How To Use HCPCS Code G0155

HCPCS code G0155 describes the services of a clinical social worker in home health or hospice settings, with each session lasting for 15 minutes. This code is used to identify and bill for the specific services provided by a clinical social worker in these settings.

1. What is HCPCS G0155?

HCPCS code G0155 is a specific code used to identify and bill for the services of a clinical social worker in home health or hospice settings. It is important to note that this code is only applicable for services provided by a clinical social worker and not for other healthcare professionals.

2. Official Description

The official description of HCPCS code G0155 is “Services of clinical social worker in home health or hospice settings, each 15 minutes”. The short description for this code is “Hhcp-svs of csw,ea 15 min”. These descriptions accurately reflect the nature and duration of the services provided by a clinical social worker in these settings.

3. Procedure

1. The clinical social worker assesses the patient’s social and emotional needs in the home health or hospice setting.
2. Based on the assessment, the social worker develops a care plan to address the patient’s specific needs.
3. The social worker provides counseling and support to the patient and their family members, helping them cope with the emotional and social challenges they may be facing.
4. The social worker may also provide education and resources to the patient and their family members, helping them navigate the healthcare system and access necessary support services.
5. Each session with the clinical social worker lasts for 15 minutes, during which the social worker provides the necessary services and documents the encounter.

4. When to use HCPCS code G0155

HCPCS code G0155 should be used when a clinical social worker provides services in a home health or hospice setting. It is important to ensure that the services provided meet the specific criteria outlined in the code description. This code should not be used for services provided by other healthcare professionals or in different settings.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G0155, healthcare providers need to ensure that they document the following:

• The date and duration of each session with the clinical social worker
• The specific services provided during each session
• The patient’s response to the services provided
• Any changes or updates to the care plan based on the social worker’s assessment

Providers should also ensure that they follow the appropriate billing guidelines and submit the necessary documentation to support the services billed.

6. Historical Information and Code Maintenance

HCPCS code G0155 was added to the Healthcare Common Procedure Coding System on July 01, 1999. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has been in use since its addition and continues to be relevant for billing and reimbursement purposes.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the services provided by a clinical social worker using HCPCS code G0155. However, it is important to check with individual payers to determine their specific coverage policies and requirements. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. The multiple pricing indicator code is 9, indicating that the value for this code is not established.

8. Examples

Here are five examples of when HCPCS code G0155 should be billed:

1. A clinical social worker provides counseling and support to a patient with a terminal illness and their family members in a hospice setting.
2. A clinical social worker assesses the social and emotional needs of a homebound patient and develops a care plan to address those needs.
3. A clinical social worker provides education and resources to a patient and their family members to help them navigate the healthcare system and access necessary support services.
4. A clinical social worker provides counseling to a patient with a chronic illness to help them cope with the emotional and social challenges associated with their condition.
5. A clinical social worker provides grief counseling to a patient who has recently lost a loved one in a home health setting.