New Mental Health Procedure Codes- Reimbursement Cuts

The mental health procedure codes used by insurance companies are being revised, and will be reimbursed at a different rate. While some codes stay the same, one of the changes that will lead to a cut in pay for most therapists, and a cut in service for most mental health patients, is the code for outpatient psychotherapy.

The old code of 90806 was used by most therapists and was reimbursed for the typical 50 or 55 minute therapy session. However the way the new codes are set up, if a 50 minute session is preauthorized (and that is the way blue cross and many other insurers do it), then you are expected to round down to 45 minutes, and that session is equivalent to the old 90804, paid at a much lower rate of reimbursement.

This is a hidden pay cut and service cut, for therapists and clients respectively. If therapist usually takes the whole hour (adding time at the end for record keeping), then the new rules will try to force them to do 45 minute session, (or donate the time) seeing three patients over a little over two hours, if they plan to make as much or more money as in the previous system, when they saw two patients in that time.

So far the actual reimbursement rates have yet to be published although they were due in November. Hopefully that will include an increase, but the projection is for a cut in reimbursement, when both are taken into account. I still make less from an insurance company now than I did in the 1980’s, and that is one reason many of my colleagues do not fool with insurance.

 

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Published in: on November 28, 2012 at 5:23 pm  Comments (1)  
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  1. As a psychologist in private practice for 15 years, I have waited patiently for insurance companies to raise my reimbursement rate. Surely, as these companies asked patients to pay a larger co-pay, some of that would be passed along to the providers? Surely, people who work for these insurance companies haven’t gone the last decade without a raise? Yet after 12 years, and absolutely no increase in reimburrsement from multiple insurance companies, we are now faced with a decrease in the reimbursement rate, somewhere between 5% and 10%. After cutting my expensses to the bone (I do all of my own billing and scheduling….no staff here), I’m not sure where to go from here. I’ve toyed with the idea of going off of all insurance panels, but in an area with many therapists, including a variety with less experience and training who can charge less, I’m not sure if I can earn a living. While I never went into the mental health field to make a lot of money, it is disheartening to contemplate a future of declining income.

    It is ironic that these cuts happen at a time when the media and government have turned their attention back to mental health, and suddenly realized that it has been neglected for years. It is also ironic that these cuts occur after a variety of studies show that mental health treatment leads to substatntial savings in other, more costly medical care.


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