Behavioral Health reimbursement when just looking at the per session or visit rate, it is demoralizing or discouraging.
What is the breakdown on Commercial insurance, Medicare/Medicare Advantage, Medicaid and self-pay in your mental behavioral health workspace. When is the last time you examined what you've collected after you billed the CPT codes and the proper documentation needed to bill?
Why more Mental and Behavioral Health professionals are adding other revenue streams to their business and personalized care plans.
Prescribed medications, medical devices standout along with the market noise on Ai Don't leave money on the table that CMS started in 2020 during the pandemic and digital solutions like remote therapeutic monitoring that in 2023 added behavioral health. In 2024 to provide access to mental services CMS opened up to Master level licenses to bill Medicare. Average reimbursement $90-$150 per patient new added revenue recurring monthly.
What does reimbursement look like for RTM remote therapeutic monitoring?
Medicare reimburses for the CPT codes for RTM. Commercial plans will vary depending on your contract with them usually payout slightly higher than CMS rates average 110%-125%. Medicaid programs at state level plans will fluctuate and it depends on the regional network, ACO, MCO or value-based models in place. Parity laws are in play in states given the access and need for mental health services.
Behavioral and Mental Health groups and practices that have been adding remote therapeutic monitoring and looked beyond one mode for revenue and adopting new digital solutions to fill the revenue gap.
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Sources and References
• Centers for Medicare & Medicaid Services. CY 2025 Medicare Physician Fee Schedule Final Rule.• MedPAC. March 2025 Report to Congress: Medicare Payment Policy.
• APA Services. 2024 Physician Fee Schedule final rule released.
• National Board for Certified Counselors. Mental Health Payment Parity.
• American Psychiatric Association. (2024). Parity Report.
• Centers for Medicare & Medicaid Services. RTM CPT 98975–98981 coverage guidance.
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#Reimbursement #Medicaid #PracticeRevenue
