Medicare and Mental Health Coverage updates 07/18/25

Medicare is expanding access and reimbursement for mental health and substance use services. With the 2025 updates from CMS, providers such as LCSWs, MFTs, MHCs, psychologists, and psychiatrists now have greater billing flexibility, telehealth coverage, and recognition of new, evidence-based interventions.

This blog covers:

• ✅ New billing codes

• ✅ Telehealth rules

• ✅ Same-day billing

• ✅ Substance use disorder (SUD) treatment

• ✅ Safety Planning Interventions (NEW)

  
  

🆕 Safety Planning Interventions (SPI) — Medicare-Covered Suicide Prevention

A Safety Planning Intervention (SPI) is a structured, evidence-based suicide prevention tool developed collaboratively between a provider and a patient at risk of self-harm.

📋 What’s in an SPI?

• Recognizing personal warning signs

• Listing internal coping strategies

• Identifying people and social settings that can offer distraction

• Listing trusted individuals to contact during crisis

• Knowing when and how to contact professionals or 988

• Making the environment safer (e.g., removing weapons or medications)

  
  

💰 Medicare Coverage for SPI (2025)

Medicare now reimburses SPI when delivered by licensed behavioral health professionals. SPI may be:

• Integrated into psychotherapy sessions (e.g., 90834, 90837)

• Billed as part of Collaborative Care (CoCM) or BHI codes

• Billed using 99499 (unlisted E/M) when delivered as a standalone or brief phone check-in

🔊 Telehealth & Audio-Only: SPIs can be delivered via telehealth, including audio-only, especially for follow-up after a crisis event or hospital discharge.

📞 Follow-Up Calls Are Covered

Medicare allows brief phone follow-ups to check in on patients after an SPI. Providers must:

• Document the date, method, and clinical need

• Use Modifier 95 if by telehealth

• Use POS 10 if the patient is at home

  
  

👩‍⚕️ Who Can Provide SPIs?

• Psychiatrists, psychologists, LCSWs, MFTs, MHCs

• Nurse practitioners, physician assistants

• Certified crisis clinicians (under supervision in some settings)

🧾 Example Documentation

“SPI completed today. Patient identified early warning signs and three internal coping strategies. Contact list created. Plan provided in print and discussed. 48-hour follow-up call scheduled.”

💻 Telehealth Billing

• POS 10 = Telehealth in home

• Modifier 95 = Real-time audio/video

• Audio-only allowed with justification

  
  

  Tobacco Use Counseling — Covered Under Medicare

  Tobacco cessation counseling is reimbursable under Medicare for patients who:

  • Use tobacco, and

  • Have a tobacco-related condition or are taking medication impacted by tobacco use

  • Up to 2 quit attempts per year

  • Each attempt = up to 4 sessions (8 total per year)

  • No co-pay or deductible for eligible beneficiaries

  • Covered for telehealth and audio-only, when clinically appropriate

  • Use Modifier 95 and POS 10 if patient is at home

  🧾 CPT/HCPCS Codes for Tobacco Cessation:

Code	Description	Time	Notes
99406	Intermediate counseling	3–10 mins	Individual session
99407	Intensive counseling	>10 mins	Individual session

SUD Billing Codes-ubstance Use Disorder (SUD) Treatment — Medicare Billing Codes

Code	Description
G2086	70-min initial SUD treatment
G2087	60-min ongoing therapy
G2088	Add-on 30 mins

Collaborative Care / BHI

Code	Description
99484	General BHI (20+ mins)
99492	CoCM initial (70 min)
99493	CoCM ongoing (60 min)
99494	Add-on time (30 min)

New 2025 Telehealth Requirements

Rule	Effective	Details
In-person visit before telehealth	Oct 1, 2025	Must occur within 6 months before first tele-visit
Annual in-person follow-up	2025	Required every 12 months
C7900–C7902 codes	Active	Mental health services at home via hospital-based care
POS 10 + Modifier 95	Ongoing	Required for billing tele-mental health

Final Thoughts

● You can provide caregiver training, depression screening, and tobacco use cessation counseling services through telehealth

● Added coverage information for:

● Digital mental health treatment (DMHT) devices

● Safety planning intervention (SPI) and post-discharge phone follow-up contacts intervention (FCI) to reduce the risk of suicide

● Opioid treatment programs (OTPs), including Brixadi® and Opvee®

● Updated in-person telehealth requirements for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

● Updated coverage requirements for marriage and family therapists (MFTs) and mental health counselors (MHCs)

● We allow the physician or non-physician practitioner (NPP) written order or referral to substitute for the signature on the initial plan of care (POC) certification for certain therapies

● Added to the HCPCS/CPT code table, including clarifying which are eligible for telehealth.