This is the first in a series of data analytic articles addressing financial and clinical trends in behavioral health practice.  We base our analysis on the data in our emr and practice management system which represents a broad cross section of clinicians nationwide.  We are reporting data on outpatient claims only.  We have excluded inpatient and residential levels of care. The data also only represents reimbursement from the primary payer.

The first graph shows insurance reimbursement by type of visit  (bear in mind the the reimbursement rate we report is based on actual insurance payments which do not include copays, co-insurance, etc). The second graph breaks down reimbursement by CPT code.

The initial visit reimbursement increased from $127.91 to $161.62. It is noteworthy that psychiatrists use 90872, the replacement for the CPT code 90801. This code not only pays better than the E and M new patient codes, but also has less onerous documentary requirements.

The follow up visit reimbursement rate increased from $62.03 to $83.71. The CPT code data on the second graph suggests that, as a result of the CPT code changes, psychiatrists may be changing the way they practice or bill for services. In 2012, 90805 and 90807, which were medication and psychotherapy follow up visits, accounted for almost 35% of all services delivered. In 2013, only 18.6% (the sum of add on codes 90833 and 90836) of follow-ups are billed for services that include psychotherapy services. So what has happened?  Either 1) psychiatrists have changed their practice style and do not provide as much counseling; 2) they have not changed their practice style but are not being reimbursed by the payers for these services; or 3) they are not billing for these services, perhaps because they are getting paid well enough or forget to add the add on code.

Another significant change in psychiatric practice is that the billing profile for psychiatrists is coming to resemble that of internists and family practitioners. 99213 accounted for 42.8% of psychiatric visits in 2013 (as opposed to 2.4% in 2012) , which is fairly close to the 48% use rate of internists and family practitioners.

In summary, the 2013 CPT changes were not revenue neutral insofar as psychiatry is concerned. We don’t know if insurers anticipated this. Psychiatrists are being paid better for routine psychiatric services.  It may well be that psychiatrists are under-coding follow-up visits.