Payment at 75%
Medicare pays clinical social workers 75% of the fee schedule amount paid to clinical psychologists, and they must accept assignment. NASW notes that Medicare rates do not automatically carry over to Medicaid or private plans.
LCSW claims carry their own Medicare limits
Clinical social workers bill many of the same therapy codes as other clinicians, but Medicare pays them at a lower rate and excludes some settings. Taiga works with mental health practices, drafting codes from your notes for clinician approval and following every denial to resolution.
Book a demoWhat shapes social work claims
The codes look familiar. The payment and setting rules differ.
Settings Medicare excludes
Medicare does not pay under the clinical social worker benefit for hospital inpatient services, PHP or IOP services at hospital outpatient departments or community mental health centers, or certain skilled nursing facility patients.
No incident-to under a social worker
Social workers can work incident to a physician or psychologist, but services cannot be billed incident to the social worker's own care. They can bill general behavioral health integration with G0323 when they personally lead it.
Sharing the billing load
Clinical work and client relationships stay with your social workers.
Practice keeps
Assessments, treatment plans, session notes, and approval of every code before it goes out.
Taiga takes on
Eligibility checks, claim scrubbing and submission, patient statements, and work on each denial and appeal, small claims included.
Settle together
Decide who manages credentialing for newly licensed social workers, supervision arrangements, and any services delivered in facilities.
Questions for a social work fit call
Bring de-identified session examples from a typical week. Keep client details out of the booking form.
Where do your social workers practice?
List office, telehealth, home, school, and facility settings, since place of service changes what Medicare pays.
Which licenses are on staff?
Note independent licenses versus associate or supervised licenses, and which payers recognize each.
Which payers do you bill?
Break out Medicare, Medicaid, commercial plans, employee assistance programs, and self-pay.
Who this fits
Solo LCSWs and social work group practices that bill insurance and want claim follow-up off their plate. Taiga works alongside your existing EHR, and onboarding takes about two weeks.
Scope note
Medicaid and commercial plans set their own rules for social work licenses and supervision. This page focuses on Medicare's framework and does not settle any state's requirements.
Questions about clinical social work billing
Does Taiga work with LCSW practices?
Yes. Clinical social work is part of the mental health work Taiga supports. Bring your settings and payer mix to confirm the details.
How much does Medicare pay an LCSW?
Medicare pays clinical social workers 75% of the fee schedule amount for clinical psychologists, and they must accept assignment.
Can an LCSW bill Medicare for services in an IOP or PHP?
Not under the clinical social worker benefit when the program runs in a hospital outpatient department or community mental health center. Those services are part of the program's facility payment.
Can someone bill incident to an LCSW?
No. Medicare does not cover services billed incident to a clinical social worker. A social worker can provide services incident to a physician or psychologist when the rules are met.
Bring your social work caseload mix
Share your settings, licenses, and payers, and Taiga will show how it would handle the claims.
System guides show possible billing handoffs, not proven specialty compatibility.