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 modifications. The fee schedule for your region should be available by now on the MAC website for your locale.

Nationally, H&B Assessment/reassessment will increase $6.25, or 6.7%, over the value of the equivalent procedure in 2019. Individual H&B Intervention shows an increase of $30.81, or 36.2% relative to the value of the equivalent procedure codes in 2019.

Clearly these increases represent substantial increases in the rate and direction of change in pricing and absolute value of these procedures. Indeed, the 36% increase from 2019 – 2020 in H&B treatment code reimbursement is the greatest single year increase seen in more than a decade. Professional advocacy organizations (and individual psychologists) ought to be commended to the extent they were instrumental in effectively advocating for these increases. At the same time, a previously announced prediction that the increases “will make them essentially equal to psychotherapy code reimbursement” was not attained. Despite the gains, the national (and local) payment amounts for H&B assessment and treatment will continue to lag substantially behind payment amounts for individual assessment and treatment procedure codes for individuals with mental health diagnoses in 2020. H&B Assessment this year is valued at about 69% of a diagnostic interview for mental health conditions. H&B Treatment is valued at about 82% of the value of an equivalent treatment visit for a mental health condition.

It remains to be seen whether changes in reimbursement for H&B codes will be sufficient incentive to contribute to increased numbers of psychologists providing these services in 2020 and beyond. Increased provision of these services would reverse the declining provision of H&B services since 2013, and undoubtedly would be of great benefit to Medicare beneficiaries and population health outcomes generally. But the continued gap between reimbursement for H&B services relative to mental health diagnostic and treatment services likely sustains a disincentive. Other than cost containment and unfounded biases against (proven) effectiveness of psychological interventions for individuals with physical health conditions, this continued gap would seem to have no credible rationale.

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