Behavioral Treatment Claim Details for Focused Treatment Services

Previously, some behavioral treatment (BT) providers used modifier 52 (Reduced services) for focused treatment claims when the team providing services included a BT technician. This guidance clarifies that BT providers must only use modifier 52 on focused behavioral treatment claims when the services were rendered by a technician.

This page contains instructions for:

• When to use modifier 52.
• How to correct paid claims where modifier 52 was used in error.
• Additional resources for behavioral treatment service providers.

Instructions for Using Modifier 52

Effective immediately, providers seeking reimbursement for focused treatment services must:

• Use modifier 52 with 97153 TF on a claim for services rendered by a BT technician.
• Not use modifier 52 with 97153 TF on a claim for services rendered by a BT licensed supervisor or therapist.

The prior authorization (PA) request process for focused treatment has not changed. If BT technicians are on the team for PA services, they should include modifier 52 with procedure code 97153 TF.

Making Corrections to Paid Claims

Some providers may have submitted claims for dates of service (DOS) on and after May 15, 2026, when the services were not rendered by a BT technician, resulting in an incorrect reimbursement rate. If such a claim was already paid the provider must either:

• Submit a claims adjustment. Review the ForwardHealth Online Handbook Electronic topic #512 for additional information.
• Void the claim and resubmit it without modifier 52. Review the Voiding Claims topic #8417 for additional information.

Providers will have 365 days from the DOS to submit a correction.

Resources

Field representatives can answer additional questions about this change. Review the field rep map.

Behavioral treatment providers can visit their resource page.

Behavioral treatment providers can review these other Online Handbook topics:

• Modifiers topic #18957
• Procedure Codes topic #18959