Update – Psychotherapy in Medicare

I have previously reported about provision of psychotherapy in Medicare, most recently in 2019 and 2018. CMS data releases related to utilization are always at least 2 years behind the year of service provision. Data for services in 2018 became available early in February 2021, and the following analyses are based on those data, available at Data.CMS.gov. Analyses are for individual therapy sessions only. Psychotherapy plus medication, family, and group therapy type sessions are not included. Pricing information reported is updated annually, and released depending on the timing of adoption of the final CMS rules in a given year, and associated budgeting determinations. Thus, pricing information is reported through the 2021 fee schedule, and reported national values. Reimbursement will vary by geographic location.

How much psychotherapy is being provided?

In 2018, 10,095,173 psychotherapy sessions were provided, the second year in a row more than ten million sessions were provided. This was essentially flat (+6,000 sessions) relative to 10,089,575 sessions in 2017.

The number of individual psychotherapy sessions has increased yearly since 2013, by 13.8% from 2013-2018. There was a negligible increase from 2017-2018 (< 1%), the lowest increase seen during this six year span.

Who is providing the therapy?

LCSWs provided 4.8 million sessions of a combined 90832, 90834, and 90837. Psychologists provided 4.6 million sessions, psychiatry provided 479 thousand, and all other specialties provided 202 thousand sessions.

How is therapy being provided?

Changes in utilization of varying session lengths are noticeable. For the second year in a row, more 90837s were provided than 90834s. 90837s increased by 4.2% over 2017, while 90834s decreased by 2.9% from 2017-2018. Growth in 90837s has occurred every year since these first became available in 2013, increasing by 92.2% from 2013-2018, while 90834s have decreased by 15.5% from 2013-2018.

Are there differences in therapy delivery among clinicians?

There is variation in the pattern of session lengths provided by the different specialites. LCSWs provided 22% more 90837s than they did 90834s, while psychologists provided 4% fewer 90837s than 90834s. Psychiatrists also provided (fewer 90837s than 90834s (1% fewer), while other medical specialties provided more 90837s than 90834s (5% more).

Both LCSWs and psychologists have shown increased utilization of 90837s from 2013 to 2018. LCSW use of 90837 has increased by 126% since these first became available in 2013. Psychologist use has increased by 89% since 2013. Psychiatry use has decreased by 5% relative to 2013, and use by other medical specialties has increased by 13% since 2013.

In contrast, use of 90834 by psychologists has decreased by 22% from 2013-2018, and remained relative stable (-1%) among social workers from 2013-2018, while decreasing by 36% in psychiatry, and 46% among other specialties.

Use of 90832 has increased only among LCSWs from 2013-2018, by 28%. Use of 90832 has decreased by 5% among psychologists, by 60% in psychiatry, and by 48% among other specialties, since 2013.

Psychotherapy Prices in Medicare
90832 increased by 9.4%, to $77.81, from 2020 to 2021. 90834 increased by 9.2%, to $103.28, from 2020 to 2021. 90837 increased by 7.8%, to $152.48, from 2020 to 2021.

These increases were the largest single year increase since 2013. From 2013 to 2020, the average yearly increase in 90832 was 1.9% (prior highest increase of 3.8% in 2019-2020). From 2013 to 2020, the average yearly increase in 90834 was 2.5% (prior highest increase of 3.7% in 2018 and 2020). From 2013 to 2020, the average yearly increase in 90837 was 2.8% (prior highest increase of 3.7% in 2018)

The unusual increases in 2021 are the result of idiosyncratic budgeting and legislative conditions, not an increased inherent value of these services.

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