Does Insurance Cover Psychiatric Care in Maryland?

Short answer: yes, in most cases. Psychiatric care is covered by nearly every insurance plan available in Maryland, including Medicaid, Medicare, employer plans, and individual marketplace plans. The longer answer is that what coverage actually looks like, what it costs, and which providers are in your network varies a lot.

Here is what you should know before you start care.

Mental health parity, in plain terms

Federal and Maryland state law require most health insurance plans to cover mental health and substance use treatment on the same terms as other medical care. That means a plan cannot have a higher copay for a psychiatric visit than for a primary care visit, cannot have a separate deductible for mental health, and cannot place stricter visit limits on psychiatric care than on equivalent medical care.

Parity is the floor, not the ceiling. Some plans cover more. Some providers offer reduced-rate self-pay for patients with restrictive coverage. The details are worth knowing.

What is typically covered

• Initial psychiatric evaluation. A new-patient evaluation, typically billed as CPT 90792 (psychiatric diagnostic evaluation with medical services).
• Ongoing medication management. Follow-up visits with a psychiatric provider, billed as E/M codes (99213, 99214) with or without an add-on psychotherapy code.
• Therapy and counseling. Visits with a licensed therapist, billed as psychotherapy codes (90834, 90837).
• Substance use disorder treatment. Including medication-assisted treatment (MAT) for opioid and alcohol use disorder.
• Telehealth visits. Maryland requires parity in telehealth coverage. A covered visit by video is covered.

What might not be covered, or might be partially covered

• Out-of-network providers. If a provider does not take your plan, you usually pay the full rate up front. Some plans reimburse part of out-of-network costs after you submit a superbill.
• Concierge or "boutique" psychiatry. Some private-pay-only practices charge an annual retainer plus per-visit fees and do not bill insurance. None of this is required by parity laws.
• Some neuropsychological testing. Coverage of extensive testing batteries can require prior authorization.
• Some specialty therapies. A small number of specialized treatments require prior authorization or are partially covered.

The numbers you should know before you book

Before your first visit, you should know:

• In-network status. Is the provider in your specific plan?
• Copay or coinsurance. What will each visit cost?
• Deductible status. How much of your deductible remains? Until it is met, you often pay the negotiated rate (still much lower than self-pay).
• Visit limits. Most plans no longer have specific mental health visit limits, but some still do.

A good practice will verify these before booking and tell you what to expect. We do this for every new patient before the first visit.

How to verify your benefits yourself

1. Look at your insurance card. The back of the card has a member services number and often a separate behavioral health number.
2. Call behavioral health. Ask: "Is this provider in-network for my plan? What is my copay or coinsurance for a psychiatric evaluation (CPT 90792) and follow-up (CPT 99213)? Do I need prior authorization? What is my remaining deductible?"
3. Take notes. Get the rep's name, date, and a reference number for the call.
4. Check the member portal. Many plans show your deductible, out-of-pocket maximum, and recent claims.

Maryland-specific notes

• Maryland Medicaid (HealthChoice). Covers psychiatric care, substance use treatment, and most therapy with very low or no patient cost. Behavioral health services are managed by Optum (Maryland's Administrative Services Organization) for most members.
• Maryland Medicare. Covers psychiatric care under Part B. Medicare Advantage plans vary on networks and copays.
• CareFirst / BCBS of Maryland. Has a large behavioral health network across the state. Most members can see a psychiatric provider without a referral.
• Maryland marketplace plans. All Affordable Care Act marketplace plans in Maryland cover mental health and substance use treatment as essential health benefits.

What if you don't have insurance?

Self-pay psychiatry is an option. Rates vary widely, from sliding-scale community clinics to private-pay practices. Frederick County has community resources that include reduced-cost behavioral health care, and NAMI Frederick County maintains a local resource list.

At Paraview, we offer self-pay for patients without insurance. Reach out for current rates and to discuss options.

The short version

Psychiatric care is covered by nearly every insurance plan available in Maryland. Parity laws require it. Verifying your benefits before the first visit saves headaches, and a good practice does the verification for you.

See our current list of accepted insurance plans, or start the new-patient process. We verify benefits and share expected cost before your first visit.