When Do You Really Need a Med Check? Rethinking Follow-Up Intervals

This article reflects my clinical approach to follow-up scheduling, not legal advice.
Adapt these frameworks to your scope, setting, and clinical judgment.

One of the first things I had to unlearn in practice: the assumption that stable patients need monthly medication checks.

That's not a clinical standard. It's a billing default.

Sometimes policy forces shorter intervals. But most of the time, monthly is just inertia.

And once you see it, you realize how much unnecessary scheduling happens not because patients need it, but because it's what the workflow expects.

The Default Monthly Schedule Problem

Most practices run on a simple rule:

Patient on medication = monthly follow-up.

But clinical need doesn't work that way.

A patient stable on sertraline 100mg for two years doesn't need the same follow-up frequency as someone starting lithium. A controlled ADHD patient with no dose changes for six months doesn't need monthly checks unless something else is happening.

Yet many practices schedule both the same way: every 4 weeks, forever.

Why this happens:

• Billing templates default to monthly

• EMRs auto-generate 4-week follow-ups

• Medical necessity documentation expects regular contact

• Clinicians worry about liability if they extend intervals

What gets lost: clinical judgment about what the patient actually needs.

When Shorter Intervals ARE Appropriate

Some situations require frequent follow-up. These are about active risk and change management.

Clinically appropriate reasons for 2-4 week intervals:

• New medication starts (especially high-risk meds)

• Dose titrations in progress

• Active suicidality or safety concerns

• Unstable symptoms requiring close monitoring

• Substance use patterns requiring frequent check-ins

• Medication interactions or side effect monitoring

• Serious medical comorbidities affecting psychiatric treatment

• Recent discharge from higher level of care

These aren't about billing. They're about actual clinical need.

When Longer Intervals Make Sense

For stable patients with no active changes, extending follow-up is often more appropriate than reflexive monthly scheduling.

Clinically appropriate for 6-8 week (or longer) intervals:

• Stable on current regimen for 6+ months

• No ongoing titration or changes planned

• Minimal side effects or complications

• Good medication adherence

• Stable psychosocial situation

• Strong therapeutic alliance

• Patient capable of self-monitoring and reaching out if needed

Example Scenarios

Stable major depression on SSRI
Presentation: Patient on escitalopram 20mg for 18 months, working full-time, no SI, no side effects, exercising regularly. Sees therapist biweekly. Last three visits: medication refills, brief check-in, no changes.
Appropriate interval: 8-12 weeks

Controlled ADHD, same dose for a year
Presentation: Patient on Adderall XR 30mg daily, stable job, no escalation requests, no substance use concerns, no comorbid mood issues.
Appropriate interval: 6-8 weeks (with consideration for controlled substance regulations)

Bipolar disorder, stable on lithium
Presentation: Patient on lithium 900mg nightly with consistent therapeutic levels, no episodes in two years, excellent medication adherence, strong family support, sees therapist monthly.
Appropriate interval: 6-8 weeks (with regular lab monitoring)

Stable bipolar with limited protective factors
Presentation: Patient stable on lithium for 2 years, but family history of rapid decompensation and patient has limited insight into early warning signs.
Appropriate interval: Monthly despite stability, due to reduced protective factors

The Questions That Determine Interval

Instead of defaulting to monthly, ask:

1. What am I actively managing right now?

2. Is there a clinical reason this patient needs to be seen in 4 weeks vs. 8 weeks?

3. What would actually change between now and the next visit?

4. Is the follow-up for my comfort or their clinical need?

5. Can this patient reliably self-monitor and contact me if something changes?

If the honest answer is "nothing will change, they're stable, and I'm just refilling," then monthly scheduling isn't clinically driven.

What About Controlled Substances?

Regulatory requirements vary by state and payer. Use this as a clinical framework, then verify your local rules.

Controlled substances add regulatory complexity, but they're not a separate clinical category. They're a regulatory overlay on your clinical judgment.

Federal law (DEA): No specific interval requirement for Schedule II medication refills. You can write for 90 days if clinically appropriate.

State laws vary: Some states limit refill quantities, require certain visit frequencies, or have specific monitoring requirements.

Insurance requirements: Some payers require contact within certain intervals for prior authorization or coverage.

The key: Base interval on clinical stability, not reflexive monthly scheduling.

For stable ADHD patients with no escalation patterns, no substance use concerns, and consistent follow-through, 6-8 week intervals with monthly refills (or 90-day prescriptions where legal) can be entirely appropriate.

Addressing the "What If Something Happens?" Anxiety

This is the fear that keeps clinicians scheduling monthly when it's not needed:

"What if they decompensate between visits and something bad happens?"

Reality check:

Patients don't decompensate on a calendar schedule. Monthly visits don't prevent crises that happen in week 2 or week 5. Stable patients with good insight know to reach out when things shift. Extending stable patients to 8 weeks frees time for patients who actually need closer follow-up.

The clinical skill is teaching patients when to contact you sooner, not scheduling them monthly just in case.

How to Extend Intervals Without Increasing Risk

When you extend follow-up for stable patients, set clear parameters:

Script:

"You're doing really well on your current medication. I don't see a clinical need to see you every month. Let's plan on 8 weeks. But if you notice [specific warning signs], or if anything changes with your mood, sleep, or functioning, reach out sooner. We can always move the appointment up if needed."

Documentation example:

"Patient stable on current regimen for 12 months with excellent adherence and no side effects. Symptoms well-controlled, no safety concerns. Follow-up scheduled in 8 weeks. Patient educated on warning signs and when to contact sooner."

Make sure they have access:

• Clear instructions on how to reach you if needed

• Established plan for urgent concerns

• Refills timed appropriately

• Backup plan if they can't reach you

When Patients Request More Frequent Visits

Sometimes patients want monthly visits even when clinically stable.

Legitimate reasons:

• They feel reassured by regular contact

• They're anxious about longer intervals

• They value the therapeutic relationship

• They're in a transition period and want closer monitoring

If a stable patient requests monthly visits, that's fine. Clinical appropriateness includes patient preference.

Documentation example:

"Patient stable on current regimen. Discussed option to extend to 8-week intervals. Patient prefers monthly check-ins for ongoing support. Plan: continue monthly follow-up per patient preference."

What This Isn't About

This isn't about:

• Abandoning patients

• Maximizing revenue by seeing fewer people

• Avoiding liability by scheduling less

• Eliminating frequent follow-up when clinically needed

This is about: Matching visit frequency to actual clinical need, not billing templates.

The Takeaway

Visit frequency should reflect clinical need, not calendar defaults.

Stable patients don't need monthly visits just because they're on medication. Unstable patients might need weekly contact regardless of what the billing template says.

The clinical skill is distinguishing between the two and documenting your reasoning.