Potential Changes to CPT Codes & Medicare Rates 10-27-12

Act By Date: 
No action needed; still need more information

October 27, 2012


Dear CSWA Members,


I have received questions from several members on the possible changes to Medicare reimbursement rates due to the implementation of the long-delayed Sustainable Growth Rate cut, now at 27.9%, and the impact of the CPT code changes on reimbursement.


While there is cause for concern, I wanted to give you a report on the meeting of the Mental Health Liaison Group in Washington D.C. on October 5, which I attended.  For your information, MHLG is made up of 63 national mental health groups and has usually provided CSWA with reliable information.  The consensus at the meeting was as follows.


There are several factors which will affect the Medicare reimbursement rates that are currently unknown:


1) The Relative Value Units for psychotherapy codes will be announced by CMS on November 2 in the Federal Register.  RVUs are the way that all medical services are given a 'value', and then a reimbursement rate by Medicare and insurers.  All codes are reviewed and adjusted every five years; this is the year for psychotherapy codes.  CMS may raise or lower the 'value' of psychotherapy which could affect Medicare and insurance reimbursement rates. 


2) Congress could again decide to put off the 27.9% SGR cut.  The imminent elections are making any action or attention to legislation highly unlikely until after November 6, and probably after the Thanksgiving break.  Making Congress aware of our concerns is likely to be much more effective at that time.


3) The "sequester", or automatic cuts to all government programs to reduce the deficit, is currently scheduled to go into effect on January 1, 2013.  The MHLG believes that it is highly likely that the sequester will be delayed and/or replaced with another method for lowering the deficit, depending on the result of the elections.


When these issues become clearer in the next 2-4 weeks, CSWA will advise members on the best way to advocate for our interests. 


Finally, there is concern that the new CPT codes will lower reimbursement rates.  The change from a 45-50 minute psychotherapy hour to a 45 minute and 60 minute hour are likely to affect reimbursement rates, but changes may be offset by #1 above.  Rates are not directly affected by CPT codes and the impact of all these unknowns makes this impossible to determine how the code changes will affect rates at this time.


CSWA believes that targeted advocacy to the right legislative bodies at the right time is more effective than a less organized effort.   We will continue to monitor all these potential changes and keep members advised. 


The uncertainty we face is uncomfortable for all of us, but I encourage you to wait to see how these issues play out before we weigh in.


Laura Groshong, LICSW, Director, Government Relations

Clinical Social Work Association

lwgroshong [at] clinicalsocialworkassociation [dot] org

Legislative Alerts

  • 05/08/2015 - 10:21pm

     We were glad to note this month that NASW is joining us in pursuing our goals for Medicare parity. The more the social work community is united on legislative goals that benefit all LCSWs and our patients, the more successful we are likely to be.