Medicare_Carriers_Manual / 5113 / 5113

Why This Topic Matters

The article helps readers identify the Medicare policy context for clinical social worker claims and understand the broad payment and coding categories involved. It is useful for determining whether the guidance applies to a particular billing situation and for locating the manual’s references to related instructions.

Article Sections

1. Payment to Clinical Social Workers

   Introduces the Medicare payment framework for clinical social worker services and the effective date discussed in the manual entry. It also frames the policy in terms of covered diagnostic and therapeutic services.

2. Fee Schedule to Be Used for Payment of Clinical Social Worker Services

   Addresses the fee schedule basis referenced for this provider type and its relationship to comparable services. The section explains the general payment methodology at a high level.

3. Payment Limitation

   Summarizes the article’s discussion of a payment limitation that applies to certain services and notes the distinction between diagnostic and other services. It also references related manual provisions.

4. Assignment Requirement

   Covers the claim submission requirement discussed for these services and the related Medicare payment handling concepts. The section references an alternate payment procedure in the manual.

5. Coinsurance and Deductible

   Notes the general cost-sharing elements associated with these services under Medicare. It presents the topic at a high level without operational detail.

6. Coding

   Identifies the coding references associated with clinical social worker services, including specialty coding, procedure coding, and a modifier reference. It also points to a related billing instruction source.