Survey of psychological testing codes could influence reimbursement rates in 2003

 Paula Hartman-Stein, Ph.D.

Q. Can anything be done about the low reimbursement rate of psychological testing codes under the Medicare system? It has been discouraging to have such low rates of reimbursement for the complex work of neuropsychological testing.

A. Yes, something is being done at long last. A survey by the American Medical Association (AMA) is underway this summer to determine the “work value” of the testing codes.   Psychological testing codes had not been assigned work values, and reimbursement for providers to date has been based only on malpractice costs and overhead expenses.

James Georgoulakis, the APA representative to the Relative Update Committee (RUC) of the AMA)said, “a number of factors are beyond our control, but the possibility does exist for impacting fees in 2003.”

Q. Which codes are being surveyed?

A. Testing codes 96100, 96105, 96110, 96111, 96115, and 96117 of the Current Procedural Terminology (CPT) manual published by the AMA are being surveyed.

Q. Who will complete the survey?

A. Specialty societies such as the APA, American Neurological Association, and AMA have been recruiting individuals to complete the survey. Georgoulakis noted: “It is critical that psychologists keep in mind that we do not own the codes, but we use the codes just as do other specialties.”

Antonio Puente, Ph.D., APA’s representative to the AMA Current Procedural Panel (HCPAC) and the CMS’s Medicare Coverage Panel, explained that the survey is a lengthy instrument to complete, requiring careful attention to detail. He suggested that individuals and groups of psychologists and neuropsychologists who perform such testing services and would like to participate in this important project should contact him directly at PUENTE@UNCWIL.EDU.

Q.    Will the professional and technical components of the testing services be assigned separate work values?

A.  “At this point in time, the survey has been designed to measure professional as well as technical components. Additionally, we will be surveying the practice expense for the codes,” said Georgoulakis.

 Q. Who wrote the survey?

A. The questionnaire is modeled after the standard survey utilized by the AMA with specific vignettes developed in cooperation with the medical specialties that use the codes such as psychology, neurology, and pediatrics, among others, explained Georgoulakis. 

Q. When will the survey be completed?

A. The survey of testing codes is taking place in early summer and must be completed, results analyzed, and recommendations written by August 21, 2002.

Q. Who will review the results and decide on the reimbursement of the surveyed codes?

A. Representatives from the professional groups including Georgoulakis on behalf of the APA will review the results and make recommendations at the RUC meeting in Chicago Sept. 25-29. The recommendations from the RUC will then be forwarded to the Center for Medicare and Medicaid Services (CMS), formerly HCFA, for final decision.

Q. Besides possible reimbursement changes in the future, does the survey have additional implications for psychology?

A. Puente believes the fact that the survey separately examines professional and technical components reflects the continuing evolution of the practices of psychology and neuropsychology.

 Paula E. Hartman-Stein, Ph.D. is a geropsychologist, trainer, and consultant at the Center for Healthy Aging in Kent, Ohio. She can be contacted through her website, www.centerforhealthyaging.com.

Hartman-Stein, P.E. (2002). Survey of psych testing codes may affect reimbursement rates in ’03. The National Psychologist, Vol. 11, No. 4, p 5.