Mental Health Modifiers: The Definitive Guide [2022]

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)
  • HO Modifier – Masters Level (MA)
  • 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)
  • UD Modifier – Missouri Behavioral Health Modifier for LPC (Source, pg 183)

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.

ModifierDescription
25Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service
27Multiple outpatient hospital E/M encounters on the same date
50Bilateral procedure
52Reduced services
59Distinct procedural service
AERegistered dietitian
AFPhysician delivering SUD group counseling
AHClinical psychologist
AMPhysician, team member (ACT)
GNServices delivered under an outpatient speech language pathology plan of care
GOServices delivered under an outpatient occupational therapy plan of care
GPServices delivered under an outpatient physical therapy plan of care
GTIdentifies a service as telehealth
H9Court-ordered
HAChild/adolescent program
HBAdult program, non geriatric
HCAdult program, geriatric
HDBuprenorphine, generic, per 1 mg
HEMental health program
HFSubstance abuse program
HGOpioid addiction treatment program
HHIntegrated mental health/substance abuse program
HIIntegrated mental health and intellectual disability/developmental disabilities program
HJEmployee assistance program
HKSpecialized mental health programs for high-risk populations
HLIntern
HMLess than bachelor degree level
HNBachelor's level degree
HNBachelors degree level
HOMaster's level degree
HPDoctoral level
HQGroup setting
HRFamily/couple with client present
HSFamily/couple without client present
HTMulti-disciplinary team
HUFunded by child welfare agency
HVFunded state addictions agency
HWFunded by state mental health agency
HXFunded by county/local agency
HYFunded by juvenile justice agency
HZFunded by criminal justice agency
KXCrisis [used with T1002, H2017 (PSR only, not LPN nursing service), H2019, H0004, and 90832]
Q6Substitute practitioner (locum tenens)
QWCLIA waived laboratory procedure or CLIA waived version of a high-or moderate-complexity laboratory procedure
SAPhysician's assistant or clinical nurse specialist, team member (ACT)
SEDrug acquired through the 340B drug pricing program
TDAdditional license, registered nurse (RN)
TEAdditional license, licensed practical nurse (LPN)
TGComplex/high-tech level of care
TSOTP three-week administration (15-21 days)
TVOTP one-week administration (2-7 days)
U1Psychology assistant, psychology assistant intern, psychology assistant trainee // Medicaid level of care 1, as defined by each state
U2Licensed professional counselor // Medicaid level of care 2, as defined by each state /
U3Used to identify the patient location of “inpatient hospital” when a telehealth service was delivered / Medicaid level of care 3, as defined by each state / Licensed chemical dependency counselor III
U4Licensed social worker (LSW) / Used to identify the patient location of “outpatient hospital” when a telehealth service was delivered / Medicaid level of care 4, as defined by each state
U5Licensed marriage and family therapist (LMFT) / Used to identify the patient location of “nursing facility” when a telehealth service was delivered / Medicaid level of care 5, as defined by each state
U6Chemical dependency counselor assistant / Medicaid level of care 6, as defined by each state / Used to identify the patient location of “Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)” when a telehealth service was delivered
U7Counselor trainee / Medicaid level of care 7, as defined by each state
U8Social worker assistant / Medicaid level of care 8, as defined by each state
U9Social worker trainee / Medicaid level of care 9, as defined by each state
UAMarriage and family therapist trainee / Medicaid level of care 10, as defined by each state
UBAdditional license, licensed independent clinical dependency counselor (LICDC) or OTP two-week administration (8-14 days) / Medicaid level of care 11, as defined by each state
UCCertified nurse practitioner, team member (ACT) / Medicaid level of care 12, as defined by each state
UDMedicaid level of care 13, as defined by each state
UEUsed durable medical equipment
UFAdditional license, licensed independent social worker (LISW)
UGAdditional license, licensed independent marriage and family therapist (LIMFT)
UHAdditional license, licensed professional clinical counselor (LPCC)
UJServices provided at night
UKQMHS with 3 years' experience
UNTwo patients served
UPThree patients served
UQFour patients served
URFive patients served
USSix or more patients served
XEService that is distinct because it occurred during a separate encounter
XPService that is distinct because it was performed by a different practitioner
XSService that is distinct because it was performed on a separate organ/structure
XUService that is distinct because it does not overlap usual components of the main service

Mental Health License Level Modifiers

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!

Sources:

No comments yet.

Leave a Reply