Medicaid

Georgia Medicare Outpatient Mental Health Benefit

::: hero Medicare's coverage of outpatient mental health services has undergone the most consequential expansion in two decades.

Brevy Care Team

· 34 min read

::: hero

By Brevy Care Team · Last verified May 13, 2026

Medicare's coverage of outpatient mental health services has undergone the most consequential expansion in two decades. Until January 1, 2024, the set of providers authorized to bill Medicare directly for outpatient mental health services was tightly bounded: psychiatrists, clinical psychologists under Section 1861(ss) of the Social Security Act, clinical social workers under Section 1861(hh), and nurse practitioners and physician assistants providing services within their scope. Marriage and family therapists, licensed professional counselors, and mental health counselors, who together represent the bulk of the outpatient behavioral health workforce in the United States, could not bill Medicare directly. For Georgia, where licensed professional counselors and marriage and family therapists form the backbone of the outpatient behavioral health workforce, this gap forced thousands of Medicare beneficiaries to either pay out of pocket or hunt for the limited supply of LCSWs and psychologists accepting new Medicare patients.

The Consolidated Appropriations Act 2023 (Public Law 117-328) changed this landscape on January 1, 2024. Section 4121 of CAA 2023 added Section 1861(lll) to the Social Security Act, authorizing marriage and family therapists (MFTs) and mental health counselors (MHCs, including licensed professional counselors) as Medicare providers. Section 4124 of CAA 2023 added Section 1861(ff)(3) authorizing intensive outpatient programs (IOP) as a new Medicare benefit, closing the gap between standard outpatient therapy and partial hospitalization. For Georgia beneficiaries, these two expansions together nearly doubled the practical access points for outpatient mental health care.

This guide explains the federal statutory architecture of Medicare's outpatient mental health benefit, the provider authorities under Sections 1861(ss), 1861(hh), and 1861(lll), the institutional benefits under Section 1861(ff)(2) for partial hospitalization and Section 1861(ff)(3) for intensive outpatient, the unique 190-day lifetime cap on freestanding psychiatric hospital admissions under Section 1812(b)(3), the historic 50 percent coinsurance burden eliminated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA 2008) Section 102, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), the telehealth permanence and modifications under CAA 2021/2022/2023/2024, and how Georgia beneficiaries access outpatient mental health care across the Department of Behavioral Health and Developmental Disabilities (DBHDD), the 25 Community Service Boards (CSBs), the freestanding psychiatric hospitals, the psychiatric units in general hospitals, and the private practice and group practice landscape. We will work through six detailed case examples and fourteen common mistakes that cost Georgia families thousands of dollars and unnecessary access barriers every year. :::

::: callout Key Takeaways

Medicare outpatient mental health services are covered under Section 1861(s)(2)(F) of the Social Security Act and paid under Part B at the standard 20 percent coinsurance after the Part B deductible. The historic 50 percent coinsurance limitation under former Section 1833(c) was phased out by Section 102 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA 2008) and fully eliminated effective January 1, 2014.
Authorized Medicare mental health providers include psychiatrists, clinical psychologists under Section 1861(ss), clinical social workers under Section 1861(hh), marriage and family therapists and mental health counselors under Section 1861(lll) (added by Section 4121 of the Consolidated Appropriations Act 2023, effective January 1, 2024), nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse-midwives within their scope.
Clinical social workers, marriage and family therapists, and mental health counselors are paid at 75 percent of the Medicare Physician Fee Schedule rate. Psychologists, psychiatrists, nurse practitioners, and physician assistants are paid at 100 percent of the MPFS rate.
Partial hospitalization programs (PHP) under Section 1861(ff)(2) are covered when delivered at hospital outpatient departments or community mental health centers (CMHCs) under physician-certified treatment plans for beneficiaries who would otherwise require inpatient psychiatric care. PHP is paid under OPPS as a per diem (APC 8009 or 8010).
Intensive outpatient programs (IOP) under Section 1861(ff)(3) became a new Medicare benefit effective January 1, 2024 under Section 4124 of the Consolidated Appropriations Act 2023. IOP is less intensive than PHP (typically 3 days per week, 3 or more hours per day) and fills the gap between standard once-weekly outpatient and the daily PHP level of care.
Section 1812(b)(3) of the Social Security Act limits Medicare coverage of inpatient psychiatric services in freestanding psychiatric hospitals (Institutions for Mental Diseases, IMDs) to 190 days over the beneficiary's lifetime. This is a non-renewable cap. The 190-day limit does NOT apply to psychiatric care delivered in a psychiatric unit of a general hospital, which uses the standard 60-day benefit period structure.
Annual depression screening (HCPCS G0444) is covered with zero cost-sharing under the ACA preventive services umbrella established by Section 1861(ddd). Annual alcohol misuse screening (G0442) and counseling (G0443) are also zero cost-sharing. Tobacco cessation counseling (99406, 99407) is zero cost-sharing.
Behavioral health telehealth is permanent under CAA 2023. Medicare beneficiaries can receive psychotherapy, psychiatric medication management, and other behavioral health services via telehealth from any geographic location including the beneficiary's home. Audio-only telehealth is permitted under specified conditions. The in-person visit requirement for ongoing telehealth mental health is once every 12 months under current rules. :::

Federal Statutory and Regulatory Framework

Medicare's outpatient mental health benefit is anchored in a small set of Social Security Act provisions that together define coverage, provider authority, payment, and beneficiary cost-sharing. Reading these provisions in sequence is the only way to understand how Medicare reaches the result that a 78-year-old Georgia beneficiary can see a licensed marriage and family therapist for couples therapy in 2026 in a way she could not have done in 2023.

Section 1861(s)(2)(F): Outpatient Mental Health Services

Section 1861(s)(2)(F) of the Social Security Act defines "medical and other health services" covered under Part B to include outpatient mental health services. This is the broad coverage authority. The specifics of which providers may bill, which services qualify, and what payment rates apply are spelled out in companion provisions and implementing regulations.

Section 1861(ss): Clinical Psychologist Services

Clinical psychologists became authorized independent Medicare providers under the Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239). Section 1861(ss) of the Social Security Act and the implementing regulation at 42 CFR 410.71 require: a doctoral degree in psychology from an accredited educational institution, two years of supervised clinical experience (one of which must be post-doctoral), licensure or certification as a psychologist by the state in which the services are furnished, and practice within the scope of state law. Clinical psychologists bill Medicare independently under their own National Provider Identifier (NPI). They are paid at 100 percent of the Medicare Physician Fee Schedule (MPFS) rate for mental health services.

