Licensed Social Workers should bill under their supervising practitioner

Like Licensed Associate Professional Counselors (LAPCs) and Licensed Associate Marriage and Family Therapists (LAMFTs), Licensed Social Workers (LSWs) work under the supervision of a physician or practitioner. Because supervision is needed, these provider types are not considered Licensed Independent Practitioners in the Commonwealth of Pennsylvania, nor by Geisinger Health Plan’s credentialing criteria.

LSWs may not represent themselves independently. Therefore, they can’t be listed in Geisinger Health Plan’s member directory and are unable to independently bill for their services. Instead, LSWs should follow the same incident-to billing process as LAPCs and LAMFTs.

CMS has specific guidelines and criteria that must be met to properly bill “incident to” services. Details can be found on the CMS webpage at cms.gov under Regulations and Guidance, Manuals, Internet-Only Manual, Publication 100-02, Chapter 15, Section 60.

Novitas Solutions (the Medicare administrative contractor for Jurisdiction L) offers additional information, including an “incident to” self-service tool to assist providers with understanding the CMS Part B rules and requirements for these services. This information can be found at novitas-solutions.com.

We recognize the critical role LSWs play in the continuum of behavioral health care for our members and our intention is not to dissuade LSWs from seeing members. The purpose of this notification is simply to clarify credentialing requirements and how LSWs must bill Geisinger Health Plan. After LSWs complete a clinical supervision program, requisite training hours and are granted professional licensure, they may apply for empanelment with Geisinger Health Plan.