U4 Modifier In Behavioral Health

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APG Modifiers - New York State Office of Mental Health

Details: U4 (Modifier) respect for those served and for their culture must be assured. Although the use of friends or family members as interpreters is not generally recommended, it is not prohibited. However, decisions to do so should be subject to careful clinical review and behavioral health modifiers for billing

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› Url: http://omh.ny.gov/omhweb/medicaid_reimbursement/clinics/apg-modifiers.pdf Go Now

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NYS APG Modifiers - New York State Department of Health

Details: 34 rows · Mental Health Program: OMH, DOH: 04/01/13: 04/01/13: Medical visits that … modifier u4 definition

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› Url: https://www.health.ny.gov/health_care/medicaid/rates/methodology/modifiers.htm Go Now

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OH-SP-0071 Behavioral Health Billing Guide

Details: BEHAVIORAL HEALTH BILLING GUIDE . CONTENTS . U4 = Licensed Social Worker . U5 = Licensed Marriage Family Therapist . When used with HCPCS codes: UK = Qualified Mental Health Specialist - 3 Years of Experience . HN = Qualified Mental Health Specialist - Bachelor’s . behavioral health modifiers 2020

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› Url: https://www.caresource.com/documents/oh-sp-0071-cmhc-behavioral-health-billing-guide/ Go Now

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COMMUNITY BASED SERVICES Outpatient Mental Health …

Details: H0004 HF U1 U4 Behavioral health counseling and therapy (ASAM Level 1), community $22.57 H0004 HF HR U4 Behavioral health counseling and therapy (ASAM Level 1), family/couple w/client present $19.33 H0004 HF HR U1 U4 Behavioral health counseling and therapy (ASAM Level 1), family/couple w/client present, community $22.57 u4 modifier kentucky

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› Url: https://kidsfiles.delaware.gov/pbhs/pdfs/2021_communitybased_cpt_hcpc_codes_modifiers.pdf Go Now

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Kentucky Medicaid Behavioral Health & Substance Abuse

Details: LABA, LCADCA= U4 Modifier: CADC= U6 Modifiers: Other Non-Bachelors-level: PSS= U7; CSA= UC +90836 Psychotherapy, 45 minutes with patient and/or family member when Kentucky Medicaid Behavioral Health & Substance Abuse Services Facility Fee Schedule (Effective 4/1/2020, rev. 7/1/2020) Code Description Unit of Service Modifiers: modifiers for mental health providers

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› Url: https://chfs.ky.gov/agencies/dms/DMSFeeRateSchedules/BHInpatientFeeScheduleApril2020revJuly1.pdf Go Now

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Outpatient Behavioral Health Services (OBHS) Section II

Details: National Codes Required Modifier Service Title 90832. 90834 90837 U4 U5. U4 U5. U4 U5 Individual Behavioral Health Counseling – Substance Abuse. A Mental Health Diagnosis will be required for all children through 47 months to receive services. This service includes up to four encounters for children through the age of 47 months and can be medicaid mental health modifiers

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› Url: https://medicaid.mmis.arkansas.gov/Download/provider/provdocs/Manuals/OBHS/OBHS_II.doc Go Now

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Mental Health Modifiers: The Definitive Guide [2021]

Details: 10 rows · Mental Health Modifiers are two digit alphanumerical codes used on CMS1500 insurance … behavioral health modifiers for medicaid

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Ambulatory Patient Groups (APG) Payment Modifiers

Details: 7 rows · Ambulatory Patient Groups (APG) Payment Modifiers – Effective 1/1/2012. …

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› Url: http://omh.ny.gov/omhweb/medicaid_reimbursement/clinics/apg/modifiers.html Go Now

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Claim Modifiers for Behavioral Health Services

Details: Delaware Behavioral Health Fee Schedule with applicable modifiers. Claims submitted without applicable modifiers will be denied by the health plan. Please use the chart below as a guide to acceptable Current Procedural Terminology (CPT) code and modifier combinations for the most commonly-provided behavioral health services.

