96101 as an LCSW

Greetings forum!

My name is Joe and I'm a newly licensed LCSW in Virginia. I'm writing today because I've got questions pertaining to billing codes; I'm new to this and want to make sure I know as much as possible about how billing should look.

I have been extensively trained and approved to utilize an Autism diagnostic tool called the ADOS-2 & ADI-R.* In combination these tools are considered the "gold standard' diagnostic method for Autism and I've gotten 24 hours of training, a certificate and perhaps 200 of these assessments completed as an hourly employee working at a separate business.

I now have been hired exclusively to do ADOS-2 diagnostic assessments by a local private practice and am being credentialed by various insurance providers, all of whom wary of giving specific billing advice.* I have been told by my employer that I can bill for the testing and report writing time under the code 96101 and wanted to:

1) *Confirm that this was true.
2) *If so, ask what the process would be like (i.e. do I need to preauthorize)
3) *If you're unsure, determine perhaps who I should talk to, and*
4) *If NOT, find out what billing code a masters level licensed clinician can use for diagnostic testing and report writing.

Thanks in advance for your consideration.

Respectfully,

Joe

Hi Joe. I have a feeling you aren't going to find answers to these questions here. This is a patient support board and few people if any are going to know anything so specific about billing codes.

Your professional organization or licensing board should be able to help you. When I was a new OT I was taught codes to use by co-workers and never was led astray.

You need to look at a 2017 CPT manual for this procedure code and timing guidelines

Is a masters level licensed clinician ever able to bill 96101, under any circumstance?

If not, what would be a good code for one who's trained & credentialed in a diagnostic process and would need time compensated for hours spent scoring & summarizing results? Test takes as long to score & summarize as it does to conduct with the client so I want that time to be paid.

Why do you doubt that what your employer told you is true?

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