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CAPC Palliative Care Discussion Forum
Billing and Financial

Next Reply: Re:Social Work Billing
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Post Social Work Billing
Author: pattonl
Date: Nov 19, 2007 5:54 pm
We are also expandeing our outpatient palliative care program and would like to be able to have our LCSW be able to bill. I am seeking any input from programs that have the social worker bill for counseling services. Our program is a fee for service program. We are affiliated with a hospice program and the medical director for the hospice program is also our medical director. Any information would be helpful.
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Re:Social Work Billing (by AmberBJones on 12/09/2007)
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.

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