Billing / Billing Codes

Currently, most of the Medicare waivers that were developed during the COVID-19 pandemic are scheduled to end on March 31, 2025. This includes the geographic and origination site restrictions and the in-person requirements for telehealth services. Unless Congress passes legislation to extend the waivers, clinical social workers and other Medicare providers may be required to adhere to pre-COVID Medicare reimbursement guidelines. This may significantly impact clinical social workers and other providers who have closed their in-person offices and developed telehealth practices.

During the COV-19 pandemic, Medicare expanded telehealth access by waiving geographic restrictions, broadening provider eligibility, and covering more services. Many of the telehealth waivers were scheduled to end on December 31, 2024.

Congress has intervened and approved the following telehealth updates through legislation, https://www.congress.gov/118/bills/hr10545/BILLS-118hr10545enr.pdf

Effective January 1, 2025, clinical social workers will be able to seek reimbursement for Safety Planning and Follow-up Interventions. Establishment of these payment services is an important step by the Center for Medicare and Medicaid Services (CMS) to help address the growing suicide and overdose populations.

ffective October 1, 2024, clinical social workers were impacted by several code changes to the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM). Clinical social workers should pay attention to Chapter 5, Mental, Behavioral, and Neurodevelopmental Disorders. Six new codes have been added to mental health disorders: four are for eating disorders and two are for adults. 

Effective January 1, 2025, clinical social workers may receive reimbursement for services using a digital mental health treatment (DMHT) device. The device is a software approved by the Food and Drug Administration to treat a mental health condition in conjunction with ongoing mental health treatment that includes a plan of care.

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2024 Medicare Physician Fee Schedule (CMS–1784–P). The 2024 Physician Fee Schedule details services to address health equity and health-related social needs available to Medicare beneficiaries.