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March 2018
Reimbursement policy update coming in behavioral health
Beginning June 1, Blue Cross will update our reimbursement policy for services billed by supervising providers of limited license behavioral health providers.
Services rendered by a Limited Licensed Professional Counselor (LLPC), Limited Licensed Master Social Worker (LLMSW), Temporary Limited Licensed Psychologist (TLLP), and Limited Licensed Marriage & Family Therapist (LLMFT) and billed by the supervising MD, DO, or Fully Licensed Psychologist, should include the appropriate modifier to identify the level of the rendering provider. Modifiers HO and AJ are required on the claim for proper reimbursement (see chart below).
Payable services billed with the appropriate modifier will be processed for reimbursement at 80% of the Traditional Fee Schedule (minus applicable member copay).
State Licensed Rendering Provider |
Modifier Required |
Nomenclature |
LLMFT, LLPC, or TLLP |
HO |
Master’s level clinician |
LLMSW |
AJ |
Licensed master’s social worker - clinical social worker |
Per the Centers for Medicare & Medicaid Services, to qualify as “incident to,” services must be part of your patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment.
Blue Cross defines direct supervision (which is required for “incident to” billing) as services rendered in the office setting with the physician present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.
For more information about billing for services, see your online provider manuals.
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