Medicare reimbursement of clinical social worker (CSW) services at 75% of the reimbursement rate for clinical psychologists’ services was enacted by Congress in 1989 when it recognized CSWs as direct providers of outpatient mental health services through the Medicare program (PL 101-239).
Although this reimbursement policy has been in effect since 1989, many CSWs only recently became aware of the problem when the Health Care Financing Administration (HCFA) revised the coding system. As you may be aware, the new system differentiates between the codes and reimbursement for psychotherapy services that are provided with and without medical evaluation and management (i.e., medication). Psychotherapy services that are provided in conjunction with medication management are reimbursed at a higher rate and are only reimbursable to psychiatrists. Psychotherapy services that are provided without medication management are reimbursed at the same level for psychiatrists and clinical psychologists, but are reimbursed at a reduced rate for clinical social workers.
HCFA could not establish the same reimbursement level for non-medical psychotherapy services provided by clinical social workers, because the CSW reimbursement methodology is established in the law. HCFA does not have the administrative authority to change it. Ironically, the coding change highlighted the existing inequity in reimbursement, but many social worker providers actually realized an increase in reimbursement as a result of the HCFA change. (An increase in the reimbursement for clinical psychologists resulted in an increase for clinical social workers.)
As a statutory provision, the Medicare reimbursement methodology for CSW services can only be changed by amending the law. S.158, the Clinical Social Worker Services Act of 1997, was introduced in the US Senate this year by Senator Daniel Inouye (D-HI) to improve reimbursement for CSW services under Medicare Part B. NASW members may receive additional information on S. 158 by referring to the March 1997 NASW NEWS, the NASW Home Page at http://www.naswdc.org., or the January 21, 1997 Congressional Record.
w NASW members should be encouraged to contact each of their Senators to ask them to cosponsor S. 158 and to lend their support for its passage.
w NASW members should also be encouraged to contact their Representative and ask that he/she introduce identical legislation in the House of Representatives.
NASW Government Relations Contact:
Madeleine Golde,
Phone: (202) 336-8261 or 1-800-638-8799,
extension 237
Fax: (202) 336-8311
E-mail: mgolde@naswdc.org
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The National Association of Social Workers is the largest organization of professional social workers with 155,000 members. It promotes, develops and protects the practice of social work and social workers. NASW also seeks to enhance the well-being of individuals, families, and communities through its work and through its advocacy. A professional social worker has a degree in social work and meets state legal requirements. Professional social workers practice in many settings including family service agencies, child welfare, community mental health centers, private practice, schools, hospitals, employee assistance programs, and public and private agencies. Professional social workers are the nation's largest group of mental health services providers.
The National Association of Social Workers (NASW) is located at 750 First Street, NE, Suite 700, Washington DC 20002-4241. Telephone is 202/408-8600, FAX 202/336-8311 and TTD 202/408-8396.