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› Url: https://www.amerihealthcaritasde.com/assets/pdf/provider/claims-billing/bh-modifier-chart.pdf Go Now

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OH-SP-0071 Behavioral Health Billing Guide

Details: MODIFIER DESCRIPTIONS 25 - When using a 25 modifier it has to be a Significant and Separate Identifiable Evolution and Management Service by the same physician or other qualified health care professional on the same day of

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› Url: https://www.caresource.com/documents/oh-sp-0075-hospital-behavioral-health-billing-guide/ Go Now

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Title: B3 Peer Support H0038 U4 Type: Group Code: H0038 HQ

Details: Division of Mental Health, Developmental Disabilities and Substance Abuse Services (D MH/DD/SAS), the requirements of 10A N.C.A.C 27G and NC G.S. 122C, and any competencies specified by the NC Division of Medical Assistance (D MA). STAFFING REQUIREMENTS

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› Url: https://providers.partnersbhm.org/wp-content/uploads/2017/06/B3_Peer_Support_update_2017-06-27.pdf Go Now

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COMMUNITY BASED SERVICES Outpatient Mental Health …

Details: H0001 U1 U4 Alcohol and/or drug assessment, community $90.26 H0004 HF U4 Behavioral health counseling and therapy (ASAM Level 1) $19.33 H0004 HF U1 U4 Behavioral health counseling and therapy (ASAM Level 1), community $22.57 H0004 HF HR U4 Behavioral health

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› Url: http://kidsfiles.delaware.gov/pbhs/pdfs/2020_communitybased_cpt_hcpc_codes_modifiers.pdf Go Now

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Billing Policy - Minnesota-defined U Modifiers

Details: U4. Doula service. 99199, S9445. Consumer Directed Community Supports (CDCS) – self-direction support activities. T2028. Individualized Education Program (IEP) mental health – evaluation. T1018 . Individualized Education Program (IEP) mental health – services. T1018+HE+-

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› Url: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_167693 Go Now

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Billing Guidance for Developmental and Behavior Health Screens

Details: “Developmental and Behavioral Health Screens in Primary Care-Requirement of Modifiers”, which was published July, 2014. As outlined in PB 2014-43, effective for dates of service August 1, 2014 and forward, modifiers U3 and U4 are required when a physician, physician group, APRN, APRN

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› Url: https://www.huskyhealthct.org/providers/provider_postings/Billing_Guidance_for_Developmental_and_Behavior_Health_Screens.pdf Go Now

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Kentucky Medicaid Fee-For-Service Behavioral Health

Details: LABA, LCADCA= U4 Modifier: CADC= U6 Modifiers: Other Non-Bachelors-level: PSS= U7; CSA, RBT= UC +90785 Interactive Complexity Use in conjunction with codes for Kentucky Medicaid Behavioral Health & Substance Abuse Services Outpatient (Non-Facility) Fee Schedule (Effective 1/1/2020) Code Description Unit of Service Modifiers:

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› Url: https://chfs.ky.gov/agencies/dms/DMSFeeRateSchedules/2020BHOutpatientNonFacilityFeeSchedule.pdf Go Now

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Outpatient Behavioral Health Services Fee Schedule

Details: 90791 U4 $114.43 90792 U4 $121.74 90832 U4 U5 $46.38 90832 U4 UC UK $51.02 90832 U4 $46.38 billing instructions, frequency of services, third party liability, age restrictions, prior authorization, Outpatient Behavioral Health Services Fee Schedule

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› Url: https://humanservices.arkansas.gov/wp-content/uploads/OBHS-fees.pdf Go Now

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Commonwealth of Massachusetts Executive Office of Health

Details: health centers.) 96110 U4 Covered for members birth to 21 for the administration and scoring of a standardized above modifiers, U1–U8. * “Behavioral health need identified” means the provider administering the screening tool, in his or her professional judgment, identifies a child with a potential behavioral health services need.

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› Url: https://www.mass.gov/files/documents/2017/06/zp/chc-110.pdf Go Now

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Behavioral Health Authorization Requirements* - Effective

Details: A modifier is NOT required at point of authorization. Behavioral Health Residential- psychiatric 1001 On only covered for ages 18 and under Detox - Docimillary (DASA) 1002 On 0 Psychotherapy, 30 mins 90832 U4 Practitioner Level 4 1 1 encounter On On At visit 21

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› Url: https://www.wellcare.com/~/media/PDFs/Georgia/Provider/2018/GA_CAID_Prov_BH_Authroization_Requirements_ENG_9_2018.ashx Go Now

