Brief Session Psychotherapy In The Medicare Population

In the Medicare population, psychotherapy is most commonly provided in 45 minute sessions (90834, technically, 38 to 52 minutes in length). Sessions of 53+ minute length (90837) are the second most frequently provided. When the 53+ minute code first became available in 2013, many mental health professionals raised alarms about whether this session length would be reimbursed either by Medicare or commercial payers, with anticipatory anxieties about pending payer pressures to allow only the 45 minute session with its relatively lower reimbursement. These feared outcomes do not appear to have materialized — yet. Medicare clearly is reimbursing the 53+ minute session, and in growing numbers. Whether that growth is sustainable, and clinically justifiable, remain open questions. And, because they hide the numbers, the pattern of psychotherapy provision in the commercial payer setting remains unknown, beyond the occasional anecdotes of payment denials and threats of purported “outlier” use of the 90837.

Perhaps obscured in this context is that there is another treatment session length available: 30 minutes (technically ranging from 16 to 37 minutes), the 90832 code. How common is psychotherapy in this session length in the very large Medicare population?

More than 2 million 30-minute psychotherapy sessions were provided to Medicare beneficiaries in each of the years 2013 through 2015. There has been an approximately 8% reduction in the use of these sessions from 2013 to 2015. During those years, psychologists provided nearly 57% of these sessions, social workers about 31%, psychiatry almost 8%, and all other health professionals about 4%.

Another way to look at this is to compare the number of brief psychotherapy sessions provided to 45-minute and 53+ minute sessions.

In 2015, twice as many of the most common, 45 minute, sessions were provided (4,104,037) as brief sessions (2,050,961), and 1.6 times as many 53+ minute sessions were provided (3,190,518) as brief sessions. For the years 2013 through 2015, twice as many 45 minute sessions were provided as 20 minute sessions, and 1.26 times as many 53+ minute sessions were provided as brief sessions.

Based on the average Medicare reimbursement for 30 minute sessions, expenditures are estimated to have been approximately $87.4 million in 2015. This is decreased by slightly more than 5% from 2014, though increased by almost 24% from 2013. This latter increase is attributable to an increase in the reimbursed amount for 90832 from 2013 to 2015, not any increase in the number of sessions provided — which showed the 8% decrease in use previously noted. The following shows a comparison of estimated expenditures for 90832 services relative to 45 minute and 53+ minute sessions.

Briefer therapy visits approximately 30 minutes in length are the third most common format for psychotherapy in the Medicare population, after 45 minute and 53+ minute formats. Use of this session length has declined from 2013 to 2015. However, with more than 2 million such visits provided in 2015 — representing at least 500,000 hours of psychotherapy — provision of psychotherapy in briefer sessions certainly remains common, supporting access to psychotherapy for Medicare beneficiaries.

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