HO modifier Behavioral Health

[Sfulton]

I am billing a therapy service to Medicare Plus Blues of Michigan. The provider has a Master’s degree. I am using modifier HO and it is being denied. It is telehealth services and I’m using the Psychiatrist as the supervising doctor. Can anyone help?

 

[Ebarnold]

I am billing a therapy service to Medicare Plus Blues of Michigan. The provider has a Master’s degree. I am using modifier HO and it is being denied. It is telehealth services and I’m using the Psychiatrist as the supervising doctor. Can anyone help?

Can they do medicare? I know most are only paying for medicaid

 

[Sfulton]

I’m not sure. I just started working at this new job but I think they have been billing like this for awhile.

 

[SharonCollachi]

A supervising doctor? Do you mean you are trying to bill incident-to, or are you billing in a teaching setting?

 

[Sfulton]

It’s a teaching setting.

 

[CathieA]

You may need to look at each insurance as they have specific telehealth modifiers required. I bill for OT and our telehealth had to have a place of service change to 02 and modifiers were either 95, or GT or GQ if I remember correctly. We've gone back to in person so going off memory.

 

[ckeeney]

Medicare does not consider Master's level providers as QHP's unless they are licensed clinical social workers as defined by your state licensing bureau. You may need to review whether or not they are eligible under your Medicare rules. I am in Indiana (WPS) and cannot bill unless they hold the license as noted and then they are credentialed and bill under their own NPI. For Indiana Medicaid the modifier for Master's level (not LCSW) is HE.

 

[01289355]

Check out the below one and it may help you,

HN = the rendering provider has a highest educational attainment of a bachelor’s degree
HO= the rendering provider has a highest educational attainment of a master’s degree.
HP = the rendering provider has a highest educational attainment of a doctoral degree
SA = use when billing on behalf of a PA, ANP, or CRNFA for non-surgical services. (Modifier SA is used when the PA, ANP, or CRNFA is assisting with any other procedure that does not include surgery.)
U1 = Medicaid level of care 1, as defined by each state

Reference