Medical Billing Forum

Billing => Billing => : kwardbilling July 08, 2019, 05:51:21 PM

: Modifier
: kwardbilling July 08, 2019, 05:51:21 PM

Hi Everyone,

It's been a long time since I've needed to check in, but here is a question I have.  I have been billing for an LICSW (Massachusetts), I have used an HO modifier in the past when needed, but Optum, just refused a claim saying I was using the wrong modifier.  I thought HO was the correct modifier, can anyone tell me if this is correct?  If not, can you tell me which modifier I should use.  This if for an individual session 90834 outpatient mental health.

Thanks in advance,
Karen

: Re: Modifier
: Kerry July 08, 2019, 09:18:54 PM

Why would you use an HO modifier?  In my neck of the woods, modifiers are not used for that code for that credential.

: Re: Modifier
: Michele July 09, 2019, 04:11:10 PM

I agree, I don't know why you are using the HO modifier.  I don't believe any modifier is needed. 

: Re: Modifier
: PMRNC July 11, 2019, 09:32:44 AM

I know Magellan requires the credentialed level modifier..but I think LICSW would be the AJ modifier

: Re: Modifier
: kwardbilling July 11, 2019, 02:26:20 PM

I finally got through to a Supervisor.  She said I was using the correct modifier "HO", she is masters level, however, she said for this particular plan they don't use modifiers.  She had me re-submit to her and claims are paid.  Strange, I've been submitting with the HO modifier (in Massachusetts), with no issues, this was the first time.  Thanks everyone for your input.