Medicare

Telehealth

Guidance on Medicare coverage of various telehealth services.

CMS Guidance on Coding for Visit Complexity

Medicare guidance for the implementation of the office and outpatient (O/O) evaluation and management (E/M) visit complexity add-on code G2211.

Coverage of Office-Based Substance Use Disorder Treatment

Medicare guidance for billing for office-based SUD treatment.

Opioid Treatment Programs

Medicare guidance for enrolling in and billing for treatment services delivered in OTPs.

Behavioral Health Integration Services

Information from Medicare on when and how to bill for care management services aimed at improving patients' behavioral health. FAQs on billing for these services can be found here.

Intensive Outpatient Coverage

Medicare now coverers intensive outpatient care for substance use disorder. Find out where these services are covered and how to bill for them.

Intensive Outpatient Coverage in FQHCs/RHCs

Specific information on payment and coverage of IOP services in FQHCs/RHCs.

Marriage and Family Therapists/Mental Health Counselors

Beginning in 2024, marriage and family therapists, as well as mental health counselors are covered Medicare providers. Find out how to enroll in Medicare and bill for these services.

Psychotherapy for Crisis

Medicare pays for psychotherapy for crisis (currently billed using CPT codes 90839 and 90840). These services help reduce a patient’s mental health crisis through an urgent assessment and history of a crisis state, a mental status exam, and a disposition (or what happens next for the patient). Psychotherapy for crisis services are appropriate for patients in high distress with life-threatening, complex problems that require immediate attention. 

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Evaluation and Management Visits

Learn how to manage documentation and payment under the Medicare Physician Fee Schedule for evaluation and management (E/M) visits.

Medicaid

Medicaid State Overviews

Every state’s Medicaid and CHIP program is changing and improving. The State Overviews page on Medicaid.gov provides resources that highlight the key characteristics of states’ Medicaid and CHIP programs and report data to increase public transparency about the programs’ administration and outcomes.

Behavioral Health Coverage Resources

Medicaid is the single largest payer for mental health/SUD treatment services in the United States and is increasingly playing a larger role in the reimbursement of services to treat substance use disorder. 

Medicaid Policy Guidance

Various forms of guidance from CMS regarding the implementation of laws and regulations. In addition, CMS frequently issues sub-regulatory guidance to address policy issues as well as operational updates and technical clarifications of existing guidance.

Coverage of OTP Services

Medicaid has been required to cover OTP services since 2020, subject to an exception process as defined by the Secretary of HHS. This page has information on guidance to states on how to cover OTP services for eligible beneficiaries.

Medicaid Waiver Tracker

This tracker from the Kaiser Family Foundation tracks pending and approved Medicaid waivers in total, as well as by topic areas such as expanding access to treatment for substance use disorder.

Coverage of Medications to Reverse Opioid Overdose and Treat Alcohol and Opioid Use Disorders

This report from SAMHSA provides an update on the present state of coverage, availability of, and access to, medications for treating ongoing alcohol use disorder and opioid use disorder and reversing an opioid overdose within state Medicaid plans. It also includes examples of innovative efforts to increase access to medications for the treatment of SUDs.

Commercial

Payer Contracting Resources

This resource from the American Medical Association provides an overview of varying payment options for physicians to consider when navigating a complex healthcare system.

AMA Managed Care Legal Database

The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such as prior authorization, credentialing, network adequacy, out-of-network payment, and contract termination.  The Database also contains relevant AMA policy, issue briefs, advocacy resources, model legislation, and a State Laws Map.