Most Common Addiction Treatment Billing CPT and HCPCS Code Modifiers for Behavioral Health Billing in 2024

May 21, 2024 Ben Weiss

What are CPT codes? Why are they important to behavioral health billing?

CPT codes - aka “current procedural terminology” codes - are the standard coding language behavioral health billers use to record and bill for all addiction treatment services. The CPT codeset or code list is updated every year to reflect the changes that come about in the behavioral health space. While CPT codes are generated and updated by the Center for Medicare and Medicaid Services (CMS) and are used officially to describe Medicare services, nearly all public and private insurance providers use CPT codes to communicate with providers about medical services. CPT codes aren’t just useful, they are essential. Without CPT codes, there is no way to seek reimbursement for services rendered.

For more on CPT codes and addiction treatment, see 2024 - Most Commonly Used Addiction Treatment and Behavioral Health CPT Codes for Billing and Reimbursement.

What’s a CPT or HCPCS modifier? When do I need to use one for addiction treatment billing and coding?

Basic CPT codes are made up of 5 alphanumeric characters. Sometimes, in addition to the CPT code, billers add two additional characters to the end of the CPT code. These two additional characters are also known as “modifiers.” These modifiers further describe the services rendered - usually who provided the services, where the services occurred, or what specific type of program provided the context for the services rendered.

In some cases modifiers aren’t required. In other cases, they are mandatory. Whether or not modifiers are mandatory will depend on the specific payer’s rules.

What are some of the most common addiction treatment CPT and HCPCS code modifiers in use in 2024?

Here’s a list of the most commonly used CPT and HCPCS code modifiers that addiction treatment billers will use in 2024:

HA: Services provided in a program that was designed for young people under 18 years of age, also known as a “child/adolescent program”

HB: Services provided in an adults-only program for people between 18 and 64 years of age, also known as an “adult program”

HC: Services provided in a program designed for older adults over the age of 64, also known as a “geriatric program”

HD: Services rendered in a program designed for pregnant and or parenting women

HG: Services rendered in an OTP or opioid treatment program, often involving methadone treatment or other MAT services

HH: Services rendered in a dual diagnosis program or “integrated mental health/addiction treatment program”

HJ: Services rendered in the context of an employee assistance program or EAP

HQ: Services rendered in a group setting that is not familial (ie. group therapy)

HR: Services rendered in a family context (ie. family therapy or couple’s counseling)

HS: Services rendered to the family or significant other of the patient but without the patient present

H9: Services rendered according to court order, probation, or parole

HO: Services rendered by a provider who holds a master’s degree

HP: Services rendered by a provider who holds a doctoral level degree

UA: Services rendered by a psychiatrist

HN: Services rendered by a provider who holds a bachelor’s degree

What changes were made to CPT code modifiers for addiction treatment in the CMS 2024 update?

There were very few significant changes made to the 2024 CMS codeset update that affect behavioral health billing. However, there was one change that did have an impact: rules for telehealth reimbursement.

During COVID, telehealth services were eligible for reimbursement at the same rate as in-facility services. That has officially ended as of 2024. Now, all telehealth services must be billed at non-facility rates and must be amended with a two digit modifier - “95” - to designate the service as such.

How can I figure out what behavioral health CPT or HCPCS code modifiers are required for Medicaid patients in my state?

The easiest way to check the most current rules in your state is to Google “provider manual [state] medicaid” with a focus on results that end in .gov. Often, your state will provide the provider’s manual in a PDF format which will automatically download to your computer when you click on the link. These provider manuals are packed with information on how to make successful claims according to the most recent rules for your state’s public healthcare system.

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