Art therapy is a form of expressive therapy delivered by a credentialed professional who uses the creative process of art-making to improve a person’s mental and emotional well-being. This specialized mental health treatment can address a wide range of psychological difficulties, from trauma and anxiety to substance use disorders. However, obtaining insurance coverage for art therapy is often complex. Coverage depends heavily on your specific insurance plan and the therapist’s credentials, as this treatment is often categorized outside of traditional medical models.
Defining Art Therapy for Insurance Purposes
A fundamental challenge for coverage lies in how insurance providers classify art therapy. Insurers must view it as a necessary mental health treatment, comparable to talk therapy, rather than an experimental or complementary wellness program. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that mental health benefits be covered no more restrictively than medical or surgical benefits, helping establish art therapy as a protected mental health service when properly coded.
Therapist Credentials
The therapist’s credentials are a major factor in meeting insurer requirements. Art therapists are master’s-level clinicians who often hold a Board-Certified Registered Art Therapist (ATR-BC) credential. However, many insurers require the art therapist to also hold a state-issued mental health license, such as Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW), to be recognized as an in-network provider. This dual credentialing is often required to solidify the therapist’s standing as a licensed mental health professional.
The Role of Billing Codes and Diagnosis
The practical mechanism for insurance coverage relies on using specific billing codes and documenting medical necessity. Since there is no universal, dedicated Current Procedural Terminology (CPT) code for art therapy, practitioners typically bill using standard mental health CPT codes. These codes include 90832 (30 minutes of psychotherapy), 90834 (45 minutes), or 90837 (60 minutes), covering the time spent in the therapeutic session.
Documenting Medical Necessity
To secure reimbursement, the art therapist must provide a recognized mental health diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-10). Crucially, they must also document the “medical necessity” of the art medium itself. This documentation must demonstrate that the use of art materials, such as paint or clay, is an integral part of the treatment plan, not merely a recreational activity. For example, notes might explain how nonverbal expression through image-making is required to address trauma where verbalization is blocked.
Coverage Differences Across Major Payers
Insurance coverage for art therapy varies significantly depending on the type of payer. Private insurance plans, including Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), often cover mental health services, though specifics are plan-dependent. PPOs offer flexibility, allowing patients to see an out-of-network art therapist and receive partial reimbursement, though at a higher cost. HMOs require strict pre-authorization and limit coverage to a specific network, making it harder to find a covered art therapist unless they hold a broad state mental health license.
Government Plans and Parity
The federal Mental Health Parity Act mandates that private plans cannot impose higher co-pays, deductibles, or annual limits on mental health benefits than they do for physical health benefits. This ensures that if a plan covers talk therapy, it must cover art therapy delivered by a licensed professional using the same criteria. Government plans, such as Medicare, cover mental health services, but art therapy is often only reimbursed when delivered as part of a comprehensive program, like partial hospitalization, or by a professional meeting strict state licensing requirements. Medicaid, a joint federal and state program, also covers mental health services, but the extent of art therapy coverage differs significantly by state, often requiring the therapist to be licensed as a general mental health counselor.
Alternative Payment and Access Options
When insurance coverage is denied or unavailable, several alternative payment options exist to make art therapy affordable. Many individual practitioners and community health centers offer a sliding scale fee structure, adjusting the cost of a session based on the client’s income and financial need. This approach helps ensure care remains accessible.
Employer and Tax-Advantaged Accounts
Another option is to utilize Employee Assistance Programs (EAPs), which are employer-sponsored benefits that often cover a set number of short-term counseling sessions at no cost. These sessions can be used to cover the initial intake and a few subsequent art therapy sessions. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can also be used to pay for art therapy. These pre-tax funds are designated for qualified medical expenses, including mental health treatment, and can cover co-pays, deductibles, and fees for out-of-network providers.