Healthcare is about more than treating a diagnosis. A patient’s ability to manage their health is often shaped by factors that happen outside the doctor’s office—access to food and housing, transportation, family support, mental health, financial stability, and the ability to understand and follow a treatment plan – often recognized as social drivers of health.
Social workers are uniquely trained to help patients navigate these challenges.
As the Centers for Medicare & Medicaid Services (CMS) considers changes to the 2027 Medicare Physician Fee Schedule – which outlines policy and payment under Medicare Part B – the Coalition for Social Work and Health (CSWH) is calling attention to opportunities under Medicare to better leverage the important role social workers play in improving health outcomes, expanding access to care, and supporting patients with complex needs.
At the heart of CSWH’s recommendations is a straightforward message: if we want a healthcare system that truly treats the whole person, social workers need to be recognized and reimbursed as essential members of the healthcare team.
Removing Outdated Billing Barriers
CSWH’s central recommendations revolve around two billing barriers: 1) outdated restrictions that prevent clinical social workers from billing Medicare directly for services they are qualified and licensed to provide, and related, 2) the use of supervised, or “incident to”, billing for social work services.
Under current Medicare rules, clinical social workers are generally able to bill directly for services provided within their role as mental health professionals. However, many services related to chronic disease management and physical health fall outside those existing billing pathways, which then must be billed under another eligible practitioner, such as a physician or other qualified provider.
These policies creates a disconnect between a social worker’s training and the services Medicare allows them to bill for in their setting of practice. This holds especially true in rural and underserved communities, where access to physicians and other supervising practitioners may already be limited.
A social worker may be fully qualified to help a patient manage a chronic condition, coordinate care, or address barriers to treatment, but may not be able to bill Medicare directly when the primary diagnosis is physical rather than behavioral health.Because social workers often practice in community health settings that may span clinics and serve hard-to-reach populations that may not be fully engaged with a physician practice, team-based billing opportunities such as chronic care management and community health integration are hard to operationalize.
Additionally, if a qualified social worker is available to provide care but cannot bill independently because a supervising practitioner is not readily accessible, patients may ultimately have fewer options for receiving care.
CSWH is asking CMS to authorize Medicare Part B reimbursement for relevant services that fall within clinical social workers’ state-defined scopes of practice. To prompt this legislatively, CSWH has also supported bipartisan legislation HR 4185 “Integrating Social Workers Across Healthcare Settings Act”.
CSWH also encourages CMS to consider allowing social workers functioning independently within their scope of practice to serve as supervising practitioners for appropriate professionals. In practice, clinical social workers often play supervisory roles that guide patient care for case managers, community health workers, and patient care navigators, and enabling incident to billing arrangements would expand access to services provided by these workforces. In this way, allowing qualified clinical social workers to bill independently for appropriate services could expand access to the breadth and depth of social work expertise from an existing workforce while reducing unnecessary administrative complexity.
Investing in Prevention and Behavioral Health
CSWH supports CMS’s proposed increase in the valuation of smoking and tobacco cessation services.
Quitting tobacco is notoriously difficult because of the addictive nature of nicotine. Effective cessation often requires more than medication alone. Behavioral counseling and ongoing support are important components of helping people successfully change their behavior.
Social workers are particularly well positioned to provide this support. Their training allows them to consider the social, behavioral, environmental, and economic factors that can influence a person’s health and use that insight to inform interventions in a way that meets people “where they are at”.
For example, a patient may understand the health risks of smoking but struggle to quit because of stress, mental health challenges, housing instability, or other circumstances. Addressing those underlying issues can be an important part of successful prevention and chronic disease management.
Investing in these services recognizes that prevention is an essential part of healthcare—not an afterthought.
Connecting Behavioral and Physical Health
Mental and physical health are deeply connected. Patients managing chronic or complex health conditions frequently experience behavioral health needs that can affect their treatment and long-term outcomes.
CSWH supports CMS’s continued investment in the behavioral health integration, including increased valuation for psychiatric collaborative care management and behavioral health care management services.
Behavioral Health Care Managers play a critical role in connecting patients, primary care providers, and mental health specialists. They can regularly follow up with patients, support treatment adherence, monitor progress, and help ensure that concerns are addressed before they become larger problems.
This collaborative approach is particularly valuable for patients who might otherwise struggle to navigate a fragmented healthcare system.
Recognizing the contributions of these professionals is an important step toward building healthcare teams that can address the full range of a patient’s needs.
Social Workers Can Be Leveraged For Health Coaching
Another area of opportunity is CMS’s proposed creation of health coaching codes. CSWH supports this whole-person approach.
For many social workers, health coaching is not a new concept. It is aligned with and a part of the work they do every day.
Social workers help patients living with chronic conditions understand their care plans, identify priorities and what matters most, navigate uncertainty, make lifestyle changes, connect with community resources, and overcome barriers to treatment. They also work with families and other healthcare professionals to ensure that care reflects the patient’s priorities, values, and circumstances. These activities align well with health coaching, and we anticipate social workers working in the limited settings with the ability to provide services incident to a physician will engage in these opportunities.
Current Medicare reimbursement rules can make it difficult for individuals providing these to be reimbursed for many of these services. By adding health coaching codes, CMS supports a whole-person approach that can make healthcare more effective and efficient. It can also reduce pressure on already overburdened healthcare systems by helping patients address problems before they escalate.
Making Care More Accessible Through Telehealth
CSWH supports CMS’s proposal to add new proposed advance care planning and group-based medical services to the permanent Medicare Telehealth Services List.
Telehealth has become an important way to reach patients who face barriers to receiving care in person. For people living in rural communities, those with limited mobility, or patients who have difficulty arranging transportation, virtual services can make the difference between receiving care and going without it.
Expanding access to services such as advance care planning can also help patients and families make informed decisions earlier. More timely and consistent care may help prevent complications and reduce the need for more intensive interventions down the road.
Telehealth is not a replacement for every type of care, but when used appropriately, it can make healthcare more accessible and responsive to patients’ needs.
Supporting Substance Use Disorder Treatment
CSWH supports CMS’s proposal to broaden the focus of bundled payments from opioid use disorder to substance use disorder more broadly.
This change better reflects the range of substance use conditions for which people seek treatment and can help expand access to services.
It also supports an important goal: reducing the stigma surrounding substance use disorders. Patients deserve access to effective treatment regardless of which substance is involved.
The Future of Healthcare Is Whole-Person Care
The changes under consideration in the 2026 Physician Fee Schedule represent an opportunity to think differently about how healthcare is delivered—and who is essential to delivering it.
Social workers are already helping patients navigate the complicated intersection of medical care, behavioral health, and everyday life. They help people understand their conditions, connect to resources, coordinate care, build motivation for change, and overcome barriers that can stand in the way of better health.
But patients cannot fully benefit from that expertise when outdated reimbursement policies limit the services social workers can provide and bill for.
A healthcare system focused on prevention, access, coordination, and whole-person care needs social workers at the table—and at the center of the care team.
Recognizing their expertise through appropriate Medicare reimbursement is not simply an investment in the social work profession. It is an investment in patients, healthcare teams, and a stronger, more effective healthcare system for everyone.