A mental health diagnosis is required for insurance to pay for counseling. 2022 by the American Hospital Association. What if I don't have a mental health diagnosis? If counseling services are not focused on a diagnosed mental health disorder, they are not generally reimbursable by private health insurance companies. At Lewisville Family Counseling, almost all of our counselors are currently credentialed with most Blue Cross Blue Shield plans (except Blue Value, Blue Local, Blue Home, or Medicare/Medicaid policies), and we are happy to file your insurance claim for you. Don't need the accessible version of this site? Generally, insurance companies do not reimburse for Z-codes in the DSM-5, because these codes are not classified as mental health disorders. In addition to the seven new 2022 ICD-10 procedure codes announcedin November, the Centers for Medicare & Medicaid Services on April 1 will implement, The AHA has posted updated guidanceto help hospitals and clinicians use ICD-10-CM Z codes to capture data on the social needs of patient populations,, The Centers for Disease Control and Prevention will implement three new ICD-10 diagnosis codes for reporting COVID-19 vaccination status effective April 1,, The American Medical Association this week publisheda Current Procedural Terminology code for providers administering a booster dose of the Johnson, The Centers for Medicare & Medicaid Services today added 12 new ICD-10 procedure codes to identify new therapies for COVID-19. Your insurance company can tell you what your out of network benefits and eligibility for reimbursement would be. Which diagnoses will insurance pay for? If counseling services are not focused on a diagnosed mental health disorder, they are not generally reimbursable by private health insurance companies. When people pay privately, Lewisville Family Counseling offers the option of providing a superbill, which you can in turn submit to your insurance company for reimbursement should you choose to do so. Many people do not realize that they also have the option to pay for counseling privately. Your insurance company can tell you what your out of network benefits and eligibility for reimbursement would be. There are also substance-related diagnoses such as Cannabis Use Disorder, Cocaine Use Disorder, Opioid Use Disorders, etc. How does this work for the intake counseling session? Marriage counseling is designed to focus on the relationship between spouses or partners, and not on a clinical mental health diagnosis. For counseling, insurance companies will only provide reimbursement to treat certain diagnoses. Often these are called "billable diagnoses." responsibility to inform you that when you use health insurance to pay for counseling services, your mental health diagnosis becomes a part of your permanent health record. Why is a mental health diagnosis required for insurance to pay for counseling? Generally, insurance companies do not reimburse for Z-codes in the DSM-5, because these codes are not classified as mental health disorders. If you were to have a sports injury, you might go to the doctor to determine exactly what the issue is. We now offer Telehealth Counseling for new and existing clients! Why do people choose to pay privately for counseling? Thats only 1.6% of Medicare FFS beneficiaries, but 6.2% more than in 2018 and 17.9% more than in 2016, when the codes became available to document SDOHs as part of the new ICD-10-CM coding system for health care claims, the report notes. If you choose to submit a superbill, please be aware that any diagnosis that has been assessed will appear on your superbill and will become a part of your permanent health record. Following are some frequently asked questions that are related to health insurance reimbursement for counseling services. Often these are called "billable diagnoses." Often, when clients call their insurance company, they find that they have a deductible, co-insurance, or co-payment; that payment can be made at the time of your session by cash, check, or credit card. Why doesn't insurance generally cover marriage counseling? If you choose to pay privately and not submit a superbill, that will not be the case. If there is no mental health diagnosis discovered during the intake session, generally this session will not be covered by health insurance. In mental health, diagnoses we use include such things as Major Depressive Disorder, Panic Disorder, Generalized Anxiety Disorder, Bipolar Disorder, Schizophrenia, Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder, Post Traumatic Stress Disorder, etc. These billable diagnoses vary among different insurance companies. In mental health, diagnoses we use include such things as Major Depressive Disorder, Panic Disorder, Generalized Anxiety Disorder, Bipolar Disorder, Schizophrenia, Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder, Post Traumatic Stress Disorder, etc. Many people have questions about whether or not counseling services are reimbursable by their health insurance. Why is a mental health diagnosis required for insurance to pay for counseling? How does this work for the intake counseling session? Insurance companies require that counseling services are treating a specific condition (the diagnosis). For counseling, insurance companies will only provide reimbursement to treat certain diagnoses. These codes, Medicare releases data on Z code use to document social determinants of health, Updates and Resources on Novel Coronavirus (COVID-19), Institute for Diversity and Health Equity, Rural Health and Critical Access Hospitals, National Uniform Billing Committee (NUBC), AHA Rural Health Care Leadership Conference, Individual Membership Organization Events, The Important Role Hospitals Have in Serving Their Communities, ICD-10-CM Coding for Social Determinants of Health, ICD-10-CM and ICD-10-PCS Codes and Coding, CMS announces new ICD-10 codes for COVID-19 monoclonal antibodies, AHA updates guidance on using Z-codes for social needs, Agencies announce new ICD-10 codes for reporting COVID-19 therapeutics, vaccination status effective April 1, Claims code released for J&J COVID-19 vaccine booster, CMS releases ICD-10 codes for new COVID-19 therapies, American Organization