Clinical social workers became authorized independent Medicare providers under OBRA 1989 alongside clinical psychologists. Section 1861(hh) and 42 CFR 410.73 require: a master's degree or doctorate from an accredited school of social work, two years of supervised clinical experience after the master's degree, state licensure (in Georgia, the Licensed Clinical Social Worker or LCSW license issued by the Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists), and practice within state scope. LCSWs bill Medicare under their own NPI. Critically, LCSWs are paid at 75 percent of the MPFS rate (not 100 percent). This 25 percent payment differential has been the subject of repeated advocacy efforts by social work organizations seeking parity with psychologists, but as of 2026 the differential remains in place.

Section 1861(lll): Marriage and Family Therapist and Mental Health Counselor Services

Section 1861(lll) was added to the Social Security Act by Section 4121 of the Consolidated Appropriations Act 2023 (Public Law 117-328), effective January 1, 2024. The provision authorizes two new categories of Medicare mental health providers:

Marriage and Family Therapist (MFT): a person who holds a master's or doctoral degree in marriage and family therapy (or a related discipline) from an accredited educational program, has performed at least two years of clinical supervised experience in marriage and family therapy after the qualifying degree, is licensed or certified as a marriage and family therapist by the state in which the services are furnished, and meets other criteria specified by the Secretary.
Mental Health Counselor (MHC): a person who holds a master's or doctoral degree in counseling, mental health counseling, or a related field from an accredited educational program, has performed at least two years of clinical supervised experience in mental health counseling after the qualifying degree, is licensed or certified as a mental health counselor or professional counselor by the state in which the services are furnished, and meets other criteria specified by the Secretary. In Georgia, the relevant license is the Licensed Professional Counselor (LPC).

Both MFTs and MHCs are paid at 75 percent of MPFS, the same rate as LCSWs. The expansion was implemented through CMS rulemaking in the 2024 Medicare Physician Fee Schedule Final Rule, which set enrollment procedures, billing requirements, and supervision standards.

The practical effect of Section 1861(lll) is enormous. In Georgia alone, the addition of LPCs and LMFTs to the Medicare-billing provider pool roughly doubled the licensed behavioral health workforce that could see Medicare patients. For specialized services such as couples and family therapy that are traditionally the domain of MFTs, the expansion was particularly significant, because LCSWs and psychologists historically did less couples and family work.

Section 1861(ff)(2): Partial Hospitalization Services

Section 1861(ff)(2) of the Social Security Act defines partial hospitalization services. A partial hospitalization program (PHP) is an intensive outpatient psychiatric program structured to provide patients with services that would otherwise require inpatient psychiatric care. The statute and implementing regulation at 42 CFR 410.43 require:

The services must be furnished under a written treatment plan certified by a physician.
The patient must be under the active care of a physician.
The patient would otherwise require inpatient psychiatric hospitalization.
Services must be furnished at a hospital outpatient department or at a Community Mental Health Center (CMHC).
The program must operate at least 20 hours per week.

PHP is paid under OPPS as a per diem. Tier 1 (APC 8009) applies when four or more services are furnished on a day, with full per diem payment. Tier 2 (APC 8010) applies for shorter or less intensive days.

Section 1861(ff)(3): Intensive Outpatient Services

Section 1861(ff)(3) was added by Section 4124 of CAA 2023, effective January 1, 2024. The provision defines intensive outpatient services (IOP) as a structured outpatient psychiatric program that is less intensive than PHP. The statute and 42 CFR 410.44 require:

Services furnished under a physician-certified treatment plan.
Patient under active physician care.
Program operating at least 9 hours per week (typically three days per week, three hours per day).
Furnished at a hospital outpatient department, CMHC, FQHC, RHC, or opioid treatment program.

IOP is paid under OPPS at a per diem rate established by CMS in the 2024 OPPS Final Rule and updated annually.

Section 1812(b)(3): 190-Day Lifetime Inpatient Psychiatric Limit

Section 1812(b)(3) of the Social Security Act caps Medicare coverage of inpatient psychiatric services in freestanding psychiatric hospitals at 190 days over the beneficiary's lifetime. This is fundamentally different from the structure of general hospital coverage under Section 1812(a)(1), which uses a renewable 60-day benefit period (with up to 90 days plus 60 lifetime reserve days per benefit period).

The 190-day limit:

Applies only to freestanding psychiatric hospitals classified as Institutions for Mental Diseases (IMDs).
Does NOT apply to psychiatric care delivered in a psychiatric unit of a general acute care hospital.
Is a non-renewable lifetime cap; once exhausted, no further Medicare coverage in freestanding psychiatric hospitals is available.
Was originally enacted with the Medicare program in 1965 and has not been amended despite repeated reform proposals.

For Georgia, the practical implication is that a beneficiary needing recurrent psychiatric hospitalization should be steered toward psychiatric units in general hospitals (Emory Wesley Woods, Wellstar Cobb Hospital, Piedmont Newnan, Memorial Health, etc.) rather than freestanding psychiatric hospitals (Anchor Hospital, Peachford Hospital, Ridgeview Institute, Riverwoods Behavioral Health, Lakeview Behavioral Health, etc.) where the 190-day cap will eventually run out for high-utilizing beneficiaries.

Section 1833(c) and the MIPPA 2008 Mental Health Treatment Limitation Phase-Out

From 1965 through 2013, Medicare imposed a 50 percent coinsurance on outpatient mental health services rather than the standard 20 percent for other Part B services. The mechanism was a limitation on the amount of charges that could count toward the "Medicare-approved" amount for mental health services. The practical effect: a Georgia beneficiary owed 50 percent of an outpatient psychotherapy bill, compared to 20 percent for a same-cost physical therapy session. This produced major access barriers and discouraged beneficiaries from seeking care.

Section 102 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA 2008, Public Law 110-275) phased out the mental health treatment limitation over four years (2010–2013), with the standard Part B 20 percent coinsurance taking effect on January 1, 2014.

Effective January 1, 2014, outpatient mental health is at parity with other Part B services. The 50 percent coinsurance is gone, but the legacy effect persists: many older beneficiaries still believe Medicare imposes higher mental health cost-sharing, and many providers report patients delaying care based on outdated assumptions.

Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)

The MHPAEA (Public Law 110-343) generally requires group health plans, individual market plans, and Medicare Advantage organizations to provide mental health and substance use disorder benefits on parity with medical/surgical benefits. The Act covers financial requirements (deductibles, copays, coinsurance, out-of-pocket maximums) and non-quantitative treatment limitations (prior authorization, step therapy, network access standards). For traditional Medicare, parity is achieved structurally through the MIPPA 2008 elimination of the 50 percent coinsurance and the equal application of Part B rules to mental health and physical health.

For Medicare Advantage beneficiaries in Georgia, MHPAEA means that the plan's cost-sharing for outpatient psychotherapy must be no more restrictive than its cost-sharing for outpatient physical therapy, the prior authorization rules must not be more burdensome, and the provider network must be sufficient.

Telehealth for Behavioral Health

Section 1834(o) of the Social Security Act, as amended by the Consolidated Appropriations Act 2021, CAA 2022, CAA 2023, and CAA 2024, made permanent the COVID-era telehealth flexibilities for behavioral health services. Effective beyond the COVID public health emergency:

Medicare beneficiaries can receive mental health services via telehealth from any geographic location including the beneficiary's home.
Audio-only telehealth is permitted for established patients under specified conditions.
Originating site restrictions and the requirement for the patient to travel to a clinical facility were eliminated for behavioral health.
The in-person visit requirement for ongoing telehealth mental health is currently once every 12 months (extended from six months under CAA 2023, subject to further legislative extension).

For Georgia, telehealth has been transformative for rural areas where in-person mental health providers are scarce. A Medicare beneficiary in rural Georgia can now receive weekly psychotherapy via telehealth from a clinician in Atlanta or any other location, paid under standard Part B with 20 percent coinsurance.

Section 1861(s)(2)(GG) and SUPPORT Act Opioid Treatment Programs

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (Public Law 115-271, the SUPPORT Act) added Section 1861(s)(2)(GG) authorizing Medicare payment for opioid treatment program (OTP) services. The companion provision Section 1861(jjj) defines OTP services to include medications (methadone, buprenorphine, naltrexone, extended-release naltrexone), counseling, drug testing, and toxicology screens. OTP services are paid as a weekly bundled per-beneficiary payment.

For Georgia, OTPs operate in metro Atlanta, Augusta, Savannah, Columbus, Macon, Albany, and select rural areas. Medicare coverage of OTP services has substantially expanded access to medication-assisted treatment for opioid use disorder among older adults.

Covered Outpatient Mental Health Services

Psychotherapy

Medicare covers individual, group, and family psychotherapy when delivered by an authorized provider. Common CPT codes:

90832: Individual psychotherapy, 30 minutes
90834: Individual psychotherapy, 45 minutes
90837: Individual psychotherapy, 60 minutes
90839: Crisis psychotherapy, first 60 minutes
90840: Crisis psychotherapy, each additional 30 minutes
90846: Family psychotherapy without patient present
90847: Family psychotherapy with patient present (couples therapy)
90853: Group psychotherapy

Psychiatric Diagnostic Evaluation

90791: Psychiatric diagnostic evaluation (by any authorized provider)
90792: Psychiatric diagnostic evaluation with medical services (physicians, NPs, PAs only)

Medication Management

Psychiatric medication management is billed by physicians, nurse practitioners, physician assistants, and clinical nurse specialists as E/M codes (99202-99215 for new and established office visits), often with psychotherapy add-on codes (90833 for 16-30 minutes of psychotherapy, 90836 for 38-52 minutes, 90838 for 53+ minutes added to the E/M).

Screening and Prevention Services

G0444: Annual depression screening (15-minute encounter, zero cost-sharing)
G0442: Annual alcohol misuse screening (zero cost-sharing)
G0443: Annual alcohol misuse counseling, up to 4 brief sessions (zero cost-sharing)
G0396, G0397: SBIRT screening, brief intervention, and referral to treatment
99406: Tobacco cessation counseling, 3-10 minutes (zero cost-sharing)
99407: Tobacco cessation counseling, more than 10 minutes (zero cost-sharing)

Health Behavior Assessment and Intervention

Introduced in 2020 to capture behavioral interventions for medical conditions:

96156: Health behavior assessment or reassessment
96158: Health behavior intervention, first 30 minutes
96159: Each additional 15 minutes
96164-96171: Group and family variants

Behavioral Health Integration and Collaborative Care

99492: Initial psychiatric Collaborative Care Model (CoCM) services
99493: Subsequent month CoCM
99494: Each additional 30 minutes CoCM
99484: General Behavioral Health Integration
G0511: General care management at FQHC/RHC
G0512: Psychiatric CoCM at FQHC/RHC
G2214: Initial or subsequent BHI

Partial Hospitalization and Intensive Outpatient

PHP is paid as a per diem under OPPS APC 8009 (Tier 1, full intensity, four or more services per day) or APC 8010 (Tier 2, lower intensity, fewer services). IOP is paid as a per diem under the new IOP APCs effective January 1, 2024.

Provider Payment Rates

Medicare pays outpatient mental health providers under the Medicare Physician Fee Schedule (MPFS) at the following rates:

Psychiatrists, nurse practitioners, physician assistants, clinical nurse specialists: 100 percent of MPFS
Clinical psychologists: 100 percent of MPFS
Clinical social workers (LCSWs): 75 percent of MPFS
Marriage and family therapists (LMFTs): 75 percent of MPFS
Mental health counselors (LPCs): 75 percent of MPFS

The 75 percent rate for LCSWs, LMFTs, and LPCs is set by statute (Section 1833(a)(1)(F) of the Social Security Act). Mental health advocacy organizations have repeatedly sought legislation to raise these rates to parity with psychologists; CAA 2023 raised the issue but did not change the payment differential.

Part B deductible: $283 per year (applies to mental health services and all other Part B services collectively)
Coinsurance for psychotherapy, medication management, diagnostic evaluation: 20 percent of the Medicare-approved amount after deductible
Annual depression screening (G0444): Zero cost-sharing
Annual alcohol screening (G0442) and counseling (G0443): Zero cost-sharing
Tobacco cessation counseling (99406, 99407): Zero cost-sharing
PHP per diem: 20 percent of OPPS payment, capped per service at the Part A inpatient deductible ($1,736 in 2026)
IOP per diem: 20 percent of OPPS payment, capped per service at the Part A inpatient deductible

All standardized Medigap plans cover Part B coinsurance for mental health services. Medigap Plan G and grandfathered Plan F cover the full 20 percent coinsurance with no copay. Medigap Plan N covers the coinsurance subject to a per-visit copay (waived for ED visits not resulting in admission).

