Diagnostic neuropsychological and psychological testing are predominantly psychologist-performed services in Medicare. The following provides an initial look at these services by psychologists and other health professionals in 2020 – the first year of the pandemic – based on data that have recently become available through CMS*.
Seventeen diagnostic testing/evaluation services were available to psychologists in Medicare as of 1/1/2019. Psychologists provided 64% of the more than 1.9 million units of these services that were provided to Medicare beneficiaries in 2020.
Ten services accounted for 97% of all psychodiagnostic testing and related services provided to Medicare beneficiaries by all health professions in 2020, and 99.9% of all diagnostic testing performed by psychologists in 2020. For eight of these services, psychologists provided more of these services than all other health professions combined.
Practice patterns varied. Specialists other than psychologists performed virtually all of the 96127 service, described as “brief emotional/behavioral assessment,” typically involving a single test or measure such as a depression scale or rating inventory.
While psychologists provided about 31% of initial 30 minute technician-administered testing services, many other specialties provided this service as well.
Provision of this service showed substantial changes among the specialties from 2019 to 2020. Psychologists decreased use by -19%, while anesthesiology (+220%), pain management (+111%), and interventional pain management (+80%) showed the greatest increases in use.
Given that these services described and coded in this manner became available in 2019 (though were carried over from prior years having been described, coded and billed differently), some initial information is available to provide a view of changes from the 2019 “baseline” year into the first year of the pandemic. Among the ten most frequently provided of these services, here is the pattern of change 2019-2020.
Perhaps not surprisingly, fewer neuropsychological and psychological testing services were provided in Medicare in the first year of the pandemic relative to the preceding year, decreased by about 16% overall. Only one service – the initial 30 minutes of technician administered testing – showed increased use, by about 8%. Otherwise, decreased testing services ranging from -3% (initial hour of testing by physician or other qualified professional) to as much as -25% (each additional 30 minutes of testing by physician or other qualified professional). Initial information also reflects an increase in briefer assessments, including among other specialists. Psychologists continued to provide the bulk of more extended evaluations.
To summarize
- More than 1.9 million units of psychological/neuropsychological testing and assessment were provided to Medicare beneficiaries in 2020
- Psychologists provided 64% of these services
- For 8 of the 10 most frequently provided services, psychologists performed more of these services than all other specialties combined
- Testing/assessment services decreased by an average of 18% in 2020 compared to 2019 for 9 of the 10 most commonly performed services
- Family practice, internal medicine, and nurse practitioners performed a combined 63% of brief (single measure) emotional/behavioral assessments
- Pain management, nurse practitioners, anesthesiology, neurology, physical medicine and rehabilitation, internal medicine and other specialties provided almost 70% of initial 30 minute technician administered testing
- Initial 30 minutes of technician-administered psychological or neuropsychological testing is the only testing service with increased use overall (+8%) from 2019 to 2020.
- Increased use occurred primarily in anesthesiology (+220%), pain management (+111%), interventional pain management (+80%), and physical medicine and rehabilitation (+68%).
- Psychologists decreased use of this service 2019-2020 by -19%.