Page 152 - Medicare Benefit Policy Manual

G. Assignment Requirement
Assignment is required.

170 - Clinical Social Worker (CSW) Services
(Rev. 1, 10-01-03)
B3-2152

See the Medicare Claims Processing Manual Chapter 12, Physician/Nonphysician
Practitioners, §150, “Clinical Social Worker Services,” for payment requirements.

A. Clinical Social Worker Defined

Section 1861(hh) of the Act defines a “clinical social worker” as an individual who:

• Possesses a master’s or doctor’s degree in social work;

• Has performed at least two years of supervised clinical social work; and

• Is licensed or certified as a clinical social worker by the State in which the
services are performed; or

• In the case of an individual in a State that does not provide for licensure or
certification, has completed at least 2 years or 3,000 hours of post master’s degree
supervised clinical social work practice under the supervision of a master’s level
social worker in an appropriate setting such as a hospital, SNF, or clinic.

B. Clinical Social Worker Services Defined

Section 1861(hh)(2) of the Act defines “clinical social worker services” as those services
that the CSW is legally authorized to perform under State law (or the State regulatory
mechanism provided by State law) of the State in which such services are performed for
the diagnosis and treatment of mental illnesses. Services furnished to an inpatient of a
hospital or an inpatient of a SNF that the SNF is required to provide as a requirement for
participation are not included. The services that are covered are those that are otherwise
covered if furnished by a physician or as incident to a physician’s professional service.

C. Covered Services

Coverage is limited to the services a CSW is legally authorized to perform in accordance
with State law (or State regulatory mechanism established by State law). The services of
a CSW may be covered under Part B if they are:

• The type of services that are otherwise covered if furnished by a physician, or as
incident to a physician’s service. (See §30 for a description of physicians’
services and §70 of Pub 100-1, the Medicare General Information, Eligibility, and
Entitlement Manual, Chapter 5, for the definition of a physician.);