Colleagues, this is excellent news for us as we move into the implementation of the Affordable Care Act. As you know, the health care exchanges rely heavily on increased participation in Medicaid. This will be of benefit to those who work with Medicaid populations. I need not remind you that these actions do not happen without significant advocacy – your involvement in this process is essential for the well being or our professions!
December 3, 2013
The Centers for Medicare and Medicaid Services (CMS) released on November 27 the final rule on the 2014 Medicare physician fee schedule, which includes important payment information for psychologists who treat Medicare patients. As CMS reports, “The 2014 payment rates increase payments for many medical specialties with some of the greatest increases going to providers of mental health services including psychiatry, clinical psychologists and clinical social workers.” Psychologists are listed as having the second largest boost for 2014, with a combined increase across all billed services of approximately 8 percent.
"Some of the greatest increases go to providers of mental health services including... clinical psychologists."- Centers for Medicare and Medicaid Services, 11/27/13
The good news for psychology resulted from the APA Practice Organization’s (APAPO) work on the psychotherapy codes review through the American Medical Association (AMA) RVS Update Committee (RUC) process. As noted in the Medicare final rule, CMS established higher values for the work (cognitive effort and intensity) component of psychotherapy codes payment based on the AMA RUC recommendations.What makes this so significant, according to James Georgoulakis, PhD, JD, APAPO’s advisor to the AMA RUC and member of the RUC Research Subcommittee, is that “both the RUC and CMS recognized the challenges and complexity of mental health work.” As a result, with the exception of the diagnostic evaluation (90971), 30-minute psychotherapy (90832), and multiple family group psychotherapy (90849) codes, all of the psychotherapy codes will receive 2014 payment boosts, several of them substantial.Psychotherapy Payment Changes Estimated for 2014
Based on our preliminary examination of the final rule, which does not list actual payment amounts because they vary by geographic area, we estimate the following approximate changes to psychotherapy code payments in 2014 compared to 2013:
Psychiatric diagnostic evaluation (90791)
30-minute psychotherapy (90832)
45-minute psychotherapy (90834)
60-minute psychotherapy (90837)
Family psychotherapy w/o patient (90846)
Family psychotherapy w/ patient (90847)
Multiple family group psychotherapy (90849)
Group psychotherapy (90853)
Interactive complexity add-on (90875)
Testing Codes a Mixed Bag
Beyond the psychotherapy codes, psychologists will see additional gains but also some losses for other services. On the plus side there will be an increase to the health and behavior codes (96150 - 96155) of approximately 1.5 percent. The testing and assessment codes, however, will vary with some paying more and others paying less.
The largest increases will be for neuropsychological testing (+3 percent for 96118) and neuropsychological testing by a technician (+4 percent for 96119). The largest decreases pertain to the two codes for testing by computer, with a loss of 38 percent for 96103 and 55 percent for 96120. Psychological testing by a technician (96102) will lose 28 percent while psychological testing (96101) will decline by 7 percent. Losses to the testing codes are due to changes by CMS in the practice expense component of Medicare payment.
Sustained Advocacy Efforts Are Vital
Throughout 2013, APAPO met with top CMS officials and key members of Congress urging action to avert lower psychotherapy payment rates. APAPO also submitted comments to CMS on the proposed physician fee schedule rule. Our communications repeatedly emphasize the need to take action to prevent lower payment rates for psychologists' services.
We believe that psychology's voice has been heard. Yet much work remains to be done. Medicare payments to psychologists have drastically declined in recent years, particularly since 2007.
Please continue to support the profession by responding to calls for grassroots members to advocate with your members of Congress on behalf of professional psychology. Your continued support of APAPO through payment of your 2014 Practice Assessment also is vital to sustaining our legislative advocacy efforts on your behalf.
NOTE: The preliminary estimated payment rate changes for the services referenced above do not include the impact of the Sustainable Growth Rate (SGR) payment cut scheduled for January 1, 2014. APAPO will keep you updated on the status of the SGR and will provide additional information about the final Medicare fee schedule for 2014 through our PracticeUpdate e-newsletter.