Final Medicare fee schedule rule is a mixed bag for psychology

by Government Relations Staff

November 23, 2009 — The Centers for Medicare and Medicaid Services (CMS) recently released its final rule on the 2010 fee schedule for Medicare. The rule includes a combination of favorable and unfavorable decisions regarding Medicare payment for psychological services.

Payment reductions
The final rule makes changes to Medicare payments for the practice expense portion of all covered services, including those commonly billed by psychologists. Based on the recent rule from CMS, Medicare payments for psychological services are scheduled to be reduced an average of 2 percent per year for four years, beginning January 1, 2010 and lasting through 2013.

Some services are hit harder than others. For example, fees for neuropsychological testing will decline 7 percent in 2010, while outpatient psychotherapy fees are reduced by less than 2 percent.

A companion article in this issue of the e-newsletter contains detailed information about the changes and related questions and answers.

Health and behavior codes
Meanwhile, the final rule from CMS also contains some positive news for practicing psychologists. Individual health and behavior assessment and intervention services (CPT® codes 96150-96152) have been added to the list of covered Medicare telehealth services. This program allows for selected services to be provided via specified telehealth processes to patients in rural and underserved areas. CMS made its decision in response to the American Psychological Association (APA) Practice Directorate's request to have health and behavior services added to telehealth.

Physician Quality Reporting Initiative
The CMS final rule also contains several items of interest to psychologists who participate in the voluntary reporting program known as the Physician Quality Reporting Initiative (PQRI).

In its proposed rule on the 2010 fee schedule, CMS announced that it planned to impose a 15-patient minimum for claims-based reporting in the PQRI. But the agency dropped the proposed requirement following APA's comment letter arguing that such a change would hinder participation by those with small practices and/or few Medicare beneficiaries. APA had also pointed out that many eligible professionals who can now successfully report under the current requirements would no longer be able to do so with a 15-patient minimum, a position that CMS found was confirmed by data from the 2008 PQRI program.

Further, CMS had proposed eliminating claims-based reporting for PQRI after 2010 in favor of reporting through registries and electronic health records. In its final rule, the agency recognizes the need to continue to allow for claims-based reporting, in addition to reporting through registries and electronic health records, beyond 2010. APA's comment letter stated that there were not enough qualified registries available to psychologists to make this a viable alternative to claims-based reporting and that registries can carry financial costs that would be burdensome to solo and small practitioners. While acknowledging that the federal agency will continue to permit claims-based reporting in the near future, CMS also indicated it may avoid introducing new claims-based measures and may limit the circumstances where claims-based reporting is an option.

CMS is introducing a new option that will allow for a 6-month reporting period for claims-based reporting of individual measures. This means that psychologists will be able to choose whether to report on services provided throughout the calendar year or only those services furnished between July 1, 2010 and December 31, 2010.