2022 Medicare Conversion Factor “Final” – Quick Update

UPDATE 1/1/2022: The American Academy of Sleep Medicine (AAPM) is reporting the same $34.6062 CF I previously reported 12/27/2021. This is now confirmed via the complete PFS (Physician Fee Schedule) at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Carrier-Specific-Files. So, the National Payment Amount (NPA) for the top ten services most frequently provided by psychologists in Medicare will be as follows this …

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Reimbursement Estimates For Psychological Services In Medicare 2022

November 26, 2021 Update: Clinical Psychologist (and Physician) and Social Worker Fee schedule, Medicare in Wisconsin, 2022. Source:  https://www.ngsmedicare.com/web/ngs/fee-schedule-lookup?lob=96664&state=97006&region=93624 National Government Services, Inc. – Wisconsin (00) 2022 Clinical Psych & Social Worker Fee Schedule CODE CP FEE CP FAC FEE (#) CSW 75% FEE CSW 75% FAC FEE (#) EFFECTIVE DATE 90785 $14.04 $12.45 $10.53 …

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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, …

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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 …

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Update #3 Medicare 2021 – “Final” Reimbursement For Psychological Services

With the passage of the Consolidated Appropriations Act December 21, 2020, signed into law six days later, the Medicare Physicians Fee Schedule received an unexpected pardon from the planned, unprecedented 10.2% reduction in the Conversion Factor governing all fees. Instead, the CF was increased from 32.4085 to 34.8931. An additional $3 Billion was allocated to …

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2021 Medicare Prices For Psychological Services

“NPA” = “National Payment Amount.” This will vary based on your geographic region. “RVU” = “Relative Value Unit.” This value is the total of the Work, Practice Expense (PE), and Malpractice components that make up every procedure that Medicare pays for. RVUs used to be objectively determined, but the process to determine these has become …

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Beware of Success

Historically, the “overhead” component (practice expense, PE) of the formula for pricing psychotherapy in Medicare has averaged 21% from 2000 to 2020. As a reminder, the national price of a service in Medicare is determined by three components, work, practice expense, and malpractice, which are then moderated by geographic location to produce the local values. …

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If You Are A Psychologist, What Are You Waiting For?

In the current context, an active discussion I have encountered is the supposed meagerness of the emergency refunds being paid to health care professionals by Medicare. I did a quick analysis. In 2017 (the most recent year for which data appear to be publicly available*), Medicare paid psychologists $490,497,820 for the diagnostic and treatment services …

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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 …

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Psychotherapy In Medicare Update – As Predicted, 10 Million+ Sessions Were Provided For The First Time In 2017

In June 2018 I wrote here, “The exact 2017 numbers are not available yet, but it is all but certain that, for the first time, more than 10 million psychotherapy sessions were provided to Medicare beneficiaries in 2017.” The data are now available: 10,089,575 psychotherapy sessions were provided to Medicare beneficiaries in 2017 (source: https://data.cms.gov/), …

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