Can a social worker (LCSW-R) bill cpt code 96150? I have conflicting information that says yes then can and other information that says only a clinical psychologist is allowed to use this code. Any guidance would be appreciated.
I'm sure that you went on the CMS site. This is what I found. Granted this is under the WPS (Wisconsin Physician Services) contract so I don't know if this pertains to where you're at or not.
CMS National Coverage Policy:
Title XVIII of the Social Security Act section 1862 (a)(1)(A). This section allows coverage and
payment of those services that are considered medically reasonable and necessary.
Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical
examinations and services p
Title XVIII of the Social Security Act section §1833 (c) and §1833 (e). This section prohibits
Medicare payment for any claim which lacks the necessary information to process the claim.’
Code of Federal Register
CFR Title 42, Part 410.73(b)(1) [Revised as of October 1, 2004][CITE: 42CFR410.73]
CMS) of the Act and in §2470ff
(1) Definition. ‘‘Clinical social worker services’’ means, except as specified in paragraph (b)(2)
of this section, the services of a clinical social worker furnished for the diagnosis and treatment of
mental illness that the clinical social worker is legally authorized to perform under State law (or
the State regulatory mechanism provided by State law) of the State in which the services are
performed. The services must be of a type that would be covered if they were furnished by a
physician or as an incident to a physician’s professional service and must meet the requirements
of this section.
Coding Guidelines
1. CPT codes 96150 - 96154 represent services offered to beneficiary who present with
established illness or symptoms, the purpose of the assessment is not for the diagnosis or
treatment of mental illness, and may benefit for evaluations that focus on the
biopsychosocial factor related to the beneficiary’s physical health status
2. Physician’s must bill health and behavior assessment and/or intervention services with an
Evaluation and Management or preventive Medicine service codes.
3. Medical records must document the specific underlying medical problem
4. Health and behavior assessment normally will be performed in an office or facility
setting.
5. Health and behavior assessment codes may not be used for physician (example: medical
doctor, nurse practitioner, physician assistant, clinical nurse practitioner) or clinical social
worker services.