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Psychiatry Coding & Reimbursement Alert

You Be the Coder:

See if Modifiers AJ/ AH are Mandatory For CSW and CP Claims

Question: I used to do psychiatry coding long back when the old codes were in force. I recently took up the task of handling psychiatry coding once again. I do not have much experience using the new codes. Earlier, we used to use modifiers like AJ and AH for the work performed by clinical social workers and clinical psychologists. Should these modifiers still need to be used when these providers perform any services?

New Hampshire Subscriber

Answer: You are right that certain payers did specify that you needed to use modifiers such as AJ (Clinical social worker) and AH (Clinical psychologist) when you had to file claims for these provider types. These modifiers had to be listed in field 24d of the CMS 1500 form.

However, CMS, through a transmittal (# R2656CP) issued in Feb. 2013, has clarified that “Contractors shall not require the submission of modifier AJ for clinical social workers (CSWs) or modifier AH for clinical psychologists (CPs).” The transmittal also clarifies that modifiers AJ and AH are not eliminated, but they no longer need to be submitted with the claims, because they are not needed for identification purposes.

So, it is not mandated that you will have to list the modifiers AJ and AH in all the claim forms that you submit for services provided by your clinical social workers or clinical psychologists. However, if you are in doubt, it is best to check payer policies regarding the use of these modifiers to see if they need these modifiers to be listed in the CMS 1500 form so that you do not face the risk of denials to your claims.

Resource: For more information on the use of modifiers for the services of your CSWs or CPs, check the MLN Matters article at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8010.pdf.