License Level Modifiers for Mental Health Claims

License level modifiers for mental health professionals aren't straight forward.  We'll teach you what modifier to use for your mental health insurance claims based on your license, including the CPT codes allowed for those services.

Refer to the table below to find the correct license level modifier to use when coding mental health claims for behavioral health providers.  Usually, only state run Medicaid programs require the use of license level modifiers for mental health claims, but check with each insurance company you’re billing with to be sure.

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.

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.

Sources:

  • https://sites.magellanhealth.com/media/129211/la_org_medicaid_degree_level_modifiers.pdf
  • https://www.magellanprovider.com/media/11711/degree-level-modifiers.pdf
  • https://www.tagolden.com/Modifiers%20Best%20List.pdf
  • https://www.amerihealthcaritasde.com/assets/pdf/provider/claims-billing/bh-modifier-chart.pdf
No comments yet.

Leave a Reply