NASW Social Work Talks - EP 110: Health Behavior Assessment and Intervention Services Payment Update

Episode Date: February 9, 2024

Mirean Coleman, LICSW, director of clinical practice at the National Association of Social Workers, talks about a new regulation that will allow clinical social workers to bill for Health Behavior Assessment and Intervention (HBAI) Services. Learn why this development is so important for social workers.

This episode is sponsored by the Cape Cod Institute. This is Social Work Talks. I'm your host, Aaliyah Wright. Joining us today is Marion Coleman, LICSW-CT. Marion is NASW's Director of Clinical Practice, and she's here with some good news. For those of you who may be unaware, in November of 2023, the Centers for Medicaid and Medicaid Services released the final rule for the 2024 Medicare Physician Payment Schedule. Starting January 1st of this year, clinical social workers have been able to be reimbursed for HBAI services they've performed. HBAI stands for Health Behavior Assessment and Intervention Services.

These services are used to identify the psychological, behavioral, emotional, cognitive, and social factors included in the treatment of physical health problems. Today, we're going to discuss how social workers can use them in their clinical practice. Welcome, Marianne. Thank you. I'm very happy to be here today. And we're happy to have you. So, Marianne, let's dive in. What exactly does this change mean for clinical social workers? In other words, why is this good news? Well, this is good news because clinical social workers can now be reimbursed for HVAC services they perform in a private practice setting.

And how long has NASW been advocating for the acceptance of these codes? NASW has been advocating for clinical social workers to receive reimbursement for these codes since 2003. We've had meetings and phone calls with the Centers for Medicare and Medicaid Services and we even introduced legislation improving mental health services for Medicare beneficiaries. That's great. Can you tell us the name of the codes and perhaps we should describe exactly what the codes are? These codes and services are reported by using CPT billing codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168. These codes include assessment and reassessment, individual, family, and group interventions. You can find the codes at

at socialworkers.org or in your show notes page. Thank you. So Mary, what are those billing codes for typically? Well, there is an HVAC assessment, which includes an evaluation of a patient's response to their disease, their illness or injury, their motivation, and their adherence to medical treatment. and if you look at an HVAC intervention, it helps to promote functional improvement,

it reduces psychological and psychosocial barriers to recovery, and it improves one's ability to manage their health condition. Now let me give you a couple of examples. You may have a diabetic patient who's in denial about their health condition and does not follow their treatment plan, and they require help improving their health condition before things get worse. Or you may have a newly diagnosed cancer patient without mental health problems, and they're emotionally upset, and they require support to just move forward. And can we let social workers and the general public that's listening know HVAC stands for HVAC stands for health assessment and intervention, health behavior assessment and intervention.

Okay. And how can social workers use these codes? Clinical social workers can use these codes by reporting them on the CMS 1500 claim form along with the appropriate diagnostic ICD-10-CM code from section F01 through F99 of the ICD-10-CM diagnostic code book. Listeners, we'll be right back. Now in its 44th year, the Cape Cod Institute will offer a summer series of week-long, half-day CE courses taught by master teachers from July 1st August 23rd. Courses for social workers and allied mental health professionals are offered concurrently in person and live online. The Institute is approved to provide continuing

education by ASWB, ACE, and the New York State Education Department State Board for Social Work. Visit www.cape.org for more information and to register. Use discount code NASW24 for $25 off. And we're back. Recently you held a webinar discussing what clinical social workers need to know about these codes. Can you cover what else is important? Yes.

There are several other HVAC codes that include services without the patient's presence that include 96170, 96171, and 96161. Most third-party payers only reimburse for services that include the patient. Therefore, reimbursement is unlikely for these codes because they don't include the patient. They are inclusive of family members and other caretakers. Wow. And what are some of the other things clinical social workers need to know about the HBAI rule? The reimbursement for HVAC services will vary in each state and among third-party payers. However, the reimbursement would be the same value as for psychotherapy services. And Marion, is there anything else you'd like to add?

Yes, clinical social work services are bundled in a hospital setting and they are considered incident two providers. They are unable to bill for these services, however, the hospital can bill for the services they provide or they can use them for tracking services performed by clinical social workers in the hospital. Marion, thank you so much for joining us today and allowing us to discuss this very important change that's underway as we speak. We're sure clinical social workers appreciate how NASW has advocated for them in this area.

Listeners, you can find a detailed summary of what we've discussed, including the actual codes, by visiting the show notes section of our website, where you can also find the text of the final rule as well. who have questions about coding for HBAI services may contact Marion at mcoleman.nasw at socialworkers.org. Thanks again for tuning into this episode of Social Work Talks. We hope you enjoyed our conversation with Marion Coleman about the new HBAI codes and what clinical social workers should know. Again, thank you so much for listening.