Medicare Updates

Medicare Physician Fee Schedule Final Rule Summary: CY 2024

The final rule for the Medicare Physician Fee Schedule (PFS) in 2024 has been issued and will go into effect on January 1, 2024. This link is to the complete Summary: https://www.cms.gov/files/document/mm13452-medicare-physician-fee-schedule-final-rule-summary-cy-2024.pdf
Please find a list of the changes that will affect clinical social workers below.
Physician Fee Schedule Changes
New codes:

• CPT 0591T-0593T will now be available for “health and well-being coaching services” on a temporary basis.
• HCPCS G0136 will now be available for Social Determinants of Health Risk Assessment (SDOH) permanently.

Telemental Health Services:

• Telemental health services will continue to be covered through 2024, regardless of where the patient is located.
• The requirement that patients be seen in person every six months is delayed throughout 2024.
• The modifier for telemental health services will continue to be “95”.

Expansion of Behavioral Health Services:

• LMFTs and LMHCs will be included as mental health providers under Medicare.

Expansion of Crisis Codes:

• CPT codes for crisis services, 90839 and 90840, will be covered by Medicare regardless of the location of the patient.

New Codes for LCSWs:

• Health Behavior Assessment and Intervention (HBAI) services will now be covered for LCSWs by Medicare using CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168. These codes are designed to assess the psychological, behavioral, emotional, cognitive, and social factors included in the treatment of physical health problems.

Change to Relative Value Units (RVUs) for LCSWs:

• Over the next four years there will be an increase in payment for in-office psychotherapy, to be determined.

Clinical Social Work Association
The National Voice of Clinical Social Work