Reminder: Behavioral health midlevel providers may not bill E&M services codes

Anthem Blue Cross and Blue Shield wants to reiterate that behavioral health and substance use midlevel practitioners (such as social workers, marriage and family therapists, psychologists, etc.) are not permitted to perform or supervise medical services. This includes evaluation and management (E&M) procedure codes (99201-99499). E&M codes submitted with either a midlevel provider as the rendering provider or a physician rendering provider and midlevel modifier (AJ, AH, HE, HF) will be subject to denial or recoupment if the claim was paid.

• AJ (social workers)
• AH (psychologists)
• HE (licensed mental health counselors)
• HF (licensed clinical addiction counselors)

 

Exception: Behavioral health and substance use midlevel practitioners can provide bridge appointment services (99401 HK) and tobacco, alcohol dependence and substance use disorder counseling and screening (99407 U6, 99408 and 99409). These services must append the following modifiers when the services are billed with the NPI of the supervising physician of health service provider of psychology (HSPP). The modifier is not necessary when the midlevel provider is enrolled with the Indiana Health Coverage Program (IHCP) and the services are billed with the midlevel practitioner’s own NPI.

 

If you have any questions, please contact Provider Services:

• Hoosier Healthwise: 1-866-408-6132
• Healthy Indiana Plan: 1-844-533-1995
• Hoosier Care Connect: 1-844-284-1798

 

AIN-NU-0280-21