The HP modifier, like the HO modifier and HN, is a HCPCS modifier used in coding claims. This group of modifiers are used to describe something else about the claim.

One more commonly used example is the HJ modifier which is usually used to code Employee Assistance Program (EAP) visits.

Insurance companies will request that these be filed used in addition to the CPT codes to fully describe the service and the credentials of the rendering provider.

HP Modifier Description

In a behavioral health context, the HP signifies that the highest degree the provider has is at a clinical psychologist or doctoral level. (Source)

The similar modifier, HO signifies a masters degree and HN a bachelor’s degree level. Not sure if you are fully credentialed to file with HP?

This is where a billing service such as TheraThink can help to determine by calling the insurance company and asking.

Even more complicated:  AH and HP signify the same levels of degrees.  So make sure to call each insurance provider to ask them which modifier to use (this is what we do at TheraThink).

(Source)

Who Requires the HP Modifier and/or HCPCS Modifiers?

The vast majority of insurance companies, including private insurance and Medicare, do not require claims to be filed with a HCPCS modifier. So who does require it?

Many Medicaid plans require the use of a degree modifier. Medicaid coding standards can vary by state and even within them so it is important to know when this is relevant.

Medicaid insurers that require a HCPCS education level modifier will deny the claim completely if the appropriate modifier is not applied to the claim.

Also if HO is filed when HP is relevant, the insurance may pay less! A service like TheraThink can call ahead to make sure it is being properly billed.

HP, HN, and HO are different from AJ and AF, two somewhat similar modifiers that are sometimes required.

What CPT Code Do I use With This Modifier?

For behavioral health therapists HP is billed with standard mental health procedure codes like 90791, 90834, or 90837.

Modifier HO CPT codes:

• 90801 – 90820
• 90821 – 90828
• 90830 – 90899
• 95880 – 95883
• 96100 – 96103
• 96105 – 96120

Modifier HO HCPCS codes:

• G0071
• G0073
• G0075
• G0077
• G0079
• G0081
• G0083
• G0085
• G0087
  G0089
• G0091
• G0093
• H5010 – H5030

(Source)

How Do I Bill the HP Modifier on a CMS 1500 Form?

Like other HCPCS, the HP modifier is used in  the 24d field on the CMS 1500. Be sure to include the CPT code in 24c.