Inpatient Psychiatric Coverage and the 190-Day Lifetime Cap

While this guide focuses on outpatient mental health, the inpatient psychiatric framework is closely intertwined and deserves a clear explanation.

Freestanding Psychiatric Hospitals (IMDs)

A freestanding psychiatric hospital is a hospital primarily engaged in providing inpatient psychiatric services. Under Section 1861(f)(2) of the Social Security Act, such hospitals are classified as Institutions for Mental Diseases (IMDs). The 190-day lifetime cap under Section 1812(b)(3) applies to admissions at these facilities.

Major Georgia freestanding psychiatric hospitals (IMDs):

Anchor Hospital (Atlanta, Acadia Healthcare)
Peachford Hospital (Atlanta, Universal Health Services)
Ridgeview Institute (Smyrna)
Riverwoods Behavioral Health (Riverdale, Acadia)
Lakeview Behavioral Health (Norcross, Acadia)
Coastal Harbor Health System (Savannah)
HCA Floyd Behavioral Health (Rome)
Turning Point Hospital (Moultrie)

Psychiatric Units in General Hospitals

Psychiatric care delivered in a designated psychiatric unit of a general acute care hospital is NOT subject to the 190-day lifetime cap. The Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) under 42 CFR Part 412 Subpart N governs payment to both freestanding psychiatric hospitals and to psychiatric units in general hospitals, but the 190-day cap is statutorily limited to freestanding facilities.

Major Georgia psychiatric units in general hospitals:

Emory Wesley Woods Center (geriatric psychiatry)
Emory Saint Joseph's Hospital
Emory Decatur Hospital
Wellstar Cobb Hospital
Wellstar Spalding Regional
Piedmont Athens Regional
Piedmont Newnan Hospital
Memorial Health University Medical Center (Savannah)
Northeast Georgia Medical Center (Gainesville)
AU Medical Center (Augusta)
Phoebe Putney Memorial Hospital (Albany)
Tanner Medical Center (Carrollton)
Grady Memorial Hospital (Atlanta)

Inpatient psychiatric coverage uses the standard Part A structure:

Part A inpatient deductible: $1,736 per benefit period (2026)
No coinsurance for days 1 through 60 of the benefit period
Coinsurance day 61 through 90: $434 per day (2026)
Lifetime reserve days 91 through 150: $868 per day (2026)
After lifetime reserve days exhausted, no further coverage (general hospital limit, separate from 190-day psych limit)

For freestanding psychiatric hospital admissions, days drawn down also count against the 190-day lifetime cap. For psychiatric unit admissions in general hospitals, no 190-day cap applies, but the standard benefit period structure governs (renewable after 60 consecutive days outside of hospital or SNF).

Georgia Behavioral Health System

Department of Behavioral Health and Developmental Disabilities (DBHDD)

DBHDD is the Georgia state agency overseeing public mental health, substance use, and developmental disabilities services. DBHDD operates a statewide network of 25 Community Service Boards (CSBs), each serving a designated catchment area with outpatient mental health, addiction treatment, and developmental disability services. DBHDD also operates the Georgia Crisis and Access Line (1-800-715-4225), the statewide 24/7 behavioral health crisis line.

Community Service Boards

Georgia has roughly 25 CSBs covering every county in the state. CSBs are non-profit entities created under Georgia law to provide community-based behavioral health and developmental disability services. CSBs serve as safety-net providers for low-income and Medicaid populations and also serve Medicare beneficiaries, billing Medicare under Section 1861(s)(2)(F).

Major Georgia CSBs:

View Point Health (Gwinnett, Newton, Rockdale)
DeKalb Community Service Board
Fulton County Behavioral Health Division
Cobb-Douglas Community Services Board
Aspire Behavioral Health (Houston, Macon-Bibb, Crawford)
River Edge Behavioral Health (central Georgia)
Pathways Center for Behavioral Health (Carroll, Heard, Coweta)
Highland Rivers Behavioral Health (Northwest Georgia)
Lookout Mountain Community Services
Avita Community Partners (Northeast Georgia)
McIntosh Trail Community Service Board
Phoenix Center Behavioral Health (Lowndes area)
Behavioral Health Services of South Georgia
Unison Behavioral Health (Southeast Georgia)
Gateway Behavioral Health Services (Coastal Georgia)

Private Practice and Group Practice

The CAA 2023 expansion has substantially grown the Medicare-billing private practice landscape in Georgia. A growing fraction of Georgia LPCs and LMFTs have enrolled in Medicare since January 1, 2024. Common practice settings include solo practice, multi-clinician group practices, behavioral health subdivisions of multispecialty groups, and academic medical center outpatient clinics (Emory, AU MCG, Mercer, Morehouse).

FQHCs and RHCs

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in Georgia commonly integrate behavioral health services into primary care. Medicare pays FQHCs under a Prospective Payment System and pays RHCs under an All-Inclusive Rate, with behavioral health integration codes (G0511, G0512) available for collaborative care delivery.

Telehealth Providers

A large and growing market of telehealth behavioral health providers serves Georgia Medicare beneficiaries. National platforms like Talkspace, BetterHelp, Brightside, Headway, Grow Therapy, and others now have many Medicare-enrolled clinicians available for telehealth psychotherapy across Georgia.

Worked Example 1: Margaret, 78, Atlanta, Major Depression Psychotherapy with LCSW and Medication Management with Psychiatrist at Emory

Margaret is 78 years old, lives in Buckhead, has traditional Medicare with a Medigap Plan G supplement. Six months ago her husband Robert passed away after a long illness. Over the four months that followed, Margaret developed significant depressive symptoms: persistent low mood, anhedonia, sleep disturbance, weight loss, social withdrawal, and intermittent thoughts that life is not worth living (without active suicidal planning). Her primary care physician screens her with the PHQ-9 at her annual wellness visit and she scores 18 (moderately severe depression).

Her PCP refers her to a behavioral health team at Emory Healthcare: Sarah Patel, LCSW, for weekly individual psychotherapy, and Dr. Kim, a geriatric psychiatrist, for medication evaluation and management.

LCSW Sarah Patel sees Margaret weekly for cognitive behavioral therapy adapted for grief and late-life depression. Each session is billed as CPT 90834 (individual psychotherapy, 45 minutes). LCSWs are paid at 75 percent of the Medicare Physician Fee Schedule rate. Margaret has met her Part B deductible from earlier physician visits, so she owes 20 percent coinsurance on the Medicare-approved amount. Medigap Plan G covers the entire coinsurance. Margaret's out-of-pocket per session: $0.

