Introduction
Clinical psychology services span intervention and assessment, with the aims of diagnostic clarification, identifying risk factors, and treatment planning to promote functioning. While we would assert that all clinical psychology services are highly valuable, “work relative value units” (wRVU) and reimbursement rates assigned to individual psychology billing codes by the Centers for Medicare and Medicaid (CMS) do not align with that perspective (e.g., CMS, 2026; APA, 2020). Unfortunately, inequitable valuation of psychology services can limit provider salaries when directly associated with a wRVU target (Sweet et al., 2021; Petranovich, et al., 2023; Dawson & Speelman, 2023). Inequitable valuation also risks reducing access to health-related psychology services in the long term if psychologists can achieve higher wRVU and reimbursement for other services (e.g., Dawson & Speelman, 2023).
In this article, we briefly review the history of the RVU system, break down available data on current wRVU and reimbursement rates for various psychology services, and conclude with a call to action for psychologists offering clinical services to stand together to improve recognition of the true value of all psychology services.
Brief Primer on Value Determination
CMS originally created the RVU system to improve consistency in reimbursement for medical services rendered in various settings (Chan, Huynh, & Studdert, 2019). wRVUs were originally created to reflect the time and intensity associated with individual medical services based on feedback from a committee comprised of approximately 30 medical professionals from organizations representing multiple medical subspecialties and adjacent fields (AMA, 2025). Feedback from the American Psychological Association (APA) is considered when updating value determinations for psychology billing codes (APA, 2017). However, estimating intensity associated with various medical services has been based on a process that has been heavily criticized, as has implementation of wRVU as a measure of provider productivity (e.g., Childers & Maggard-Gibbons, 2020; Urwin & Emanuel, 2019; Satiani, Matthews, & Gable, 2012; Katz & Melmed, 2016; Steel, Rolin, & Davis, 2024; Chan, Huynh, & Studdert, 2019).
Some psychologists may feel unimpacted by this issue if their productivity is measured by hours billed, revenue generated, or another metric. However, the same system that determines wRVUs (i.e., CMS) associated with specific billing codes also determines reimbursement rates for those codes, thereby directly impacting all of us. Further compounding this issue is the direct link between productivity targets, when based on wRVU or revenue generated, and provider salary. Furthermore, CMS guidelines for reimbursement of services are often referenced by other government and commercial insurance plans when determining if and to what extent specific services should be covered (Chan, Huynh, & Studdert, 2019).
For many psychologists, especially in academic medical settings, wRVU targets and salary are based on proprietary data published by companies that may have limited sample sizes, especially of psychologists (Sweet et al., 2021; Petranovich, et al., 2023; Rosner & Faulk, 2020). As a result, they often do not distinguish psychology subspecialists who are likely to bill different service codes from traditional psychotherapy (Dawson & Speelman, 2023). Because wRVUs vary across psychology billing codes, this results in some psychologists literally working more hours in order to meet the same target as their colleagues (Dawson & Speelman 2023). This particularly affects those of us whose services focus on patients experiencing acute or chronic health conditions, including cognitive decline.
What the Data Show
The table below reflects the wRVU and reimbursement rates for common psychology intervention and assessment codes at the time this manuscript was prepared (CMS, 2026). Facility versus non-facility prices reflect the type of environment in which services occur, with facilities commonly being hospital or “hybrid” settings and non-facilities typically being outpatient clinical spaces.
