The 'S of CSW Billing
The 'S of CSW Billing
The
’s of CSW Billing
A
clinical social worker (CSW) is a programs, and government programs and In addition, covered services include
practitioner trained, educated, can assist patients and their families in those that the CSW is legally authorized
and licensed at the graduate accessing this support. In many can- to perform under State law or regulation
level, with a master’s degree or higher in cer programs, the clinical social worker to diagnose and treat mental illnesses.
social work, to provide mental health ser- coordinates and/or facilitates patient and Services provided to beneficiaries that are
vices for individuals, families, and groups. caregiver support groups. inpatient or in a partial hospitalization
Some states have licensing requirements, The clinical social worker is generally program are considered to be Medicare Part
and these practitioners are referred to as part of a multidisciplinary team that works A expenses, while services performed in a
licensed clinical social workers (LCSWs). together to meet the needs of the cancer physician’s office, outpatient hospital, hos-
The profession of clinical social work patient and/or family. The CSW may be pice, or community mental health center
originated in the 1920s, and the role primarily responsible for managing practi- can be billed by the CSW to Medicare Part
of social workers shifted over time with cal issues, such as transportation, hous- B. Mental health services provided to a
increasing attention on individual social ing, financial assistance, and language or skilled nursing home patient may be Part A
adjustment. By the mid-20th Century, cultural barriers to treatment or ancillary or Part B, depending on the nature of the
psychiatric social work was an accepted services. While the primary assistance pro- patient’s admission to the SNF.
area of practice and laid the foundation vided by the social worker may be providing Covered therapeutic services are reim-
for what would be labeled “clinical social education related to the disease process, bursed as follows:
work” in the 1970s. discussion of treatment decisions, and sup- • The payment for CSW services is based
Of the four core mental health profes- port with coping skills, the CSW may also on 80 percent of the lesser of 1) the
sions, social workers comprise the largest provide and document individual and family actual charge, or 2) 75 percent of the
group of clinically trained practitioners in counseling sessions. physician fee schedule.
the United States. In addition, social work- • Professional services billed outpatient
ers are more likely than psychologists and Reimbursement in a Critical Access Hospital (CAH)
psychiatrists to work in rural communities.1 For purposes of Medicare reimbursement, are reimbursed at 115 percent of the
a clinical social worker is an individual allowed amount (75 percent of the
Cancer Center Social Work who possesses a master’s degree or physician fee schedule). The CAH is
A cancer center social worker typi- doctorate in social work, has performed required to append HCPCS Level II
cally provides psychosocial services to at least two years of supervised clinical modifier AJ (clinical social worker) to
patients, families, and caregivers facing social work, and either: the professional charges.
the impact of a cancer diagnosis. Social 1. Is licensed or certified as a clinical • The annual Medicare Part B deductible
workers are knowledgeable about the social worker by the State in which the and 20 percent coinsurance apply to
psychosocial, emotional, and financial services are performed, or CSW services.
issues that cancer patients may con- 2. If the State does not have a licensing or
front. Oncology social workers help fa- certification process, has completed at Covered clinical social worker services
cilitate the patient’s adjustment to can- least two years or 3,000 hours of post in the hospital outpatient setting are
cer and can help patients navigate the master’s degree supervised clinical social reimbursed by Medicare Part B, regard-
healthcare system. In addition, oncology work practice under the supervision of a less of whether the CSW is employed by
social workers are knowledgeable about master’s level social worker in an appro- the hospital or practices independently.
local resources, pharmaceutical and priate setting, such as a hospital, skilled However, clinical social workers cannot bill
non-pharmaceutical patient assistance nursing facility (SNF), or clinic. Medicare directly for outpatient services;