| Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | Outpatient Mental Health | | 05/09/2024 | Covered and Noncovered Services : CodesTopic #6218 Modifiers
The following tables list the applicable modifiers that providers are required to use when requesting PA and submitting claims for outpatient mental health services. Not all providers may be reimbursed for all mental health services.
| Professional Level Modifiers |
| Modifier |
Description |
Providers |
| HO |
Master's degree level |
Master's-level psychotherapist includes the following:
- Certified psychotherapist
- Licensed psychotherapist
Master's-level psychotherapists are advanced practice social workers; certified independent social workers; and licensed social workers, professional counselors, or marriage/family therapists who have completed their 3,000 post-graduate supervised clinical hours per Wisconsin DSPS or who have a DQA Provider Status Approval letter. This includes RNs who have a Master's degree in psychiatric mental health nursing or community nursing who have a DQA Provider Status Approval letter. |
| HP |
Doctoral level |
Psychologist |
| U6 |
QTT with a graduate degree |
QTTs with a graduate degree are required to either have a doctoral degree from an accredited institution and be working toward full Wisconsin DSPS licensure as a licensed psychologist or be certified by the Wisconsin DSPS as one of the following:
- Marriage and family therapist in training
- Professional counselor in training
|
| UA* |
Psychiatrist |
Psychiatrist billing mental health services |
| UB |
APNP or Physician Assistant with Psychiatric Specialty |
APNPs with a psychiatric specialty may only be reimbursed for a limited number of procedure codes. For reimbursement of psychotherapy procedure codes, APNPs with a psychiatric specialty must have 3,000 hours of supervised clinical experience, which has been verified by issuance of an individual Provider Status Approval letter by the DHS DQA.
Physician assistant with a psychiatric specialty who works under a licensed psychiatrist and possesses a current license to practice in Wisconsin. |
APNPs with a psychiatric specialty and psychiatrists are the only mental health providers who can submit claims for psychotherapy services that include a medical E&M component. Additionally, APNPs with a psychiatric specialty are required to be separately enrolled in Wisconsin Medicaid as a nurse practitioner in order to be reimbursed for an E&M service.
*Physicians can bill for CPT central nervous system assessments/tests procedure codes.
| Informational Modifier |
| Modifier |
Description |
| U7 |
Services rendered by an individual during a practicum are reimbursable under the conditions specified in Wis. Admin. Code § DHS 107.01(2), which include, but are not limited to, the following:
- The student does not bill and is not reimbursed directly for their services.
- The student provides services under the direct, immediate, on-premises supervision of a Medicaid-enrolled provider.
- The supervisor documents in writing all services provided by the student.
|
|