Key takeaways
Eligible patients with Original Medicare can access Nerva's gut-brain therapy program for IBS at no out-of-pocket cost as part of their care plan through the CMS ACCESS Model.¹
Referring is unchanged: refer patients as you do today, with eligibility confirmed by a short check at sign-up.
Medicare Part B-enrolled clinicians can bill CMS's co-management payment for coordinating these patients' care.²
Patients aged 65+ without Original Medicare may still be eligible to access Nerva at no cost through their insurer or Mindset Health-funded access.
What a new outcomes-based Medicare model means for the patients you refer
Eligible patients with Original Medicare can now access Nerva's gut-brain therapy program for IBS and other gut-brain conditions at no out-of-pocket cost through the CMS ACCESS Model, confirmed by a short eligibility check at sign-up.¹
If you manage IBS in your practice, you'll recognize the pattern this solves: you explain to a patient that their IBS is a gut-brain disorder. You tell them behavioral approaches are recommended alongside diet and medication, and that a program like Nerva could help – but not everyone follows through. For many, cost is the deciding factor: they want to try it, but they can't afford it, or their insurance won't cover it.
It's a frustrating gap, because the evidence is already there. The American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the Rome Foundation all recognize brain-gut behavioral therapies for gut-brain disorders like IBS – but without a reimbursement pathway, that recommendation has been difficult to act on at scale.
That's what ACCESS changes.
ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a new CMS Medicare model that supports technology-enabled care for chronic conditions.¹ Mindset Health, the company behind Nerva, is participating from July 5, 2026 – so for the first time, eligible patients with Original Medicare have a pathway to gut-brain therapy at no out-of-pocket cost.
You refer them exactly as you do today, and their eligibility and access route are confirmed by a short check at sign-up.
Patient resource: Help more of your referrals actually get started
Cost is the biggest barrier – but it isn't the only one. Even after a patient is referred, the small hurdles of downloading the app, logging in, and finding that first session can be enough to stall them before they begin. So we've created a simple, step-by-step guide that walks your patients through the whole process, from referral to their first session, including support for any technical barriers along the way.
Share it with every patient you refer.
Download the Nerva patient setup guide →
What is the ACCESS model, and why does it matter for GI practice?
ACCESS is a voluntary national model from the CMS Innovation Center that introduces Outcome-Aligned Payments (OAPs) for chronic disease management.² Instead of paying per visit or per service, Medicare pays participating organizations for managing qualifying conditions, and a defined portion of payment is earned only when an established share of patients meet clinical outcome targets.²
The behavioral health track addresses depression and anxiety, measured through the PHQ-9, GAD-7, and WHODAS 2.0 (12-item).² The musculoskeletal track addresses chronic musculoskeletal pain, including chronic low back pain.²
Both tracks are relevant to gastroenterology. Gut-brain disorders share a central-sensitization mechanism with chronic pain conditions, and anxiety and depression are common in IBS – a meta-analysis found that roughly one in three patients with IBS have anxiety, and around a quarter have depression.³
The behavioral health track is the natural entry point for IBS and other gut-brain disorders, while the musculoskeletal track speaks to the chronic-pain conditions these patients so often live with alongside them.
Watch CMS explain the ACCESS model below to grow your understanding of the changes.
How does ACCESS cover gut-brain therapy for your Medicare patients?
The practical impact for your eligible Medicare patients is straightforward: you refer a patient to Nerva the same way you do now via the HIPAA-compliant online form.
Eligible patients with Original Medicare will be able to access Nerva at no out-of-pocket cost, confirmed by a short eligibility check at sign-up.
For eligible patients aged 65+ without Original Medicare, we'll work with their insurer where possible to secure coverage and cover the cost ourselves when coverage isn't available.
This way, all eligible patients can access the full 6-week gut-brain therapy program at no out-of-pocket cost.²
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We hear the same thing from clinicians every week – my patient needs this, but they cannot afford it.
Delivering an evidence-based, outcomes-measured gut-brain therapy program costs real money to build and maintain, and right now that cost falls on the patient.
ACCESS shifts that burden – creating a Medicare pathway where what matters is whether the program helps the patient get better.
Alex Naoumidis
Nerva Co-Founder and Co-CEO
nervahealth.com
Why does removing the cost barrier matter?
Patients keep all their existing Medicare benefits. They continue seeing you and any other Medicare provider – ACCESS is designed to complement traditional care, not replace it.¹
This matters because cost is consistently the most common reason patients do not follow through on a Nerva referral – a pattern that clinicians across gastroenterology, primary care, and dietetics report in practice.
Removing that financial barrier could meaningfully increase the proportion of referred patients who actually start and complete the program.
What ACCESS means for referring clinicians
ACCESS includes a co-management payment for referring clinicians, established and paid by CMS.²
You can bill this payment when the following apply:
You're a Medicare Part B-enrolled clinician
You review an ACCESS care update for the patient
You document the assessment and any care-coordination action in the patient's record
Participation in the model is not required to bill it. This is a CMS payment, generally available to referring clinicians – including physicians and dietitians – and it is paid by CMS, not by Mindset Health. CMS sets out the amounts, billing frequency, and eligibility in its co-management payment billing guidance.²
You would also receive structured outcome updates from the program, giving you visibility into your patient's progress. This supports continuity of care and gives you data to inform follow-up decisions.
