HHS Hikes Value of Mental Health Services in Medicare

Family physicians treating seniors for mental health disorders, such as depression, recently got a pay raise from the federal government.

For 18 months beginning July 1, 2008, HHS will increase the physician fee schedule by 5 percent for the provision of specified mental health services, including psychiatric therapeutic procedures furnished in the office or other outpatient facility settings.

The payment adjustment is buried in Section 138 of the recently passed Medicare payment legislation, H.R. 6331.

Although CMS has not yet officially posted the adjusted fee schedule, Cynthia Hughes, C.P.C., an AAFP coding specialist, said that it appeared the adjustment included CPT codes ranging from 90801 through 90829, which cover psychotherapy services that are insight-oriented, behavior-modifying, interactive, and/or supportive. She suggested FPs refer to a CPT manual for complete descriptions of the codes.

The adjustment for mental health services is not subject to the budget-neutrality constraints that initially stalled passage of H.R. 6331.

Furthermore, Section 102 of the same Medicare bill gives beneficiaries a financial break by first reducing, and eventually eliminating, long-standing discriminatory copayment rates for Medicare outpatient psychiatric therapeutic services.

Initially, Medicare patients won't see any change in their out-of-pocket expenses. They will continue to pay 50 percent of the Medicare allowable amount for mental health services and 20 percent for other Medicare services.

However, in 2010, beneficiaries will begin to see their mental health co-insurance rate drop incrementally during a period of several years. They will pay

"Medicare beneficiaries have paid the current co-insurance rate of 50 percent for a number of years, and the added cost undoubtedly caused some of them to delay needed health care," said Hughes. She added that physicians' cash flow also might get a boost when Medicare starts paying a larger portion of the payment, because payments from the government may roll in faster than those collected from patients.

In addition, leveling co-insurance percentages for all Medicare services may ease patient distress about higher-than-expected billed charges. "Sometimes patients may get upset when they get their explanation of benefits from Medicare and learn that they're going to have to pay more of the bill because the physician reported a diagnosis of something such as anxiety or depression," said Hughes.