Update On Brief Session Psychotherapy In Medicare

Brief session psychotherapy showed a 3.9% increase in use in 2016 relative to 2015, the first increase in 3 years, to nearly the same level of use in 2013. 2.13 million brief sessions were provided in 2016. With a National Payment Amount of $64.09 in office settings and $63.73 in facility settings in 2016, a rough estimate is that Medicare payments were around $109.1 million for these sessions in 2016.

Increased use was predominantly due to increases among Licensed Clinical Social Workers (LCSWs), who provided 10% more of these sessions in 2016 relative to 2015, and to a lesser degree to use among Clinical Psychologists, who provided 2.6% more of these sessions in 2016 relative to 2015. Psychiatrists and other health professionals showed decreased use from 2015 to 2016, by about 6% and 15%, respectively.

Psychologists continue to provide the bulk of the brief psychotherapy sessions. From 2013 to 2015, psychologists provided about 57% of these sessions, social workers about 31%, psychiatry almost 8%, and all other health professionals about 4%. In 2016, psychologists provided 56%, social workers provided 36%, psychiatrists provided 5.4%, with the balance provided by other health professionals.

It seems possible that increased use of 90832 from 2015 to 2016 could be associated with a trend toward integrated care. If that is the case, one might anticipate utilization increases would tend to be seen in facility settings relative to office settings. This turns out not to be the case, however, with the 2015-2016 increase attributable to brief sessions in office settings, with the highest utilization in office settings in 2016 observed since 2013. The trend actually seems to suggests clinicians are decreasing brief sessions in facility settings, and increasingly providing these in the office setting.

It could be that some of the office location therapy is in offices co-located with various sorts of the health care teams and services. This possibility would not be detectable through the straightforward “office” versus “facility” coding information that appears on claims and in the available CMS databases.

It will be interesting to see whether provision of psychotherapy in the briefer session length continued in 2017 and potentially into the future. Given that the overall trend is toward increased provision of psychotherapy to the Medicare population — with growth in both the briefer and longer (53+ minute) sessions as use of the 45-50 minute session declines — it seems the likely prediction is that growth will continue. We shall see.


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