7 Examples of Behavioral Health Medical Billing Modifiers

7 Examples of Behavioral Health Medical Billing Modifiers

In the medical billing field, modifiers are codes which indicate that a service or procedure that has been performed has been altered by some specific circumstance, but has not changed in its definition or code.

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These are important because modifiers determine the amount of reimbursement a provider will receive. Specifically, behavioral health professionals tend to deal with a lot of atypical circumstances when it comes to their field and providing treatment.

A few examples of instances where these modifiers are useful include:
* Codes for services provided via telemedicine
* The use of multiple providers in the same session
* The provision of crisis intervention services

By using these modifiers, behavioral healthcare providers can ensure that their claims are processed correctly and that they receive the appropriate payment for their services.

Modifiers indicate the type of service provided by adding a two-digit code to the end of the procedure code for the service.

Here’s an example: if a procedure code for a therapeutic session is 90837, then modifier 52 (which means “reduced services”) could be added after that code to indicate that the session ran shorter than usual.

Common modifiers range from a discontinued procedure to service expectations not being met.

Some of the most common modifiers used in behavioral health billing include:
1. Modifier 25: significant, separately identifiable evaluation and management service by the same physician or provider on the same day as another service
2. Modifier 27: various evaluation and management encounters conducted on the same day
3. Modifier AF: physician delivering SUG group counseling
4. Modifier GT: to identify a service as telehealth
5. Modifier HE: mental health program
6. Modifier HP: doctoral level
7. Modifier HQ: group setting

It’s important to note that each insurance company may have specific requirements and policies regarding the use of these and other modifiers for behavioral health billing. Behavioral healthcare providers should familiarize themselves with the policies of the insurance companies they work with in order to ensure that claims are processed accurately and that appropriate payment is received for the services provided.

Modifiers used for behavioral health billing, and all medical billing really, are vital components of submitting your claims. Making sure the codes you use are accurate will result in reimbursement that precisely reflects the services rendered to your patients.

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