Dr. Kim conducts an initial psychiatric diagnostic evaluation with medical services (CPT 90792). Margaret's 20 percent coinsurance is covered fully by Medigap. Dr. Kim then sees Margaret monthly for medication management, billing 99214 (established patient, moderate complexity E/M) with add-on 90833 (psychotherapy 16-30 minutes). Margaret's 20 percent coinsurance is covered by Medigap.

Over six months, Margaret completes 24 weekly LCSW sessions and 6 monthly psychiatrist visits. Her PHQ-9 score has dropped to 4 (minimal depression). Her annual out-of-pocket cost for this treatment: $0 (Medigap covers the cost-sharing entirely). Her annual out-of-pocket for her Medigap premium is around $1,800 to $2,400 in metro Atlanta.

Worked Example 2: Robert, 82, Savannah, PHP at Memorial Health Behavioral Health After Suicidal Ideation

Robert is 82, lives in Savannah, has traditional Medicare with no Medigap (he has a Humana Medicare Advantage HMO plan). After a hip fracture eight months ago and prolonged recovery with limited mobility, he developed major depression with passive suicidal ideation ("I wish I would just not wake up tomorrow"). His daughter brings him to the Memorial Health emergency department.

He is briefly hospitalized at Memorial Health inpatient psychiatric unit for three days for safety stabilization. The discharge plan steps him down to Memorial Health Behavioral Health partial hospitalization program (PHP). The PHP runs five days per week, six hours per day, for four weeks (twenty days).

Each PHP day is billed under OPPS APC 8009 (Tier 1, four or more services per day) at a per diem rate established under the Outpatient Prospective Payment System.

Under Robert's Medicare Advantage plan, PHP cost-sharing is $100 per day (a flat copay). Twenty days of PHP produces a $2,000 cost-sharing total. Robert's MA plan annual out-of-pocket maximum for in-network services in 2026 is $9,250 (the federal MA in-network OOP cap for 2026). His prior inpatient hospitalization (three days at MA-specified copay) consumed approximately $1,800 of his OOP max, so after the twenty PHP days he is approaching but not exceeding his OOP maximum.

If Robert had been in traditional Medicare with a Medigap Plan G supplement, his PHP days would have been covered entirely (20 percent of OPPS payment covered by Medigap), at $0 OOP except for the Medigap monthly premium.

Worked Example 3: Linda, 75, Macon, IOP at Atrium Health Navicent Post-Discharge (New Benefit Effective January 1, 2024)

Linda is 75 years old, lives in Macon, has traditional Medicare with a Medigap Plan G supplement. After her husband retired and the household structure changed, she developed a moderate alcohol use disorder over approximately eighteen months, drinking three to four glasses of wine daily and increasing on weekends. She was hospitalized briefly at Atrium Navicent for detoxification after a fall related to alcohol use.

The discharge plan recommends step-down to an intensive outpatient program (IOP). Atrium Navicent Behavioral Health operates an IOP running three days per week (Monday, Wednesday, Friday), three hours per day (12:30 to 3:30 PM), for a six-week curriculum focused on substance use disorder recovery, relapse prevention, and dual diagnosis support.

Before January 1, 2024, this level of care did not exist as a Medicare benefit. Linda's options would have been either daily PHP (more intensive than she clinically needed) or once-weekly outpatient (insufficient intensity for early recovery). She would have either paid out of pocket for IOP (typically $200 to $300 per day) or accepted suboptimal care.

Effective January 1, 2024, under Section 4124 of the Consolidated Appropriations Act 2023 and the new Section 1861(ff)(3) of the Social Security Act, IOP is a Medicare benefit. Each IOP day is paid under OPPS as a per diem under the IOP APCs effective January 1, 2024.

Linda's Part B cost-sharing: she has met her Part B deductible. She owes 20 percent of the per diem as Part B coinsurance. Medigap Plan G covers the entire coinsurance. Linda's OOP: $0.

Over six weeks of IOP (18 sessions), Linda makes substantial progress, achieves abstinence, and steps down to once-weekly outpatient therapy with an LCSW. Her total out-of-pocket cost for the IOP component of her recovery: $0.

Worked Example 4: Charles, 80, Augusta, MFT Therapy with Newly Enrolled MFT Provider (CAA 2023)

Charles is 80 years old, lives in Augusta, has traditional Medicare with a Medigap Plan G supplement. His first wife passed away three years ago. He remarried two years ago and the relationship has been strained, with frequent conflict and Charles experiencing complicated grief that interferes with the new marriage. He and his current wife agree to seek couples therapy.

Charles searches for therapists in Augusta and finds Linda Davis, LMFT, a licensed marriage and family therapist with twenty-five years of experience including geriatric couples work. Linda Davis enrolled in Medicare in February 2024 after Section 4121 of CAA 2023 made MFTs eligible Medicare providers effective January 1, 2024.

Before January 1, 2024, Linda Davis could not have billed Medicare for her services. Charles would have had to pay out of pocket at the market rate or find a different type of therapist (LCSW or psychologist, with most LCSWs and psychologists doing less couples work than MFTs).

Effective January 1, 2024, Linda Davis bills Medicare for Charles's couples therapy as CPT 90847 (family psychotherapy with patient present, used for couples sessions). LMFTs are paid at 75 percent of the Medicare Physician Fee Schedule rate. Charles has met his Part B deductible. He owes 20 percent coinsurance on the Medicare-approved amount. Medigap Plan G covers the entire amount. Charles's OOP per session: $0.

Linda and Charles complete twelve couples sessions over four months. The conflicts diminish, communication improves, and Charles's complicated grief integrates more healthfully. Charles's total OOP for the therapy: $0.

Worked Example 5: Patricia, 73, Columbus, Inpatient Psychiatric Admission at Anchor Hospital Tracking 190-Day

Patricia is 73 years old, lives in Columbus, has traditional Medicare with a Medigap Plan G supplement. She has a long history of recurrent major depression with two prior inpatient psychiatric hospitalizations (one at age 65 for 7 days and one at age 70 for 14 days, both at Anchor Hospital in Atlanta). She presents to the Piedmont Columbus emergency department with severe depression and active suicidal ideation with a plan. She is transferred via medical transport to Anchor Hospital in Atlanta because Piedmont Columbus does not have a psychiatric unit and Anchor Hospital has bed availability.

