53+ minute psychotherapy sessions can hardly be called ‘outlier’ or ‘atypical’ session lengths, as some insurers may now be asserting.
However, 53+ minute sessions are not necessarily the most commonly employed increment for treatment visits. Here’s a look at the 2013 numbers from the large Medicare population (approximately 52 million in 2013).
|30 Minutes (90832)||45 Minutes (90834)||53+ Minutes (90837)|
|Number of Sessions Provided||2220572||4499933||2149958|
|Number of Clinicians Providing*||8344||19311||11485|
|Number of Beneficiaries Receiving||391921||594321||293743|
|Average Charge Submitted||$96.47||$134.62||$162.11|
|Average Medicare Allowed||$52.18||$70.33||$102.01|
|Average Medicare Payment||$31.82||$42.63||$62.34|
Source: https://data.cms.gov/. *Number of clinicians includes those providing services in multiple locations.
Indeed, 53+ minute visits were the third most commonly provided length of visits among the three key codes available for psychotherapy in 2013, with 45 minute visits leading the way and 30 minute sessions a distant second.
Looked at another way, about one quarter of the 8.87 million psychotherapy visits provided to Medicare beneficiaries in 2013 were 30 minute sessions, about one quarter were 53+ minutes, and slightly more than half were 45 minute sessions.
Furthermore, the proportion of Medicare beneficiaries who received sessions of different lengths varied in 2013. Almost half received 45 minute sessions, slightly less than one-third received 30 minute sessions, and somewhat less than one quarter received 53+ minute sessions.
Clinicians certainly are able to demonstrate each of these session lengths are commonly used. However, the data do not support that 53+ minute sessions are the dominant session length. Forty-five minute visits appear to be the most frequently provided session length, delivered to the largest proportion of Medicare beneficiaries receiving psychotherapy.
Many questions remain unanswered. Is there any demonstrable difference in effectiveness among the session lengths? Is the service delivery pattern similar or different in Medicaid, among private insurers or those paying privately for therapy? Do individuals in private pay treatment typically receive sessions of different length than those with insurance, and if so, why? What changes occurred from 2013 to 2015, possibly reflecting pressures in reimbursement patterns? Are any changes attributable to reimbursement forces that are separate from past patterns of treatment delivery, from what patients need, and from what works?