CMS Announces 2014 RVU Values Substantially Increased for Psychotherapy Add-on Codes

On November 29, 2013, CMS issued its interim final rule establishing Medicare RVU values for 2014.  CMS accepted all the increased values recommended by the RUC for the new psychiatry psychotherapy codes to be used only in combination with an E/M code. 

CMS also corrected the error in the RVU values for psychiatric diagnostic interview that resulted in a lower value for an initial visit provided by psychiatrist.  For 2014, the RVU value for code 90791 for non-physicians will be decreased to 3.74 and the RVU value for code 90872 (psychiatric diagnostic interview with medical services) was increased to 4.03. 

The RVU values for the individual psychotherapy add-on codes for psychiatrists were substantial increased:  code 90833 (30 minutes) was increased from 1.22 to 1.85 and code 90836 (45 minutes) was increased from 1.98 to 2.34.  These changes reflect the continued advocacy by APA and the support of the AMA for full implementation of the new combination codes for psychotherapy provided by a physician.  RVU values for psychotherapy provided by a psychologist or social worker were essentially unchanged and did not benefit from the increases given to the add-on psychotherapy codes.  (A full list of the RVU changes for the most frequently used codes is included at the end of this article.)

There were slight decreases in the RVU value for code 90838, the 60 minute psychotherapy session, and also small decreases in the total RVUs for the office E/M codes due to reductions in the practice expense component of the RVU.

CMS also refused to assign any value to the new CPT code 90863 intended to be used by psychologists with prescribing authority inLouisianaandNew Mexico.  CMS stated that it was declining to assign any value to this service because “pharmacologic management services requires some know and ability to furnish E/M services” and psychologists inLouisianaandNew Mexico“remain unlicensed and unauthorized by their state to furnish E/M services.”  This language should provide powerful arguments for psychiatrists in those states struggling with efforts by psychology to secure prescribing authority.

Although RVU values for almost all psychiatrists’ services have substantially increased, Medicare Part B is once again facing the annual SGR crisis that threatens a precipitous drop in all Medicare fees because of a mandatory decrease in the Medicare Part B conversion factor.  Once again, all physicians will await action by Congress to prevent a cut in fee in excess of 25%.  Legislative proposals have been introduced to correct the SGR problem, but as in the past, final resolution remains uncertain.


CPT1/
HCPCS

Description

2014
Non-Facility

2013
Non-Facility

90785

Psytx complex interactive

0.40

0.14

90791

Psych diagnostic evaluation

3.74

4.43

90792

Psych diag eval w/med srvcs

4.03

3.65

90832

Psytx pt&/family 30 minutes

1.81

1.84

90833

Psytx pt&/fam w/e&m 30 min

1.85

1.22

90834

Psytx pt&/family 45 minutes

2.40

2.37

90836

Psytx pt&/fam w/e&m 45 min

2.34

1.98

90837

Psytx pt&/family 60 minutes

3.59

3.47

90838

Psytx pt&/fam w/e&m 60 min

3.09

3.19

90845

Psychoanalysis

2.59

2.20

90846

Family psytx w/o patient

2.91

2.17

90847

Family psytx w/patient

3.00

2.60

99204

Office/outpatient visit new

4.64

4.84

99205

Office/outpatient visit new

5.78

5.99

99213

Office/outpatient visit est

2.04

2.13

99214

Office/outpatient visit est

3.01

3.13

99215

Office/outpatient visit est

4.03

4.20

1 CPT codes and descriptors only are copyright 2013 American Medical Association.  All Rights Reserved.  Applicable FARS/DFARS apply.