Center to Advance Palliative Care

To bill under Medicare, you will need to know what services your State regulations authorize for the diagnosis and treatment of mental illness by an LCSW. In most cases, Medicare billing for the LCSW is relatively straight-forward. A DSM III diagnosis is required and billed with an AJ modifier (eg 90801AJ). LCSW's do NOT bill using Evaluation and Management Codes - psychotherapy services codes are based on time. As you may know, Medicare does not reimburse outpatient providers for LCSW services delivered in the hospital or in a Skilled Nursing Facility.

Each private insurer has its own set of rules for LCSW billing and reimbursement. You should also be aware that some private insurance companies have a separate mental health subcontractor. You will need to gather qualifying and documentating information from non-Medicare insurers.

Finally, it is important to note that all mental health services are subject to an outpatient psychiatric services limit.