Billing / Billing Codes

NASW receives frequent telephone calls regarding place of service codes required on the professional claim form, CMS-1500, when seeking reimbursement from third-party payers. These codes specify where services are rendered, and may result in a denied claim if used inappropriately. There are more than 40 place of service codes used for reimbursement purposes, and third-party payers may have different payment policies regarding them. Thus, clinical social workers should familiarize themselves with the payment policies for place of service codes of health plans utilized in their practices. The codes frequently used by clinical social workers in private practice are listed below.

The Health and Behavior Assessment (H and B) Current Procedural Terminology (CPT) Codes were introduced to the physician fee schedule in January 2002, after several years of development, in which NASW was an active participant. (NASW’s role in the development of these codes is discussed in the Clinical Social Work Practice Update, New Health and Behavior Assessment CPT Codes for use by Clinical Social Workers.) These codes identify the psychological, behavioral, emotional, cognitive, and social factors significant to prevention, treatment, or management of a physical illness. The primary focus of the assessment is on the biopsychosocial factors important to physical health and treatment. These codes identify services that clinical social workers are trained to perform and have been conducting for years without compensation. The social work profession was excited to finally have reimbursement procedures identified for physical health purposes.

Effective January 1, 2002, clinical social workers have access to additional CPT billing codes for procedures and services performed in their private practices. The codes are called health and behavior assessment and are for use by clinical social workers and other health and mental health practitioners. They are published in the Current Procedural Terminology CPT 2002 and are reimbursable through insurance carriers.