The business of neuropsychology: Training in neuropsychology further widens the wRVU gap

<b>Objective:</b> Meaningful differences exist in billing and work productivity, as measured using wRVU, associated with psychological intervention versus assessment services. This paper focuses on billing for work completed by psychology trainees and how those services differentially impact supervisors' productivity indicators, potentially threatening the future of psychological and neuropsychological assessment. We provide suggestions on how to address this and related issues affecting supervising neuropsychologists. <b>Methods:</b> A review was performed of the limited literature pertaining to billing practices for psychological services conducted by various levels of trainees. Resources pertaining to productivity associated with trainee services under supervising physicians were also reviewed. <b>Conclusions:</b> Psychotherapy and other psychological intervention services enable supervising psychologists to use "incident to" or supervisory billing, which can confer productivity to the supervisor. In contrast, this is not allowable for most aspects of trainee involvement in neuropsychological evaluation, except when the supervisor is physically present. No clear rationale was uncovered for this striking difference. We propose a call to action for members of our national organizations to advocate for better representation of neuropsychologists' services, with the goal of obtaining parity with our clinical psychologist colleagues in terms of work productivity for supervising trainees.