How Many Counseling Sessions Does Medicare Pay For?

There is no limit on the number of counseling sessions Medicare will pay for. Coverage for mental health services, including talk therapy, is based on medical necessity. 

We’ll explain what medical necessity means, how to make sure your therapy sessions stay covered, and why you don’t need to "get cured" to keep qualifying.

Key takeaways

• There is no limit to the number of counseling sessions covered by Medicare Part B, as long as therapy is considered medically necessary. 
• You and your therapist decide together on how often you have sessions and what’s best for your treatment plan. 
• You have options if Medicare stops paying for therapy services, such as appealing a claim or paying out-of-pocket.

Why there’s no cap on the number of sessions

You might be wondering if Medicare enforces a strict limit on the number of therapy sessions you can have per calendar year, such as 10 or 20 visits. We’re here to reassure you, this isn’t the case. 

Due to federal mental health parity laws, insurers need to treat mental health care like physical health care. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) says that treatment limitations for mental health benefits can’t be more restrictive than limitations for medical care. 

While private insurance plans are bound by the Affordable Care Act (ACA) to eliminate annual limits, Medicare has its own set of rules.

Historically, Medicare mental health coverage was more expensive than medical care, but the Medicare Improvements for Patients and Providers Act (MIPPA) fixed this disparity. Today, Medicare Part B ensures access to care by covering outpatient therapy sessions without any hard limit on the number of visits, as long as they remain medically necessary.

How often can you see your therapist?

How often you attend counseling sessions will be decided by your therapist, with input from you, as part of your treatment plan. Medicare decides only whether it will pay or not.

Because coverage is based on medical necessity, not how often therapy occurs, Medicare will even cover weekly therapy sessions. Your therapist just needs to provide documentation and justification for continued services. 

This means that if you are currently in crisis and need more frequent sessions than once a week with a therapist, Medicare will usually cover these visits as long they’re medically necessary. 

One thing to note is that if you see your therapist more than once a week, Medicare may be more likely to “audit” you. This means Medicare may require more “proof” that sessions continue to be medically necessary. But this is something your therapist will handle, not you. 

Understanding "medical necessity" for mental health treatments

Instead of imposing a limit on the number of counseling sessions, Medicare has specific criteria to decide if it will keep paying for therapy. 

Unlike home health care or skilled nursing visits, Medicare doesn’t require mental health treatment plans to be recertified in a set number of days to keep coverage active. Instead, coverage continues as long as therapy sessions are medically necessary and are accurately documented by your therapist. 

Mental health therapy is considered medically necessary if, without it, your symptoms or diagnosis would get worse instead of improving. Your healthcare provider or mental health therapist can provide this documentation in order for Medicare to pay for therapy sessions. 

The therapist will create a treatment plan for you and provide documentation to Medicare to indicate that therapy sessions continue to be needed. They will send Medicare clinical documentation on an ongoing basis, which includes the treatment plan, goals for therapy, and progress notes. 

The treatment plan is updated when:

• Goals are met or adjusted
• There’s a change in symptoms — either improving or worsening
• Sessions have changed in frequency, such as from biweekly to weekly

Therapy coverage for maintenance vs. improvement

Due to a class-action lawsuit against Medicare, known as Jimmo v Sebelius, Medicare cannot deny coverage if a person isn’t expected to improve. This lawsuit was about coverage for skilled nursing, but the ruling also applies broadly to all Medicare-covered conditions, including mental health.

What does this mean for you if you have a chronic condition like anxiety? Therapy doesn’t have to “cure” your anxiety for you to have covered counseling sessions. Coverage is still justified as long as it’s medically necessary to maintain your health or prevent symptoms from getting worse. 

When Medicare might stop paying for therapy sessions

There’s a chance Medicare might stop paying for therapy sessions, but before that happens you need to be provided with documentation of this. 

An Advance Beneficiary Notice (ABN) is a form your therapist might give you if they think Medicare might not pay for therapy sessions. Likely, it’s because the therapy services aren’t considered medically necessary, and the ABN form will state the reason why coverage is stopping. 

Your therapist will give you this form before your session if they think your session won’t be covered. You will know the estimated amount you’re responsible for if your session isn’t covered, and your therapist can bill you if Medicare denies your claim. 

On the form, you’ll be asked to choose an option and sign it, saying you understand it. Here are the options listed on the form:

• If you want to see if Medicare will cover the service: Check “Option 1” on the form. You may get a bill while Medicare decides if they will continue to cover the service. If Medicare does pay, you’ll be issued a refund for payments. If Medicare denies the payment, you will need to pay the bill in full. You can file an appeal with Medicare. 
• If you want therapy, but don’t want to bill Medicare: Check “Option 2.” You’ll still receive the therapy session, but the claim won’t be sent to Medicare and you might have to pay upfront. Because Medicare isn’t billed, you can’t appeal the coverage decision. 
• If you decide to end therapy: Check “Option 3” on the form. A claim won’t be sent to Medicare, and you won’t be responsible for payment. 

If your Medicare coverage for counseling ends, you can still choose to pay out-of-pocket to continue seeing your therapist. Medicare Part C (Medicare Advantage) also covers therapy for mental health, but the coverage varies between plans, including how much you pay out of pocket.

How Sailor Health can help

Sailor Health makes it easy for Medicare beneficiaries to find a provider and get started with therapy, and all of our experienced therapists are covered by Medicare. We specialize in older adult mental health services that you can receive from the comfort of your home, either by phone or computer. 

Because we’re in network with Medicare, including Medicare Advantage, we are able to offer more accessible and affordable services. Most people receiving therapy with Sailor Health have little to no out-of-pocket costs or copays. Getting started is easy, and you can begin therapy with care and support in as little as 24 hours after.

You can view a list of our providers and search by specialty. If you have other questions about Medicare coverage for therapy, we’re here to help. Reach out to us today. 

References

1. U.S. Centers for Medicare & Medicaid Services. (n.d.). The Mental Health Parity and Addiction Equity Act (MHPAEA). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
2. U.S. Centers for Medicare & Medicaid Services. (2025). Medicare & Your Mental Health Benefits. https://www.medicare.gov/publications/10184-medicare-and-your-mental-health-benefits.pdf
3. Wilkinson, D. J. (2023). What is ‘medical necessity’? Clinical Ethics, 18(3), 285. https://doi.org/10.1177/14777509231190521
4. Center for Medicare Advocacy. (2013). Jimmo v. Sebelius Improvement Standard Case Summary. https://medicareadvocacy.org/jimmo-v-sebelius-improvement-standard-case-summary/
5. U.S. Centers for Medicare & Medicaid Services. (n.d.). Your Protections. https://www.medicare.gov/basics/your-medicare-rights/your-protections