Approximate 2013 national Medicare payment rates for psychological services

Check our estimated Medicare rate lists as well as the schedule published by your Medicare Administrative Contractor

By Government Relations staff

Nov. 29, 2012—The charts below contain approximate 2013 national Medicare fees for psychological services. The first chart includes billing codes from the psychotherapy family of codes, while the second and third charts contain testing as well as health and behavior services.  

Two estimated rates appear for each psychological service in the lists. One column lists the payment amount including the considerable Sustainable Growth Rate (SGR) cut of 26.5 percent across-the-board for all Medicare services scheduled to take effect Jan. 1, 2013, while the adjacent column has payment rates without the SGR cut. 

Your actual payment rate likely will differ due to geographic adjustments applied to the national Medicare rates.  Check your Medicare Administrator Contractor (MAC) website (PDF, 150KB) for published rates that will pertain to Medicare services that you provide effective Jan 1. Be aware that rate lists that now appear on MAC websites include the SGR cut for all services.

Approximate 2013 National Medicare Fees for New Psychotherapy Codes

Code

 

Service

 

With SGR cut

 

Without SGR cut*

 

90785

Interactive complexity add-on $4 $5

90791

Psychiatric diagnostic evaluation 111 151

90832

Psychotherapy, 30 minutes 46 63

90834

Psychotherapy, 45 minutes 59 81

90837

Psychotherapy, 60 minutes 87 118

90845

Psychoanalysis 55 75

90846

Family psychotherapy without patient 54 74

90847

Family psychotherapy with patient 65 88

90849

Multiple family group psychotherapy 25 34

90853

Group psychotherapy, per patient 18 25

* Assumes Congress postpones SGR cut scheduled for Jan. 1, 2013

 

Approximate 2013 National Medicare Fees for Testing and H&B Services

Testing

Code

 

Service

 

With SGR cut

 

Without SGR cut*

 

96101 Psychological testing, professional $61 $83
96102 Psychological testing, technician 63 86
96103 Psychological testing, computer 51 70
96116 Neurobehavioral status exam 66 89
96118 Neuropsychological testing, professional 67 92
96119 Neuropsychological testing, technician 55 74
96120 Neuropsychological testing, computer 76 103

* Assumes Congress postpones SGR cut scheduled for Jan. 1, 2013

Health and Behavior (H&B) – per 15-minute unit of service

Code

 

Service

 

With SGR cut

 

Without SGR cut*

 

96150 Initial H&B assessment $15 $20
96151 H&B re-assessment 14 19
96152 H&B individual intervention 14 18
96153 H&B group intervention, per patient 3 4
96154 H&B family intervention with patient 13 18

* Assumes Congress postpones SGR cut scheduled for Jan. 1, 2013 


In addition to checking your MAC website for 2013 rates that apply to your geographic area, if applicable to your practice, you may also wish to visit private insurance carrier websites to check for details about their 2013 payment rates for psychological services.

Call to Action

If Congress fails to take action by the end of December, the scheduled SGR payment cut of 26.5 percent will apply to all Medicare services effective Jan. 1, 2013. Congress has blocked the SGR cut 14 times since 2001. The APA Practice Organization (APAPO) and virtually all other health care organizations are advocating aggressively to prevent the SGR cut again. The stakes are high for practicing psychologists, as changes in Medicare reimbursement rates will not only affect Medicare beneficiaries but also individuals with TRICARE or private insurance from third party payers that follow Medicare’s lead. 

Grassroots advocacy is a crucial element of legislative advocacy. Your members of Congress need to hear from you immediately about doing what’s right for Medicare beneficiaries and preventing the SGR cut from taking effect. 

Visit the Legislative Action Center to urge your Senators and Representative to halt Medicare cuts to psychological services. Please take action as soon as possible and no later than Dec. 5.

For more information about the new psychotherapy codes for 2013, please visit the 2013 Psychotherapy Codes for Psychologists section of APAPO’s Practice Central website or email us.