Modifiers are used in healthcare billing to indicate a procedure or type of service provided in addition to an evaluation and management service or to identify the level of a provider. A modifier code is typically two characters (numbers or letters) that are added to the procedure codes in the claim. Modifiers in behavioral health billing are just as important as in medical billing. They are essential to ensure that reimbursement is captured at the highest level possible.
Maintaining a clear understanding of these modifiers and their intricacies can help optimize your documentation and improve the performance of your behavioral health billing process.
What are behavioral health billing modifiers?
Behavioral health billing modifiers are codes added to a claim for reimbursement for behavioral health services. These modifiers indicate specific circumstances that impact the way a service was performed or the patient’s condition and are used to determine the amount of reimbursement that a behavioral health provider will receive. Common examples of behavioral health billing modifiers include:
- Codes for services provided via telemedicine
- The use of multiple providers in the same session
- The provision of crisis intervention services
Why are they necessary?
Behavioral health billing modifiers are necessary to indicate the specific type of services provided, such as those that are extended, unique, or exceptional. This information helps the insurance companies determine the reimbursement amount for the services provided and helps in proper claim processing and payment.
By using these modifiers, behavioral healthcare providers can ensure that their claims are accurately processed and receive appropriate payment for their services.
How do you use modifiers to indicate the type of service provided?
Modifiers indicate the type of service provided by adding a two-digit code to the end of the procedure code for the service.
- For example, the procedure code for a therapeutic session with a mental health provider is 90837, and the modifier 52 (reduced services) could be added to indicate that the session was shorter than the typical session. Similarly, the modifier GT (via interactive audio and video telecommunications systems) could be added to indicate that the session was provided via telemedicine.
The exact codes and their usage will depend on the specific guidelines of the payer, such as Medicare or a third-party payer.
What are some of the most common modifiers used in behavioral health billing?
Behavioral health medical billing demands accuracy from the documentation that ultimately dictates the codes and modifiers that will generate reimbursement. 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:
- Modifier 25: significant, separately identifiable evaluation and management service by the same physician or provider on the same day as another service
- Modifier 27: various evaluation and management encounters conducted on the same day
- Modifier AF: physician delivering SUG group counseling
- Modifier GT: to identify a service as telehealth
- Modifier HE: mental health program
- Modifier HP: doctoral level
- 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.
How can you ensure that your claims are processed correctly when using modifiers for behavioral health services?
Modifiers used for behavioral health billing are vital components of submitting claims that will result in reimbursement that precisely reflects the services rendered to your patients.
Following these best practices may reduce claim denials and help to give you the most out of your documentation:
- Understanding your payers: policies and requirements vary from one insurance company to the next and may update periodically. Stay updated with each payer to ensure you get all the critical information that could affect your facility.
- Accuracy in coding: applying the correct modifier is essential. Match the modifier to the type of service provided, which gives the payer a clear understanding of the documentation. Clean claims and a reduction in denials are the results of accurate coding.
- Thorough documentation: always include the diagnosis codes and the treatment plan in your documentation. Proper annotation of codes and plans is fundamental for processing claims accurately.
- Regulatory updates: Changes in coding and billing regulations may impact the use of modifiers. Staying informed of these changes can help ensure that claims are processed correctly.
- Consider outsourcing your billing: partnering with a reputable billing and coding company can ease the burden of the overall billing process and give you back the time you need to focus on patient care.
Coronis Health is more than a billing company. We can partner with your facility to optimize your documentation practices and improve the health of your revenue cycle.
If you want to learn more about how to get back to what matters most – your patients – schedule a free financial health checkup with Coronis Health. Our team finds missing revenue in 95% of our audits.