clinical social work association

Reimbursement Updates for LCSWs

November 6, 2024

Laura Groshong, LICSW, CSWA Director of Policy and Practice

 

There is some important information about changes - and potential changes - to LCSW reimbursement that we wanted to let you know about.

Physician Fee Schedule

The Physician Fee Schedule (PFS) came out on Friday, November 1, and outlines changes to reimbursement rates for the over 300 categories of Medicare providers, including LCSWs. The PFS is not finalized, but the recommendation is that there be a 4% raise in LCSW rates for all CPT codes that we are eligible to use. This is one of the largest increases suggested for any group. Of course, our rates are still much lower than other mental health clinicians, so this is only a start toward the reimbursement we should be receiving. But it is a start.

 

Telemental Health

Another important issue that many members are concerned about is the continuation of coverage for telemental health and audio-only psychotherapy. These delivery systems are currently scheduled to end on December 31, 2024. There are several bills in Congress that would extend coverage in some way. The most likely bill to pass is one which would continue it for two years until December 31, 2026, when it would be reviewed again. The likelihood is that nothing will happen until after elections are counted, so probably next week at the earliest. We will keep you posted on developments as they occur.

 

Optum Audits

Finally, Optum, without explaining why they engaged in audits of LCSWs, is reporting that the audits of LCSWs (and others) who received overpayments are over. If you are still having problems with reimbursement as a result of the Optum error, please let us know.