Psychology responds to proposed rule on 2012 Medicare fee schedule

Comment letter raises concerns about elements of proposed rule

By Government Relations Staff

September 15, 2011—As part of psychology’s effort to fight for the interests of the profession through the ongoing challenges facing Medicare reimbursement, APA recently responded to the Centers for Medicare and Medicaid Services (CMS) proposed rule on the 2012 Medicare fee schedule with these comments:

  • Following changes to the Medicare Economic Index (MEI) earlier this year that disproportionately penalized cost-effective psychological services to boost reimbursement for overhead-intensive specialties, CMS should consider alternative approaches to budget neutrality that more fairly apportion the burden among all specialties. When psychology raised this issue during the previous rulemaking and secured 22 members of Congress to send a joint letter calling attention to the harmful impact of the cuts on Medicare mental health services, CMS announced it would convene a Technical Advisory Panel (MEI TAP) to review the MEI going forward. CMS should ensure that the MEI TAP explores the issue of disparate impact. 

  • CMS should not adjust provider time as proposed for selected group service codes, which include three psychotherapy services (90849, 90853 and 90857) and the health and behavior group intervention (96153). Since group services are billed per patient, CMS has suggested dividing the codes by the typical number of patients per session, which CMS believes to be six patients. The proposal lacks an understanding about the nature of group services, which require therapists to manage the concerns and engagement of multiple individuals throughout the entire session. 

  • CMS should not impose any new timelines on the American Medical Association (AMA) Relative Value Update Committee (RUC) process that would involve revaluing the psychotherapy codes currently under review by the Current Procedural Terminology (CPT®) Editorial Panel. The CPT Editorial Panel develops the codes that are used to identify professional services provided by psychologists and other health care professionals and the RUC then recommends work relative values for the codes. CMS is suggesting that the AMA RUC review by July 2012 a number of codes that have not been reviewed in the past six to ten years, including several psychotherapy codes (90801, 90805, 90806, 90808 and 90818). Because the CPT review is already underway, the psychotherapy codes should not be subject to an expedited RUC process. 

  • As CMS makes changes to requirements for annual wellness visits, CMS should indicate that upon identification or suspicion of mental illness, psychosocial risks or behavioral risks, primary care providers should refer beneficiaries to mental health professionals when necessary. As CMS works to expand coverage for preventive care at a time when most primary care settings have not yet integrated mental health professionals into primary care, it is important that primary care providers understand the need for, and are prepared to make, referrals to psychologists and other mental health providers.

The comment letter (PDF, 29KB) is available online at Practice Central. The final rule is expected in early November. Look for information about the final fee schedule later this year in the PracticeUpdate.

Medicare reimbursement remains a top priority of the APA Practice Organization (APAPO). As challenges and opportunities arise, APAPO will continue to press at both the legislative and regulatory levels for the professional interests of psychologists.

Current Procedural Terminology (CPT®) copyright 2011 American Medical Association. All rights reserved.