Table 1. CMS Physician Lookup Tool Data
(Based on the first line of values listed under all Medicare Administrative Contractor options for simplicity)
| Code | Description | Type of unit | wRVU | Non-Facility Price | Facility Price |
|---|---|---|---|---|---|
| Traditional intake and intervention services | |||||
| 90791 | Psychiatric intake interview | unspecified | 3.84 | $166.91 | $142.97 |
| 90832 | Psychotherapy, 30 min | 30 min | 1.86 | $78.93 | $68.90 |
| 90834 | Psychotherapy, 45 min | 45 min | 2.45 | $104.16 | $90.89 |
| 90837 | Psychotherapy, 60 min | 60 min | 3.63 | $154.29 | $134.56 |
| Health and Behavior intake and intervention services | |||||
| 96156 | Health & Behavior intake | unspecified | 2.30 | $98.98 | $86.69 |
| 96158 | Health & Behavior intervention, first 30 min | 30 min | 1.59 | $67.93 | $23.29 |
| 96159 | Health & Behavior intervention, each additional 15 min | 15 min | 0.55 | $23.29 | $20.38 |
| Common assessment services | |||||
| 96116 | Neurobehavioral intake interview, first hour | hourly | 1.86 | $88.63 | $76.34 |
| 96121 | Neurobehavioral intake interview, each additional hour | hourly | 1.71 | $72.78 | $63.72 |
| 96130 | Psychological evaluation, first hour | hourly | 2.56 | $117.42 | $106.10 |
| 96131 | Psychological evaluation, each additional hour | hourly | 1.96 | $82.81 | $72.46 |
| 96132 | Neuropsychological evaluation, first hour | hourly | 2.56 | $125.18 | $102.86 |
| 96133 | Neuropsychological evaluation, each additional hour | hourly | 1.96 | $93.48 | $72.78 |
| 96136 | Psychological or neuropsychological test administration by psychologist, first 30 min | 30 min | 0.55 | $40.76 | $22.63 |
| 96137 | Psychological or neuropsychological test administration by psychologist, each additional 30 min | 30 min | 0.46 | $35.90 | $17.14 |
| Note. Add on codes identified in gray | |||||
Note that the table above does not convey the additional negative impacts of the RVU system on productivity measurement and reimbursement in the context of working with psychometrists or trainees in the area of psychological and neuropsychological assessment. Interested readers are encouraged to review Dawson, Boxley, & Wishart, 2026 and Dawson, Wishart, & Boxley, 2026. Also note that lower reimbursement for services rendered in a facility is due to a separate, additional facility fee that is charged for work in those settings.
Productivity
A key takeaway from Table 1 is the much higher wRVU associated with psychotherapy codes and “psychiatric” intake interviews (90791). 90791 is typically used preceding initiation of psychotherapy and is associated with a high wRVU. The health psychology interview and intervention codes are undervalued by comparison. Similarly, all psychology assessment codes are undervalued. A striking example is the equivalent wRVU associated with a 30-min psychotherapy session (90832) and a 60-min neuropsychological intake interview (96116). Another takeaway that is challenging to understand is the determination that the first 30-60 min of a given service has been determined to somehow be more complex than the remainder of time spent on the same activity (e.g., 96132/96133; 96130/96131). The wRVU associated with psychological and neuropsychological test administration is particularly low, at less than 1.0 wRVU per 60 minutes (96136/96137); this is despite the fact that the psychologist or neuropsychologist is most likely continuing to mentally perform case conceptualization and clinical decision making throughout test administration. Figure 1 provides another way to visualize how these rates clearly reflect different valuations.
Figure 1.
Illustration of Major Differences in Hourly wRVU Associated with Select Clinical Psychology Billing Codes
Note. Dark bars represent one unit of traditional psychiatric interview and a 60-min psychotherapy session, medium gray bars represent health and neuropsychology interviews and interventions per unit or per hour, and light gray represents the first hour of psychological/neuropsychological test administration.
Reimbursement
A similar pattern in reimbursement rates is visualized in Figure 2, where traditional psychological interviews and psychotherapy are associated with much higher reimbursement by CMS than other clinical psychology services. It also illustrates that the first hour of a multi-hour service is valued at a higher rate (e.g., 96130 versus 96313; 96132 versus 96133), although how the first hour might be more valuable than subsequent hours is unclear if all hours of that service are clinically warranted and necessary to complete a specific service (e.g., psychological or neuropsychological evaluation).
Figure 2.
Illustration of Major Differences in CMS Reimbursement Rates for Select Clinical Psychology Codes in a Non-Facility Setting
Note. As with Figure 1, dark bars represent one unit of traditional psychiatric interview and a 60-min psychotherapy session, medium gray bars represent health and neuropsychology interviews and interventions per unit or per hour, and light gray represents the first hour of psychological/neuropsychological test administration.
