Episode 110 Transcript: HBAI Payment

Aliah Wright:

This is Social Work Talks. I'm your host, Aliah Wright.

Joining us today is Mirean Coleman LICSW, CT. Mirean is NASW's Director of Clinical Practice and she's here with some good news.

For those of you who may be unaware, in November of 2023, the Centers for Medicaid and Medicaid Services released the final rule for the 2024 Medicare physician payment schedule. Starting January 1st of this year, clinical social workers have been able to be reimbursed for HBAI services they've performed. HPAI stands for health behavior assessment and intervention services. These services are used to identify the psychological, behavioral, emotional, cognitive, and social factors included in the treatment of physical health problems. Today we're going to discuss how social workers can use them in their clinical practice.

Welcome, Mirean.

Mirean Coleman:

Thank you. I'm very happy to be here today.

Aliah Wright:

And we're happy to have you. So Mirean, let's dive in.

What exactly does this change mean for clinical social workers? In other words, why is this good news?

Mirean Coleman:

Well, this is good news because clinical social workers can now be reimbursed for HBAI services they perform in a private practice setting.

Aliah Wright:

And how long has NASW been advocating for the acceptance of these codes?

Mirean Coleman:

NASW has been advocating for clinical social workers to receive reimbursement for these codes since 2003. We've had meetings and phone calls with the Centers for Medicare and Medicaid Services, and we even introduced legislation improving mental health services for Medicare beneficiaries.

Aliah Wright:

That's great. Can you tell us the name of the codes? And perhaps we should describe exactly what the codes are.

Mirean Coleman:

These codes and services are reported by using CPT billing codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168. These codes include assessment and reassessment, individual, family, and group interventions. You can find the codes at socialworkers.org or in your show notes page.

Aliah Wright:

Thank you. So Mirean, what are those billing codes for typically?

Mirean Coleman:

Well, there's an HBAI assessment which includes an evaluation of a patient's response to their disease, their illness or injury injury, their motivation, and their adherence to medical treatment. And if you look at an HBAI intervention, it helps to promote functional improvement, it reduces psychological and psychosocial barriers to recovery, and it improves one's ability to manage their health condition.

Now let me give you a couple of examples. You may have a diabetic patient who's in denial about their health condition and does not follow their treatment plan, and they require help improving their health condition before things get worse. Or you may have a newly diagnosed cancer patient without mental health problems and they're emotionally upset and they require support to just move forward.

Aliah Wright:

And can we let social workers and the general public that's listening know, HBAI stands for?

Mirean Coleman:

HBAI stands for health behavior assessment and intervention.

Aliah Wright:

Okay. And how can social workers use these codes?

Mirean Coleman:

Clinical social workers can use these codes by reporting them on the CMS 1500 claim form, along with the appropriate diagnostic ICD-10-CM code from section F-01 through F-99 of the ICD-10-CM Diagnostic Codebook.

Aliah Wright:

Listeners, we'll be right back.

Now in its 44th year, the Cape Cod Institute will offer a summer series of week-long half-day CE courses taught by master teachers from July 1st to August 23. Courses for social workers and allied mental health professionals are offered concurrently in person and live online. The institute is approved to provide continuing education by ASWB, ACE, and the New York State Education Department's State Board for social work. Visit http://www.cape.org for more information and to register. Use discount code NASW24 for $25 off.

And we're back. Recently you held a webinar discussing what clinical social workers need to know about these codes. Can you cover what else is important?

Mirean Coleman:

Yes. There are several other HBAI codes that include services without the patient's presence that include 96170, 96171, 96161. Most third-party payers only reimburse for services that include the patient. Therefore, reimbursement is unlikely for these codes because they don't include the patient; they are inclusive of family members and other caretakers.

Aliah Wright:

Wow. And what are some of the other things clinical social workers need to know about the HBAI rule?

Mirean Coleman:

The reimbursement for HBAI services will vary in each state and among third-party payers. However, the reimbursement would be the same value as for psychotherapy services.

Aliah Wright:

And Mirean, is there anything else you'd like to add?

Mirean Coleman:

Yes. Clinical social work services are bundled in a hospital setting and they are considered incident to providers. They're unable to bill for these services. However, the hospital can bill for the services they provide or they can use them for tracking services performed by clinical social workers in the hospital.

Aliah Wright:

Mirean, thank you so much for joining us today and allowing us to discuss this very important change that's underway as we speak. We're sure clinical social workers appreciate how NASW has advocated for them in this area.

Listeners, you can find a detailed summary of what we've discussed, including the actual codes, by visiting the show notes section of our website where you can also find the text of the final rule as well. Members who have questions about coding for HBAI services may contact Mirean at mcolman.nasw@socialworkers.org.

Thanks again for tuning into this episode of Social Work Talks. We hope you enjoyed our conversation with Mirean Coleman about the new HBAI codes and what clinical social workers should know. Again, thank you so much for listening.