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).
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.
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:
- H5010 – H5030
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.