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Mental Health Services - Psychiatric Consultations to

Details: Add the U4 modifier if not face-to-face. Add the U7 modifier if provided by a Physician Extender. 99499. HE AM. Consulting Professionals. Communication between a consulting professional and a primary care provider, for consultation or medical management; or behavioral health care and treatment of a recipient. 1 Session. Add the U4 modifier if

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› Url: https://www.dhs.state.mn.us/main/idcplg/CPA_Instructions%20v5.pdf?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_138238 Go Now

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SPECIAL BULLETIN COVID-19 #76: Telehealth and Virtual

Details: H2023 U4 H2026 U4. HQ for group. Supported Employment (Initial and Maintenance) For Supported Employment for individuals with Mental Health needs, (b)(3) follows the State definition. * For Supported Employment for individuals with Mental Health needs, Service may be provided via two-way, real-time audio and video - as well as telephonically.

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› Url: https://medicaid.ncdhhs.gov/blog/2020/05/01/special-bulletin-covid-19-76-telehealth-and-virtual-patient-communications-clinical Go Now

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BCN Provider Manual - Chapter 13: Behavioral Health

Details: Chapter 13: Behavioral Health Behavioral health overview Behavioral health providers seeking BCN affiliation BCN contracts with a limited but diverse network of behavioral health providers to ensure that BCN members have access to the range of behavioral health services required to address their needs in the geographic areas in which they are

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› Url: http://ereferrals.bcbsm.com/docs/bcn/bcn-13b_health.pdf Go Now

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Pennsylvania Bulletin

Details: **Modifier U4 must be used with all procedures codes when billing for services excluding benefit allowance. Modifier TD is used to identify services rendered by a RN. Copies of this notice may be obtained at the local Mental Health/Intellectual Disability (MH/ID) County Program, Administrative Entity (AE) or regional Office of Developmental

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› Url: http://www.pacodeandbulletin.gov/Display/pabull?file=/secure/pabulletin/data/vol47/47-33/1381.html Go Now

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FOR COMMUNITY BEHAVIORAL H P

Details: The Behavioral Health Assessment process consists of a face-to-face comprehensive clinical assessment with the individual, which must include the youth’s perspective as a full partner and should include family/responsible caregiver(s) and others significant in the youth’s life as well as collateral agencies/treatment providers.

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› Url: https://dbhdd.georgia.gov/sites/dbhdd.georgia.gov/files/imported/DBHDD/Files/Combined%20BH%20FY13%20FINAL.pdf Go Now

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Using Correct License-level Modifiers on Your Claims

Details: ©2005-2021 Magellan Health, Inc. Last reviewed 02/2021 Using Correct License-level Modifiers on Your Claims Magellan organizational providers and individual providers submitting professional claims as part of an organization (using the organization’s Taxpayer Identification Number) must submit claims with the license-level modifier that represents the treating provider’s license level.

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› Url: https://www.magellanprovider.com/media/11711/degree-level-modifiers.pdf Go Now

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Georgia Department of Behavioral Health and Developmental

Details: Georgia Department of Behavioral Health and Developmental Disabilities Procedure Codes and Modifiers for Developmental Disabilities Services Service Descrip. 1 CPT Mod 1 Mod 2 Mod 3 Descrip. 1 Descrip. 2 CPT Mod 1 Mod 2 Mod 3 Adult Occupational Therapy Eval. 97003 97003 Self-Directed 97003 UC Self-Directed 97003 UC

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› Url: https://dbhdd.georgia.gov/sites/dbhdd.georgia.gov/files/imported/DBHDD/DD/Rate_Study/Tab%203%20-%20Modifiers%20and%20Procedure%20Codes.pdf Go Now

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Behavioral Health Professional Refresher Workshop

Details: health clinicians, behavioral health clinics, psychiatrists and psychiatric APRNs to utilize the U3 and U4 modifiers, as applicable, use of the modifiers is not a requirement for claims submission and CPT code 96110 will not deny if U3 or U4 is not submitted. •Modifier U3 should be …

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› Url: https://www.ctdssmap.com/CTPortal/portals/0/StaticContent/Publications/BHP%20Refresher%20Workshop%202014.pdf Go Now

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Medicaid Uses New CPT Code 96127 for Billing Behavioral

Details: CPT code 96127 to the physician office and outpatient fee schedule to be used for behavioral health assessments. Providers will be required to bill with the appropriate modifier (U3 or U4) similar to when billing for developmental screens. Effective for dates of service January 1, 2015 and forward there will be a new CPT code for billing behavioral health screens (BH screens).

