December 2022

Reminder: Bill new, corrected original claim when reporting a modifier change on OPC facility claims

For Blue Cross Blue Shield of Michigan commercial members, you must bill a new, corrected claim when changing the modifier on an outpatient psychiatric care, or OPC, facility claim. A replacement claim (frequency code 7) can’t be reported in these instances.

The modifier on a claim identifies the level of therapist who rendered the service. Any change in the modifier may cause the claim to be denied.

Additionally, any change to the patient’s information or to the health care provider’s information — including NPI, 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 claim.

You can avoid having to submit a new, corrected claim by including the correct information on the claim the first time you submit it. Here’s how to do that.

In the CMS-1500 claim:

In field 24D – enter the appropriate modifier to identify the type of therapist who provided the service:

Therapist	Modifier
Clinical psychologist	AH
Clinical social worker or CLMSW	AJ
Master’s-level clinician: Certified nurse practitioner or CNP Clinical nurse specialist – Certified or CNS-C Limited licensed psychologist or LLP Licensed marriage and family therapist or LMFT Licensed professional counselor or LPC	HO
Psychiatrist M.D., D.O.

In field 24J – RENDERING PROVIDER ID, leave both the shaded and unshaded areas blank.

For more information about billing for outpatient psychiatric care facilities, see the “Psychiatric Care Services” chapter of the Blue Cross Commercial Provider Manual.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2021 American Medical Association. All rights reserved.