The HJ billing modifier is a H Code HCPCS modifier used in coding claims. This H group of modifiers are used to describe either something about the claim or the credentials of the provider.
The HJ modifier is the most commonly used of the HCPCS modifiers in behavioral health claims.
HJ Modifier Description
The HJ modifier is used to code Employee Assistance Program (EAP) visits. It is considered the standard for filing EAP claims with most, but not all insurers.
This contrasts with other commonly used H codes which are used to describe the level of education of the rendering provider.
Are you or your client not sure if they have EAP visits. We always recommend calling and asking. Situations like this are where a billing service like TheraThink can do this for you.
Who Requires the HJ Modifier?
The majority of insurance companies require the HJ modifier for EAP visits. This includes most but not all private insurance companies. Companies like Anthem, BCBS, Aetna, and United Healthcare follow this standard for EAP visits.
However, one major insurer, Cigna will not process these and instead asks that EAP claims be filed with procedure code 99404.
EAP claims also usually require authorization. Be sure to include this number in your CMS 1500 claim. It is also important to make sure that the client still has EAP visits left.
Typically insurance will allow a certain amount per year. If you file with HJ but they are out of visits, your claim will likely be denied!
If you’re not sure, a service like TheraThink can call ahead to make sure EAP is being properly billed with the correct coding standards.
What CPT Code Do I use With This Modifier?
For behavioral health therapists HJ is billed with standard mental health procedure codes like 90791, 90834, or 90837.
HJ EAP Reimbursement
Reimbursement for HJ EAP sessions by insurance companies tends to be similar to routine sessions, like 90834 or 90837.
Because all sessions billed as 99404 are EAP, they should not have any patient responsibility and the insurance will cover the full allowed amount.
How Do I Bill the HJ Modifier on a CMS 1500 Form?
Like other HCPCS, the HJ modifier should be placed in the 24d field on the CMS 1500. Be sure to include the CPT code in 24c.
As a result, it may show up in insurance portals as 90834HJ or 90837HJ. Be sure to also include the authorization in box 23.