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› Url: http://archive.constantcontact.com/fs160/1102573120877/archive/1120124397696.html Go Now

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PROVIDER PAYMENT POLICY

Details: MENTAL HEALTH MODIFIERS FOR MINNESOTA HEALTH CARE PROGRAMS U4 Service provided via non face-to-face contact, e.g., telephone U5 Certified Peer Specialist Level I U6 Interactive Behavioral Health Day Treatment U8 Child Children's Clinical Care Consultation - 11 to 20

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› Url: https://docs.ucare.org/filer_public/files/providermodifiergrid.pdf Go Now

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AHCCCS/ALTCS Services, Service Codes and Applicable Units

Details: NOTE: Behavioral Health Residential may be appropriate for stays of any length. The code is the same. H0018 Per diem BEHAVIORAL HEALTH THERAPEUTIC HOME For purposes of modifier U4 or U5, family member means: Adult children/Step children of member Son/Daughter-in-law of member

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› Url: https://www.azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/Exh21-3.pdf Go Now

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DAL–Universal Billing Codes for Home and Community LTC

Details: Attached are a final set of universal codes for Long Term Care Services with respective modifiers (Attachment A) and Adult Day Health Care with respective modifiers (Attachment B). The Department is requiring the implementation of billing codes by May 1, 2017 and will request status updates on March 1, 2017 and April 3, via email.

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› Url: https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_2016-12-21_billing_codes.htm Go Now

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Changes for July 1, 2021 Updated - Alliance Health

Details: Modifier Service Description Billing Unit Rate H2011 HI U4 Primary Crisis Response 15 minutes $ 8.14 H2015 U1 U4 Community Networking - Classes/conferences H2015 HQ U4 Community Networking - Group 15 minutes $ 2.98 H2012 HA Day Tx Behavioral Health Child Per hour $ 31.41 H2015 HT Community Support Team (new rate as of 11/1/2019, code ends

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› Url: https://www.alliancehealthplan.org/wp-content/uploads/Medicaid-Rates-FY22.pdf Go Now

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Behavioral Health Redesign Testing Guidance

Details: Medicaid Mental Health Benefit 6 Therapeutic Behavioral Service (TBS) H2019 with modifier HO, HQ and UA, no rendering provider, no supervising physician Intensive Home-Based Treatment (IHBT) H2015 with modifier U4, no rendering provider, no supervising physician 90837 with a independent rendering provider, no modifier, no supervising physician

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› Url: https://www.molinahealthcare.com/providers/common/PDF/BH-Redesign-Testing-Guidance.pdf Go Now

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Connecticut Medical Assistance - HUSKY Health Program

Details: behavioral health clinicians, behavioral health clinics, psychiatrists and psychiatric APRNs to utilize the U3 and U4 modifiers, as applicable, use of the modifiers is not a requirement for claims submission and CPT code 96110 will not deny if U3 or U4 is not submitted. The Department is implementing the use of modifiers

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› Url: https://www.huskyhealthct.org/providers/provider_postings/PB%202014-43%20Developmental%20and%20Behavioral%20Health%20Screens.pdf Go Now

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Arkansas Medicaid Adult Behavioral Health Services for

Details: 90885 U4 $57.60 H0019 HQ U4 UC $250.00 H0019 HQ U4 $175.00 H0035 U4 $214.05 H0038 U4 UC $16.77 H0038 U4 $8.39 H0043 U4 $25.59 H2017 U1 U4 $12.82 H2017 U2 U4 $12.82 H2017 U4 U3 $11.15 H2017 U4 U5 $11.15 H2017 U4 UA $7.68 H2017 U4 UB $9.60 H2023 U4 $25.59 Provider Type/Specialty: 26/R6 Arkansas Medicaid Adult Behavioral Health Services for Community

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› Url: https://humanservices.arkansas.gov/wp-content/uploads/ABHSCI-fees.pdf Go Now

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Behavioral Health Services in Ohio Hospitals

