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 analyzed from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier2017 and https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.

In 2017 (the most recent year for which utilization data are publicly available), psychologists provided a total of 6,843,274 units of service. The top three services (90834, 90837, 90832) accounted for 69% of all units provided. The top five services accounted for 85% of all services provided by psychologists, the top seven services accounted for 90% of all units provided, and the top ten services accounted for 96% of all services provided by psychologists. More than half (51.2%) of all units of service provided by psychologists in 2017 are accounted for by just two services: 90834 and 90837.

Most Common Procedures Provided By Psychologists in 2017

Based on these most common procedures, I selected the top five services to highlight the pattern of the national payment amount over the past 10 years, from from 2012 through 2021. Here is the pattern.

Testing codes used prior to 2019 (96101, 96118, 96119 prior to 2019) are not completely equivalent to new codes implemented in 2019. However, reasonable comparisons are possible based both on consistency of the RVUs as well as the nature of the services. The 2019-2021 code 96133 was judged comparable to 96118 from 2012-2018 (RVU = 2.74 in 2018, 2.83 in 2019, both designating one hour of doctoral/other qualified professional provision of neuropsychological testing.

The top five services provided by psychologists show an average increase of 3.14% from 2020 to 2021. However the average here is clearly misleading, as change among the five ranges from a reduction of 4.51% (96133 = $102.49 in 2020, $97.87 in 2021) up to a gain of 15.65% for 90791 ($168.20 in 2021, $145.44 in 2020). Virtually all of the average gain occurs with the increase in the 90791. The “gain” is virtually undetectable for 90837 (0.11%). Four of the top five codes post “gains.”

Among the remaining five of the top ten codes utilized by psychologists, ALL show decreases from 2020, with an average decrease of 9.07%, codes, ranging from -7.69% (96139) to -10.18% (90785).

Overall, the top ten services provided by psychologists will show an average decline of 2.96% from 2020 when the new Medicare Physician Fee Schedule goes into effect January 1, 2021.

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