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 …

Continue reading ‘Changes in Psychotherapy Service Delivery in Medicare 2013 – 2015 – Part 1’ »

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, …

Continue reading ‘It’s Easy For A Payer To Spot An Outlier’ »

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 …

Continue reading ‘45 Minutes is The Most Common Therapy Session Length’ »

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 …

Continue reading ‘53+ Minute Psychotherapy Sessions Remain a Standard of Care’ »

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 …

Continue reading ‘Back To The Future Of Reimbursement For Psychological Services’ »