Details: After realizing some hospitals were operating community mental health center (CMHC)(Medicaid provider type 84) and substance use H2012 HE AH, AJ,U5, U2 or U4 1 hour of licensed practitioner in an ‐‘HE’ modifier (Mental Health Program) Services

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› Url: https://medicaid.ohio.gov/static/Providers/FeeScheduleRates/OutpatientBehavioral/Outpatient-Hospital-BH-Services.pdf Go Now

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Modifier > HA=Child HB=Adult - Department of Health

Details: specialized behavioral health services - cpt 7.1.15 modifier > 96119 psychological testing with interpret technician 0-20 $50.08 $40.06 $40.06 $50.08 96119 psychological testing with interpret technician 21+ $50.08 $50.08 $50.08 96120 psychological testing with interpret computer 0 …

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› Url: https://ldh.la.gov/assets/docs/BayouHealth/BHIntegration/SpecializedBehavioralHealthFeeSchedule.pdf Go Now

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Connecticut Department of Social Services

Details: the applicable U3 and U4 modifier appended. However, if a pediatrician administers a developmental screen that • Select Mental Health to access the Mental Health Initiatives page • Highlight Key Resources • Select Primary Care Tools

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HCPCS Modifier Codes - H Codes

Details: HCPCS Medical Codes & Code Modifiers (HCPCS is commonly pronounced Hick-Picks.) Each year, in the United States, health care insurers process over 5 billion claims for payment.

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Beacon Health Options Provider Handbook Beacon Health

Details: While Beacon Health Options, Inc. is licensed in numerous states as a third party administrator and/or utilization review agent of behavioral health services, some of the Beacon’s affiliates and subsidiaries are licensed as full service or limited service health plans operating in a designated state.

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CPT modifier GT, HT, HQ, GQ, T1016, H2011 - Medical

Details: H2012 Behavioral health day treatment, per hour Prior Authorization and Billing Instructions: Only Provider Type 14 Behavioral Health Community Network groups that have an approved Day Treatment Model and Specialty 308 Enrollment Checklist can request prior authorization for Day Treatment and bill code H2012.

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GT Modifier for Telehealth Billing [2021 Guide]

Details: GT Modifier for Telehealth Billing [2021 Guide] The GT modifier is a coding modifier used for Telehealth claims. For many years it was the standard for signifying Telehealth claims before being mainly supplanted by the 95 modifier. In 2018, when CMS and Medicare stopped using this mainly companies followed suit and switched to 95 modifier.

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APPENDIX B — CRITERIA FOR Behavioral Health I/DD …

Details: determine the population meeting eligibility for the Behavioral Health I/DD Tailored Plan exemption for purposes of Standard Plan launch until Behavioral Health I/DD Tailored Plan launch . The lookback period may be updated to identify beneficiaries eligible to enroll in the Behavioral Health I/DD Tailored Plans when they launch on July 1, 2022.

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Arkansas Department of Health and Human Services

Details: Licensed Mental Health Practitioner Section II 262.100 Licensed Mental Health Practitioner Procedure Codes 12-5-05 The following services are billed on a per unit basis. Unless otherwise specified in the appropriate CPT or HCPCS book, one unit equals 15 minutes. Services less than 15 minutes in duration are not reimbursable.

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› Url: https://www.sos.arkansas.gov/uploads/rulesRegs/Arkansas%20Register/2005/nov_2005/016.06.05-089F-7999.pdf Go Now

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Telehealth & Virtual Services Guide - AR Health & Wellness

Details: Behavioral health Individual counseling . 90832, 90834, 90837 . Psych. education . H2027 (Use modifiers U4 & GT) Individual physical or occupational therapists and SLP . G0261-G0263 . Parental consultation . T1014 . with appropriate modifier . Use modifiers -95 and -GT.

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› Url: https://ambetter.arhealthwellness.com/content/dam/centene/Ambetter%20of%20Arkansas/PDFs/AR%20Telehealth%20Virtual%20Services.pdf Go Now

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Nebraska Behavioral Health Authorization List

Details: patients disabling mental health problems; per session (45 minutes or more) NA : 0 : G0177 : Training and educational services related to the care and treatment of patients disabling mental health problems per session (45 minutes or more) NA : Use MN Criteria for Group ABA Therapy : G0396 : Alcohol/subs interv 15-30mn ; NA : 0 : G0397 : Alcohol

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