How Are Fees Determined?
A psychologist’s insurance payment rates are determined by their patient’s health care insurer. Those rates, however, are influenced by Medicare’s Physician Fee Schedule, released annually by the Centers for Medicare and Medicaid Services (CMS).
CMS uses the fee schedule — a list of current procedural terminology codes (CPT), health care services, their relative values and fees — to reimburse Medicare providers for their services. The relative values for each service are based in part on recommendations from the American Medical Association (AMA)/Specialty Society Relative Value Update (RUC) Committee. The RUC reviews survey responses from psychologists and other providers to determine the relative values of health care services and their associated practice expenses.
Although Medicare does not actually set the fees for other insurance plans, it can have a strong influence on how psychologists are reimbursed by other insurers.
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