Clinical social workers can be valuable for seniors dealing with mental, emotional or behavioral issues. Not only can clinical social workers provide counseling, but they can guide patients to resources that improve their health.
But how do you make an appointment with a social worker, and will Medicare cover it? Let’s find out.
What does a social worker do?
A clinical social worker diagnoses, treats and prevents mental illness and emotional or behavioral disturbances. Treatment can include individual, group and family counseling for a range of issues, including depression or anxiety. Social workers also help patients find resources that address specific health issues that could hinder their recovery from illness or injury.
To become a clinical social worker, these professionals have a social work master’s or doctoral degree and a state license to practice.
Where can I find a clinical social worker?
Clinical social workers see patients in a variety of settings. Some have a private practice. Others work in community mental health centers, hospitals, various agencies and primary care centers. Before making a clinical social worker appointment, make sure they accept assignment, meaning they agree to be paid the Medicare-Approved Amount directly by Medicare, otherwise the visit won’t be covered.
Can social workers bill Medicare?
Yes, clinical social workers can bill Medicare for some services.
Outpatient mental health services
Medicare Part B (health insurance) covers counseling or therapy appointments with a clinical social worker in a doctor’s office, a hospital outpatient department or a community mental health center.
For Medicare to cover the visit, the treatment must be reasonable and medically necessary. Also, as discussed above, the clinical social worker must accept assignment. If they don’t accept assignment, you have to pay the entire cost of the appointment.
Home care services
Medicare Part A (hospital insurance) and Part B pay for home care. This can include medical social services. The social worker can provide services, such as counseling, assessments or resource finding to help you recover from an injury or illness.
How much does Medicare pay for a therapy session?
The cost of a therapy session depends on its length and the type of services involved, and whether it’s considered an outpatient mental health service or home care.
Outpatient mental health services
Part B covers outpatient mental health services, including visits with a clinical social worker.
After meeting your Part B deductible ($233 in 2022), you pay 20 percent of the Medicare-Approved Amount for subsequent visits with a clinical social worker. There could be an additional copayment or coinsurance amount if you get your services in a hospital outpatient setting.
Medicare does not pay for clinical social worker services provided to patients in partial hospitalization programs or skilled nursing facilities.
Home care services
If you’re eligible for the home care benefit, you won’t pay anything for an appointment with a social worker, but there are rules.
For Medicare to cover any home care services, including those of a Medicare social worker, you must meet all of these conditions:
- You’re under a doctor’s care and getting services according to a plan created and regularly reviewed by a doctor.
- A doctor has certified that you are homebound.
- A doctor has certified that you need intermittent skilled nursing care, physical therapy, speech-language pathology or occupational therapy services that qualify under the home care benefit.
- A home health agency will manage your services, including visits with a social worker.
Make sure the agency tells you which services Medicare pays for and the cost of any services Medicare doesn’t cover. A written Advance Beneficiary Notice should explain the services for which you have to pay out-of-pocket before you receive them.
Can a primary care physician help me connect with a social worker?
Primary care doctors help their patients manage their health and are a doorway to specialized care, such as counseling with a clinical social worker. Some primary care providers even have a clinical social worker on site.
Where can I find a primary care physician who accepts Medicare patients?
NewPrimaryCare.com™ can help you find a quality primary care doctor near you. Our partner providers practice value-based care, meaning Medicare rewards them for helping their patients get better.
With a value-based care doctor, you have someone who will take the time to get to know you and your circumstances. You can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful connection with your physician.
Use our Find Your Doctor tool to search for and compare value-based care providers near you.
