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Neurology Now:
doi: 10.1097/01.NNN.0000410099.19489.87
Departments: Your Questions Answered

Ask the Experts: I am on Medicare. Where can I go for psychiatric care?

Jaffe, Ellen

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Ellen Jaffe is the Medicare specialist at the American Psychiatric Association's Office of Healthcare Systems and Financing.

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MEDICARE

Q I am on Medicare. Where can I go for psychiatric care?

ELLEN JAFFE RESPONDS:

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A Currently, Medicare patients are covered for all medically necessary psychiatric care for both outpatient and inpatient services. Patients can see any psychiatrist who is enrolled in Medicare for their treatment. Just as in any other treatment, there is a standard fee schedule for psychiatric care. The initial psychiatric evaluation is reimbursed at Medicare's medical service rate of 80 percent. Ongoing outpatient psychotherapy is currently reimbursed at 55 percent with the following reimbursement increases projected: 60 percent in 2012, 65 percent in 2013, and 80 percent from 2014. Inpatient psychiatric care is currently reimbursed at the same rate as other medical care.

Some psychiatrists have opted out of Medicare, so if you wish to see one of them, you may see that psychiatrist under a private contract. While Medicare will not reimburse for treatment from a physician who has opted out of the program, some secondary payers may continue to pay a portion of the Medicare fee.

A list of currently enrolled psychiatrists can be found on the Medicare Web site at medicare.gov. Your Medicare carrier, contractor, or Advantage plan (a private, Medicare-approved company offering additional coverage at a monthly premium) may also be a valuable resource and provide you with a list of enrolled psychiatrists as well as a fee range for physician visits and services.

©2011 American Academy of Neurology

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