Full detail on eligibility and billing is on CMS's page for primary care providers and referring clinicians.
Why Nerva's evidence base fits an outcomes-aligned model
An outcome-aligned payment model only works if the intervention delivers measurable results – and Nerva's evidence base is a strong fit.
In a peer-reviewed randomized controlled trial published in the American Journal of Gastroenterology, 81% of Nerva users met the primary endpoint – the IBS Symptom Severity Score (IBS-SSS) responder threshold of a ≥50-point improvement – compared with 63% on an active control, and 71% met the abdominal-pain responder threshold of a ≥30% improvement, versus 35%. Improvements in GI symptoms and quality of life were broadly maintained at 6 months.⁴
The program also captures validated measures of anxiety, depression, and functional impairment throughout – the same categories the ACCESS behavioral health track evaluates.
To support its participation, Mindset Health, Inc. is enrolled as a Medicare provider, has appointed a board-certified psychiatrist as medical director for clinical governance, and engaged specialized legal counsel for regulatory compliance.
So, for clinicians who have spent years recommending approaches their patients ultimately could not utilize, ACCESS represents something more fundamental than a new billing code.
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There are millions of people on Medicare living with gut-brain disorders who have never been offered a program that addresses the gut-brain connection directly.
With ACCESS, that care is no longer out of reach – not because the evidence was missing, but because the payment model had not caught up.
Our hope is that commercial and Medicare Advantage plans follow, and that coverage grows beyond behavioral health and musculoskeletal care to reach the many people living with GI symptoms.
Alex Naoumidis
Nerva Co-Founder and Co-CEO
nervahealth.com
Frequently asked questions
Can I bill Medicare for reviewing and coordinating care for patients in an ACCESS organization?
Medicare Part B–enrolled clinicians can bill CMS's co-management payment for reviewing ACCESS care updates and documenting care-coordination activity, and participation in the model is not required to bill it.² This applies to primary care physicians, gastroenterologists, dietitians, and other Medicare-enrolled clinicians. CMS sets out the amounts, billing frequency, and eligibility in its co-management payment billing guidance.
What conditions does the ACCESS behavioral health track address?
The behavioral health track addresses depression and anxiety, measured through the PHQ-9, GAD-7, and WHODAS 2.0 (12-item).² CMS may add tracks and conditions in future model years.
Does ACCESS replace my patients' existing Medicare coverage?
No, ACCESS complements standard Medicare benefits without replacing them. Patients retain all existing rights and can continue seeing any Medicare provider while accessing technology-supported care through an ACCESS participant.¹
Is the ACCESS program available for Medicare Advantage patients?
The current model is designed for Original Medicare (Parts A and B) beneficiaries. Medicare Advantage enrollees are not eligible during this phase.² For patients aged 65+ without Original Medicare, we'll work with their insurer where we can to secure coverage and cover the cost ourselves where coverage isn't available.
How would I refer a patient to Nerva?
The referral process works the same way it does today, and we recommend all clinicians refer via the HIPAA-compliant online form. Eligibility and the applicable access route are confirmed by a short check at sign-up. The difference from before is that eligible patients reach no out-of-pocket cost, and you receive structured outcome updates and can bill CMS's co-management payment for your coordination role.
What if my older patients need help getting started with Nerva?
Every patient has access to real, human support at any time – they can reach the Nerva team directly with any questions. You can also share our step-by-step setup guide with the patients you refer, which walks them through getting started and helps with common tech barriers.
Talk to us
If you have questions about ACCESS or referring Nerva, reach out to our Nerva Specialists at healthcare@nervahealth.com – we're always happy to help.
Nerva is a self-guided program that helps people self-manage IBS and other disorders of the gut-brain interaction (DGBI). It has not been evaluated by the FDA and is not a substitute for the care you provide. Mindset Health, Inc. participates in the CMS ACCESS Model, a voluntary Medicare payment model test; CMS does not endorse Nerva beyond Mindset's participation in the Model. Eligible US patients aged 65+ may access Nerva at no out-of-pocket cost through the CMS ACCESS Model, insurer coverage, or Mindset-sponsored access; eligibility and the applicable route are confirmed at sign-up.
References
Centers for Medicare & Medicaid Services. Improving ACCESS to technology-supported care with Outcome-Aligned Payments. CMS Newsroom Blog. December 2025.
Centers for Medicare & Medicaid Services. ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model. https://www.cms.gov/priorities/innovation/innovation-models/access; ACCESS for Primary Care Providers and Referring Clinicians, https://www.cms.gov/priorities/innovation/access-primary-care-providers-referring-clinicians; ACCESS Co-Management Payment (CMP) Billing Guidance, https://www.cms.gov/priorities/innovation/access-co-management-payment-cmp-billing-guidance; ACCESS Model Payment Amounts and Performance Targets, December 2025.
Zamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2019;50(2):132-143. doi:10.1111/apt.15325
Anderson EJ, Peters SL, Gibson PR, Halmos EP. Comparison of digitally delivered gut-directed hypnotherapy program with an active control for irritable bowel syndrome. Am J Gastroenterol. 2025;120(2):440-448. doi:10.14309/ajg.0000000000002921
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