Medicare psychotherapy coverage: codes, telehealth and limits
The short answerClinical psychologists, clinical social workers, MFTs and mental health counselors can bill Medicare; MFTs and MHCs since January 1, 2024. CMS lists 90791, 90832, 90834, 90837, 90846, 90847, 90853 and 90785 as common mental health codes and telehealth codes. Mental health telehealth to the home is permanent; in-person visit rules start after December 31, 2027.
By Javier Alvarez · Updated · 2 min read
1 row: Medicare. Public policy, not the member's benefits.
Medicare
Original Medicare (Part B) · All states
| 90785 | Listed [1] |
|---|---|
| 90791 | Listed [1] |
| 90832 | Listed [1] |
| 90834 | Listed [1] |
| 90837 | Listed [1] |
| 90846 | Listed (covered when medically reasonable and necessary with patient treatment as the primary purpose; PFS status indicator R (restricted coverage)) [1][2] |
| 90847 | Listed [1] |
| 90853 | Listed [1] |
| Other codes | Crisis psychotherapy 90839 and 90840 are on the CMS list of commonly used mental health codes and are marked as codes CPs, CSWs, MFTs and MHCs can bill. CPs, CSWs, MFTs and MHCs can bill the general behavioral health integration code G0323 when they personally perform the services. [1] |
| Telehealth POS | Use POS 02 when the patient is not at home and POS 10 when the patient is at home. Telehealth to the patient's home is paid at the non-facility rate. [3] |
| Telehealth rules | Behavioral health telehealth has no geographic or place-of-service restriction and the patient may be at home. Through December 31, 2027 audio-only is allowed at home; from January 1, 2028 audio-only behavioral health at home is allowed when the practitioner can use video but the patient cannot or does not consent to video. After December 31, 2027 an in-person visit is required within 6 months before the first home mental health telehealth service and then within 12 months of each one, with limited exceptions; patients who began mental health telehealth by December 31, 2027 count as established and need only the 12-month visit. [3][1] |
| Visit limits | Services billed by MFTs and MHCs are not paid under their benefit category when a hospital outpatient department or CMHC provides them in a partial hospitalization or intensive outpatient program. Services to SNF residents are excluded from consolidated billing, so include the SNF's Medicare provider number. [1] |
| Who can bill | Clinical psychologists, clinical social workers, MFTs and mental health counselors (including certified alcohol and drug counselors) are eligible professionals. MFTs and MHCs need a master's or doctoral degree that qualifies for state licensure or certification, a state license or certification, and at least 2 years or 3,000 hours of post-master's supervised clinical experience. Since January 1, 2024 they may enroll and bill Medicare independently. [1] |
| Payment | CSWs, MFTs and MHCs must accept assignment and are paid 75% of the PFS amount for clinical psychologists. Computed from the RVU26D October 2026 file (non-facility total RVUs x 33.4009 conversion factor, national, before geographic adjustment): about $167.00 for 90837, $113.90 for 90834, $85.84 for 90832, $173.35 for 90791, $109.55 for 90847 and $30.39 for 90853, before the 75% rate. [1][2] |
| Medicare rules | MFTs and MHCs enroll with PECOS or the paper CMS-855I, are limited screening risk, and pay no application fee. A separate CMS-855I is needed in each state where services are rendered. Medicaid enrollment does not enroll you in Medicare. [4] |
- CMS: MLN Medicare & Mental Health Coverage, MLN1986542 (March 2026), checked October 30, 2026
- CMS: PFS Relative Value Files, RVU26D (zip updated 08-26-2026, file PPRRVU2026_Oct_nonQPP), checked October 30, 2026
- CMS: Telehealth FAQ (updated 10/8/26), checked October 30, 2026
- CMS: Provider Enrollment FAQs for Marriage and Family Therapists and Mental Health Counselors (May 2024), checked October 30, 2026
What Medicare's documents say
The table above has every field we found for Medicare, with numbered sources. In short:
- Visit limits. Services billed by MFTs and MHCs are not paid under their benefit category when a hospital outpatient department or CMHC provides them in a partial hospitalization or intensive outpatient program. Services to SNF residents are excluded from consolidated billing, so include the SNF's Medicare provider number.
- Who can bill. Clinical psychologists, clinical social workers, MFTs and mental health counselors (including certified alcohol and drug counselors) are eligible professionals. MFTs and MHCs need a master's or doctoral degree that qualifies for state licensure or certification, a state license or certification, and at least 2 years or 3,000 hours of post-master's supervised clinical experience. Since January 1, 2024 they may enroll and bill Medicare independently.
- Telehealth rules. Behavioral health telehealth has no geographic or place-of-service restriction and the patient may be at home. Through December 31, 2027 audio-only is allowed at home; from January 1, 2028 audio-only behavioral health at home is allowed when the practitioner can use video but the patient cannot or does not consent to video. After December 31, 2027 an in-person visit is required within 6 months before the first home mental health telehealth service and then within 12 months of each one, with limited exceptions; patients who began mental health telehealth by December 31, 2027 count as established and need only the 12-month visit.
- Codes. 90785, 90791, 90832, 90834, 90837, 90846, 90847 and 90853 are listed.
Codes we checked at Medicare
What Medicare's own text says about one code: 90837.
Psychotherapy coverage at other national payers
Cigna and Evernorth Behavioral Health, TRICARE and UnitedHealthcare and Optum Behavioral Health.
Check Medicare's claim against the row
Before the claim goes out, compare it with the row above: the code matches the session length you documented, the place of service and modifier fit a video or audio-only visit, and the rendering clinician's license is one the payer enrolls. The psychotherapy table compares Medicare with every other payer we checked.