How Are Mental Health Services Billed In Wi Through Medicaide
Mental Health Modifiers: The Definitive Guide [2022]
Mental Health Modifiers are ii digit alphanumerical codes used on CMS1500 insurance claims to signify identifying data about the provider rendering services.
Mental wellness CPT code modifiers tin can describe the way services are rendered as well, telehealth modifiers as an case.
In this guide, you'll larn about the behavioral wellness modifiers you lot demand to utilise for billing your insurance claims.
Nosotros'll assist y'all ensure you utilize the CPT Lawmaking modifiers that all-time 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.
Nosotros'll teach you lot 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 employ when coding modifiers for your behavioral health insurance claims.
Usually, only land run Medicaid programs crave the use of license level modifiers for mental health claims based on your degree, but bank check with each insurance visitor you're billing with to be certain.
Often times they Medicaid plans crave your license level taxonomy lawmaking as well.
Mental Health Modifiers Guide Alphabetize
- 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 Wellness 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 – Available'southward Degree Level (BA, BS)
- UD Modifier – Missouri Behavioral Health Modifier for LPC (Source, pg 183)
Confused? If yous 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 i!
Behavioral Health Billing Modifiers Table
Each modifier applies to certain CPT codes (shown on the far correct cavalcade). For more than information about each modifier, click the article above.
| Modifier | Description |
|---|---|
| 25 | Significant, separately identifiable evaluation and management (E/M) service past the same physician or other qualified health intendance professional on the same twenty-four hour period of the procedure or other service |
| 27 | Multiple outpatient hospital E/1000 encounters on the same date |
| 50 | Bilateral process |
| 52 | Reduced services |
| 59 | Distinct procedural service |
| AE | Registered dietitian |
| AF | Md delivering SUD grouping counseling |
| AH | Clinical psychologist |
| AM | Physician, team member (Human activity) |
| GN | Services delivered under an outpatient spoken language language pathology plan of care |
| GO | Services delivered under an outpatient occupational therapy plan of intendance |
| GP | Services delivered nether an outpatient physical therapy program of intendance |
| GT | Identifies a service equally telehealth |
| H9 | Court-ordered |
| HA | Child/adolescent program |
| HB | Developed program, non geriatric |
| HC | Adult program, geriatric |
| Hard disk drive | Buprenorphine, generic, per i mg |
| HE | Mental health program |
| HF | Substance corruption program |
| HG | Opioid habit treatment program |
| HH | Integrated mental health/substance corruption program |
| Hi | Integrated mental health and intellectual disability/developmental disabilities program |
| HJ | Employee assistance plan |
| HK | Specialized mental health programs for high-risk populations |
| HL | Intern |
| HM | Less than bachelor caste level |
| HN | Bachelor's level degree |
| HN | Bachelors degree level |
| HO | Master's level degree |
| HP | Doctoral level |
| HQ | Grouping setting |
| Hr | Family unit/couple with client present |
| HS | Family/couple without client present |
| HT | Multi-disciplinary squad |
| HU | Funded past kid welfare bureau |
| HV | Funded state addictions agency |
| HW | Funded by country mental health agency |
| HX | Funded by county/local agency |
| HY | Funded past juvenile justice agency |
| HZ | Funded by criminal justice bureau |
| KX | Crisis [used with T1002, H2017 (PSR simply, not LPN nursing service), H2019, H0004, and 90832] |
| Q6 | Substitute practitioner (locum tenens) |
| QW | CLIA waived laboratory process or CLIA waived version of a high-or moderate-complication laboratory procedure |
| SA | Physician's assistant or clinical nurse specialist, team fellow member (ACT) |
| SE | Drug caused through the 340B drug pricing program |
| TD | Additional license, registered nurse (RN) |
| TE | Additional license, licensed practical nurse (LPN) |
| TG | Circuitous/high-tech level of intendance |
| TS | OTP 3-week administration (xv-21 days) |
| TV | OTP one-week administration (2-vii days) |
| U1 | Psychology assistant, psychology assistant intern, psychology assistant trainee // Medicaid level of care i, as defined by each land |
| U2 | Licensed professional counselor // Medicaid level of intendance 2, as defined by each state / |
| U3 | Used to place the patient location of "inpatient infirmary" when a telehealth service was delivered / Medicaid level of care iii, every bit defined by each state / Licensed chemic dependency advisor III |
| U4 | Licensed social worker (LSW) / Used to place the patient location of "outpatient hospital" when a telehealth service was delivered / Medicaid level of care 4, every bit defined past each land |
| U5 | Licensed matrimony and family therapist (LMFT) / Used to place the patient location of "nursing facility" when a telehealth service was delivered / Medicaid level of intendance v, as defined by each land |
| U6 | Chemic dependency counselor assistant / Medicaid level of intendance half-dozen, 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, every bit defined by each state |
| U8 | Social worker assistant / Medicaid level of care 8, as defined past each state |
| U9 | Social worker trainee / Medicaid level of care 9, every bit defined past each state |
| UA | Union and family therapist trainee / Medicaid level of care 10, as defined by each land |
| UB | Additional license, licensed independent clinical dependency counselor (LICDC) or OTP two-week administration (8-fourteen days) / Medicaid level of care 11, as defined by each state |
| UC | Certified nurse practitioner, team member (Deed) / Medicaid level of care 12, equally defined by each state |
| UD | Medicaid level of intendance 13, as defined by each land |
| UE | Used durable medical equipment |
| UF | Additional license, licensed independent social worker (LISW) |
| UG | Additional license, licensed independent spousal relationship and family unit therapist (LIMFT) |
| UH | Additional license, licensed professional person clinical counselor (LPCC) |
| UJ | Services provided at night |
| Britain | QMHS with 3 years' feel |
| United nations | Two patients served |
| Up | Three patients served |
| UQ | Iv patients served |
| UR | Five patients served |
| US | 6 or more patients served |
| XE | Service that is distinct because information technology occurred during a divide see |
| XP | Service that is singled-out because information technology was performed past a different practitioner |
| XS | Service that is distinct because information technology was performed on a carve up organ/construction |
| XU | Service that is distinct because it does not overlap usual components of the chief 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. |
| Doc | AG | Primary md | 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 tin can exist 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 |
| Primary'due south Level Counselor | HO | Master'south caste 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 person (LMHP). KMAP will deny the service if this modifier is billed with any code other than H2011. For farther data related to these services, refer to the Non-PAHP Outpatient Mental Wellness Provider Manual |
| Available'southward degree level counselors | HN | Available's degree level | At this fourth dimension, there are no special coding instructions applicable to Medicaid claims billing for this modifier. |
| Less than bachelor's degree level counselors | HM | Less than available's degree level | At this time, at that place are no special coding instructions applicable to Medicaid claims billing for this modifier. |
| National Certified Addictions Counselor | HF | Substance Abuse Plan | 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, at that place are no special coding instructions applicable to Medicaid claims billing for this modifier. |
Mental Health Modifier Coding Guidelines
Make sure to check the post-obit per customer:
- Eligibility and Benefits Verification
- Your License Level Modifier for that Insurance Visitor
- Are Modifiers Required For Billing? (Enquire 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 wellness billing service like TheraThink to solve these problems for you.
Nosotros are exhaustive experts able to address your billing situation with ease. Accomplish out!
CPT Codes and Modifiers for Mental Wellness 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://world wide web.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
How Are Mental Health Services Billed In Wi Through Medicaide,
Source: https://therathink.com/mental-health-modifiers/
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