Wiki Modifier AJ

[cawilson119]

I am having trouble finding up to date resources on Modifier AJ. My office is going to be hiring a social worker or drug counselor to do substance abuse therapy. I've discussed this w/ another local practice and they append the AJ modifier to everything done by anyone who is not a psychologist. When I looked it up in the CPT book the definition is "Clinical social worker." Can anyone tell me when exactly I would need to use it, if at all?? Thanks!

 

[ckeeney]

https://www.cms.gov/Outreach-and-Ed.../Mental-Health-Services-Booklet-ICN903195.pdf This link will take you to CMS' definition of CSW. It is NOT anyone who is not a psychologist. There are other modifiers for lower level providers of psychological services, but Medicare does not cover their services. Following the link will take you to a CMS presentation where the different psych providers are explained.

 

[charbanc]

In my metal health office we use the modifiers depending on what type of insurance they have.
For example for traditional Medicaid and Beacon medicaid/chip they require us to use the AJ modifier for a LCSW and LPC. For Magellan Medicaid the AJ is for LCSW only. Modifiers are not required for commercial insurances. I live in Texas, unsure if this is different per state. You may want to contact the health plans directly for guidance.

 

[cawilson119]

Thank you-this info will help a lot!