What Are The CPT Modifiers For Mental Health?

Billing insurance can be a confusing process. There are many codes that can be used by therapists who are on an insurance panel. So many, in fact, that it can feel like another full-time job trying to figure them all out.

What Are The CPT Modifiers For Mental Health?

Technically speaking, there are no CPT modifiers for mental health. Don’t let this stump you too much.

The Current Procedural Terminology (CPT) code system was created to standardize medical billing across multiple disciplines and practices. Due to this standardization, the codes in the current system are meant to be general enough for any entity within the medical system to be able to use depending on their services. The problem with this, however, is that it leaves therapists lost on the correct codes to use. Then, when you add in the many modifiers that can be used after the main CPT code? It can feel like a complicated board game with too many rules.

What Are Modifiers?

Modifiers are two-digit codes that a practitioner can use to provide additional information when billing insurance. Modifiers serve a very specific purpose. They provide an extra level of detail about a service without changing the definition or purpose of the original code.

There are many modifiers that a practitioner within the medical field can use. It’s important to know what CPT codes to use as well as the applicable modifiers. To learn more about CPT codes, check out my CPT code cheat sheet.

Common Modifiers For Private Practice Owners

Knowing what modifier to use and when can prevent billing headaches in the future. One important thing to note is that typically, only Medicaid programs run by the state require the use of a license-level modifier. However, always check with the individual insurance companies you are paneled with for their requirements.

Modifiers by License Type

  • GT Modifier – For use with telehealth services for medicare.
  • AJ Modifier – Licensed clinical social worker (LCSW)
  • HN Modifier – Bachelor’s Degree, BA or BS
  • AF Modifier – Psychiatrist (MD)
  • AH Modifier – PhD or PsyD
  • HO Modifier – MA

Modifiers by Service Type

  • 95 Modifier – For use with telehealth services conducted in real-time with video and audio.
  • 93 Modifier– Modifier 93 is a new audio-only telemedicine code that was effective on Jan. 1, 2022. Describes services that are provided via telephone or other real-time interactive audio-only telecommunication systems. 
  • GT Modifier – Synchronous Telehealth Services
  • XE Modifier – Two services in the same day
  • GQ Modifier – Two services on the same day
  • FQ MOdifier – A telehealth service furnished using real-time audio-only

Tips To Make Billing With Modifiers Easier

therapist working on CPT Modifiers

It shouldn’t feel like a never-ending chore to figure out how to bill insurance. With enough to do during the day, the last thing you want to do is spend precious minutes trying to figure it all out. Knowing what CPT code to use is a challenge all in itself. But, if you use a modifier that you don’t need, it could delay the time it takes for you to be reimbursed for that service.

Here are some tips that will make billing insurance less of a hassle.

  • Look at the requirements of the panels that you are on. Some, especially Medicaid, will require you to use the modifier code for the level of your degree obtained.
  • Instead of having to look up the requirements of each insurance company each time, create a cheat sheet for yourself that only outlines the information relative to your services.
  • Know what CPT codes to use for your services. Not every CPT code will apply to you, and having your own cheat sheet will help you streamline the billing process a little better.

Confused? You Don’t Have To Go Through This Alone

Insurance billing is not, by any definition, an easy process. With the amount of paperwork and things you need to remember, it’s easy to feel overwhelmed. I invite you to join my exclusive billing membership Bill Like a Boss.  It is a great resource for therapists to ask questions and receive the answers you are actually seeking. Feel free to also reach out to me directly at my calendar link to schedule a time to talk. 

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