Anchor Hospital is a freestanding psychiatric hospital classified as an Institution for Mental Diseases (IMD). Patricia's admission counts against her Section 1812(b)(3) 190-day lifetime cap.

Patricia's lifetime psychiatric days used to date: 7 + 14 = 21 days. Days remaining before this admission: 190 - 21 = 169 days.

She is admitted to Anchor for 12 days for stabilization, including ECT (electroconvulsive therapy) treatment for treatment-resistant depression. Her lifetime psychiatric days used after this admission: 21 + 12 = 33 days. Days remaining: 190 - 33 = 157 days.

Cost-sharing: Patricia owes the Part A inpatient deductible of $1,736 for this benefit period (assuming she has not been hospitalized for a separate medical condition in the preceding 60 days that started this benefit period). Medigap Plan G covers the entire $1,736 inpatient deductible. Patricia's OOP for the admission: $0.

Counseling: Patricia and her family should be aware of the 190-day cap and consider whether future psychiatric admissions might be more appropriate to seek at psychiatric units in general hospitals (Emory Wesley Woods, Memorial Health, Northeast Georgia Medical Center, etc.) where the 190-day cap does not apply.

Worked Example 6: Henry, 85, Athens, AWV Depression Screening and Tobacco Cessation Counseling at Northeast Georgia Medical Center

Henry is 85 years old, lives in Athens, has traditional Medicare with a Medigap Plan N supplement. He attends his annual wellness visit (AWV) with his primary care physician at Northeast Georgia Medical Center Athens.

The AWV includes a mandatory health risk assessment with a depression screening element. Henry's PCP administers the PHQ-2 followed by the full PHQ-9. Henry scores 8 (mild depression). The PCP bills:

G0438 or G0439 (AWV, subsequent year): covered with zero cost-sharing
G0444 (annual depression screening): covered with zero cost-sharing

Henry has a 30-year smoking history (15 cigarettes per day) and the PCP also delivers brief tobacco cessation counseling:

99406 (tobacco cessation counseling, 3-10 minutes): covered with zero cost-sharing

Total OOP for the AWV + depression screening + tobacco cessation: $0.

The PCP refers Henry to a Licensed Professional Counselor (LPC) at a community behavioral health practice in Athens for cognitive behavioral therapy for mild depression. The LPC enrolled in Medicare in March 2024 under Section 4121 of CAA 2023. The LPC sees Henry weekly for 90834 (45-minute individual psychotherapy) for 12 sessions.

Henry has met his Part B deductible. He owes 20 percent coinsurance on the Medicare-approved amount. Medigap Plan N covers the coinsurance subject to a per-visit copay. Henry's OOP per session is the Plan N copay.

Henry's total OOP for 12 sessions is the sum of the Medigap Plan N per-visit copays for each session.

Counterfactual: had Henry chosen Medigap Plan G instead of Plan N, his OOP would have been $0 for the LPC therapy. The choice of Medigap supplement materially affects out-of-pocket exposure for outpatient mental health services.

Fourteen Common Mistakes Georgia Beneficiaries and Families Make

Mistake 1: Assuming Medicare doesn't cover mental health

The historic 50 percent coinsurance under former Section 1833(c) (in effect 1965 through 2013) has left a lingering misconception that Medicare provides inferior mental health coverage. Since January 1, 2014, outpatient mental health is at parity with physical health at 20 percent coinsurance after the Part B deductible. Don't let the legacy 50 percent figure keep you from seeking care.

Mistake 2: Confusing the 190-day lifetime cap

The 190-day lifetime cap under Section 1812(b)(3) applies only to freestanding psychiatric hospitals (IMDs). It does NOT apply to psychiatric care delivered in a psychiatric unit of a general hospital. If you have used substantial inpatient psychiatric days in your lifetime at freestanding facilities, consider seeking future admissions at psychiatric units in general hospitals (Emory, Wellstar, Memorial, etc.) where no lifetime cap applies.

Mistake 3: Not knowing about MFT and MHC/LPC coverage under CAA 2023

If you have a therapist who is a Licensed Marriage and Family Therapist (LMFT) or Licensed Professional Counselor (LPC), Medicare has covered their services since January 1, 2024 (provided the therapist has enrolled in Medicare). Many therapists enrolled in Medicare in 2024 and 2025; ask your therapist whether they accept Medicare assignment.

Mistake 4: Missing the new Intensive Outpatient Program (IOP) benefit

Effective January 1, 2024, IOP is a covered Medicare benefit under Section 1861(ff)(3). If you are stepping down from inpatient psychiatric care or PHP, ask the hospital case management team about IOP options. IOP fills the gap between weekly outpatient and daily PHP.

Mistake 5: Not using the annual depression screening (G0444)

The annual depression screening is covered at zero cost-sharing under the ACA preventive services umbrella. Ask your PCP about it at every annual wellness visit. Early identification of depression is one of the highest-impact preventive services for older adults.

Mistake 6: Confusing PHP and IOP

PHP (Partial Hospitalization Program) is intensive: typically 5 days per week, 6 or more hours per day, for beneficiaries who would otherwise require inpatient psychiatric care. IOP (Intensive Outpatient Program) is less intensive: typically 3 days per week, 3 or more hours per day, for beneficiaries who need more than once-weekly outpatient therapy but less than full PHP intensity.

Mistake 7: Believing Medicare Advantage provides inferior mental health coverage

Medicare Advantage plans must cover all Medicare-covered services, including all outpatient mental health benefits, and are subject to the Mental Health Parity and Addiction Equity Act of 2008. Cost-sharing structures (copays, percentage coinsurance) may differ from traditional Medicare, but cannot be more restrictive than the plan's medical/surgical cost-sharing.

Mistake 8: Not appealing a denied PHP or psychiatric admission

Medicare denials of psychiatric care, including denials of inpatient psychiatric admission, PHP, IOP, or specific services, are appealable through the 5-level Medicare appeals process. The Quality Improvement Organization (Kepro at 1-844-455-8708) can also provide immediate advocacy for premature discharge from psychiatric inpatient or PHP.

Mistake 9: Paying out of pocket for couples therapy when MFT now bills Medicare

Couples therapy (CPT 90847, family psychotherapy with patient present) is a covered Medicare service when delivered by an authorized provider. Marriage and Family Therapists became Medicare providers effective January 1, 2024 under Section 4121 of CAA 2023. Many MFTs do couples work that LCSWs and psychologists historically have not done. Don't pay out of pocket if Medicare now covers the service.

