CPT Modifier Codes

Some providers need to include CPT modifier codes when billing insurance, and if yours is one of them, you already know how much they matter.

Modifiers are always two characters (numeric or alphanumeric) and gives payers the additional context they need to process a claim correctly. Miss one, and you might get a denied claim or miss out on being paid for your services rendered.

In this article:

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:

  • From any screen click (top right)
  • Select Billing & Ins. (top tab)
  • Locate the Insurance Features section and click List


  • Click on the Insurance company name:


  • Scroll down to the bottom to find Therapist Claim Options, we list each provider
  • To the right, click (or if already configured)



  • This brings you to the therapist specific settings for this specific insurance company
  • Enter your service modifiers at the top:



🎉 Success! This code will now always appear on all 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.

Locate the CPT code/Units code area — just below are the service modifiers:

Other information:

  • 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

In mental health billing, modifiers don't come up often. When they do, it's most commonly in Medicaid billing where certain payers require a modifier to indicate your professional credential.

One note on the "22" modifier: it exists to flag unusually complex services and can mean higher reimbursement in other specialties. In mental health billing, though, most times the payment stays the same. Something worth knowing before you go down that road.

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

Related Articles