NP May/June 2012

Revision of psychotherapy codes expected in early 2013

By Paula Hartman-Stein, Ph.D.
The National Psychologist, May/June 2012, Vol. 21, No. 3, p. 6

            Based on a Congressional mandate that requires Current Procedural Terminology (CPT) codes to be reviewed approximately every five years, all of the psychotherapy codes published in the American Medical Association’s official codebook are currently under review.

            A sample of clinicians from multiple disciplines who conduct psychotherapy recently took an extensive survey to assess the work value of psychotherapy services.

            According to James Georgoulakis, Ph.D., the APA representative to the Relative Update Committee of the American Medical Association, “the survey results look promising.” He added, “Thanks should go to Randy Phelps of the APA Practice Directorate for his efforts in making the survey the most successful one psychology has ever developed.”

            Georgoulakis said the results of the survey are expected to be released in late fall and could impact reimbursement as early as January.      

            Georgoulakis said that the Center for Medicare and Medicaid Services (CMS) along with the Medicare providers of Mental Health Services (e.g. psychology, social work, psychiatrists, psychiatric nurse clinicians) have been very concerned over the codes that describe psychotherapy services.

            “At this time and contrary to rumors, the present psychotherapy codes will remain as they are currently defined throughout 2012,” he said.

            Medicare providers who conduct psychotherapy services had their reimbursement cut by 5 percent in March because the Sustainable Growth Rate legislation passed last winter that averted a cut of over 27percent did not include a provision to extend a Medicare psychotherapy payment boost. 

            David Hayes, Ph.D.,  Federal Advocacy Coordinator for the Ohio Psychological Association said, “The 5 percent reduction is a very disappointing result, but the APA Practice Organization is rapidly considering how to respond going forward.”

                “Some of the most vulnerable in our country will be affected by this law,” Katherine C. Nordal, Ph.D., executive director for Professional Practice, American Psychological Association Practice Organization (APAPO), said in a press release.

            “These cuts will impact funding not only for psychotherapy outpatient services, but to community behavioral health centers, state hospitals and private hospitals with mental and behavioral health units,” Nordal said.

            A 2008 APA survey showed that 11percent of psychologists reported that they dropped out of Medicare participation, citing low reimbursement rates as a primary reason. APA estimated that 3,080 psychologists who once participated in Medicare have left the program. The concern is that even more will abandon treating Medicare recipients as a result of the most recent cut in Medicare Part B reimbursements. Medicare Part B covers outpatient services for mental health diagnosis and treatment as well as therapy services for in-patients at state and private hospitals.

            In 2006 the CMS slashed payment for psychotherapy as part of the prior Five Year Review process for psychotherapy codes.