News and Updates

News and Updates

Keep up-to-date on the latest news and information regarding reimbursement criteria and fee schedules.

Medicare Physician Fee Schedule

Latest Updates
Background

Although called the Medicare physician fee schedule, this yearly list contains the values assigned to services provided by all health care professionals including psychologists. The fee schedule is a list of services and their code numbers that utilizes a payment system known as the Resource‑Based Relative Value Scale (RBRVS). The RBRVS includes three major components of resource costs required for each service: professional work, practice expense, and malpractice expense. As a “resource-based” relative value scale, the fee schedule is designed to reflect the resources the service requires, not the service’s value to the patient.

  • Professional Work: This component reflects the professional time and intensity in providing the service. Factors such as mental effort and judgment, technical skill, physical effort, and psychological stress all measure the overall work involved in providing the service.
  • Practice Expense: This component reflects the overhead costs involved in providing a service such as rent, utilities, equipment, and staff salaries (other than professional compensation and malpractice insurance costs).
  • Malpractice Expense: This component reflects the malpractice expenses associated with the service, such as costs of insurance, etc.

The national uniform relative values for each of these components are then adjusted for each locality by geographic adjustment factors. As a result, Medicare providers are paid differently depending upon where they practice. Largely populated states, such as New York, may have multiple separate payment localities. Finally, each of the adjusted components is multiplied by an annual conversion factor that translates these values into reimbursement dollars.

Psychologists are paid 100 percent of the fee schedule so reimbursement for psychologists is exactly the same as it is for psychiatrists when providing services under the same billing codes.

Medicare Payment Advocacy

More information about APA Practice Organization advocacy related to Medicare reimbursement and access can be found in the Medicare Reimbursement and Access section of the Practice Central website.

Medicare General FAQs
  1. Can I bill for missed appointments?

    CMS reaffirmed in 2007 that providers can bill Medicare beneficiaries for missed appointments, so long as they do not discriminate against their Medicare patients. This means they must also charge non-Medicare patients for missed appointments and the charges for Medicare and non-Medicare patient must be the same. The charge for a missed appointment is a charge for a missed business opportunity, not a charge for a service itself (to which the assignment and limiting charge provisions apply). This decision by CMS is explained in MedLearn Matters Article MM5613 (PDF, 75KB)
  2. Do you need to notify Medicare of a change in your practice?

    The Centers for Medicare & Medicaid Services (CMS) has posted new fact sheets online listing the types of changes that physicians, non-physician providers and group practices are required to report to Medicare within 90 days of the applicable change. This information is accessible from the Medicare Provider Enrollment page.

    Psychologists enrolled in the Medicare program should read the fact sheets to know if and when they need to submit a report. Changes in a practice's location, business structure or legal business name are among the reasons a psychologist would be required to notify Medicare.

    The fact sheets also indicate which forms need to be submitted to report the changes and where practitioners may seek assistance. Not reporting a change may adversely affect claims processing, claims payment amounts and eligibility of a nonphysician provider or group practice to participate in Medicare.