Telehealth is transforming how mental health care is delivered, but navigating insurance coverage can be complicated. Understanding what Medicare, Medicaid, and private insurance cover for telepsychiatry ensures that your patients receive timely care while your practice remains compliant and reimbursed.
Let’s explore Medicare and Medicaid coverage and how to determine what’s covered.
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Breaking Down Telehealth and Telepsychiatry
Telehealth refers to healthcare services provided remotely through secure video technology, phone calls, or online platforms. Telepsychiatry is a specialized form of telehealth focused on mental health, including psychiatric evaluations, therapy, and medication management. Telepsychiatry allows patients to access care from their home or local clinic, improving convenience and reducing travel barriers.
Where you’ll typically find access to telehealth visits:
- Primary Care Offices
- Rural Health Clinics (RHCs)
- Federally Qualified Health Centers (FQHCs)
- Inpatient Psychiatric Hospitals
Not every practice that provides telemedicine or virtual care visits is part of a telepsychiatry network. Telepsychiatry requires separate licensure and access to certified behavioral health professionals. FasPsych is the nation’s leading telepsychiatry network, providing real-time access to qualified mental health professionals.
But how does health insurance come into play when providing telehealth visits to patients?
Navigating Your Plan’s Telehealth Coverage
Insurance coverage for telehealth varies widely. Organizations need to verify what services are reimbursable, how to bill properly, and whether patients meet eligibility requirements. Confirming coverage upfront helps practices deliver care efficiently without unexpected billing issues.
Medicare Coverage for Telepsychiatry
Medicare Part B (Medical Insurance) covers certain telehealth services. Medicare reimburses for psychiatric evaluation, medication monitoring, and several other services as long as the patient is located within a Health Professional Shortage Area (HPSA). You can identify if your region is within an HPSA here.
- Patients must typically reside in a Health Professional Shortage Area (HPSA).
- Services must be delivered via approved telehealth platforms.
- Visit frequency and location may be limited, so verification with Medicare and the provider is essential.
Medicaid Coverage for Telepsychiatry
Approximately 48 states can use Medicaid funds to pay for telepsychiatric services. Federal Medicaid regulations do not specifically address telehealth, so individual states have flexibility in determining the parameters of telehealth for coverage purposes.
- Approximately 48 states allow Medicaid funds for telepsychiatric services.
- Coverage can include psychiatric evaluations, therapy, and medication management.
- Requirements and eligible patient locations differ, so checking your state’s Medicaid rules is essential.
Private Insurance Considerations
Private insurance carriers may cover certain types of telehealth services, so it is recommended to contact your carrier to confirm coverage and correct billing information. Steps to confirm coverage:
- Contact insurers to verify covered services, billing codes, and reimbursement rules.
- Ensure your practice is in-network for the patient’s plan.
- Since FasPsych is reimbursed by your organization on an hourly basis, you will need to bill your insurance source directly for the services we provide.
How to Determine Telehealth Coverage for Your Patients
- Confirm Medicare HPSA requirements – Verify if your patient’s location qualifies for Medicare-covered telehealth services.
- Check state Medicaid rules – Understand what your state reimburses for telepsychiatry, including eligible services and documentation requirements.
- Coordinate with insurance carriers – Contact private insurers or employer-sponsored plans to verify coverage and preferred billing practices.
Talk to your telepsychiatry provider – Your provider can confirm which health services are covered and help you understand what to expect for billing.
Frequently Asked Questions About Medicare Telehealth Coverage
What if a patient’s health insurance policy doesn’t cover telehealth?
If coverage is unavailable, your organization can still partner with FasPsych for hourly telepsychiatry services, while patients may pay out-of-pocket.
Do I need a referral to provide telehealth under Medicaid?
Requirements vary by state. Some Medicaid programs require a referral from a primary care provider or therapist; others do not.
Can patients still use telepsychiatry if they live outside an HPSA?
Coverage may be limited under Medicare, but Medicaid and some private insurance plans may still reimburse for telepsychiatric services.
Check your state rules and insurance policy.
Can Medicare Advantage plans cover telepsychiatry differently from traditional Medicare?
Yes. Medicare Advantage plans may offer broader coverage or additional telehealth benefits for mental health services, including additional virtual visit options, or reduced copays compared to traditional Medicare. Always verify plan-specific rules for your patients.
Does a patient’s deductible affect coverage for telehealth services?
Yes. Medicare beneficiaries may need to meet their annual deductible before Medicare telehealth services are reimbursed. It’s important to confirm with each patient’s plan how deductibles and copays apply.
How do office visits and telehealth visits differ for billing Medicare patients?
Medicare reimburses both office visits and telehealth visits, but rules differ. Telehealth visits may have separate billing codes and eligibility criteria, including HPSA location and approved telehealth platforms.
What types of providers are part of FasPsych’s network?
Adult psychiatrists, adolescent psychiatrists, psychiatric nurse practitioners, pediatric and child psychiatrists, psychotherapy health care professionals, clinical psychologists, licensed clinical social workers, and other behavioral health care providers. You can hand-select your team, and we’ll work with you to integrate them into your organization. Join the network for free!
What telehealth flexibilities exist for Medicare patients?
Medicare offers certain telehealth flexibilities, especially for mental health services, including coverage for virtual psychiatric evaluations and therapy sessions. These flexibilities may include audio-only visits, convenient access even in rural areas, expanded patient locations, and temporary adjustments to visit frequency rules.
Support from the FasPsych Team
Our team at FasPsych can provide general information as to which types of telepsychiatric services are reimbursable. We have experience working with dozens of organizations across almost every state, and can share our insight into relevant insurance options. Get in touch with us today to find out more.