Agencies
Services
Provider Notice Issued 10/07/2020
Date: October 7, 2020
To: Local Education Agencies, School-based Health Services
Re: Change in Social Work Services Procedure Codes
The purpose of this notice is to notify Local Education Agency (LEA) providers of changes to social work services CPT codes effective with dates of service on or after January 1, 2020.
The following social work services codes have been closed and replaced with time-based codes effective with dates of service on or after January 1, 2020:
· 96152 – Individual Social Work
· 96153 – Group Social Work
For LEAs that had existing social work rates, each provider’s rate table has been updated to reflect the following new codes, short descriptors, and maximum quantity amounts effective with dates of service on or after January 1, 2020.
CPT Code |
Short Descriptor |
Max Qty |
96158 |
Individual Social Work, initial 30 minutes |
1 |
96159 |
Individual Social Work, each additional 15 minutes |
4 |
96164 |
Group Social Work, initial 30 minutes |
1 |
96165 |
Group Social Work, each additional 15 minutes |
6 |
Descriptors and maximum quantities for the new codes are based on the federal code structure. Maximum quantities billable for 96159 and 96165 continue to represent 15-minute increments and should be billed after the initial 30-minute increment for 96158 and 96164, respectively.
Claims Processing
Providers will need to resubmit electronic claims using bill type (also referred to as claim frequency) ‘1’ for any services that were billed and rejected for the C31 edit due to use of an obsolete procedure code prior to notification of the above guidance, or because claims rejected for S99 - Missing SBHS Cost Data/Pricing Rate. Rates for the new codes have now been loaded based on each LEA’s previous social work rates. As a reminder, timely filing is 18 months from date of service.
Questions may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Kelly Cunningham
Interim Medicaid Administrator