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February 2019
Clarification: Billing on behalf of a behavioral health provider
In an article in the March 2018 Record, we explained that modifiers AJ and HO are required on claims where the services are billed by a supervising behavioral health provider but rendered by one of the following provider types:
- Limited licensed professional counselor
- Limited licensed master social worker
- Temporary limited licensed psychologist
- Limited licensed marriage and family therapist
- Limited licensed psychologist
We want to let you know that these modifiers must be used when billing on behalf of any behavioral health provider, not just the ones listed above.
All of these providers are expected to follow supervisory requirements as defined by the State of Michigan for their specialty.
Modifiers AJ and HO are used to:
- Indicate that the billing provider did not render the service.
- Identify the rendering provider, which drives the appropriate reimbursement.
- Identify providers who choose not to bill us directly, including licensed master social workers – clinical, licensed professional counselors, limited licensed psychologists and licensed marriage and family therapists.
Refer to the chart below when billing on behalf of behavioral health providers:
| State licensed rendering provider |
Modifier required |
Nomenclature |
LLMFT, LLPC, TLLP |
HO |
Master’s level clinician |
LPC, LLP, LMFT (eligible to bill directly) |
HO |
Master’s level clinician |
LLMSW |
AJ |
Licensed master’s social worker – clinical |
LMSW-C (eligible to bill directly) |
AJ |
Licensed master’s social worker – clinical |
Services that are within the scope of licensure and billed using these modifiers will be reimbursed at the appropriate reimbursement of 80 percent of the traditional fee schedule. Services billed using these modifiers that are not within the scope of licensure will be rejected since they’re not payable to this provider type.
If you have any questions, contact Provider Inquiry.
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