Medicare proposals for 2021: Psychologists’ payments impacted

Psychologists providing services to Medicare beneficiaries will likely see a marked reduction in payment in 2021. In the proposed rule on the 2021 Medicare physician fee schedule, the Centers for Medicare and Medicaid Services (CMS) confirmed that to offset higher values for next year’s outpatient evaluation and management (E/M) services, the agency seeks to slash payments for all services by 10.6%.

CMS is also proposing to increase the values for some psychotherapy codes (90791, 90832, 90834, and 90837) to maintain relativity with outpatient E/M codes, however, this will not be enough to offset the losses psychologists will face.

These payment cuts stem from the agency’s legal requirement to maintain a neutral budget from one year to the next. In 2019 and again in 2020, APA called on CMS to waive budget neutrality because of the devastating effect it would have on psychologists and other health professionals. APA is also partnering with a coalition of healthcare providers asking Congress to work with CMS on a solution that will allow the increases for E/M without cutting payments to other providers.

Comments on the proposed rule are due by Oct. 5, 2020. APA will continue its review of the 1,300 page proposed rule and provide psychologists with additional information in the coming weeks about how they can advocate for our profession and the patients we serve.

CMS also proposed expanding the number of telehealth services. Psychotherapy and Health Behavior Assessment and Intervention Services are already included in the permanent telehealth list. Group psychotherapy (90853) and the add-on code for the neurobehavioral status exam (96121) are two of the codes that CMS is now proposing to permanently add to telehealth.

In addition, the agency wants to create a new temporary category for services that could be furnished via telehealth by executive order during the COVID-19 public health emergency (PHE). These services would remain on the telehealth list until the end of the calendar year in which the PHE ends. This includes the codes for psychological and neuropsychological testing evaluation services (96130-96133).

CMS is not proposing to add psychological and neuropsychological testing administration codes (96136-96139) to this temporary category during the PHE, but have asked for comments on whether the codes should also be added to this new category. APA will advocate for their inclusion.

CMS is also proposing and requesting input on whether non-physician practitioners such as nurse practitioners and physician assistants should be allowed to supervise diagnostic testing including psychological and neuropsychological testing if allowed under state law and their scope of practice. APA is adamantly opposed to this proposal and is reaching out to CMS for more information—e.g. circumstances under which such supervision could occur and what types of tests would be involved.

The low-volume threshold exemption in the Merit-based Incentive Payment System (MIPS) remains the same in 2021. Eligible clinicians, including psychologists, are exempt from reporting if they meet any one of the following three criteria:

• Providing services to 200 or fewer Medicare beneficiaries
• Allowed charges to Medicare of $90,000 or less in the previous year
• Furnishing 200 or fewer Medicare covered services

Psychologists who surpass one or two of the criteria may elect to report under MIPS if they want to.

Additional topics discussed in the proposed rule include communications technology-based services (e.g., remote assessments), direct supervision via telehealth and incident-to billing, and the Quality Payment Program. APA will provide more information on these and other topics in a future notice.