Update – Psychotherapy in Medicare

I have previously reported about provision of psychotherapy in Medicare, most recently in 2019 and 2018. CMS data releases related to utilization are always at least 2 years behind the year of service provision. Data for services in 2018 became available early in February 2021, and the following analyses are based on those data, available …

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Update #3 Medicare 2021 – “Final” Reimbursement For Psychological Services

With the passage of the Consolidated Appropriations Act December 21, 2020, signed into law six days later, the Medicare Physicians Fee Schedule received an unexpected pardon from the planned, unprecedented 10.2% reduction in the Conversion Factor governing all fees. Instead, the CF was increased from 32.4085 to 34.8931. An additional $3 Billion was allocated to …

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2021 Medicare Prices For Psychological Services

“NPA” = “National Payment Amount.” This will vary based on your geographic region. “RVU” = “Relative Value Unit.” This value is the total of the Work, Practice Expense (PE), and Malpractice components that make up every procedure that Medicare pays for. RVUs used to be objectively determined, but the process to determine these has become …

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Update 2021 Medicare Prices For Psychological Services

Much anticipated Medicare pricing for psychological services has now become available. Given the unprecedented and potentially catastrophic 10.2% reduction in the Conversion Factor, psychologists and other health professionals who rely on key procedure codes to provide services might have been waiting for the numbers, probably with dread. Here’s what 2021 looks like. Method: Data were …

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Wisconsin And Local Pandemic Data

PLEASE SEE DATE/TIME STAMP IN FOOTER OF THE FOLLOWING TABLE THAT SHOWS WHEN DATA HAVE BEEN UPDATED KEY METRICS Consistent with Johns Hopkins recommendations, “key metrics for understanding the reach and severity of COVID-19 in a given area” are being followed here. These are: number of new daily cases, percent of tests that are positive …

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Beware of Success

Historically, the “overhead” component (practice expense, PE) of the formula for pricing psychotherapy in Medicare has averaged 21% from 2000 to 2020. As a reminder, the national price of a service in Medicare is determined by three components, work, practice expense, and malpractice, which are then moderated by geographic location to produce the local values. …

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If You Are A Psychologist, What Are You Waiting For?

In the current context, an active discussion I have encountered is the supposed meagerness of the emergency refunds being paid to health care professionals by Medicare. I did a quick analysis. In 2017 (the most recent year for which data appear to be publicly available*), Medicare paid psychologists $490,497,820 for the diagnostic and treatment services …

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Telemental Health Policy Changes During The Pandemic

The following provides available information about changes in policy and insurance/coverage related to provision of mental health services by telehealth during the pandemic. Clinicians, consumers and interested others are encouraged to provide information to FORM TO REPORT TELEMENTAL HEALTH POLICY so these may be added here as they are reported. FEDERAL Centers for Medicare and …

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Update: Medicare National Values For Health and Behavior Assessment and Treatment Procedures

For interested readers, I’ve been able to extract the Medicare National Payment Amounts for the Health and Behavior (H&B) codes in 2020. An Assessment or Re-Assessment (96156) will be valued at $99.97. Sixty minutes of Individual Intervention (96158 + 2 x 96159) will be valued at $115.85. These are the National values, without geographic price …

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Psychotherapy In Medicare Update – As Predicted, 10 Million+ Sessions Were Provided For The First Time In 2017

In June 2018 I wrote here, “The exact 2017 numbers are not available yet, but it is all but certain that, for the first time, more than 10 million psychotherapy sessions were provided to Medicare beneficiaries in 2017.” The data are now available: 10,089,575 psychotherapy sessions were provided to Medicare beneficiaries in 2017 (source: https://data.cms.gov/), …

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