Wiki Interpersonal/Telephone/Internet/Electronic Health Record Consultations and QHP

[dballard2004]

Does anyone know where I can find the CMS definition of a qualified health care professional? I have the CPT manual definition.

My question centers on codes 99446-99449 and 99451. I have a licensed clinical social worker (LCSW) reaching out to see if she and her team can report these codes. CPT is vague only stating that these codes can be reported by physicians or other QHPs.

My assessment is that since these codes are categorized to the E/M section of the CPT nomenclature, the only providers who could report them are physicians (MD/DO), NPPs, and since I am referring to behavioral health, psychologists and psychiatrists. I guess I have two questions:

1. Are LCSW considered a QHP by CMS definition since CPT seems vague?
2. Can LCSWs report these codes?

Sorry for the long questions. I am hoping someone has insight. Thanks.

 

[jkyles]

Hi there, the LCSWs themselves should know whether they're allowed to report E/M services under their state scope of practice. If they can't report E/M visits, they can't report other E/M services.

 

[dballard2004]

Thanks.