Quickly learn how to bill Medicare for mental health claims.

Medicare is a federal health insurance program for older adults or younger people with disabilities. It is one of the largest health insurers in the United States, as of 2024 there were 68 million people enrolled. Medicare is divided into four different parts, A (hospital insurance), B (medical insurance), C (Medicare Advantage, private health insurance) and D (Prescription Drug Coverage). You can contact the general Medicare line at: 1-800-MEDICARE (1-800-633-4227) . For mental health providers Part B will usually be billed.

How to Bill Medicare

Once you have a copy of the client’s Medicare Card you should call your state’s Medicare office and inquire about the client’s mental health benefits.

Follow our benefits verification script to verify your paneling status with the client’s plan. For Medicare this is important as out of network benefits are typically not covered. You can alternatively also use a portal to verify their status.

You can also have us at TheraThink handle it for you. We handle verification and claims with Medicare daily.

Medicare Claims Address: Where To Send Medicare Claims

There is no Medicare address for claims everywhere in the US. Each state has a contractor (Medicare Administrative Contractor) that handles the claims locally.  You can see a list of the administrator’s here. Medicare contractor’s require that claims be filed electronically, so make sure to enroll for electronic claims with Medicare. Paper claims are usually denied. Once you are enrolled you can file claims electronically. Lookup your local Medicare office’s payer ID and file the claims there.

What is Medicare’s Timely Filing Limit (TFL)?

For standard Medicare claims the timely filing limit is 12 months after the date of service.

Do I Need To Be In-Network In Order to Bill Medicare?

Typically yes you need to be in network in order to bill Medicare. We recommend verifying online or calling and verifying the client’s plan to ensure that you will be compensated for your services.

I’m Not a Medicare Provider But I Need Medicare to Process My Claims

If you are not a Medicare provider but need Medicare to process the claims, for instance if you want the client’s secondary insurance to pay, your client will need to file a 1490S form, a patient’s request for Medical Payment.

My Client Has Medicare Advantage

If the client has Medicare Advantage, you should treat it like a private health insurance plan and not a standard Medicare plan. Contact the Medicare Advantage administrator and verify the benefits and file claims directly to them. Their insurance card will look different than a normal Medicare card.

My Client’s Medicare Card Only has Their Social Security Number

Your client has an out of date card. The cards were updated and no longer have the social security number as the primary Medicare ID. As your client for their updated card.

What Are Standard Medicare Benefits

In 2025, the annual deductible for a standard Medicare plan was set to $257 with a 20% co-insurance. The standard monthly premium for Part B was set to $185. The Medicare Benefits are adjusted annually.

Medicare Reimbursement Rates

You can lookup Medicare Reimbrusement rates by county/state. Although there are national payment rates, your locality will have an impact on your reimbursement.

Can I Accept Medicare Clients as a LPC, LMHC, or LMFT

As of 2024, Medicare does allow licensed marriage family therapists, mental health counselors, and professional counselors to panel with Medicare. Rates however, are adjusted. They are typically 75% of the current Medicare Reimbursement rate.

Which CPT Codes Should I Use to Bill Medicare?

Mental Health Providers will use:

1. 90791
2. 90834
3. 90837

This is a Nightmare!

We can help you sort out these sorts of things without your input whatsoever.  Our expertise comes in handy daily when parsing out these carve out policies (in all states).  Learn how we can handle your mental health billing today.