The HE modifier is a H Code HCPCS modifier used in coding claims. This H group of modifiers are used to describe something else about the claim beyond the procedure or ICD10 diagnosis code.
The most commonly used modifier in this group is HJ used to code Employee Assistance Program (EAP) visits. Insurance companies will sometimes request that modifiers be included in addition to the CPT codes. Another example is HO which signifies that the provider has a masters degree level.
HE Modifier Description
Unlike, HN, HO, and HP, HE does not signify degree level. Instead it simply signifies a Mental Health Program.
A similar modifier HF signifies a substance abuse program. A billing service such as TheraThink can help to determine by asking the insurance company if HE is required when you file a claim.
Who Requires the HE Modifier?
The vast majority of insurance companies do not require claims to be filed with a HCPCS modifier. This includes most private insurance companies and Medicare. So who does require it?
The majority of Medicaid plans do not require this claims modifier, but a few do.
One example is Rocky Mountain Health Plan based in Colorado has started to ask that mental health claims be filed with this standard. Medicaid coding standards can vary by state and even within them so it is important to know when this is relevant.
While it is very rare to require HE for routine behavioral health claims, a service like TheraThink can call ahead to make sure it is being properly billed with HE or any other modifier.
Other ways to ensure you know what modifier to use are to:
- Call and verify eligibility and benefits and ask specifically about this modifier,
- Review your contracting documentation and agreement about specific billing guidelines and
- Refile corrected claims.
What CPT Code Do I use With HE?
For behavioral health therapists HE is billed with standard mental health procedure codes like 90791, 90834, or 90837.
How Do I Bill the HE Modifier on a CMS 1500 Form?
Like other HCPCS, HE should be used under the 24d field on the CMS 1500. Be sure to include the CPT code in 24c.