for Nursing Leadership. An example of a Z-code is "Z63.0: Problems in relationship with spouse or partner.". Why doesn't insurance generally cover marriage counseling? A mental health diagnosis is a set of symptoms and criteria that characterizes a specific condition. The most used Z codes were those for homelessness; disappearance and death of family member; problems related to living alone; problems related to living in a residential institution; and problems in relationship with a spouse or partner. All rights reserved. Health care providers used Z codes to capture standardized data on social determinants of health for 525,987 Medicare fee-for-service beneficiaries in 2019, according to a new reportby the Centers for Medicare & Medicaid Services. If there is no mental health diagnosis discovered during the intake session, generally this session will not be covered by health insurance. What is a mental health diagnosis? An example of a Z-code is "Z63.0: Problems in relationship with spouse or partner.". A mental health diagnosis is required for insurance to pay for counseling. Marriage counseling is designed to focus on the relationship between spouses or partners, and not on a clinical mental health diagnosis. There are many reasons why people choose to pay privately for counseling: They do not have a mental health diagnosis, They want counseling to focus on an issue that is not related to their diagnosis, They do not want to be assessed for a mental health diagnosis which would become part of their permanent health record, They want to work with a specific counselor who is the best fit for them, even if that counselor is not in network with their insurance, They want to be seen more frequently than insurance would allow, They want to be seen for a longer duration than insurance would allow, They want to work with a counselor who has a specialization but may not be in network with their insurance, They want an alternative form of therapy that may not be covered by their insurance, They want Marriage or Couples Counseling, Premarital Counseling. Copyright 2022 MH Sub I, LLC dba TherapySites. These include remdesivir, The official guidelines for the new ICD-10-CM code go into effect today through Sept. 30 and have been posted by the Centers for Disease Control. Many people do not realize that they also have the option to pay for counseling privately. What if I don't have a mental health diagnosis? These billable diagnoses vary among different insurance companies. Counselors use the Diagnostic and Statistical Manuel (DSM-5) to assess for mental health and substance use diagnoses. The doctor would do the examination and any other necessary tests, and give you the name of the issue - the diagnosis. Call the office for details. This is a requirement of the insurance company, not the counselor. Counselors use the Diagnostic and Statistical Manuel (DSM-5) to assess for mental health and substance use diagnoses. Often, when clients call their insurance company, they find that they have a deductible, co-insurance, or co-payment; that payment can be made at the time of your session by cash, check, or credit card. We can also provide receipts which may be tax-deductible (without the need for a diagnosis!). Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. There are many reasons why people choose to pay privately for counseling: When you pay for counseling privately, you can be seen as often as you need to be, whether it is more often to quickly meet your goals, or less often to meet your budget. Javascript must be enabled for the correct page display. What are my payment options? Why do people choose to pay privately for counseling? Employing a standardized approach to screening for, documenting and coding social needs enables hospitals and other providers to track and develop strategies to address the social needs that impact their patients. If you choose to submit a superbill, please be aware that any diagnosis that has been assessed will appear on your superbill and will become a part of your permanent health record. Counseling for Individuals, Couples, & Families. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. There are also substance-related diagnoses such as Cannabis Use Disorder, Cocaine Use Disorder, Opioid Use Disorders, etc. The latest Updates and Resources on Novel Coronavirus (COVID-19). Would you like to switch to the accessible version of this site? A mental health diagnosis is a set of symptoms and criteria that characterizes a specific condition. For example, if a person is diagnosed with Major Depressive Disorder, the counseling services would need to be focused on reducing the symptoms of depression in order for insurance to reimburse for counseling. To request permission to reproduce AHA content, please click here. If you were to have a sports injury, you might go to the doctor to determine exactly what the issue is. These questions are best answered by a representative of your health insurance company, because benefits and coverage varies widely between health insurance companies and insurance policies. As health professionals, it is ourresponsibility to inform you that when you use health insurance to pay for counseling services, your mental health diagnosis becomes a part of your permanent health record. Counseling is an investment - in yourself, your children, your family, your community. At Lewisville Family Counseling, almost all of our counselors are currently credentialed with most Blue Cross Blue Shield plans (except Blue Value, Blue Local, Blue Home, or Medicare/Medicaid policies), and we are happy to file your insurance claim for you. When people pay privately, Lewisville Family Counseling offers the option of providing a superbill, which you can in turn submit to your insurance company for reimbursement should you choose to do so. If you choose to pay privately and not submit a superbill, that will not be the case. We can also provide receipts which may be tax-deductible (without the need for a diagnosis!). The doctor would do the examination and any other necessary tests, and give you the name of the issue - the diagnosis. For more on using Z codes, see the AHAs resource on ICD-10-CM Coding for Social Determinants of Health.