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/), an increase of about 2.3% from the number of sessions provided in 2016. Numbers reported are for “psychotherapy only” type sessions, not therapy that would have been provided in the context of “medication plus therapy” sessions.

For the first time since the 90837 code for a 60 minute sessions became available in 2013 (90837, technically 53+ minutes), the number of these sessions billed exceeded the number of 45 minute sessions (90834, technically 38 to 52 minutes in length) provided. From 2013-2016, 45-50 minute sessions remained the most commonly provided session length for Medicare beneficiaries.

Who’s Providing Therapy?

Consistent with prior years, psychologists and social workers provided most of the psychotherapy in Medicare. Together they accounted for 92% of the more than 9.8 million sessions in 2016, and about 93% of all therapy provided in 2017. Psychiatry and all other providers continued the pattern of decreased provision of psychotherapy in 2017 relative to 2016, with a total reduction of about 26% for psychiatry since 2013, and about 36% for all other providers in that same time span. Social workers have shown the steepest increase in provision of therapy, up by almost 35% since 2013. Psychologists provided about 7.5% more therapy sessions in 2017 relative to 2013. Social workers were on a trajectory to potentially have overtaken psychologists as the dominant providers of psychotherapy in Medicare in 2018.

Reimbursement for Psychotherapy

Probably contrary to conventional wisdom (and predictions I’d made here), reimbursement has not been flat and has actually shown some growth in these key services. The Medicare national payment amount for 90832 was $62.60 in 2013, and $68.47 in 2019, an increase of 9.4%. A 90834, priced at $80.63 in 2013, had a national payment amount of $91.18 this year, or 13% growth over 6 years. And the 53+ minute 90837 — which in 2017 for the first time outpaced the 45-50 minute 90834 in frequency of use — showed a 16% increase in national payment amount since 2013, from the $118.06 value in 2013, to $136.90 this year.

Increased utilization of 90837, in the context of its growth in payment amount, reinforces the suggestion that therapists are going where the money is. Different rates of change in use are seen among provider groups, with social workers showing the greatest increase (up more than 108% in use since 2013), followed by psychologists (increased use by 86.5%), with decreased use by psychiatry (down 4.8%) and other providers (decreased use by 16%). It seems extremely unlikely psychiatry and other health providers in Medicare would be moving to lower priced services.

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