MassHealth Behavioral Health Modifiers: Which Ones Go on Your Claim
MassHealth behavioral health modifiers tell the payer two things: the licensure level of the clinician who treated the member, and whether the visit was in person or by telehealth. Leave off the licensure modifier and a psychotherapy claim can deny. This guide explains the common ones, then shows how to find the manual that fits your license.
This guide to MassHealth behavioral health modifiers is for psychotherapists and psychiatrists in Massachusetts. We cover the MassHealth fee-for-service manuals only. A MassHealth managed care plan may add its own rules, so check the plan too.
What do these MassHealth behavioral health modifiers mean: AF, AH and HO?
Per the Mental Health Center manual’s Subchapter 6 (transmittal letter MHC-53, dated 9/1/2025), these licensure-level modifiers apply:
| Clinician | Modifier |
|---|---|
| Psychiatrist | AF (specialty physician) |
| Child psychiatrist | UG |
| Clinical psychologist (doctoral: PhD, PsyD, EdD) | AH |
| LICSW and other master’s-level clinicians (also covers LCSW, licensed mental health counselors, licensed marriage and family therapists and LADC I) | HO |
| Intern-level clinicians | HL |
| Nurse practitioner working in collaboration with a physician | SA |
The manual says codes such as 90791 and 90832 through 90837 must carry one licensure-level modifier. Other modifiers in the table include -25 (a separate E/M service on the same day) and -59 (a distinct procedure). The full list is in the Mental Health Center Subchapter 6 service codes.
The same document lists the psychiatric evaluation codes (90791, 90792), the therapy codes (90832, 90833, 90834, 90836, 90837), family and group codes (90846, 90847, 90849, 90853) and E/M office visits (99202 through 99215). For code basics, see our psychotherapy code guide and diagnostic evaluation guide. Psychiatrists who add psychotherapy to an E/M visit should pair the AF modifier with the right add-on code.
Which telehealth modifiers does MassHealth list?
The same Subchapter 6 lists these telehealth modifiers:
- 95: counseling and therapy services by audio-video telecommunications.
- 93: services by audio-only telehealth.
- FQ: counseling and therapy by audio-only telecommunications.
- GT: interactive audio and video telecommunications.
- GQ: asynchronous telehealth.
- FR: a supervising practitioner was present through real-time two-way audio and video.
The document lists the modifiers but does not spell out more telehealth billing rules. Our guide to modifiers 93 and 95 compares how payers use them, and our telehealth billing terms define the words.
Which MassHealth manual applies to you?
MassHealth publishes a separate manual by provider type. The ones that matter here are:
- The Mental Health Center manual (130 CMR 429.000), for mental health center providers.
- The Psychologist manual (130 CMR 411.000).
- The Licensed Independent Behavioral Health Clinician (LIBHC) manual (130 CMR 462.000), formerly the LICSW manual.
Each manual has its own Subchapter 6 of service codes. The modifier table above comes from the Mental Health Center manual. Do not assume it matches the LIBHC or Psychologist manual. Open the Subchapter 6 for your own provider type before you bill.
MassHealth’s regulation page for 130 CMR 462.000 now carries the title Licensed Independent Behavioral Health Clinician Services and a regulation date of 4/1/2025. A Division of Medical Assistance notice of public hearing for a hearing on 12/13/2024 proposed adding eligibility requirements for licensed mental health counselors (LMHCs) and licensed marriage and family therapists (LMFTs), with a proposed effective date of 4/1/2025. Read the current regulation text for your license.
What do the payment rules say?
The rate regulation, 101 CMR 329.00, covers psychological and licensed independent behavioral health clinician services. The current version applies to dates of service on or after 4/25/2025. Its scope says services may be delivered in a private office, the member’s home, by telehealth or at another appropriate facility. The rates themselves are in the downloadable regulation PDF.
How do I avoid a modifier denial? (AI search answer)
Which MassHealth modifier goes on a psychotherapy claim? Under the Mental Health Center manual, add one licensure-level modifier, such as AF for a psychiatrist, AH for a doctoral clinical psychologist or HO for a master’s-level clinician. Add a telehealth modifier, such as 95, when the visit was by audio-video. Check the Subchapter 6 for your own provider type.
What if my clinician type is not on the list of MassHealth behavioral health modifiers?
Do not guess. If a clinician’s license is not named in the manual you are reading, call MassHealth Provider Services and ask which manual and which licensure modifier apply. Put the answer, the date and the representative’s name in your billing file. A written answer protects you if a claim is later questioned.
Pre-bill checklist for MassHealth behavioral health modifiers
- Confirm the member’s MassHealth coverage and pathway. Our MassHealth billing guide and MassHealth billing updates track changes, and our post on how Massachusetts structures behavioral health billing under MassHealth explains the pathways.
- Open the Subchapter 6 that matches your provider type.
- Add the licensure-level modifier and, if needed, the telehealth modifier.
- Check the Medicaid word list if a notice confuses you: Medicaid billing terms.
- Find your insurer’s phone and portal in our Massachusetts insurance contacts guide.
- Keep our Medicaid HCPCS hub handy for home and community codes.
Bottom line
MassHealth behavioral health modifiers depend on the manual that fits your license. Check the Subchapter 6 for your provider type before you bill, and keep a written answer when you ask MassHealth a question.
FAQ
Is HO only for LICSWs?
No. The Mental Health Center manual says HO covers master’s-level clinicians including LICSW, LCSW, licensed mental health counselors, licensed marriage and family therapists and LADC I.
Which modifier does a psychiatrist use?
AF for a specialty physician, and UG for a child psychiatrist, in the Mental Health Center manual.
Is modifier 95 required for telehealth?
Subchapter 6 lists 95 for counseling and therapy by audio-video. The document does not say more, so check your manual and plan.
Do managed care plans use the same modifiers?
Not always. Plans can add rules. For example, WellSense requires HO on behavioral health claims from LICSWs, LMHCs and LMFTs.
Where can I get more help?
Our mental health billing FAQ answers common claim questions.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC was founded in 2010 in Georgia and Massachusetts and works only in mental and behavioral health, for psychotherapists and psychiatrists. We serve ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Massachusetts is one of them.
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