Networks change. We verify your specific Railroad Medicare plan before your first visit; call with your member ID and we will confirm benefits, copay and any referral or authorization requirements.
Also appears on cards as: Palmetto GBA Railroad Medicare, Railroad Retirement Board Medicare, RRB Medicare.
Railroad Medicare is Original Medicare for retired railroad workers and their families whose benefits are administered by the Railroad Retirement Board instead of the Social Security Administration. The coverage is identical to Medicare Part B, but Part B claims for railroad retirees are processed by a single national contractor, Palmetto GBA in Columbia, South Carolina, rather than by the regional Medicare contractor. Your red, white and blue card looks like a standard Medicare card but says Railroad Retirement Board on it, and providers must be enrolled separately with Palmetto GBA Railroad Medicare to bill it. Outpatient psychiatry, medication management and psychotherapy are covered under Part B, with the annual deductible and then 20 percent coinsurance unless a Medigap supplement covers it. No referrals or networks apply.
Telehealth mental health visits from home are a permanent Part B benefit for Railroad Medicare members, with an in-person visit required within six months before starting telehealth and at least once every 12 months afterward unless an exception applies. For Deep TMS, coverage follows the local coverage determination that applies where you receive treatment, which in Florida is First Coast Service Options, and typically requires a diagnosis of severe major depressive disorder, documented failure of at least two antidepressant trials and a psychotherapy trial. No prior authorization is required, but the documentation must meet the criteria. Spravato is covered as a physician-administered drug under Part B, with 20 percent coinsurance on the drug and the monitoring visit. Our billing staff submit Railroad Medicare claims directly to Palmetto GBA.
What we check before your visit
- Whether your plan is in network at the office you chose and for telehealth
- Your copay or coinsurance for an evaluation and for follow-ups
- Whether a primary-care referral is required (common with HMO plans)
- Prior-authorization criteria for Deep TMS and Spravato, if those are being considered
Frequently asked questions
Does Stedfast Psychiatry accept Railroad Medicare?
Stedfast Psychiatry accepts Railroad Medicare at our Florida and South Carolina offices, provided the treating provider is enrolled with Palmetto GBA Railroad Medicare, which is a separate enrollment from standard Medicare. Tell our front desk your card says Railroad Retirement Board when you schedule so we can confirm the provider's enrollment before your first visit.
Is my cost the same as regular Medicare Part B?
Yes. Railroad Medicare pays 80 percent of the Medicare-approved amount after the annual Part B deductible, and you pay 20 percent unless a Medigap supplement or secondary coverage pays it. For a typical medication management visit, that coinsurance is modest. There are no networks or referrals, and we accept Medicare assignment.
Does Railroad Medicare cover telehealth psychiatry?
Yes. Video and audio-only mental health visits from home are covered permanently under Part B at the same payment rate as office visits. You need an in-person visit with our practice within six months before your first telehealth visit and at least once a year afterward, unless you qualify for an exception. We track those dates for you.
Does Railroad Medicare cover Deep TMS and Spravato?
Both are covered under Part B when Medicare's criteria are met. TMS requires documented failure of at least two antidepressants and a psychotherapy trial under the local coverage determination for Florida, with no prior authorization. Spravato is covered as a physician-administered drug for treatment-resistant depression. You pay 20 percent coinsurance on each unless a supplement covers it.