2021 Update – Psychotherapy In Medicare

As with prior updates (e.g., 2019 and 2018, CMS data releases related to utilization tend to be 2 years behind the year of service provision. Data for services in 2019 became available at the end of August 2021, at Data.CMS.gov. The following analyses are for individual therapy sessions only (HCPCS 90832, 90834, and 90837). 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, for national payment amounts. Reimbursement will vary by geographic location.

How much psychotherapy is being provided?

In 2019, 9,933,384 psychotherapy sessions were provided. After two consecutive years in 2017-2018 with more than ten million sessions provided, the total number of sessions provided declined by 1.6% in 2019 relative to 2018.

 

2019 is the most recent year for which data are publicly available. Data retrieved 10/9/2021 from Medicare Physician & Other Practitioners – by Provider and Service – Centers for Medicare & Medicaid Services Data.

Who is providing psychotherapy?

LCSWs provided 4.9 million sessions (49.5% of the total) of a combined 90832, 90834, and 90837. Psychologists provided 4.4 million sessions (44.3% of the total), psychiatry provided 423 thousand sessions (4.3% of the total), and all other specialties provided 193 thousand sessions (1.9% of the total).

How is therapy being provided?

For the third consecutive year, more 90837s were provided than 90834s. 90837s increased by 0.4% over 2018, while 90834s decreased by 3%, and 90832s decreased by 2.9%. Growth in 90837s has occurred every year since these first became available in 2013, increasing by 93% from 2013-2019, while 90834s have decreased by 18%, and 90832s have decreased by 5.6% during that same time period. The 60 minute session has become the most commonly provided session length in Medicare.

 

Where is therapy being provided?

Most therapy (89%) is being provided in the office setting. There is a strong relationship between session length and location of the service, with 95% of 60 minute sessions provided in the office setting.

Number of Sessions In Office And Facility Settings
HCPCS Office Facility Total Office % of total
90832 1,625,403 470,480 2,095,883 78%
90834 3,284,215 404,804 3,689,019 89%
90837 3,952,997 195,485 4,148,482 95%
Total 8,862,615 1,070,769 9,933,383
% of total 89% 11%

How does psychotherapy delivery vary among clinician types?

In 2019, LCSWs provided 28% more 90837s than they did 90834s, while psychologists provided 3% fewer 90837s than 90834s. Psychiatrists provided 1.5% fewer 90837s than 90834s. Other medical specialties providing psychotherapy billed 23% more 90837s than 90834s.

Both LCSWs and psychologists have shown increased utilization of 90837s from 2013 to 2019. LCSW use of 90837 has increased by 136% since 2013. Psychologist use has increased by 81% since 2013. Psychiatry use has decreased by 16% relative to 2013, and use by other medical specialties has increased by 4% since 2013.

In contrast, use of 90834 by psychologists has decreased by 26% from 2013-2019, decreased slightly (-1.4%) among social workers from 2013-2019, while decreasing by 43% in psychiatry, and 49% among other specialties.

Use of 90832 has increased only among LCSWs from 2013-2019, by 31%.  Use of 90832 has decreased by 10% among psychologists, by 65% in psychiatry, and by 61% among other specialties, since 2013.

What are the prices for psychotherapy in Medicare?

These are reported for 2021, the most recent year for which data are available.

National payment amounts (NPA) for psychotherapy showed the largest single yearly increase 2020-2021 since 2013. The unusual increases resulted from an interaction between idiosyncratic budgeting conditions and increases in relative value units (RVUs) for these procedures.

HCPCS Code 2020 NPA 2021 NPA % Change 2020 RVU 2021 RVU
90832 $71.10 $77.81 9.4% 1.97 2.23
90834 $94.56 $103.28 9.2% 2.62 2.96
90837 $141.47 $152.48 7.8% 3.92 4.37

From 2013 to 2020, the average yearly increase in 90834 was 2.5%, with the prior greatest single year increases of 3.7% in 2018 and 2020. The average yearly increase in 90837 from 2013 to 2020 was 2.8%, with the greatest prior single year increase of 3.7% in 2018.

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