| Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | Behavioral Treatment Benefit | | 04/26/2024 | Covered and Noncovered Services : CodesTopic #18957 Modifiers
When submitting claims or PA requests for behavioral treatment services, providers are required to include a modifier with the procedure code to indicate the type of treatment (comprehensive or focused) that was provided. ForwardHealth recognizes modifier TG for comprehensive treatment claims and TF for focused treatment claims. In addition to the TG or TF modifiers, providers are also required to submit modifier AM when submitting claims or PA requests for team meetings. Providers are required to submit both the TF and 52 modifiers when submitting claims or PA requests for focused behavioral treatment when technicians are included on the treatment team. Each line of detail submitted on a claim or claim adjustment requires a modifier. Claims and claim adjustments submitted without the required modifier will be denied.
The following table lists the applicable modifiers providers are required to use when submitting claims for behavioral treatment services.
| Modifier |
Description |
Notes |
| AM |
Physician, team member service |
Use with code 97156 when documentation supports that a team meeting was performed. This modifier is used in addition to modifiers TG or TF based on the level of service provided. |
| TG |
Comprehensive level of service |
Benefit covers high-intensity, early intervention comprehensive behavioral treatment. |
| TF |
Focused level of service |
Benefit covers time-limited lower-intensity treatment that focuses on specific behaviors or deficits. |
| 52 |
Reduced Services |
Use with procedure code 97153. This modifier is used in addition to modifier TF to signify the level of focused behavioral treatment that can be rendered by technicians. |
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