847)
• Group psychotherapy (90853)
• Crisis psychotherapy (90839, 90840)
• Psychiatric collaborative care services under specific codes when delivered as part of an integrated care model
• Partial hospitalization and intensive outpatient program services
• Inpatient psychiatric care
• Prescription medications for mental health conditions (under Medicare Part D)

Who can bill Medicare for therapy

As of January 1, 2024, the following provider types are eligible to bill Medicare directly for mental health services:

• Psychiatrists and other physicians
• Psychiatric nurse practitioners and physician assistants
• Clinical psychologists
• Licensed Clinical Social Workers (LCSWs)
• Licensed Marriage and Family Therapists (LMFTs) — added January 1, 2024
• Mental Health Counselors, including Licensed Professional Counselors (LPCs), Licensed Mental Health Counselors (LMHCs), and similar credentials — added January 1, 2024

The addition of LMFTs and Mental Health Counselors represented the most significant expansion of Medicare mental health provider eligibility in decades. Patients who previously could not find a Medicare-enrolled therapist in their community now have a much larger pool of eligible providers.

Medical necessity and diagnosis

Medicare covers therapy when it is medically necessary for the treatment of a covered mental health condition. In practice, this means:

• The patient has a covered mental health diagnosis from the DSM-5-TR that maps to a billable ICD-10 code
• The therapy is clinically appropriate for that diagnosis
• The services are being delivered by an eligible Medicare provider within their scope of practice
• The documentation supports the services billed

V-codes and Z-codes alone (relationship problems, life transition issues, academic stress without diagnosable disorder) are generally not sufficient to support Medicare coverage for psychotherapy. A primary covered diagnosis must be present.

What Medicare does not cover

Therapy without medical necessity

Coaching, personal growth work, life transitions without a covered diagnosis, and wellness-focused therapy are generally not covered.

Couples therapy without a covered diagnosis

If the presenting problem is relational but neither partner has a covered mental health diagnosis, Medicare does not typically cover couples therapy.

Court-ordered services without medical necessity

Court-ordered therapy is not automatically covered. The service must still meet medical necessity criteria.

Routine counseling without a diagnosis

Supportive counseling, pastoral counseling, employee assistance program services, and similar services are generally not covered under Medicare psychotherapy codes.

Patient cost-sharing for Medicare therapy

Under traditional Medicare, patients receiving outpatient therapy services generally pay:

• The Part B deductible (reset annually)
• 20 percent coinsurance on the Medicare-approved amount after the deductible is met

Patients with supplemental insurance (Medigap) often have the 20 percent coinsurance covered. Patients with Medicare Advantage plans have cost-sharing that varies by plan — some Medicare Advantage plans have lower copays for mental health services, while others may have higher copays or network restrictions.

Telehealth coverage for therapy

Medicare coverage of telehealth therapy has evolved significantly since the beginning of the COVID-19 public health emergency. The general current state includes:

• Audio-video telehealth is covered for mental health services from eligible providers
• Audio-only telehealth for mental health is covered under specific conditions
• Home as an eligible originating site has been extended for mental health services
• In-person visit requirements that had been paused during the PHE have been the subject of ongoing legislative action and extension — therapists should verify current requirements each year

Because telehealth rules for mental health have been changing regularly through Congressional action and CMS rulemaking, verifying the current rules at the time of service is essential.

How patients find a therapist who accepts Medicare

Patients looking for Medicare-enrolled therapists can:

• Use the Medicare.gov Care Compare tool to search for mental health providers by ZIP code
• Call their Medicare plan directly (especially for Medicare Advantage plans, which have their own provider directories)
• Ask their primary care provider for a referral to a Medicare-enrolled therapist
• Contact their local Area Agency on Aging for referrals to community providers

Since the 2024 expansion of provider eligibility, the pool of Medicare-enrolled therapists in most communities has grown substantially. Independent LMFTs and LPCs who have enrolled in Medicare are now part of that directory for the first time.