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CSWA - CMS 2021 Medicare Coverage - 1-8-21

08 Jan 2021 12:14 PM | CSWA Administrator (Administrator)

Below is a summary of the way that the CMS Physicians’ Fee Schedule Rule will impact Medicare psychotherapy reimbursement and telemental health services for LCSWs in 2021. The final Rule was implemented at the end of December, 2020.

CPT Code Reimbursement Changes

  • 90785 Interactive Complexity -10.2%
  • 90791 Psychiatric diagnostic evaluation +15.7%
  • 90832 Psychotherapy, 30 minutes with patient +3.0%
  • 90834 Psychotherapy, 45 minutes with patient +1.5%
  • 90837 Psychotherapy, 60 minutes with patient -0.1%
  • 90839 Psychotherapy for crisis; first 60 minutes -8.7%
  • 90840 Psychotherapy for crisis; each additional 30 mins -8.4%
  • 90845 Psychoanalysis -9.2%
  • 90846 Family psychotherapy (no patient present), 50 minutes -11.1%
  • 90847 Family psychotherapy (w/ patient present), 50 minutes -11.1%
  • 90849 Multiple-family group psychotherapy -10.2%
  • *90853 Group psychotherapy -9.0%

*Group Psychotherapy, 90853, has been added to the permanent list of telemental health services.

In short,

  • diagnostic evaluation, 90791, has the largest increase in reimbursement. 
  • Individual psychotherapy codes, 90832 and 90834 have a slight increase while 90837 has a tiny decrease. 
  • Family therapy codes, 90846 and 90847, have the largest decrease over all, while psychoanalysis and group psychotherapy have a somewhat smaller decrease in reimbursement.
  • Crisis codes and interactive complexity also have a decrease in reimbursement. 
  • Remember that the actual reimbursement varies by region, so consult your Medicare Administrator Contractors if you have questions.

Telemental Health Services

Telemental health videoconferencing services have been extended indefinitely which is great news.  Audio only telemental health services, however, will only be covered through the Public Health Emergency, currently scheduled to end on January 20, 2021.  CSWA is working with the Mental Health Liaison Group to have Congress make audio only treatment covered indefinitely as well.  CMS believes that Congress must make a legislative change before audio only services can be covered.  It is likely that the Public Health Emergency will again be extended past January 20th, but has not been extended yet.

In summary, the cuts were not as severe as had been planned for individual psychotherapy, but somewhat more difficult for family and group therapy and psychoanalysis.  To reiterate: Stay tuned for the extension of the Public Health Emergency, which will allow the continuation of audio only treatment, but videoconferencing has been extended indefinitely.

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