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Medicare Part B Payments for Psychotherapy Services (Including Services Provided via Telehealth During the Public Health Emergency)

Medicare Part B covers psychotherapy services. Psychotherapy is the treatment of mental illness and behavioral disturbances in which a physician or other qualified health care professional establishes professional contact with a patient and, through therapeutic communication and techniques, attempts to alleviate emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. In calendar year 2019, Medicare Part B allowed approximately $1 billion for psychotherapy services, including individual and group therapy. A prior OIG review found that Medicare allowed $185 million in inappropriate outpatient mental health services, including psychotherapy services that were not covered and were inadequately documented. Pursuant to authority granted under the Coronavirus Aid, Relief, and Economic Security Act and section 1135 of the Social Security Act, and retroactive to March 2020, the Secretary of Health and Human Services authorized CMS to temporarily implement waivers and modifications to Medicare program requirements and conditions of participation for telehealth. Medicare beneficiaries are now able to receive psychotherapy services through telehealth. Our preliminary analysis of psychotherapy services provided during the first 8 months of calendar year 2020 determined that 43 percent of the Medicare payments were for services provided via telehealth (compared to less than 1 percent in calendar year 2019). We will conduct multiple audits of Medicare Part B payments for psychotherapy services to determine whether those services were allowable in accordance with Medicare documentation requirements. The nationwide audit of psychotherapy services will be included in phase one of our audits of Medicare Part B Telehealth Services Provided During the Public Health Emergency (work plan number W-00-21-35862) to make an early assessment of whether these services comply with Medicare requirements. We will assess the appropriateness of psychotherapy services in general and also include a review of psychotherapy services provided via telehealth.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
December 2020 Centers for Medicare & Medicaid Services Medicare Part B Payments for Psychotherapy Services (Including Services Provided via Telehealth During the Public Health Emergency) Office of Audit Services W-00-17-35801, W-00-21-35801 2021