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Thread: Psychiatry and Mental Health

  1. #11
    Join Date
    Apr 2007
    El Paso


    AAPC: Back to School
    Quote Originally Posted by KristiMass View Post
    Does anyone know what the different is between a Phd. and an MD when it comes to reimbursement? Medicare does not specify a difference but the managed care payors reimburse the Phd. at a lower reimbursement 75% of the Medicare allowable. I know this is not a particular coding question, but hoped someone may know the answer?

    Kristi Kendrick, CPC

    I've worked for payers for appx 20 years and based on that experience, commercial payers fee schedules do vary for the PhD versus MD. Generally, PhD rate is about 25% lower than MD, regardless whether fee schedule is based on the Medicare fee schedule or some other calculation. Additionally, MSW and other counselors are lower than PhD rate.

    I'm not sure what the difference is today because many payers, including my current employer, use a 3rd party vendor for behavioral health and I'm not privy to those fee schedules.

    Is there a particular basis or reasoning for the difference? I can only guess that either now or at a time in the past, Medicare paid them differently. It is similar thinking that created the disparity between CRNAs (nurse anesthesists) and MD anesthesiologists.

    Hope that helps a little!
    Susan M. Garrett, CPC, COC
    Past President El Paso Texas Chapter AAPC
    Past Member AAPCCA Board of Directors
    cell 915-204-8333

  2. #12


    I've found the CPT Handbook For Psychiatrists, Third Edition, by Chester W. Schmidt, Jr., M.D, Rebecca K. Yowell, and Ellen Jaffe to be very helpful. The ISBN number is 1-58562-157-9. It's published by American Psychiatric Publishing, Inc. www.appi.org

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