This article is for community mental health centers and opioid treatment programs caring for our members
Please share with relevant office staff and billing agencies
To ensure that your claims are processed correctly and efficiently, we encourage you to review and share the following tips with your billing department and any billing agencies that you may work with.
All services must be billed on a CMS-1500 claim form and include the following:
- Group NPI listed in both the Billing Provider and Rendering Provider fields (do not list an individual provider’s NPI)
- Correct modifier showing the licensure level of the rendering clinician (see table below)
|
Modifier |
Licensure level |
|---|---|
|
AF |
Psychiatrist |
|
AH |
Psychologist |
|
AJ |
Licensed independent clinical social worker (LICSW) |
|
HA |
Child psychiatrist |
|
HE |
Psychiatric nurse practitioner (PNP) |
|
Psychiatric physician assistant (PPA) |
|
|
HI |
Licensed applied behavioral analyst (LABA) |
|
Modifier |
Licensure level |
|---|---|
|
HH |
Licensed alcohol and drug counselor-1 (LADC-1) |
|
HR |
Licensed marriage and family therapist (LMFT) |
|
HO |
Licensed mental health counselor (LMHC) |
|
TD |
Mental health clinical nurse specialist |
|
HK |
Therapeutic behavioral services |
Note: Licensure modifiers should not be used when billing intermediate levels of care, such as intensive outpatient programs, partial hospitalization programs, crisis stabilization, and methadone maintenance.
For other important billing guidelines, please refer to our Community Mental Health Centers payment policy.
For other important billing guidelines, please refer to our Community Mental Health Centers payment policy.
To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or log in and go to Office Resources>Policies & Guidelines>Payment Policies.
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