Mistake 10: Not exploring behavioral health telehealth

Telehealth for behavioral health is permanent under CAA 2023. You can receive psychotherapy from your home, often with the same therapist you would see in person. Geographic limitations have been eliminated for behavioral health. This is particularly valuable for rural Georgia beneficiaries with limited local provider access.

Mistake 11: Confusing Community Service Boards with private practice

Georgia's 25 Community Service Boards offer outpatient mental health services and accept Medicare. CSBs are non-profit safety-net providers that also serve Medicaid and uninsured populations. Wait times, clinical specialization, and provider fit vary. Private practice and group practice are alternatives with potentially shorter waits and more clinical specialization, but availability of Medicare-accepting providers varies by location.

Mistake 12: Not asking about the in-person visit requirement for telehealth

For ongoing telehealth mental health under current Medicare rules, an in-person visit is required once every 12 months (extended from 6 months under CAA 2023). If you are receiving telehealth-only mental health care, plan for at least one annual in-person visit with the same clinician or with a clinician in the same practice.

Mistake 13: Not contacting NAMI Georgia for family support

The National Alliance on Mental Illness (NAMI) Georgia chapter offers free family support, peer-led support groups, family-to-family education, and crisis resources for Georgia families. Reach NAMI Georgia at 770-408-0625. The service is free, evidence-based, and underutilized by many Medicare families.

Mistake 14: Not knowing about 988

The 988 Suicide and Crisis Lifeline launched in July 2022 and provides 24/7 free crisis support by phone (dial 988), text (988), and chat. For acute behavioral health crises, 988 is faster, easier, and more appropriate than 911 for non-medical-emergency situations. The Lifeline routes to local crisis centers when possible.

Frequently Asked Questions

::: accordion

What outpatient mental health services does Medicare cover?

Medicare Part B covers psychotherapy (individual, group, family, and couples), psychiatric diagnostic evaluation, psychiatric medication management, partial hospitalization programs, intensive outpatient programs (effective January 1, 2024), behavioral health integration services, collaborative care model, and various screening services including annual depression screening, alcohol misuse screening and counseling, and tobacco cessation counseling.

What mental health providers can bill Medicare directly?

Psychiatrists, clinical psychologists (Section 1861(ss)), clinical social workers (Section 1861(hh)), marriage and family therapists (Section 1861(lll), effective January 1, 2024), mental health counselors and licensed professional counselors (Section 1861(lll), effective January 1, 2024), nurse practitioners, physician assistants, and clinical nurse specialists practicing within their scope.

How much does Medicare pay mental health providers?

Psychiatrists, psychologists, nurse practitioners, and physician assistants are paid at 100 percent of the Medicare Physician Fee Schedule (MPFS). Clinical social workers, marriage and family therapists, and mental health counselors are paid at 75 percent of MPFS under Section 1833(a)(1)(F) of the Social Security Act.

What is my out-of-pocket cost for outpatient psychotherapy?

After meeting the Part B deductible ($283 in 2026), you owe 20 percent coinsurance on the Medicare-approved amount. Medigap supplemental insurance covers this coinsurance (entirely under Plan G, subject to a copay under Plan N). Medicare Advantage plans set their own cost-sharing within MHPAEA limits.

When did Medicare eliminate the 50 percent mental health coinsurance?

Section 102 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA 2008, Public Law 110-275) phased out the outpatient mental health treatment limitation under former Section 1833(c) of the Social Security Act. The 50 percent coinsurance was reduced gradually from 2010 through 2013, and effective January 1, 2014, outpatient mental health services are at the standard Part B 20 percent coinsurance.

What is the 190-day lifetime inpatient psychiatric limit?

Under Section 1812(b)(3) of the Social Security Act, Medicare limits coverage of inpatient psychiatric services in freestanding psychiatric hospitals (Institutions for Mental Diseases, IMDs) to 190 days over the beneficiary's lifetime. This non-renewable cap applies only to freestanding psychiatric hospitals; it does not apply to psychiatric care delivered in a psychiatric unit of a general hospital.

Which Georgia hospitals are freestanding psychiatric hospitals subject to the 190-day cap?

Major freestanding psychiatric hospitals in Georgia include Anchor Hospital (Atlanta), Peachford Hospital (Atlanta), Ridgeview Institute (Smyrna), Riverwoods Behavioral Health (Riverdale), Lakeview Behavioral Health (Norcross), Coastal Harbor Health System (Savannah), HCA Floyd Behavioral Health (Rome), and Turning Point Hospital (Moultrie).

Which Georgia hospitals have psychiatric units in general hospitals (no 190-day cap)?

Major psychiatric units in general hospitals include Emory Wesley Woods Center, Emory Saint Joseph's Hospital, Emory Decatur Hospital, Wellstar Cobb Hospital, Wellstar Spalding Regional, Piedmont Athens Regional, Piedmont Newnan Hospital, Memorial Health (Savannah), Northeast Georgia Medical Center, AU Medical Center (Augusta), Phoebe Putney (Albany), Tanner Medical Center (Carrollton), and Grady Memorial Hospital.

What is a Partial Hospitalization Program (PHP)?

A PHP under Section 1861(ff)(2) is an intensive outpatient psychiatric program operating at least 20 hours per week (typically 5 days per week, 6 or more hours per day) under a physician-certified treatment plan for beneficiaries who would otherwise require inpatient psychiatric care. PHP is furnished at hospital outpatient departments or Community Mental Health Centers (CMHCs) and is paid under OPPS as a per diem.

What is an Intensive Outpatient Program (IOP)?

An IOP under Section 1861(ff)(3) is a structured outpatient psychiatric program operating at least 9 hours per week (typically 3 days per week, 3 or more hours per day), less intensive than PHP. The IOP benefit was added by Section 4124 of the Consolidated Appropriations Act 2023, effective January 1, 2024. IOP is paid under OPPS as a per diem.

When did Medicare add MFTs and LPCs as covered providers?

Effective January 1, 2024, marriage and family therapists (MFTs) and mental health counselors (including LPCs) became authorized Medicare providers under new Section 1861(lll) of the Social Security Act, added by Section 4121 of the Consolidated Appropriations Act 2023 (Public Law 117-328).

How much does Medicare pay an MFT or LPC?

