FAC Report: Medicare 2019 Fee Schedule Final Rule

By Samantha Slaughter, Psy.D. – Federal Advocacy Coordinator, WA State

Throughout November, you received three emails from me with information from the APA Practice Organization (APAPO) regarding the Medicare 2019 Fee Schedule Final Rule. If you did not receive these emails and would like to opt in, please email me at SamanthaSlaughterPsyD@gmail.com. The following is a summary of the information from the emails.

Overall, it appears that the 2019 fee schedule includes big wins for psychologists. Starting in 2019, the APAPO projects the reimbursement rates for psychotherapy services, psychological testing services, and neuropsychological testing services to increase significantly. Here are the projections for psychotherapy services per CPT code:

CPT code Code description Rate change
90791 Psych diagnostic evaluation +2.6%
90832 Psychotherapy, 30 minutes +3.2%
90834 Psychotherapy, 45 minutes +2.8%
90837 Psychotherapy, 60 minutes +3%
90839 Crisis psychotherapy, initial 60 minutes +2.8%
90840 Crisis psychotherapy, each additional 30 min +3.2%
90845 Psychoanalysis +2.3%
90846 Family psychotherapy w/o patient +3%
90847 Family psychotherapy w/ patient +2.9%
90849 Multiple family group psychotherapy +1.3% (billed per family group)
90853 Group psychotherapy +2.7% (billed per patient)

Here are the projections for testing services:

6-hours psychological testing administered and evaluated by professional = +13%

6-hours technician administered psychological testing w/ professional evaluation = +21.2%

6-hours neuropsychological testing administered and evaluated by professional = +2.5%

6-hours technician administered neuropsychological testing w/ professional evaluation = +5.9%

1-hour of the neurobehavioral status examination = +2%

Side note: I attended the APAPO’s first webinar on the new testing CPT codes. The biggest take away for me was the timing of assessments in December 2018. Because the new codes include add-on codes, it was highly suggested that any assessments starting in 2018 be completed in 2018. It will likely be quite difficult to bill in 2019 under the new codes if you started the assessment in 2018. Also, there is no transition period for the new codes to take effect. You must use the new codes as of January 1, 2019 for any testing services. For more on the new codes, please see the APAPO’s website or video that explains the details.

The last important piece about the Final Rule included information for psychologists regarding the Merit-based Incentive Payment System (MIPS). MIPS is the replacement for the Physician Quality Reporting System (PQRS) that ended in 2016. As of January 1, 2019, psychologists will be added to the list of providers who meet the definition of eligible clinicians (ECs) in MIPS. However, it is likely that most of us will be exempt from MIPS reporting due to changes in the rules for low volume threshold (LVT). You will not need to report under MIPS if you meet any one of the following three criteria:

  1. Treated 200 or fewer Medicare beneficiaries;
  2. Billed Medicare for $90,000 or less in allowed charges; or
  3. Provided 200 or fewer covered professional services.

Also, if you are a new provider to Medicare as of 2018, you are exempt from MIPS reporting for 2019. Again, you are only required to complete MIPS reporting if you do not meet all three of the exemption criteria. If you meet some, but not all, LVT criteria, you will be allowed to “opt in” to MIPS reporting. However, be aware that once you opt in, that decision is final and cannot be changed for that reporting year.

For group practices where more than one psychologist bills under the same tax identification number: You might review the Medicare billing for your group and find that MIPS reporting is required for the group, but exempt if you reported individually. You will have to decide how you report as you have the option to report to MIPS as an individual provider or as part of the group. The pro of reporting as a group is that then you have the possibility of earning bonus payments from Medicare starting in 2021. The con is that there are possible payment penalties as well. Individual providers reporting under MIPS can choose to report using claims, a MIPS registry, a qualified clinical data registry, through electronic health records, or through CMS directly. Groups cannot report MIPS information through claims.

If you choose or are required to report under MIPS, then starting in 2021 you may receive payment bonuses of up to 7% or penalties down to -7%. Most providers will likely have no payment adjustment, positive or negative, due to how MIPS is designed. While MIPS has four categories of reportable information (quality, promoting interoperability, advancing care initiatives, and cost), for 2019 psychologists are only asked to report on information related to quality and advancing care initiatives. Cost information will be taken from claims, and promoting interoperability will be scored a zero due to psychologists not being included in the meaningful use incentives designed to promote the adoption of electronic health records. The score for each category will then be weighted as follows and added together for a final score:

  • Quality = 45% of MIPS final score
  • Promoting Interoperability = 25% (0% for psychologists and certain other providers in 2019)
  • Cost = 15%
  • Improvement Activities = 15%

MIPS data reported for 2019 will start January 1, 2019 and end December 31, 2019. Only data submitted to CMS by March 31, 2020 will count toward your 2019 score. You will receive feedback from CMS in July 2020 and then will see any payment adjustments based on your MIPS score starting on January 1, 2021.

As always, feel free to email with questions and/or comments – SamanthaSlaughterPsyD@gmail.com.