Mental Health Modifiers: The Definitive Guide [2024]
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
License 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.
Telehealth 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.
| Modifier | Description |
|---|---|
| 25 | Significant, 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 |
| 27 | Multiple outpatient hospital E/M encounters on the same date |
| 50 | Bilateral procedure |
| 52 | Reduced services |
| 59 | Distinct procedural service |
| AE | Registered dietitian |
| AF | Physician delivering SUD group counseling |
| AH | Clinical psychologist |
| AM | Physician, team member (ACT) |
| GN | Services delivered under an outpatient speech language pathology plan of care |
| GO | Services delivered under an outpatient occupational therapy plan of care |
| GP | Services delivered under an outpatient physical therapy plan of care |
| GT | Identifies a service as telehealth |
| H9 | Court-ordered |
| HA | Child/adolescent program |
| HB | Adult program, non geriatric |
| HC | Adult program, geriatric |
| HD | Buprenorphine, generic, per 1 mg |
| HE | Mental health program |
| HF | Substance abuse program |
| HG | Opioid addiction treatment program |
| HH | Integrated mental health/substance abuse program |
| HI | Integrated mental health and intellectual disability/developmental disabilities program |
| HJ | Employee assistance program |
| HK | Specialized mental health programs for high-risk populations |
| HL | Intern |
| HM | Less than bachelor degree level |
| HN | Bachelor's level degree |
| HN | Bachelors degree level |
| HO | Master's level degree |
| HP | Doctoral level |
| HQ | Group setting |
| HR | Family/couple with client present |
| HS | Family/couple without client present |
| HT | Multi-disciplinary team |
| HU | Funded by child welfare agency |
| HV | Funded state addictions agency |
| HW | Funded by state mental health agency |
| HX | Funded by county/local agency |
| HY | Funded by juvenile justice agency |
| HZ | Funded by criminal justice agency |
| KX | Crisis [used with T1002, H2017 (PSR only, not LPN nursing service), H2019, H0004, and 90832] |
| Q6 | Substitute practitioner (locum tenens) |
| QW | CLIA waived laboratory procedure or CLIA waived version of a high-or moderate-complexity laboratory procedure |
| SA | Physician's assistant or clinical nurse specialist, team member (ACT) |
| SE | Drug acquired through the 340B drug pricing program |
| TD | Additional license, registered nurse (RN) |
| TE | Additional license, licensed practical nurse (LPN) |
| TG | Complex/high-tech level of care |
| TS | OTP three-week administration (15-21 days) |
| TV | OTP one-week administration (2-7 days) |
| U1 | Psychology assistant, psychology assistant intern, psychology assistant trainee // Medicaid level of care 1, as defined by each state |
| U2 | Licensed professional counselor // Medicaid level of care 2, as defined by each state / |
| U3 | Used 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 |
| U4 | Licensed 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 |
| U5 | Licensed 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 |
| U6 | Chemical 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 |
| U7 | Counselor trainee / Medicaid level of care 7, as defined by each state |
| U8 | Social worker assistant / Medicaid level of care 8, as defined by each state |
| U9 | Social worker trainee / Medicaid level of care 9, as defined by each state |
| UA | Marriage and family therapist trainee / Medicaid level of care 10, as defined by each state |
| UB | Additional 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 |
| UC | Certified nurse practitioner, team member (ACT) / Medicaid level of care 12, as defined by each state |
| UD | Medicaid level of care 13, as defined by each state |
| UE | Used durable medical equipment |
| UF | Additional license, licensed independent social worker (LISW) |
| UG | Additional license, licensed independent marriage and family therapist (LIMFT) |
| UH | Additional license, licensed professional clinical counselor (LPCC) |
| UJ | Services provided at night |
| UK | QMHS with 3 years' experience |
| UN | Two patients served |
| UP | Three patients served |
| UQ | Four patients served |
| UR | Five patients served |
| US | Six or more patients served |
| XE | Service that is distinct because it occurred during a separate encounter |
| XP | Service that is distinct because it was performed by a different practitioner |
| XS | Service that is distinct because it was performed on a separate organ/structure |
| XU | Service that is distinct because it does not overlap usual components of the main service |
Mental Health License Level Modifiers
| License | Modifier | Description | CPT Codes |
|---|---|---|---|
| Psychiatrist | AF | Specialty physician | These modifiers can be submitted with all HCPCS and CPT codes. |
| Physician | AG | Primary physician | These modifiers can be submitted with all HCPCS and CPT codes. |
| Psychologist | AH, HP | Clinical 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 Worker | AJ | Clinical social worker | Submit 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 Counselor | HO | Master’s degree level | The 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 counselors | HN | Bachelor’s degree level | At this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier. |
| Less than bachelor’s degree level counselors | HM | Less 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 Counselor | HF | Substance Abuse Program | At this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier. |
| Clinical Nurse Specialist | SA, TD | Nurse 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:
- 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
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c05.pdf
- https://www.hcpcsdata.com/Modifiers/U
- https://www.hcpcsdata.com/Modifiers/H
- https://medicaid.ohio.gov/static/Providers/Billing/BillingInstructions/ModifiersODM.pdf
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