Results 1 to 2 of 2

CPT code

  1. Default CPT code
    New Call-to-action
    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.

  2. #2
    Location
    South Bend, IN
    Posts
    14
    Default
    Quote Originally Posted by smithca View Post
    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.

Similar Threads

  1. cpt code 31588 versus cpt code 31541
    By jocoffey in forum ENT/Otolaryngology
    Replies: 1
    Last Post: 04-11-2016, 10:08 AM
  2. cpt code 15757 vs cpt code 40845
    By jocoffey in forum ENT/Otolaryngology
    Replies: 4
    Last Post: 04-06-2016, 01:34 PM
  3. confused - The cpt code 64590 and cpt code
    By Hibbs in forum General Surgery
    Replies: 1
    Last Post: 12-30-2015, 11:28 AM
  4. Coding ER Cpt code or outpatient cpt code
    By tkd in forum Emergency Department
    Replies: 2
    Last Post: 02-17-2012, 08:53 AM
  5. Overread CPT code 76140 vs Original CPT code
    By nperry@umc.edu in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 06-23-2011, 07:19 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.