MFTs and MHCs/LPCs are paid at 75 percent of the Medicare Physician Fee Schedule rate, the same rate as clinical social workers. This payment rate is set by Section 1833(a)(1)(F) of the Social Security Act.

Is couples therapy covered by Medicare?

Yes. CPT code 90847 (family psychotherapy with patient present) is the code used for couples therapy. With the addition of MFTs as Medicare providers under Section 1861(lll) effective January 1, 2024, Medicare beneficiaries have substantially expanded access to couples therapy.

What is the annual depression screening?

HCPCS code G0444 is the annual depression screening for Medicare beneficiaries. The screening is covered with zero cost-sharing under the ACA preventive services umbrella. The screening typically uses the PHQ-2 or PHQ-9 instrument.

Is behavioral health telehealth permanent?

Yes. Section 1834(o) of the Social Security Act, as amended by CAA 2021, CAA 2022, CAA 2023, and CAA 2024, makes telehealth for behavioral health services permanent. Beneficiaries can receive psychotherapy and other behavioral health services via telehealth from any location including their home. Audio-only telehealth is permitted under specified conditions. The in-person visit requirement for ongoing telehealth mental health is once every 12 months under current rules.

What is the Mental Health Parity and Addiction Equity Act?

The MHPAEA (Public Law 110-343, 2008) requires that group health plans, individual market plans, and Medicare Advantage organizations provide mental health and substance use disorder benefits on parity with medical/surgical benefits. The Act covers financial requirements and non-quantitative treatment limitations.

Does Medicare cover medication-assisted treatment for opioid use disorder?

Yes. Under Section 1861(s)(2)(GG) and Section 1861(jjj) of the Social Security Act, added by the SUPPORT Act of 2018, Medicare covers opioid treatment program (OTP) services including medications (methadone, buprenorphine, naltrexone), counseling, drug testing, and toxicology screens.

Can I appeal a Medicare denial of mental health services?

Yes. Under Section 1869 of the Social Security Act, Medicare beneficiaries have a five-level appeals process. For premature discharge from inpatient psychiatric or PHP, you can also request immediate advocacy from the Quality Improvement Organization (Kepro at 1-844-455-8708).

Do Georgia Community Service Boards accept Medicare?

Yes. Georgia's roughly 25 Community Service Boards (CSBs) operate under the Department of Behavioral Health and Developmental Disabilities (DBHDD) and bill Medicare for outpatient mental health services. CSBs primarily serve Medicaid and uninsured populations but also serve Medicare beneficiaries.

What is the Georgia Crisis and Access Line?

The Georgia Crisis and Access Line, operated by DBHDD, is the statewide 24/7 behavioral health crisis line at 1-800-715-4225. The line provides crisis intervention, mobile crisis dispatch, and referrals to community-based services.

What is 988?

The 988 Suicide and Crisis Lifeline launched in July 2022 and provides 24/7 free crisis support by phone (dial 988), text (988), and chat. It is the national mental health crisis line. Calls route to local crisis centers when possible.

Are there Medicare-covered group therapy options?

Yes. CPT code 90853 is group psychotherapy and is covered under Medicare. Many hospital outpatient departments, CMHCs, FQHCs, and private practices offer group therapy for various conditions including depression, anxiety, bereavement, addiction recovery, and dementia caregiver support.

Does Medicare cover dementia caregiver support?

Medicare coverage of caregiver support has been limited historically but is expanding. CMS launched the Guiding an Improved Dementia Experience (GUIDE) Model in July 2024 to provide comprehensive dementia care including caregiver support. Beneficiary cost-sharing for traditional outpatient mental health services available to caregivers (such as group therapy for caregivers themselves) follows standard Part B rules.

What is the Medicare Beneficiary Ombudsman?

The Medicare Beneficiary Ombudsman, established under Section 1808(c) of the Social Security Act, is a federal officer who advocates for Medicare beneficiaries. The ombudsman accepts complaints about Medicare programs and works to resolve them. Contact via 1-800-MEDICARE.

How do I find a Medicare-enrolled mental health provider in Georgia?

Use the Medicare Care Compare tool at Medicare.gov, search by specialty (psychiatry, clinical psychologist, clinical social worker, marriage and family therapist, mental health counselor), and filter by Georgia ZIP code. You can also contact GeorgiaCares at 1-866-552-4464 for free counseling.

:::

::: cta

Get Help With Georgia Medicare Outpatient Mental Health

If you or a loved one needs help accessing outpatient mental health care in Georgia under Medicare, the resources below can help:

Georgia Crisis and Access Line (DBHDD, 24/7 crisis): 1-800-715-4225
988 Suicide and Crisis Lifeline (24/7 national): dial 988
Georgia DBHDD: 1-800-715-4225
DCH Medicaid Member Services: 1-866-211-0950
Medicare: 1-800-MEDICARE (1-800-633-4227)
Palmetto GBA (Jurisdiction J MAC): 1-877-567-9230
Kepro QIO (Quality of Care, Premature Discharge): 1-844-455-8708
GeorgiaCares SHIP (Free Counseling): 1-866-552-4464
NAMI Georgia (Family Support, Peer Groups): 770-408-0625
SAMHSA National Helpline: 1-800-662-4357
Social Security Administration: 1-800-772-1213
HHS Office for Civil Rights: 1-800-368-1019
HHS Office of Inspector General Hotline: 1-800-447-8477
Medicare Rights Center: 1-800-333-4114
Center for Medicare Advocacy: 1-860-456-7790
Atlanta Legal Aid: 404-377-0701
Georgia Legal Services Program: 1-800-498-9469
211 Georgia: Dial 2-1-1
Eldercare Locator: 1-800-677-1116

For comprehensive eldercare guidance covering Medicare, Medicaid, VA benefits, caregiving, and senior mental health decisions, the Brevy Care Team publishes state-specific deep dives covering every Medicare benefit category, every Medicaid pathway, and the on-the-ground provider landscape for families navigating eldercare in Georgia and across the country.

This guide is for informational purposes only and does not constitute legal, medical, or financial advice. Medicare rules change, and individual circumstances vary. Always verify current rules with Medicare, your Medicare Administrative Contractor (Palmetto GBA for Georgia), GeorgiaCares, NAMI Georgia, your treating clinicians, or a qualified professional before making decisions about mental health care or appeals. If you or someone you know is in immediate danger, call 988 or 911.

Find personalized help navigating Medicare outpatient mental health coverage in Georgia at brevy.com. :::