Psychotherapy Coverage Criteria: Approved Providers of Service

Approved providers of service include physicians (MD/DO), clinical psychologists, clinical social workers, nurse practitioners, clinical nurse specialists and physician’s assistants.

Other providers of mental health services licensed or otherwise authorized by the state in which they practice (e.g., licensed clinical professional counselors, licensed marriage and family therapists).

These other providers may not bill Medicare directly for their services, but may provide mental health treatment services to Medicare beneficiaries under the "incident to" provision.
"Incident to" a physician's professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness (Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 60.1).
The "incident to" provision may also apply to coverage for psychological services furnished "incident to" the professional services of certain nonphysician practitioners including clinical psychologists, clinical social workers, nurse practitioners, and clinical nurse specialists (CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 60.2). Section 1862(a)(1)(A) of the Social Security Act governs payment for the provision of medical care to Medicare beneficiaries.

Psychotherapy Coverage Criteria: Approved Providers of Service

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