In mental health billing, the reimbursement rate is often dictated by the degree of the provider. Many Medicaid and commercial payers require specific HCPCS Level II Modifiers to identify who performed the therapy.
The Degree Modifiers
- Modifier AH: Clinical Psychologist (PhD, PsyD).
- Modifier AJ: Clinical Social Worker (LCSW).
- Modifier HO: Master’s Degree Level (e.g., LMFT, LPC).
- Modifier HN: Bachelor’s Degree Level.
Payment Reductions
Just like the PTA/OTA modifiers in physical therapy, these modifiers trigger automated payment reductions. For example, Medicare pays Clinical Social Workers (Modifier AJ) at 75% of the standard physician fee schedule for psychotherapy codes.
NCCI Edits and Telehealth
These modifiers are informational and must be stacked. If a Social Worker performs a 45-minute therapy session via Zoom, the claim line might look like: 90834-95-AJ.