APA mounted an aggressive effort to ensure that CMS hears psychologists’ perspective on changes to the CMS physician fee schedule, leading to the submission of nearly 7,800 comments from psychologists to the agency through our websites. This is a roughly 30% increase over the number of comments psychologists submitted about the changes last year. APA Advocacy and Practice staff also joined forces in assisting 37 state psychological associations in submitting comments on behalf of their members. We are hopeful that this unprecedented level of interest and engagement by psychologists will have a positive impact on the agency’s development of the final fee schedule for next year, which is expected to be issued in November. See APA’s comment letter to CMS on the proposed rule.

In 2019, the Centers for Medicare and Medicaid Services (CMS) announced its intention to adopt a new coding framework for routine evaluation and management (E/M) services in 2021 that would significantly increase payments for these services. In August 2020, CMS made this official by including billions of dollars in E/M payment increases in its proposed Medicare physician fee schedule for next year.

ecause aggregate changes in the fee schedule are required to have a neutral effect on the federal budget, increasing payments in one area of the physician fee schedule requires offsetting cuts in other payments. Consequently, CMS proposes to cut the conversion factor used to calculate Medicare reimbursement rates for psychologists and other providers by 10.6% next year so that payments for E/M services provided in office and outpatient settings can go up. Cuts of this magnitude would force many psychologists to stop seeing Medicare patients. 

CMS is also proposing to adopt some—but not all—of the recent Medicare telehealth services coverage expansions on a permanent basis. Alarmingly, CMS is also proposing to permanently allow nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives to supervise the provision of psychological and neuropsychological testing services, to the extent that they are authorized to perform such tests under their state licensure law. 

We are now focusing more attention on Congress, and gaining approval of legislation waiving budget neutrality requirements for next year’s Medicare physician fee schedule, or otherwise postponing or reducing the payment cuts CMS has proposed for implementing the new E/M codes. APA members have already sent over 8,000 messages to their members of Congress calling for budget neutrality to be waived.

APA and the Maine Psychological Association joined together in discussing the impact of the proposed Medicare payment cuts with Senator Susan Collins (R-Maine). Following a conversation with APA federal advocacy coordinator for Maine Diana Prescott, PhD about the impact the proposed cuts would have on Maine psychologists participating in Medicare, Senator Collins wrote to Senate leaders requesting that Congress take action to waive budget neutrality requirements for implementation of the new E/M codes. Maine Psychological Association President Thomas Cooper, PsyD, was quoted prominently in Senator Collins’ press release on her letter, posted on her website. In the House, more than two hundred members have signed a similar letter authored by Reps. Ami Berra (D-Calif.) and Larry Bucshon, M.D. (R-Ind.) urging House leadership to address steep Medicare cuts by the end of the year.

APA is working with a large coalition of other health care provider organizations in support of these efforts. Members of Congress in both the House and Senate, and across the political spectrum, have expressed their opposition to deep Medicare cuts, particularly amid the COVID-19 public health emergency. Legislative language to prevent CMS’s proposed 10.6% cuts could be considered in the lame-duck session of Congress that will occur after the Nov. 3 election.

We encourage psychologists to contact their members of Congress on this issue.

For more information contact Scott Barstow