Mental Health Modifiers: The Definitive Guide [2020]

Mental Health Modifiers are two digit alphanumerical codes used on CMS1500 insurance claims to signify identifying information about the provider rendering services.

Mental health CPT code modifiers can describe the way services are rendered as well, telehealth modifiers as an example.

In this guide, you’ll learn about the behavioral health modifiers you need to use for billing your insurance claims.

We’ll help you ensure you utilize the CPT Code modifiers that best describe the services you render and if you still need help, consider reaching out to our billing service.

License Level Modifiers for Therapists

mental health modifiersLicense level modifiers for mental health professionals aren’t straight forward.

We’ll teach you what behavioral health modifier to use for your insurance claims based on your license or degree, including the CPT codes allowed for those services.

Refer to the table below to find the correct license level modifier to use when coding modifiers for your behavioral health insurance claims.

Usually, only state run Medicaid programs require the use of license level modifiers for mental health claims based on your degree, but check with each insurance company you’re billing with to be sure.

Often times they Medicaid plans require your license level taxonomy code as well.

Mental Health Modifiers Guide Index

  • 95 Modifier – Synchronous Telehealth Services
  • GT Modifier – Synchronous Telehealth Services [Medicare]
  • AJ Modifier – Licensed Clinical Social Worker (LCSW)
  • HJ Modifier – EAP or Employee Assistance Program Visits (EAP)
  • HE Modifier – Mental Health Program (MHP)
  • HP Modifier – Psychologist or Doctorate Level (PsyD or PhD)
  • AH Modifier – Doctorate Level or Clinical Psychologist (PhD or PsyD)
  • AF Modifier – Psychiatrist (MD)
  • HN Modifier – Bachelor’s Degree Level (BA, BS)

Confused?  If you are struggling to find out the right modifier to use, consider hiring our mental health insurance billing service to code your insurance claims for you.

behavioral health modifiersTelehealth Modifiers for Therapists

Read our Definitive Guide to Telehealth Billing for Therapists to go through them one by one!

Behavioral Health Billing Modifiers Table

Each modifier applies to certain CPT codes (shown on the far right column).  For more information about each modifier, click the article above.

LicenseModifierDescriptionCPT Codes
PsychiatristAFSpecialty physicianThese modifiers can be submitted with all HCPCS and CPT codes.
PhysicianAGPrimary physicianThese modifiers can be submitted with all HCPCS and CPT codes.
PsychologistAH, HPClinical psychologist or
doctoral level
Submit this modifier with diagnostic psychological tests and therapeutic psychotherapy performed by a clinical psychologist.
This modifier can be submitted with the following procedure codes:
CPT codes: 90801 – 90820, 90821 – 90828, 90830 – 90899, 95880 – 95883,
96100 – 96103, and 96105 – 96120
HCPCS codes: G0071, G0073, G0075, G0077, G0079, G0081, G0083, G0085, G0087,
G0089, G0091, G0093, and H5010 – H5030
Social WorkerAJClinical social workerSubmit this modifier with diagnostic psychological tests and therapeutic psychotherapy performed by a clinical social worker.
This modifier can be submitted with the following procedure codes.
CPT codes: 90801 – 90828, 90841 – 90857, and 90875 – 90876
HCPCS codes: G0071, G0073, G0075, G0077, G0079, G0081, G0083, G0085, G0087,
G0089, G0091, G0093, and H5010 – H5030
Master’s Level CounselorHOMaster’s degree levelThe local policy E2007-010 (Mental Health Prepaid Ambulatory Health Plan [MH – PAHP]) requires modifier HO for code H2011 when performed for emergent crisis intervention by a licensed mental health professional (LMHP). KMAP will deny the service if this modifier is billed with any code other than H2011. For further information related to these services, refer to the Non-PAHP Outpatient Mental Health Provider Manual
Bachelor’s degree level counselorsHNBachelor’s degree levelAt this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier.
Less than bachelor’s degree level counselorsHMLess than bachelor’s degree
level
At this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier.
National Certified Addictions CounselorHFSubstance Abuse ProgramAt this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier.
Clinical Nurse SpecialistSA, TDNurse practitioner
RN
At this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier.

Mental Health Modifier Coding Guidelines

Make sure to check the following per client:

  • Eligibility and Benefits Verification
  • Your License Level Modifier for that Insurance Company
  • Are Modifiers Required For Billing?  (Ask on the eligibility and benefits call)
  • Does Your Taxonomy Code Need To Included?

If you are struggling to do each of these tasks for your insurance clients, considering hiring a mental health billing service like TheraThink to solve these problems for you.

We are exhaustive experts able to address your billing situation with ease.  Reach out!

CPT Codes and Modifiers for Mental Health Claims

Please review our Definitive Guide to CPT Codes for Therapists OR download our mental health CPT code cheat sheet!

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