Congress raises Medicare reimbursement
New federal legislation signed into law in late December 2020 will diminish the drastic Medicare payment reductions originally scheduled to begin on January 1, 2021. APA and other health care societies have been lobbying members of Congress to protect health care professionals, including psychologists, from the cuts projected by the Centers for Medicare and Medicaid Services (CMS) in the proposed and final rules on the 2021 Physician Fee Schedule. Psychologists submitted thousands of comments to members of Congress and to CMS warning that the cuts in reimbursement would threaten beneficiary access to vital psychologist services.
Under the Consolidated Appropriations Act 2021, rather than reducing the conversion factor by over 10%, CMS will implement a 3.75% increase as well as delayed implementation of the newly created evaluation and management visit complexity HCPCS code G2211, which dramatically effected the reimbursement of services across the fee schedule.
The conversion factor is a number multiplied by the values assigned to each billing code to produce a dollar amount for Medicare payment purposes. Prior to the changes made by the new federal law, budget neutrality required CMS to offset the costs of new higher values for certain outpatient evaluation and management (E/M) services by reducing the costs of other services in the fee schedule.
This chart compares the nationwide Medicare payment rates for billing codes used by psychologists in 2020 and 2021. Payments will vary by geographic location.
2020 vs. 2021
Total Nonfacility RVU Values and Payment Rates *with updated CF* |
|||||||
CPT Code | 2020 Total NF RVU | 2020 Total NF Rate | 2021 Total NF RUV | 2021 Total NF RVU Rate | 2020 vs. 2021 Nonfacility Rate Change | % Change (Total NF RVU) | % Change (Total NF RVU Payment Rate) |
Psychotherapy | |||||||
---|---|---|---|---|---|---|---|
90785 | 0.43 | $15.52 | 0.43 | $15.00 | ($0.51) | 0.00% | -3.30% |
90791 | 4.03 | $145.44 | 5.18 | $180.75 | $35.30 | 28.50% | 24.30% |
90832 | 1.97 | $71.10 | 2.23 | $77.81 | $6.71 | 13.20% | 9.40% |
90834 | 2.62 | $94.56 | 2.96 | $103.28 | $8.73 | 13.00% | 9.20% |
90837 | 3.92 | $141.47 | 4.37 | $152.48 | $11.01 | 11.50% | 7.80% |
90839 | 4.09 | $147.61 | 4.16 | $145.16 | ($2.45) | 1.70% | -1.70% |
90840 | 1.96 | $70.74 | 1.97 | $68.74 | ($2.00) | 0.50% | -2.80% |
90845 | 2.78 | $100.33 | 2.81 | $98.05 | ($2.28) | 1.10% | -2.30% |
90846 | 2.87 | $103.58 | 2.84 | $99.10 | ($4.48) | -1.00% | -4.30% |
90847 | 2.97 | $107.19 | 2.94 | $102.59 | ($4.60) | -1.00% | -4.30% |
90849 | 1.02 | $36.81 | 1.01 | $35.24 | ($1.57) | -1.00% | -4.30% |
90853 | 0.78 | $28.15 | 0.79 | $27.57 | ($0.58) | 1.30% | -2.10% |
90863 | 0.76 | $27.43 | 0.75 | $26.17 | ($1.26) | -1.30% | -4.60% |
Psychological and Neuropsychological Testing | |||||||
96116 | 2.76 | $99.61 | 2.78 | $97.00 | ($2.61) | 0.70% | -2.60% |
96121 | 2.39 | $86.26 | 2.36 | $82.35 | ($3.91) | -1.30% | -4.50% |
96130 | 3.38 | $121.98 | 3.46 | $120.73 | ($1.25) | 2.40% | -1.00% |
96131 | 2.6 | $93.83 | 2.62 | $91.42 | ($2.41) | 0.80% | -2.60% |
96132 | 3.78 | $136.42 | 3.82 | $133.29 | ($3.13) | 1.10% | -2.30% |
96133 | 2.84 | $102.50 | 2.98 | $103.98 | $1.49 | 4.90% | 1.40% |
96136 | 1.33 | $48.00 | 1.34 | $46.76 | ($1.24) | 0.80% | -2.60% |
96137 | 1.22 | $44.03 | 1.2 | $41.87 | ($2.16) | -1.60% | -4.90% |
96138 | 1.07 | $38.62 | 1.07 | $37.34 | ($1.28) | NA | NA |
96139 | 1.07 | $38.62 | 1.07 | $37.34 | ($1.28) | NA | NA |
96146 | 0.06 | $2.17 | 0.06 | $2.09 | ($0.07) | NA | NA |
Health Behavior Assessment and Intervention | |||||||
96156 | 2.77 | $99.97 | 2.79 | $97.35 | ($2.62) | 0.70% | -2.60% |
96158 | 1.89 | $68.21 | 1.91 | $66.65 | ($1.56) | 1.10% | -2.30% |
96159 | 0.66 | $23.82 | 0.66 | $23.03 | ($0.79) | 0.00% | -3.30% |
96164 | 0.28 | $10.11 | 0.28 | $9.77 | ($0.34) | 0.00% | -3.30% |
96165 | 0.13 | $4.69 | 0.13 | $4.54 | ($0.16) | 0.00% | -3.30% |
96167 | 2.03 | $73.26 | 2.04 | $71.18 | ($2.08) | 0.50% | -2.80% |
96168 | 0.72 | $25.98 | 0.73 | $25.47 | ($0.51) | 1.40% | -2.00% |
96170 | 2.3 | $83.01 | 2.34 | $81.65 | ($1.36) | 1.70% | -1.60% |
96171 | 0.84 | $30.32 | 0.84 | $29.31 | ($1.01) | 0.00% | -3.30% |
To compare the updated reimbursement changes with what was projected in the final rule see APA’s December 2020 Practice Update article Psychologists likely to see increases for psychotherapy services, but pay cuts for other services in Medicare for 2021.