Mental health care (intensive outpatient program services)
Medicare Coverage Information
Overview
Medicare provides coverage for Intensive Outpatient Programs (IOPs) to help beneficiaries receive comprehensive mental health treatment. These programs offer structured mental health services that allow patients to receive intensive care while maintaining daily life activities.
- Covers structured mental health treatment programs
- Typically requires a physician's referral and medical necessity
- Services include group therapy, individual counseling, and psychiatric support
- Available for beneficiaries with diagnosed mental health conditions
- Designed to provide more intensive care than standard outpatient services
- Medicare Part B beneficiaries
- Individuals with diagnosed mental health conditions
- Patients requiring more intensive treatment than standard outpatient services
- Must have a referral from a qualified healthcare provider
- Part B typically covers 80% of approved IOP services after meeting the Part B deductible
- Beneficiaries are responsible for 20% coinsurance
- Actual out-of-pocket costs may vary by specific Medicare plan
- Must be deemed medically necessary by a healthcare professional
- Requires pre-authorization from Medicare
- Limited to specific diagnosed mental health conditions
- Number of covered sessions may be restricted
- Consult with your primary care physician or mental health professional
- Verify specific coverage details with your Medicare plan
- Get a formal referral for an Intensive Outpatient Program
- Contact Medicare at 1-800-MEDICARE for specific coverage questions
Last updated: 6/15/2025
Quick Information
- Provider
- Medicare
- Last Updated
- 6/15/2025
- Topics
- Medicare mental healthintensive outpatient programIOP mental health coverageMedicare mental health servicesmental health treatment
Related Coverage Topics
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