Yes, counseling is eligible for reimbursement with a Flexible Spending Account (FSA) or Health Savings Account (HSA) when it is used to treat a diagnosed medical or mental health condition.
Why Is Counseling FSA/HSA Eligible?
Counseling qualifies as a medical expense under IRS Code Section 213(d) when it is provided to treat a specific health condition—either physical or mental. This includes mental health services like therapy for anxiety, depression, trauma, or substance abuse, as well as counseling related to managing chronic medical conditions or treatment adherence.
According to IRS Publication 502, the cost of therapy or counseling is considered eligible when it is intended to diagnose, treat, or manage a medical condition. Services must be provided by a licensed professional such as a psychologist, psychiatrist, social worker, or clinical therapist.
FSA- and HSA-eligible counseling services may include:
Mental health counseling for depression, anxiety, PTSD, etc.
Behavioral therapy (e.g., CBT or DBT)
Substance abuse or addiction counseling
Medical counseling to support treatment for chronic illness (e.g., diabetes or cancer diagnosis support)
Family or couples therapy when related to a medical or mental health diagnosis
What’s Not Covered?
The following are not eligible:
Counseling for general life improvement, career guidance, or personal growth
Spiritual or religious counseling not tied to a medical condition
Marriage counseling not associated with a diagnosed condition
Services provided by non-licensed professionals or coaches
To be eligible, counseling must be medically necessary and provided by a licensed healthcare or mental health provider.
How to Use Your FSA or HSA for Counseling
To pay for eligible counseling:
Use your FSA or HSA card at the provider’s office or through your telehealth platform
Obtain an itemized invoice listing the provider’s credentials, date of service, and type of counseling
Keep documentation to confirm that the counseling is for medical treatment in case your plan administrator requests proof
For more information, refer to IRS Publication 502.