Comparison with Similar Services
The rationale behind lower reimbursement and wRVU for most assessment versus intervention codes is unclear. This is particularly reflected by the huge difference in wRVU and reimbursement rate for a CPT code that overlaps considerably with 96116 in terms of clinical services rendered but is billed by medical providers. CMS now requires annual screening for cognitive impairment in adults aged 65+. The CPT code 99483 (“Assessment and care planning for patients with cognitive impairment”) can be used by physicians and nurses during a follow-up visit to further assess cognition and determine a “care plan” (CMS, 2025). While not specifically time-based, CMS estimates that such appointments take approximately 50 minutes to complete. 99483 is associated with 3.84 wRVU and is reimbursed at $292.93 (again, based on the first line of values listed under all Medicare Administrative Contractor options). The wRVU is identical to that assigned to 90791, yet the reimbursement is double that of 90791 and triple that of 96116.
Potential Consequences
A risk of the inequitably low values for services, such as psychological and neuropsychological evaluation, is the shift of clinicians away from providing these critical services. In hospital settings, psychologists may elect to offer primarily services associated with higher wRVU or reimbursement rates, reducing access to other important services (Stringer, 2023). In private practice, many psychologists have shifted away from accepting insurance so that they can charge a consistent fee for their services regardless of insurance status or product. This inherently reduces access to necessary services for those who are financially disadvantaged, especially individuals with Medicaid and Medicare (CMS, 2020; APA, n.d.). In effect, the inequities in the current RVU system may ultimately have broad negative consequences for behavioral health on the individual and societal level.
What We Can Do
The problem in the case of the RVU system is that, at its most basic level, its valuations lack equity and transparency. On a more conceptual level, the RVU system manifests as anachronistic in the context of the modernized move away from hierarchical to interprofessional models of care in which the unique contributions of each clinician on a team are intrinsically valued and respected equitably (Doherty & Crowley, 2013).
Short of eliminating the RVU system altogether, which is a solution that should ultimately be considered, there are potential avenues for working within the system to effect change. On a local level, psychologists are encouraged to work with administrators in their departments to promote equitable wRVU expectations across psychology subspecialties within their institutions. Psychologists can also become involved in their professional organizations, bringing inappropriate RVU valuations to light, generating creative solutions where possible, and advocating for change. Beyond working within our own subspecialities, we can collaborate with other subspecialists in support of all psychology services. While those actions may not change the RVU system, they might help decouple that system from influencing individual clinician’s salaries and work performance evaluations.
Participation in state psychology associations is also recommended, which can elevate individual voices at the collective level through Action Alerts and voting opportunities. Furthermore, state psychology associations commonly engage with government and for profit health insurance agencies, as well as with APA. As noted above, APA provides feedback to the Relative Value Scale Update Committee (RUC) of the American Medical Association, which ultimately makes recommendations on the perceived value and intensity of our clinical activities to CMS (APA 2017). It should be noted that the RUC is composed almost entirely of physicians and, as such, there is limited representation of the field of psychology on the committee. Indeed, the composition of the committee and its processes may be worthy targets for review and advocacy (AMA, 2025; Chan, Huynh, & Studdert, 2019). Ideally, we recommend increasing the number of organizations with direct communication with the RUC to include both APA and representatives from psychology subspecialist organizations to widen our impact, with an emphasis on those whose clinical services appear underrepresented (e.g., health and neuropsychology).
Outside of advocacy and governance opportunities, additional research illustrating specific positive outcomes of our clinical services and broader efforts illustrating the value of subspecialty psychology services for patients with chronic health conditions and cognitive issues are needed (e.g., Colvin, et al., 2022; Sanders, 2019).
Conclusion
In summary, psychologists are encouraged to work together to ensure the viability of all clinical services. This means increasing awareness of factors affecting subspecialist psychologists and combining our voices to improve awareness of the value of our services. There is an imperative to continue to meet the needs of our ever-changing population. Access to some specialty psychology services is already limited, with long wait times even in large metropolitan areas (Stringer, 2023). Furthermore, the world’s population is steadily increasing and aging, which in turn results in increased demand for all psychology services, including those that focus on health-related needs (APA, 2026). Our prospective ability to meet the clinical psychology needs of people in the United States will be impacted by policy and valuation decisions and therefore deserves to be front-and-center.
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Erica L. Dawson, PhD, ABPP
Board Certified in Clinical Neuropsychology
Correspondence: Erica.Dawson@osumc.edu
Laura Boxley, PhD, ABPP
Board Certified in Clinical Neuropsychology
Correspondence: Laura.Boxley@osumc.edu
Heather Wishart, PhD
Correspondence: Heather.A.Wishart@hitchcock.org