Wiki LCSWs and E/M Codes

[dballard2004]

Does anyone know where I can find the CMS definition of a qualified health care professional? I have the CPT manual definition.

My question centers on codes 99446-99449 and 99451. I have a licensed clinical social worker (LCSW) reaching out to see if she and her team can report these codes. CPT is vague only stating that these codes can be reported by physicians or other QHPs.

My assessment is that since these codes are categorized to the E/M section of the CPT nomenclature, the only providers who could report them are physicians (MD/DO), NPPs, and since I am referring to behavioral health, psychologists and psychiatrists. I guess I have two questions:

1. Are LCSW considered a QHP by CMS definition since CPT seems vague?
2. Can LCSWs report these codes?

Sorry for the long questions. I am hoping someone has insight. Thanks.

 

[TThivierge]

Hi D Ballard 2004,
Yes can use those CPT codes above for all QHP and MD if desire as long as document. On the phone calls made by MD vs LCSW are different codes Need to use CPT 98966-98968 for LCSW or NP or Nurse or other QHP plus ensure they put minutes recorded in documentation. Whereas MD PA NP for phone calls can use 99441 -99446. If video recorded add modifier 95 (video) to other Eval Mgnt codes. Modifier 93 (phone) can be used for Eval Mgt codes too.
I hope helped you.
Lady T

 

[dballard2004]

Thanks so much!