Archive of posts filed under the Medicare category.

Initial Estimates of 2026 Medicare Reimbursement for Psychological Services

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The 2026 Proposed Rule for payment policies under the Physician Fee Schedule was published 7/16/2025, opening up a comment period until 9/12/2025. Quick review of the proposed rule shows a projected Conversion Factor (CF) of 33.4209, amounting to a 3.3% increase over the 2025 CF of 32.3465, taking into account several adjustment factors. The CF …

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Total costs of psychological services in Medicare

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Working on an ezine type post this morning, I was able to do some quick calculations on the total cost of psychological services in Medicare. Here’s a quick look. 2024 Projected Allowed Charges (Millions)¹ 2024 Percent of Medicare Outlays² 2024 Percent of Total Mandatory Outlays Clinical Psychologists $717 .08% .017% Clinical Social Workers $801 .09% .02% …

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Specialties Opting Out Of Medicare As Of January 2025

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    Nearly 60% of clinicians who have opted out of Medicare are behavioral health specialists. 1,031 psychologists opted out in 2024, the most ever in a single year, a 34% increase over 2023. Mental Health Counselors (MHC) and Marriage and Family Therapists (MFT) became the third and fourth most numerous of the specialties to …

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2025 Reimbursement Top Ten Psychologist Medicare Services

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The searchable 2025 Medicare Physician Fee Schedule (MPFS) was published 1/1/2025. Happy New Year? This is the latest in the year prior to prices going into effect these have been published, though I suppose one could say this is the earliest in the effective year the searchable databse has been provided. 2025 national reimbursement for …

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Impact of Four Year Phased-In Increase of Work RVUs for Psychological Services

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In 2023, successful psychology organization advocacy for much-needed increases in the WORK component of the Relative Value Units (RVU) of key behavioral health services (HCPCS psychotherapy codes 90832, 90834, 90837, Health Behavior Assessment and Intervention [HBAI] services, crisis, family, and group therapy services) resulted in CMS’s adoption of an increase of 19.1% in the work …

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2025 Estimated Reimbursement Top Ten Psychologist Services In Medicare

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As I’d surmised, the WORK component of the RVUs of the top three services provided by psychologists in Medicare (HCPCS 90837, 90834, 90832) will increase from 2024 to 2025. So, in the context of a Conversion Factor (CF) that will be reduced by nearly 3% in 2025 relative to 2024, these services (plus one other) …

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Medicare 2025 Fee Schedule Initial Reactions

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Well the Final Rule for the 2025 Medicare Physician Fee Schedule (MPFS) dropped into my email Friday about 4:40 pm. Of course they announce this on a Friday evening. The headline – which should be no surprise – is that the Conversion Factor (CF) will be decreasing by 2.83% from its 2024 value, to $32.35. …

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Update Medicare Opt-Outs 2024 YTD

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NOTE:  Data in the “Annual and Cumulative” chart were updated 8 November 2024, based on the Opt Out Affidavits dataset through September 2024. Other chart data were not updated. 2024 will be (already has been) a record year for the number of psychologists opting out. As of the August 2024 Update to CMS’s Opt Out …

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MFT And MHC Uptake In Medicare

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As of January 1, 2024, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) became eligible to bill Medicare independently for their services to diagnose and treat mental illnesses. Expansion to new mental health clinicians in Medicare – with reimbursement at 75% of the physician fee schedule – was thought to be a cost-effective …

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