July 3, 2025

By Laura Groshong, LICSW, CSWA Director of Policy and Practice

A new rule issued by CMS affects the practices of LCSWs. I encourage all CSWA members to read the entire rule at https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf. I want to call your attention to two parts of the rule that are problematic (I added the yellow highlighting), specifically related to clinical social workers’ ability to provide services in skilled nursing facilities, as well as in-person visit requirements. See the glossary of terms used by CMS below*, as well as a detailed interpretation of the rule:

MFT Scope of Medicare Practice/MHC Scope of Medicare Practice

Payment

- We pay only on assignment.

- We pay for services at 80% of the lesser of the actual charge or 75% of the amount a CP gets under the PFS.

- We don’t pay under the MFT benefit category for MFT services to patients under a PHP or an IOP by a hospital outpatient department or CMHC.

- We exclude MFT services provided to SNF residents from consolidated billing. Include the SNF’s Medicare provider number when you bill for these Part B services. This means MFTs and MHCs can bill Medicare for independent services in SNFs while CSWs cannot.

LCSW Scope of Medicare Practice

Clinical Social Worker

Payment

- We pay only on assignment

- Paid at 80% of the lesser of the actual charge for the service or 75% of the CP’s PFS

[No coverage of independent CSW services as for MFTs and MHCs] This means that CSWs cannot bill Medicare for independent services in SNFs while MFTs/MHCs can.

All Mental Health Clinicians

In-Person Meetings

Starting October 1, 2025, in-person visit requirements will apply for mental health services provided by telehealth. This includes a required in-person visit within the 6 months before the initial telehealth treatment, as well as the required subsequent in-person visits at least every 12 months.

Problems:

The problems CSWA sees with this rule are as follows:

1. The long standing (1997) rule that has prevented LCSWs from providing psychotherapy for residents of skilled nursing facilities does not apply to MFTs and MHCs who are allowed to do so. This is extremely unfair to LCSWs. We must be allowed the same privilege.

2. There will be an in-person requirement every 6 months/12 months when patients are being seen virtually. This would likely make it impossible to work with virtual patients who are more than an hour away; in addition, some LCSWs no longer have an actual office. This will also interfere with the way the Social Work Compact will be run when it opens in the next year, as the Compact will allow LCSWs to work in all member states without seeing patients in person.

Action steps:

CSWA will be addressing the disparity in Part B coverage between CSWs and MFTs/MHCs working in SNFs, as well as the issue of seeing patients in person every 6 months/12 months to conduct virtual psychotherapy. Your help is needed. Please send the following message to your members of Congress at https://www.congress.gov/contact-us: “I am a constituent and a member of the Clinical Social Work Association. The new Medicare rule at https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf will seriously impact the psychotherapy practices of licensed clinical social workers, the largest group of mental health clinicians in the country (370,000). Please tell CMS to include LCSWs as a group that can bill independently for psychotherapy services in SNFS under Part B; all other Master’s mental health clinicians are now allowed to do so. Also, please eliminate the requirement that patients being seen virtually must be seen in person every 6-12 months. This would make it impossible to see patients in other states or jurisdictions as many LCSWs do now.”

As always, please send me an email at lwgroshong@clinicalsocialworkassociation.org when you have sent your messages.

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*GLOSSARY

CMHC = community mental health center (Federal)

CP = clinical psychologists

IOP = intensive outpatient services

MFT = licensed marriage and family therapist

MHC = licensed mental health counselor

PFS = physician fee schedule [includes LCSWs]

PHP = primary health provider

SNF = skilled nursing facility