Some psychologists are increasing their incomes with the new 2013 psychiatric CPT* codes. Our data are based on claims paid data from the Carepaths EMR. The findings:
The most frequently paid code in both 2012 and 2013 was for 45 minutes of psychotherapy (90806 in 2012 and 90834 in 2013). Average reimbursement for 45 minute sessions has not changed significantly. However, there are big changes in payment for longer and shorter sessions.
In 2012 the code for a longer session was 90808 (75 minutes). In 2013 the code for a longer session is 90837 (60 minutes). Insurers are paying for 90837 (60 minutes) at a dramatically higher frequency than they were for 90808 (75 minutes). In 2012 90808 represented less than 2% of claims paid and about 2% of revenue. In 2013 90837 represents almost 16% of what gets reimbursed and over 18% of revenue. The amount of the payment for a 90837 in 2013 is less than what was paid for 90808 in 2012, but psychologists come out ahead because they are being paid for longer sessions. Clinicians need to spend 53 minutes with the patient to bill for the longer code in 2013. It is likely that many clinicians are now using 90837 for what would have been billed as a 45 minute session in 2012.
Insurers have dramatically increased reimbursement for shorter sessions. In 2013 reimbursement for 90832 (30 minutes), the replacement for 90804 (20-30 minutes) went from $41.92 to $51.62, about a 23% raise. Clinicians can bill for 90832 as long as they spend 16 minutes with the patient.
Intake reimbursement increased also from $100.81 for 90801 in 2012 to $106.94 for 90791 in 2013, an increase of about 6%.
+90785 (interactive complexity add-on code) is being used and paid for on regular basis although average reimbursement is small, $4.36. The other add-on code +90840 (Crisis) has been used only once in our sample. Either psychologists are not providing the service, are not billing for it, or are not being paid for it.
Psychologists are increasingly using PQRS codes to protect their medicare reimbursement. No psychologists used PQRS codes in 2012. Through August of this year they have used these codes 1406 times. The most used PQRS codes are: G8734 (Elder Maltreatment Screening) 33.3%; G8930 (Assessment of Depression Severity) 27.6%; and G8932 (Suicide Risk) 16.2%.
Astonishingly, Health and Behavior Codes were not used by any psychologist in our database in the year’s 2012 or 2013. These codes became available in 2002 for use by psychologists as a result of advocacy by the American Psychological Association. At the time they were expected to promote integration with primary care services and provide a way for psychologists to be compensated in this arena. But in our sample no psychologist has even tried billing with these codes. Medicare intermediaries and over 50 private insurers pay for them.
Overall, the 2013 cpt code changes are good news for psychologists. There are real opportunities for psychologists to increase their incomes by using 90837 and 90832 more frequently, and by using the add-on code +90785.
Graphs courtesy of Gordon Herz, Ph.D.
Update 11/11/13–We are beginning to hear from clinicians about which insurers pay for 90837 and which ones do not. We will do a furrter analysis of the data to determine which payers reimburse for 90837 and which do not. In the meantime, here are comments from clinicians
“United behavioral health denies claims without authorization for 90837 and refuses to give the authorization unless you use a particular type of treatment that they deem appropriate for only a few diagnoses. They also reduced their reimbursement for 90791 and 90834 as soon as the new codes came out.”
“When our claims were not processed correctly, we contracted Cigna was were told they “made a mistake” in their crosswalk and they have retracted their fee for 90837 and reduced it to 90834. They claim it was not a rate change at all, only a “crosswalk mistake”.”
*CPT copyright 2013 American Medical Association. All rights reserved.