Psychotherapy In Medicare Update – Initial Look At The First Pandemic Year

Public use data have recently become available through CMS, allowing initial looks at practice patterns during the first year of the pandemic.

2020 may have been a banner year for a shift to telehealth, but the increased flexibilities do not seem to have yielded increased provision of psychotherapy overall to the Medicare population. Indeed, an overall reduction in services occurred. Time will tell whether this change potentially signaled a new trend (2019 also showed a slight decrease from the prior year – 1.6% – in total number of psychotherapy sessions provided ), or the result of uncertainties and disruptions occurring in the first quarter or half of the year or indeed that continued throughout the year.

2020 showed an unprecedented decrease of 10.2% fewer total sessions relative to 2019, after the 1.6% contraction from 2018-19 (10,095,173 sessions in 2018, 9,933,384 in 2019).*

Changes in provision of services were not uniform among professions providing psychotherapy, or among session lengths provided.

All professions showed an overall decrease of 6.5% in use of 60 minute sessions, ranging from a 10.9% reduction from 2019 to 2020 in utilization by non-mental health professions which had been providing this service, to a 2.5% reduction in 90837 use among clinical psychologists.

Psychiatry showed the greatest increase in use of the 20-30 minute session code from 2019 to 2020, an increase of 21.2%, with non-mental health professions increasing use by 2.3%, and LCSWs by 0.9%. Clinical psychologists showed the greatest reduction in use of 90832, by 15.9% from 2019-2020.

And 15.9% fewer 45 minute session codes were used in 2020 compared to 2019 across all professions providing this service, with reductions in use ranging from -5.2% among other professions providing this service, to -17% among LCSWs.

To summarize

  • 10.2% fewer therapy sessions were provided to Medicare beneficiaries in 2020 relative to 2019, the largest decrease seen since 2013
  • Use of 60 minute sessions decreased by 6.5% overall from 2019 to 2020
  • Psychiatry increased use of 20-30 minute sessions by 21.2%, and clinical psychologists reduced use of these sessions by 15.9%, from 2019 to 2020
  • Use of 45-50 minute sessions decreased by 15.9% overall from 2019 to 2020, with licensed clinical social workers showing the greatest decrease (17% fewer), from 2019-2020.

*Analyses include only HCPCs 90832, 90834, and 90837, not other “medication plus psychotherapy” codes.

Source:  https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-provider-and-service

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