Medicare and payment
Good care needs a way to keep going.
A practice may want to connect medical care and counseling. It may want better follow-up. It may want to add a care-team member to the team. Each idea needs people, time, and a way to pay for the work.
We believe the care comes first. Then a practice asks how to support it. This page shows how to start that conversation.
Describe the work first
Who would give the care? What would they do? Where would it happen? Which insurance does the patient have?
Those facts matter. Work that looks the same in the room can be paid in different ways. A job title, a referral, or a shared office cannot answer the whole question.
What payment can support
Whole-person care needs people, time, and a way to support the work. Medicare and private insurance can each help pay for this kind of care. Each one has its own rules, and the rules can change.
Begin with the care you want to give. Then ask which arrangement can support it.
Care is moving this way
Medicare is testing new ways to pay for whole-person care. The ACCESS Model pays practices to help people with chronic pain, depression, and other long-term conditions. Part of that payment depends on how patients actually do. The MAHA ELEVATE Model will fund care that includes food, movement, sleep, and stress. Its first group of practices is due to start in October 2026. The IBH Model helps states put mental health care, substance use care, and medical care on one team. These are test programs for some practices, not payment every practice can bill today.
Private insurers are moving too. Insurance coverage for acupuncture grew over the last decade. More people use these approaches for pain than twenty years ago.
For a practice, this means the care you want to give may soon have more ways to be paid for. Start by describing the care. Then ask what could support it.
Start with the kind of arrangement
There is more than one way to be paid for similar work. Some ways depend on the patient’s insurance. Some depend on who does the work and who is in charge. Some depend on how the team is set up.
Our Medicare book sorts these into groups so a reader can compare them. The first job is to know which group you are in. Four facts help you find it.
Kedge, a separate company, helps practices work through the specific rules for their situation.
A license is one question. Payment is another.
A license says what a person may do under state rules. A new counselor may hold a limited or temporary license while they finish training. That is a question about the person.
Payment rules are a separate question about the work. One answer does not settle the other. Ask both.
A label is not a permission
Some payment arrangements have special names. Incident-to is one Medicare term. It describes care that is billed as part of another clinician’s services.
A name like that cannot, by itself, give someone a license. It cannot make every service count. It cannot make a paid claim correct.
The book looks at these questions in depth. This page helps you notice when that deeper look is needed.
Before you act
Write down the need, the work, the people, the place, and the insurance. Mark what you know. Mark what you still need to find out. Name who can answer each open question.
That short list gives your team a clearer talk about care, staffing, and payment. It is a small step. It is also the best first one.
This page teaches a way to compare. It does not decide what any real service is allowed, covered, or paid.
Educational only. Not legal, billing, coding, clinical, or compliance advice. Do not submit patient or claim information through public website forms.