As an example, an hour of medical psychotherapy went, in terms of coding numbers, from 90844 to G0076 to 90807. Additionally, the descriptors changed, subtly but importantly. In addition, the practice of psychiatry, including medical psychotherapy, changed radically during this period. The changes needed to be reflected in the data if psychiatrists were to get any equity within this Byzantine system. This process is still ongoing.
Payers define the system.
In order to be paid, physicians then must try to modify their system to conform with the payers' system. In the Medicare system, the rules are set by laws, and regulations that have the force of law. The goal is a standard of fairness within the context of the entire medical system that preserves equitable payment without harming our patients. In the managed care arena, the fees set by private insurers are frequently based on the Medicare fee schedule. We do not have to accept those fees unless we sign their contracts.