New Jersey Issues Medicaid Update on FQHC Billing for LCSWs

In June 2024, the New Jersey Department of Human Services, Division of Medical Assistance & Health Services (the Division), issued a Newsletter announcing the ability of Licensed Clinical Social Workers (LCSWs) to enroll as billing providers in NJ FamilyCare/Medicaid for claims with service dates on or after July 1, 2024. This month, the Division issued a Medicaid Alert advising Federally Qualified Health Centers (FQHCs) how they are affected by this change.

What is Changing for FQHCs?

The Alert confirms that FQHCs can continue to bill for services provided by LCSWs, regardless of whether or not the LCSW rendering services is enrolled as a Medicaid billing provider. The FQHC will continue to be listed as both the rendering and billing provider.

However, FQHCs must now utilize new billing codes and modifiers to identify that the service was provided by a LCSW. Services provided by a LCSW at an FQHC must be billed using the appropriate Healthcare Common Procedure Coding System (HCPCS) procedure code.

In addition to the correct HCPCS procedure code, (i) psychotherapy services performed by a LCSW at an FQHC must be billed with the appropriate AJHE modifier; and (ii) substance use counseling services performed by a LCSW at an FQHC must be billed with the appropriate AJHF modifier combination.

FQHCs must continue to bill these new HCPCS/modifier code combinations with the current Prospective Payment System (PPS) encounter codes.

Garfunkel Wild Attorneys and Garfunkel Health Advisors are available to assist clients with all of their legal and billing/credentialing needs relating to FQHCs.

Should you have any questions regarding the above, please contact the authors, the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.