Behavioral and Mental Health
This page is a central location for behavioral and mental health information, including CMS resources.
Spotlight
The CMS Behavioral Health Strategy promotes healthy behaviors through the integration of physical and behavioral health care, helping to strengthen overall mental well-being.
Enrolling
The following resources support enrollment activities for behavioral and mental health:
- Marriage and Family Therapists & Mental Health Counselors
- Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) Provider Enrollment Frequently Asked Questions (FAQs)
Policy Information
Not all services have a policy associated with them. We will consider Reasonable and Necessary Guidelines in the absence of an LCD, billing and coding article, NCD, or CMS manual instruction that limits coverage.
LCDs
Learn more about the LCD development process through the following:
Search for behavioral and mental health-related LCDs using these available resources:
NCDs
Search for behavioral and mental health-related NCDs using these available tools:
Medical Documentation
For a claim to be valid, documentation must demonstrate compliance with all applicable coverage, coding and billing requirements and substantiate the level of care billed. The following resources are specific to behavioral and mental health, but may not address all required medical documentation requirements:
- Medical Documentation and Checklists
- Checklist: Psychotherapy Services
- CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 80.2
- CMS IOM Pub. 100-03 Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 2, Section 130
- CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 12, Sections 150, 160 and 170
Claim Submission and Reimbursement
Additional Information
- Behavioral Health Services
- Incident To for Mental Health Provision
- Mental Health Coverage
- Revisions to Social Determinants of Health Risk Assessment (HCPCS code G0136)
- Service Specific Medical Review Results
- View our FastTrack to Medicare Coverage Policies Tool to locate guidelines
CMS
- MLN Booklet MLN1986542, Medicare & Mental Health Coverage
- MLN Booklet MLN904084, Screening, Brief Intervention, & Referral to Treatment (SBIRT) Services
- MLN Booklet MLN9560465, Substance Use Screening & Treatment
- MLN Booklet MLN909432, Behavioral Health Integration Services
- Frequently Asked Questions about Billing Medicare for Behavioral Health Integration (BHI) Services
- MLN Educational Tool MLN006559, Medicare Preventive Services
- Psychotherapy for Crisis
- Principal Illness Navigation Services
- Caregiver Training (CTS), Community Health Integration (CHI), Principal Illness Navigation (PIN), and Physical Activity and Nutrition Risk Assessment Services
Education
View our wide selection of free, live and on-demand training options:
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