Amerigroup Mental Health Coverage Guide
Amerigroup is the Medicaid managed care subsidiary of Elevance Health (Anthem), serving approximately 5 million Medicaid members across multiple states. They focus exclusively on government-sponsored health programs.
Low-Cost Mental Health Access
Medicaid covers mental health services at little to no cost to you. Coverage includes individual therapy, group therapy, psychiatric services, and substance use treatment. No prior authorization is typically required for outpatient therapy.
How to Verify Your Mental Health Benefits
Before your first appointment, verify your specific benefits so you know what to expect. Here is a step-by-step process for Amerigroup members:
- Call 1-800-600-4441 and have your member ID card ready.
- Ask to speak with the behavioral health benefits department.
- Ask: "What is my deductible for outpatient mental health services, and how much have I met?"
- Ask: "What is my copay or coinsurance for an in-network therapy session?"
- Ask: "Do I have out-of-network benefits, and what is the reimbursement rate?"
- Ask: "Is prior authorization required for outpatient therapy?"
- Ask: "Is there a session limit per year?"
- Ask: "Are telehealth sessions covered at the same rate as in-person?"
Know Your Rights: Mental Health Parity Act
Federal law requires Amerigroup to cover mental health services at the same level as medical and surgical benefits. If you are denied coverage, ask for the denial in writing and reference the Mental Health Parity and Addiction Equity Act.
Want to keep track of all these details? Use our free benefits verification worksheet to organize your coverage information.
Finding an In-Network Therapist
Search Amerigroup's provider directory directly: Find a therapist in your area
Tips for Using the Amerigroup Directory
- Filter by "Behavioral Health" or "Mental Health" specialty.
- Check that the provider is accepting new patients before calling.
- Confirm the provider is in-network for your specific plan (not just Amerigroup generally).
- Look for providers who specialize in your specific concern (anxiety, depression, trauma, etc.).
Types of Providers Covered
Telehealth Coverage
Amerigroup covers telehealth therapy sessions, so you can meet with a therapist from home via video or phone.
Couples & Family Therapy
Family therapy covered per state Medicaid guidelines.
Understanding Your Amerigroup Coverage
Available Plan Types
Behavioral Health Managed By
Carelon Behavioral Health
Some Amerigroup plans outsource behavioral health management. You may need to call the behavioral health manager directly for authorizations and provider searches.
Prior Authorization
Varies by state Medicaid program.
Substance Use Treatment
Amerigroup covers substance use disorder treatment, including outpatient counseling, intensive outpatient programs, and inpatient rehabilitation.
Common CPT Codes for Therapy
These are the billing codes your therapist will use when filing claims with Amerigroup:
| CPT Code | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation |
| 90834 | Individual therapy (45 minutes) |
| 90837 | Individual therapy (60 minutes) |
| 90847 | Family / couples therapy (with patient present) |
| 90846 | Family therapy (without patient present) |
| 90853 | Group therapy |
How to Get Reimbursed (Out-of-Network)
If you are seeing a therapist who is not in Amerigroup's network, you may still be able to get reimbursed. Here is how:
- Pay your therapist directly at the time of your session.
- Request a superbill from your therapist after each session. This is a detailed receipt with the information Amerigroup needs to process your claim.
- Submit your claim to Amerigroup using one of these methods:
- Online: Submit through the member portal
- Mobile App: Submit via the Amerigroup app
- Fax: 1-800-454-3730
- Mail: Amerigroup, P.O. Box 62509, Virginia Beach, VA 23466
- Wait for processing. Most claims are processed within 30 days. You will receive an Explanation of Benefits (EOB) showing what was covered.
Amerigroup Claims Note
Claims address varies by state.
What Your Superbill Should Include
- Therapist's name, credentials, NPI number, and tax ID
- Date of service
- CPT code (e.g., 90834 or 90837)
- ICD-10 diagnosis code
- Amount charged
- Your name and date of birth
Amerigroup tip: Amerigroup is primarily Medicaid managed care. Claims processes and addresses vary by state. Use the information on your member ID card.
Save Money on Therapy with Amerigroup
Use Your HSA or FSA
Therapy is an eligible expense for Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). You can use these pre-tax dollars to pay for copays, coinsurance, and out-of-network therapy costs, effectively saving 20-35% on your therapy expenses.
Ask About Sliding Scale Fees
Many therapists offer reduced rates based on your income. If you have a high deductible Amerigroupplan or high out-of-pocket costs, ask your therapist about sliding scale options. Some therapists will also offer "single-case agreements" with Amerigroup at a negotiated rate.
Low-Cost Access
As a Medicaid member, your therapy sessions should have little to no out-of-pocket cost. If you are charged a copay, it is typically $1-$5 per visit. Contact 1-800-600-4441 if you receive an unexpected bill.