Psychotherapy codes survey now complete

Survey data will help determine values for future Medicare reimbursement rates

By Government Relations staff

April 12, 2012—For the last 15 months, the APA Practice Organization (APAPO) and its volunteer psychologist experts have been representing the practitioner community in the American Medical Association’s (AMA) complicated process of examining definitions of the psychotherapy codes.

In December 2009, APA Practice made the case (PDF, 1.4MB) to the Centers for Medicare and Medicaid Services (CMS) that the work provided under the current psychotherapy codes had changed such that the codes were undervalued relative to other services in the Medicare fee schedule and needed to be reviewed. CMS agreed to include the psychotherapy codes in the 2010 five-year review, a periodic process in which codes are reviewed to assess their valuations.

The codes recommended for CPT were sent to the Relative Value Update Committee (RUC) of the AMA to begin phase two, the code valuation process. Psychology and other professions then participated in an AMA survey of the codes. The AMA’s RUC survey gave professional psychology an important opportunity to report on what practicing psychologists’ work entails — both the complexity of the services and the time it takes to provide them.

A random sample of approximately 1,400 psychologists was invited to take the AMA survey and 100 psychologists attending the State Leadership Conference March 10-13 participated in a “convenience sample.”

The survey portion of the AMA/Specialty Society Relative Value Scale Update Committee valuation process for the psychotherapy codes is now complete.

The RUC will use the AMA survey data to determine values for the codes. After that, CMS will decide whether to accept the RUC’s recommended code values when it sets the 2013 Medicare reimbursement rates, which ultimately affect rates throughout the private sector as well. The process will not conclude until late in the year, just before any new rates go into effect. At this time, APAPO cannot predict any particular outcome regarding reimbursement rates for psychotherapy services.

Although we are unable to report on much of the ongoing work because of confidentiality requirements, APAPO is working diligently to protect the practice of psychology and access to psychological services for those in need. We will keep members apprised of future developments as permitted.

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

For more about reimbursement, see Practice Central Billing & Coding.