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November 2016
Bill new corrected original when reporting a modifier change on outpatient psychiatric claim
A replacement claim (frequency code 7) cannot be reported when changing the modifier on an OPC claim.
The modifier or the absence of a modifier on a claim identifies the level of therapist rendering the service to your patient. This changes the provider’s demographics on the claim.
As we explained in a June 2016 Record article, any change to patient or provider demographics, NPI, provider PIN or taxonomy code requires that you void or cancel your original paid claim, and report the member or provider change in a new, corrected original.
To avoid canceling your original claim, be sure you report the correct modifier on the original CMS-1500 claim form. Use field 24D-PROCEDURES OR SUPPLIES to identify the level of therapist who provided the service. Correct therapist-level codes are:
Code |
Level |
AH |
Fully-licensed psychologist |
AJ |
- Licensed master’s level social worker
- Clinical social worker
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HO |
Master’s-level clinician:
- Certified nurse practitioner
- Licensed professional counselor
- Limited licensed psychologist
- Licensed marriage and family therapist
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Note: For board-certified or board eligible psychiatrists, leave the code area blank.
On the CMS-1500 claim form, in field 24J - RENDERING PROVIDER ID, leave both the shaded and unshaded areas blank.
A replacement claim (frequency code 7) should be reported when changing a procedure code, charge or quantity on the claim.
Want to learn more?
For more information on outpatient psychiatric care claims, including helpful articles, examples and links, go to the Claims chapter of the OPC online provider manual.
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