The Centers for Medicare & Medicaid Services (CMS) has finalized new rules aimed at expanding access to behavioral health services for Medicare beneficiaries. These updates are a major step forward in improving care for patients across the country. Announced on Tuesday, the rules provide greater flexibility in billing and supervising certain providers and permanently cover some telehealth services delivered in patients’ homes. This move represents a significant milestone in Medicare behavioral health expansion.
These finalized rules align with the proposed regulations released by CMS in July 2023 for the Physician Fee Schedule and the Hospital Outpatient Prospective Payment System. They support the Biden administration’s unity agenda and the U.S. Department of Health and Human Services (HHS) Roadmap to Behavioral Health Integration. “Access to services promoting behavioral health, wellness, and whole-person care is key to helping people achieve the best health possible,” said CMS Administrator Chiquita Brooks-LaSure. “The Physician Fee Schedule final rule ensures that the people we serve will experience coordinated care and that they have access to prevention and treatment services for substance use, mental health services, crisis intervention, and pain care.”
Medicare Physician Fee Schedule Final Rule: Expanding Provider Access
A key element of the Physician Fee Schedule final rule is the authorization for providers to bill Medicare for services delivered by licensed professional counselors (LPCs) and licensed marriage and family therapists (LMFTs). These providers can now bill under general supervision of a physician or non-physician practitioner, rather than requiring direct supervision. This change removes barriers to care and represents a significant advancement in Medicare behavioral health expansion.
The final rule also clarifies that mental health and substance use disorder (SUD) treatment services delivered under general supervision are eligible for billing. Beginning in 2024, Medicare will cover new codes for “caregiver behavioral management training,” providing additional support for families managing behavioral health needs at home.
For SUD treatment, Medicare will reimburse opioid treatment programs (OTPs) for initiating medication-assisted treatment (MAT) with buprenorphine via telehealth and for treatment delivered through mobile units. Additionally, new codes for general behavioral health integration (BHI) will track services provided by clinical psychologists and licensed clinical social workers in primary care settings. Psychiatric diagnostic evaluations can serve as the initiating visit for these new BHI services, further advancing Medicare behavioral health expansion by integrating behavioral health into routine care.
Hospital Outpatient Prospective Payment System Final Rule
The finalized Hospital Outpatient Prospective Payment System (OPPS) rule also supports Medicare behavioral health expansion by making permanent telebehavioral health flexibilities introduced during the public health emergency. Hospital outpatient departments can bill for in-home telebehavioral health services, ensuring patients receive care where it’s most convenient.
Patients must have an in-person visit within six months before the telehealth service and again every 12 months, with exceptions allowed when risks outweigh the benefits. Audio-only visits are also permitted when video technology is unavailable.
The rule introduces new Healthcare Common Procedure Coding System (HCPCS) codes for telehealth services recognized as partial hospitalization program (PHP) services. Hospitals may bill for non-PHP outpatient services delivered to PHP patients, such as therapy, but these cannot be billed as PHP services. Compliance with PHP documentation requirements ensures proper billing and quality care. These updates are another example of CMS advancing Medicare behavioral health expansion.
What This Means for Beneficiaries and Providers
These CMS updates significantly enhance access to behavioral health care. By reducing supervision requirements, expanding telehealth options, and integrating services into primary care, Medicare beneficiaries now have more opportunities to access mental health and substance use disorder care. For patients, caregivers, and providers, this represents a meaningful step forward in Medicare behavioral health expansion.
Providers gain new flexibility in delivering care efficiently while meeting Medicare billing requirements. Hospitals, outpatient clinics, and primary care practices can integrate behavioral health services into routine care, improving patient outcomes and supporting families. New codes for caregiver support and general behavioral health integration demonstrate CMS’s commitment to a coordinated, patient-centered approach, advancing nationwide Medicare behavioral health expansion.
Looking Ahead
CMS’s finalized rules mark a transformative moment for behavioral health services in the Medicare program. By expanding billing flexibility, integrating telehealth, and emphasizing coordinated care, these updates aim to make behavioral health services more accessible, convenient, and patient-centered.
For Medicare beneficiaries, these changes mean greater access to mental health and substance use disorder services through telehealth, mobile treatment programs, and integrated primary care services. Providers now have new tools to deliver care effectively while supporting patients’ whole-person health. Overall, these updates reflect a strong commitment to Medicare behavioral health expansion and a more comprehensive system of care that prioritizes patient needs and wellness.
