Medicare has created a specific payment for care coordination in the ACCESS Model, and clinical social workers should pay close attention. Licensed clinical social workers who are enrolled in Medicare Part B have been eligible to bill the ACCESS Co Management Payment since July 5, 2026. Federally qualified health centers and rural health clinics become eligible on October 1. The payment recognizes something social workers have long argued: reviewing information, communicating across teams, and helping a person act on a care plan are real clinical work.
The new payment does not reward a vague referral. CMS requires an eligible practitioner to review an ACCESS care update from a participating organization and complete at least one qualifying coordination activity. The work must take at least five minutes, be medically necessary, and be documented. That structure creates an opportunity for social work, but only if agencies build a careful workflow before billing begins.
What the payment covers
CMS created three billing codes. Code G0676 applies to the early chronic kidney disease and chronic kidney disease track. Code G0677 applies to the musculoskeletal track. Code G0678 applies to the behavioral health track. Each code has a payment amount of $30 before geographic adjustment and sequestration.
An AC modifier adds a one time onboarding payment of $10 when the billing practitioner completes the required onboarding activity. A practitioner may generally receive the coordination payment up to three times during a twelve month period for the same beneficiary in the same track. CMS states that the beneficiary has no cost sharing for the payment.
The amount is modest, but the policy is important. Medicare is recognizing that collaboration between a treating practitioner and an ACCESS participant has value. It also creates a record of whether care updates are reviewed and translated into action.
Build a defined review process
Agencies should decide who receives the care update, how it enters the record, and who is responsible for review. The document should not sit in a general inbox. A named staff member should confirm the beneficiary, track, date of service, and participating organization before routing it to the eligible practitioner.
The practitioner should review the update before contacting the beneficiary or another member of the care team. The record should show what information was considered and what changed as a result. An adequate note should identify the coordination activity, the people involved, the time spent, and the reason the work was medically necessary.
Qualifying activity may include discussing the update with the beneficiary, communicating with another practitioner, integrating recommendations into an existing plan, addressing a barrier to treatment, or arranging a needed service. The note should describe the actual work. Copying generic language into every record would weaken both compliance and clinical value.
Social work can make the payment meaningful
Clinical social workers are well positioned to connect the care update with the conditions of a person’s life. A recommendation may depend on transportation, stable housing, medication access, caregiver support, language assistance, or safety planning. The social worker can identify the barrier, coordinate an appropriate response, and explain the plan to the beneficiary.
This work should not become a narrow billing exercise. The payment should support reliable communication and follow through. Agencies should ask whether the person understood the plan, whether the referral was accepted, whether the service was available, and whether another barrier appeared. A closed loop is more valuable than a documented attempt.
Prepare FQHCs and rural health clinics now
Organizations that become eligible on October 1 should use the remaining time to train staff and test the workflow. Training should explain the three codes, eligible practitioners, minimum time, frequency limits, modifier rules, and documentation requirements. Billing staff and clinical staff should use the same written guidance.
Agencies should also identify whether their electronic record can flag ACCESS care updates, track prior payments, and prevent duplicate billing. A brief internal audit after the first month can compare claims with clinical notes. Any discrepancy should lead to correction and additional training.
Patients should receive a simple explanation. They should know that Medicare does not impose cost sharing for this payment and that coordination may involve communication with the ACCESS participant and other treating professionals. Privacy rules still apply, and the agency should use only the information needed for care.
Measure outcomes, not only claims
The profession should evaluate whether the payment improves continuity. Useful measures include completed referrals, medication access, follow up after a care update, reduced duplication, beneficiary understanding, and resolution of social barriers. Agencies should also examine whether rural residents, people with disabilities, and people with limited English proficiency receive equal benefit.
A payment code cannot create collaboration by itself. It can, however, fund a small but important part of the work that collaboration requires. Social work organizations should use this opportunity to demonstrate that coordination is a skilled service with measurable consequences. The strongest response is a workflow that is clinically useful, ethically sound, and ready before the first claim is submitted.
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