Big wins for psychology in Centers for Medicare and Medicaid Services 2024 Physician Fee Schedule Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) CY2024 Physician Fee Schedule (PFS) Proposed Rule was released on Thursday July 13, 2023. APA Services, Inc. (APASI) is very pleased to see positive results from our advocacy efforts and responsiveness from CMS. 

Here are a few of the proposals CMS is putting forward to improve beneficiary access to behavioral health services:

• Increase the work values for the psychotherapy codes by 19.1% over a 4-year period.
• Continue paying the nonfacility rate for mental health telehealth services furnished to patients in their homes.
• Reimburse for group caregiver training services needed to support the patient in carrying out a treatment plan. For more information, please see the previous PracticeUpdate article, Providing and reporting new Group Caregiver Behavior Management Training Services.
• Create two new codes for psychotherapy for crisis services furnished outside of an office or facility with increased reimbursement.

APASI will call upon CMS to increase the work values for the psychological and neuropsychological testing services, as well as the Health Behavior Assessment and Intervention services, like they are proposing for psychotherapy services.

Although CMS is proposing a mechanism for reimbursement for Community Health Worker Integration services and Social Determinants of Health Assessments, these services are restricted to only physicians and providers who can bill Evaluation and Management Services. APA will advocate to CMS that psychologists are able to utilize these services to better address population health and health equity.

Another important change in 2024 is the addition of marriage and family therapists (MFTs) and mental health counselors (MHCs) as providers who can independently bill Medicare for their services, as established by Congress under the Consolidated Appropriations Act, 2023. CMS is proposing to pay MFTs and MHCs 75% of the PFS rate paid to clinical psychologists. Addiction counselors may be able to enroll as MHCs if they meet the education and clinical training requirements. APA is carefully reviewing the requirements to determine if master’s level psychological associates could potentially qualify as MHCs.

Separate from our response to the CMS proposed rule, an ongoing challenge for all providers in Medicare is that Congress has capped annual payment updates, and requires CMS to adjust the annual conversion factor (CF) in order to achieve budget neutrality. The CF, used to turn code values into payment amounts, is applied to almost all services in the PFS. For 2024 the CF is projected to be $32.75, which is a reduction of $1.14 (3.34%) from this year’s CF of $33.89.

The Strengthening Medicare for Patients and Providers Actopens in new window (H.R. 2474opens in new window) would address CF reductions and payment updates this year and in the future by pegging increases to the Medicare Economic Index, a measure of health care cost inflation.

CMS is also requesting information on digital cognitive behavioral therapy and practice expense adjustments for behavioral health rate-setting methodology. APA has been working with CMS on both of these issues.

APA will provide additional information to psychologists on the proposed rule, including suggested changes for the Quality Payment Program, and how psychologists can continue to impact Medicare policy by submitting comments. Given the complexity of the proposal, APA will continue its review of the 1,920-page document and provide psychologists with additional information in the coming weeks about how they can advocate for our profession and the patients we serve.

[Read: The CMS Physician Fee Schedule: Submit comments, protect access, improve practice]

In the meantime, APASI has made it easy for psychologists to weigh in with CMS on key components of the proposal. Our dedicated action center pageopens in new window offers tailored, prewritten messages that individuals can submit directly to CMS. Submitting a comment takes roughly 2 minutes, so we encourage psychologists to submit comments and share the alert page broadly. These messages can play an influential role in the development of this year’s PFS as well as future proposals. Last year, psychologists made up 50% of all comments submitted nationwide—please join in to make this year’s campaign a success as well.

Comments on the proposed rule are due by September 11, 2023.