Written by Marilyn Glidden, CPC, CPMA, CGSC, CGIC
So you are thinking of adding Social Workers to your practice. But you are thinking- Will the services be covered? What requirements must be met? Is it even worth it? What codes can they bill?
Here are the answers to your questions-
Clinical social workers (CSW); are recognized as being eligible under Part B of the Medicare Program to provide diagnostic and/or therapeutic treatment for mental, psychoneurotic, and personality disorders to the extent permitted under State law. I have found that private payers are also following these same requirements & guidelines. As always check with your local carriers to verify coverage.
REQUIRED QUALIFICATIONS for Clinical Social Workers (CSW)
He or she must meet the following qualifications:
- Has a Master’s or Doctoral degree in social work;
- Has performed at least two years of supervised clinical social work; and
- Is licensed or certified as a CSW by the State in which the services are performed; or
- If the individual practices in a State that does not provide for licensure or certification, has completed at least two years or 3,000 hours of post Master’s degree supervised clinical social work practice under the supervision of a Master’s level social worker in an appropriate setting (e.g., a hospital, Skilled Nursing Facility [SNF], or clinic).
COVERAGE
The following coverage criteria apply:
- He or she is legally authorized to furnish the services in the State where they are performed;
- Services are not otherwise precluded due to a statutory exclusion, and the services must be reasonable and necessary;
- Services are for the diagnosis and treatment of mental illnesses;
- CSW services furnished to hospital inpatients are not covered as CSW services;
- CSW services to hospital outpatients are covered and paid under the CSW benefit when billed by the hospital to a Part B Carrier or Medicare Contractor under the CSW’s National Provider Identifier;
- CSW services furnished to patients under a Partial Hospitalization Program (PHP) that is provided by a hospital outpatient department or Community Mental Health Center (CMHC) are not covered and paid under the CSW benefit;
- CSW services furnished to SNF inpatients and patients in Medicare-participating End-Stage Renal Disease facilities are not covered and paid under the CSW benefit if the services furnished are required under the respective requirements for participation;
- Incident to services that CSWs furnish for physicians, CPs, CNSs, NPs, PAs, or CNMs may be covered; and
- Services furnished as an incident to a CSW’s personal professional services are not covered
PAYMENT
The following payment guidelines apply for Medicare:
- Payment is made only on an assignment basis; and
- Services are paid at 75 percent of the amount that a CP is paid under the Physician Fee Schedule (PFS).
Codes used by Clinical Social Workers – CSW’s use psychotherapy codes for their patients not E/M codes. In 2013 there were numerous changes, deletions & revisions to these codes that you need to be aware of. Here is a list of CPT codes most used by CSW’s. (This is not a complete list)-
- 90791 Psychiatric Diagnostic Interview.
- 90832 Psychotherapy, 30 minutes with patient and/or family member.
- 90834 Psychotherapy, 45 minutes with patient and/or family member.
- 90837 Psychotherapy, 60 minutes with patient and/or family member.
- 90785 Interactive complexity (Use only as an add-on code with the following new and existing psychotherapy codes: 90791, 90832, 90834, 90837, and 90853).
- 90839 Psychotherapy for crisis; first 60 minutes.
- 90840 Psychotherapy for crisis; each additional 30 minutes.
- 90845Psychoanalysis.
- 90846 Family psychotherapy (without the patient present).
- 90847 Family psychotherapy (conjoint psychotherapy, with the patient present).
- 90849 Multiple-family group psychotherapy.
- 90853 Group psychotherapy (other than of a multiple-family group).
- 90880 Hypnotherapy.
- 90889 Preparation of report of patient’s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other physicians, agencies, or insurance carriers.
As far as adding CSW’s to a practice being worth it, the information outlined above should provide some considerations to staffing and billable services. For many practices specializing in behavioral health, CSW’s could be a valuable asset to increase revenue and lighten an MD/DO case load.
http://www.socialworkers.org/assets/secured/documents/practice/clinical/ppnewcodes.pdf