CPT Modifier Codes

Some practitioners need to enter "CPT Modifier Codes" when billing for clients.

CPT Modifiers are always two characters and may be numeric or alphanumeric.

Modifiers provide other information that may be critical to a claim's status with the insurance payer. 

Modifiers can be divided into two categories: 
  1. Conditions that are ALWAYS true for this insurance company: e.g. the code "AH" which indicates "I am a licensed psychologist".
  2. Conditions that are SOMETIMES true: e.g. the code "22" which indicates "This service was exceptionally difficult to give today."

Modifiers in Category 1

These are placed in the Insurance Company Setup following these steps:

  • Click Practice Settings (left menu)
  • Select Billing & Insurance (top tab)
  • Locate the 'Insurance Features' section and click
  • Select the insurance company, then scroll down to the 'Therapist Claim Settings'
  • From the list, select the provider you wish to adjust:

  • This screen is where you can edit Insurance Company Claim Settings. Enter the code here, then save the change:

🎉 Success! This code will now always appear on the claims that you submit to this insurance company.

Modifiers in Category 2

To add these, the Provider can enter them at the time of charting within the Charting screen. Locate the CPT code/Units code area, just below is where you enter the modifiers.

A common mistake is putting the identical code in BOTH places. This will result in a rejected claim. Put the code in one place or the other, but never put the same code in both places for the same claim.

Modifiers are rarely needed in mental health billing. One of the most common reasons that a modifier may be needed is in Medicaid billing, where an indication of your profession by a modifier code may be required. We have yet to hear of a "22" code resulting in higher payment for a mental health service.

In order to find out what modifier codes 'mean', you will have to contact the insurance company in question. There is not a 'modifier code standard' --  each insurance company can and does set codes unique to them.

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