Update: Mental Health Clinician Flight from Medicare Fails to Materialize

Dire warnings of wholesale flight of mental clinicians from the Medicare system, with complaints of low and declining reimbursement, and increasing documentation and measurement burdens, did not materialize, at least from 2012 to 2014. 2015 data became available earlier this year from CMS. Here is what the continued pattern looks like. Two percent fewer psychiatrists …

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Brief Session Psychotherapy In The Medicare Population

In the Medicare population, psychotherapy is most commonly provided in 45 minute sessions (90834, technically, 38 to 52 minutes in length). Sessions of 53+ minute length (90837) are the second most frequently provided. When the 53+ minute code first became available in 2013, many mental health professionals raised alarms about whether this session length would …

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Changes in Psychotherapy Service Delivery in Medicare 2013 – 2015 – Part 2

Newly available data show that the number of 53+ minute sessions (CPT code 90837) provided to Medicare beneficiaries increased by 48% from 2013 to 2015, to nearly 3.2 million of these sessions. Estimated Medicare payments for these sessions nearly doubled in that same period, to more than $263 million. The increase in total payments is not …

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Changes in Psychotherapy Service Delivery in Medicare 2013 – 2015 – Part 1

In the context of recent reports that Medicare abruptly halted release of much-anticipated data which could have shed light on the performance of Medicare Advantage plans, CMS recently made available its “public use file” on “Provider Utilization and Payment Data” for 2015. Data provide a resource to better understand individual and aggregate delivery of health …

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It’s Easy For A Payer To Spot An Outlier

How easy? The following information is based on the 2013 “Medicare Data” (Data.CMS.gov). Can you spot the outliers? That’s right. It’s easy to see that the overwhelming majority of clinicians provided 1000 or fewer 53+ minute sessions in 2013. A few obviously break away from the pack providing 1-2,000 such sessions, fewer still between 2-3,000, …

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45 Minutes is The Most Common Therapy Session Length

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). Source:  https://data.cms.gov/. *Number of …

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53+ Minute Psychotherapy Sessions Remain a Standard of Care

Reports are emerging that insurance companies are directly or indirectly pressuring clinicians to decrease their use of CPT Code 90837 (for a psychotherapy session 53+ minutes in length), or outright refusing to reimburse for these. Clinicians are once again alarmed about potential bias against coverage of reasonable lengths for psychotherapy sessions for appropriate conditions. I …

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Back To The Future Of Reimbursement For Psychological Services

In February 2014, I estimated that the national average for third party reimbursement for a diagnostic interview could stabilize at around $137 for doctoral providers from 2019-2023, that 45 minutes of psychotherapy would stabilize at about $88 during that same time frame, 60 minutes of psychotherapy at about $131, and psychological testing in the $82-$83 …

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Further Insights from the “Medicare Data”

Initial analyses of “What the Medicare data reveal about mental health services” were previously reported here. Watch this page for updates on information developed from the “Medicare Provider Utilization and Payment Data: Physician and Other Supplier” data released by CMS April 9, 2014. The data allow insights into health services provided to Medicare Beneficiaries in 2012 …

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What the Medicare Data Reveal About Mental Health Services

Associated with a great deal of fanfare, particularly in the popular press, on April 9 Medicare released data about how much it paid physicians and other suppliers in 2012. Popular reporting quickly focused on the “top billers” to Medicare for health services, including setting up “look up your own doctor” type of search websites. Who …

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