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Psychiatrists Still Not Reimbursed on Par With Primary Care Physicians

Monday, July 27, 2020  
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APA Psychiatric News Alert
Friday, July 24, 2020

Medicaid often reimburses psychiatrists less than primary care physicians for treating mental or substance use disorders, according to a report published today in Psychiatric Services in Advance. This disparity in reimbursement may explain why psychiatrists are less likely to participate in Medicaid than primary care physicians and why some regions face a shortage of psychiatrists, the researchers wrote.


Tami L. Mark, Ph.D., M.B.A., and colleagues analyzed data from outpatient medical claims from 2014 for 11 states. The claims were for a primary behavioral health diagnosis such as a mental or substance use disorder and included evaluation and management procedure codes of 99213 (established patient office visit, low to moderate severity) or 99214 (established patient office visit, moderate severity). The states included were Georgia, Idaho, Michigan, Minnesota, Mississippi, New Jersey, Pennsylvania, South Dakota, Vermont, West Virginia, and Wyoming.

Primary care physicians were reimbursed more than psychiatrists for code 99213 in 10 of the states and for code 99214 in nine of the states. Primary care physicians were reimbursed $1 to $34 more than psychiatrists for code 99213 and $5 to $40 more for code 99214.

“The disparity in reimbursement rates between psychiatrists and primary care physicians is inconsistent with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires that provider reimbursement rates for treating mental and substance use disorders be based on criteria that are comparable to the criteria for setting reimbursement rates for medical providers and applied no more stringently,” the researchers wrote. However, although MHPAEA applied to Medicaid managed care plans and the Children's Health Insurance Program as of 2009, these health programs had until 2017 to comply, the researchers noted.

“A key implication of these findings is that reducing reimbursement disparities between psychiatrists and other medical doctors may increase the supply of psychiatrists willing to treat Medicaid patients,” the researchers wrote.