Reimbursement changes for psychologists

Centers for Medicare and Medicaid Services' 2018 physician fee schedule focuses on services and new codes.

Every year the Centers for Medicare and Medicaid Services (CMS) releases its Medicare Physician Fee Schedule detailing how Medicare providers should be reimbursed for their services. The fee schedule is frequently used as a benchmark by other insurers for how to pay providers participating in their plans.

Changes included in the 2018 fee schedule take effect Jan. 1, 2018.

No major changes to Medicare payments

Psychologists who are Medicare providers can expect their 2018 payments to look much like they did in 2017.

CMS projects that on average psychologists will see a 2 percent increase in their 2018 Medicare payments based on changes in practice expenses, but that gain will be offset by a mandatory Medicare sequestration cut of 2 percent.

As part of an annual update, all Medicare providers, including psychologists, will have their payments increased by 0.41 percent.

Fewer psychologists will be penalized for PQRS reporting

CMS has decided to retroactively reduce the number of measures required for 2016 PQRS reporting from nine to six in any National Quality Strategy domain.

For many psychologists it was impossible to find nine measures that fit their practice.

The agency’s decision means that more psychologists should have successfully reported quality measures under PQRS last year and fewer will face a 2 percent penalty in 2018.

Billing codes and payments for cognitive function intervention services change in 2018

Psychologists who provide cognitive function intervention services will no longer be able to bill CPT code 97352. Psychologists will have to use the temporary code G0515, which has the same payment rate as 97352, until CMS decides whether to adopt a new for these services.

For the proposed new code providers would only be allowed to bill cognitive function intervention in one unit, instead of in units of four or more allowed under code 97352. Psychologists, who typically bill four or more units when providing this service, will suffer a loss in payment for these cognitive function services if CMS adopts the new code.

The Practice Organization is working with CMS and other specialties who provide this service to find an effective permanent coding solution that permits sufficient coverage of and fair payment for cognitive function intervention.

Psychologists cannot use the newly adopted CPT code for dementia care planning

The new CPT code, 99483, for dementia care planning will not be available to psychologists, even though they provide several of the services included in the code. The reason is that 99483 will be an evaluation and management (E/M) code and CMS only recognizes physicians and physician extenders such as nurse practitioners as being able to provide E/M services.

CMS may consider new codes for behavioral health management

CMS acknowledged receiving comments, such as those made by the Practice Organization, asking the agency to create separate codes to describe behavioral health management services that could be billed by psychologists and other non-physicians who cannot bill Medicare for E/M services. CMS said it will consider these comments for future rulemaking.