Billing and Coding News for Clinical Social Workers
Mirean Coleman, LICSW
Director of Clinical Practice
June 13, 2023
There have been several coding changes for private practitioners who are licensed as clinical social workers to diagnose and treat mental illness.This document outlines two recent major coding updates on prolonged services and behavioral health integration (BHI) that clinical social workers should be aware of when filing a claim for reimbursement.
Prolonged Services
Prolonged service codes allow clinical social workers to seek reimbursement for clinical services for direct patient contact that goes beyond the usual service or requires an extended psychotherapy treatment session.Prolonged service codes 99354 and 99355 were previously used to report outpatient psychotherapy services.Beginning January 2023, deletion of the prolonged service codes became problematic for private practitioners who used them to report trauma related services requiring 90 minutes or more.
After several months of research and meetings, the National Association of Social Workers and other mental health associations were able to discover a solution through contacts with the Centers for Medicare and Medicaid Services (CMS) and other third-party payers.To report prolonged services, clinical social workers may now report two units of 90834, individual psychotherapy for 45 minutes, for a total of 90 minutes on the CMS-1500 form. If a session needs to be extended due to a crisis, then the psychotherapy crisis codes 90839 and 90840 should be reported.
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When providing prolonged services beyond 50 minutes for 90847, family therapy with the patient present, report two units also. If the family psychotherapy session requires an extension due to a crisis, then the psychotherapy crisis codes would be appropriate to report.
Although reporting two units of time is the preferred method of reporting prolonged services for psychotherapy, not all third-party payers are using this model.Therefore, clinical social workers should contact third-party payers with whom they are credentialed to learn what their preferred method of reporting prolonged services is.
In addition, it is important to document in the clinical record why the prolonged service was necessary.The rationale must be related to the patient’s needs, not the clinical social worker’s needs.For example, a trauma related treatment modality generally requires a prolonged service.
Behavioral Health Integration Services
CMS has approved BHI services for use by clinical social workers allowing them to be reimbursed for monthly care integration when the mental health services they offer are the focus of care. BHI services are for the facilitation and coordination of mental health conditions. The services may be reported by using code, G0323, and include an initial assessment and follow-up including the administration of validated rating scales.The patient must be seen for at least 20 minutes per calendar month. A primary care setting is an example of where these services may be provided.
NASW is a member of the American Medical Association Current Procedural Terminology Health Care Professional Advisory Committee (AMA/CPT/HCPAC) where codes are developed and revised. The association advocates for the best coding procedures for clinical social workers.
Members who have questions about coding for reimbursement may email mcoleman.nasw@socialworkers.org