Friday, November 6, 2009

How do PLCSWs in NC bill for services?

by Jack Register, Director of Advocacy & Legislation & Hull House NC Editor

This is a frequent question we get at NASW-NC. I want to spend some time describing the current state of billing for PLCSWs in the state. But before I do I want to preface the comments with this statement.

NASW-NC is reporting this to you. We don't agree with the current state of affairs in NC. We don't support the state's position that PLCSWs are not "fully licensed." We do not support the current practice of PLCSWs being in the QP or Qualified Professional catagory. In our opinion, and according to the statute, a PLCSW is fully licensed as a PLCSW with all the rights and privileges associated with licensure.

In terms of billing, there are currently two (2) mechanisms. The first is called incident to. " Incident to" is a model where you use an MD's Medicaid number in order to bill. The MD must be employed by or in a contractual relationship with the agency the PLCSW works in. The MD is responsible for practice in so far as Medicaid is concerned. However, they DO NOT replace the clinical supervisor (LCSW) as deemed by the licensure board. So, in some cases, it may seem like the PLCSW has two supervisors. Incident to is a medicalized model of billing that allows several allied professionals to see a client and bill under the physician. It requires medical neccessity to be met as well.

The second model of billing is the H code. The H codes are billed through the LME. There is usually a cost, approxiamtely $.15 according to the last Implementation Update. The LME creates a contract with the agency the PLCSW works in and bills Medicaid for these services. As of now, H codes are slated for elimination from Medciaid in July 2010.

Another key issue regarding billing is what payor sources do PLCSWs qualify to use. The answer is there are two (2). Private payment for services and Medicaid. A PLCSW cannot direct enroll, cannot apply for panel membership with any third party payor at this time.

Jack is the Director of Advocacy & Legislation for NASW-NC and the Editor of Hull House NC. He is the lobbyist and advocate for the association and represents NASW-NC in statewide advocacy coalitions, to the departments of state government, and is the lobbyist for the legislature. Jack is an LCSW and has practice experience in a wide variety of mental health, medical and addiction settings. He can be reached at the association by email at

1 comment:

Jessica Holton said...

Thank you Jack for offering clarification regarding this matter. Keep up the great work!