Proposed Rule Offers Better Medicare Reimbursement for Psychologists

Posted: September 2, 2019

Practicing psychologists who help Medicare patients cope with or manage a physical health condition should see an increase in their 2020 payments for these services when billing health and behavior assessment and intervention (H&B) CPT codes.

In a proposal released July 29, the Centers for Medicare and Medicaid Services (CMS) indicated that the agency has accepted recommendations presented by APA Services to increase the relative value units (RVUs) for H&B services. The proposal would raise reimbursement rates for H&B services to a level that is comparable to payments for psychotherapy services.

This rate increase and other proposed payment policy and billing changes for health care services are included in the agency’s 2020 Medicare Physician Fee Schedule proposed rule.

In addition to increased values for H&B services, CMS has proposed: 

  • Replacing the existing CPT® codes (96150-96155) for H&B services with new codes and updated descriptors.
  • Using a single, nontimed code to report H&B assessment (similar to CPT code 90791; Psychiatric diagnostic evaluation).
  • Making structural changes to codes that describe the primary or base service, and add-on codes to describe additional work and time beyond the primary/base service.
  • Increasing the units of time for reporting the base codes from 15 minutes to 30 minutes.

CMS will announce final changes to 2020 values and CPT codes when it releases the physician fee schedule final rule in November. Implementation of the new codes and values will begin Jan. 1, 2020.

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