CPT Modifiers for Mental Health Billing: 25, 59, 95, 93, AH, AJ and State Medicaid Modifiers
A modifier is a two-character add-on that tells the payer how a service was done. This guide covers modifier 25, the 59 and X modifiers, the telehealth modifiers 95, 93, FQ, GT and GQ, provider-type modifiers AH and AJ, and state Medicaid modifiers. Checked against CMS.gov on 9/29/26.
Get My Free ConsultationIn this guide
- ✓ Modifiers 25, 59, XE, XP, XS and XU
- ✓ Telehealth modifiers 95, 93, FQ, GT, GQ
- ✓ Provider-type modifiers AH and AJ
- ✓ State Medicaid modifiers HN, HO, HP, HQ
- ✓ Six mistakes that cause denials
CPT Modifiers at a glance
This page covers cpt modifiers for mental health billing: what the codes cover, how payers apply them, and what to document. Psychotherapists and psychiatrists both use these codes, so the sections below call out differences where they matter. Payer rules vary, so confirm current requirements with the payer before you bill.
Modifiers change how a payer reads a CPT code. CPT modifiers such as 95 for synchronous audio-video telehealth and 93 for audio-only telehealth must match the documentation. Review your CPT modifiers list against each payer policy, because CPT modifiers that one payer accepts another may reject. Keep your CPT modifiers reference current, and train billing staff on the CPT modifiers your top payers require most.
What is a CPT modifier?
A modifier is a two-character add-on to a CPT or HCPCS code. It tells the payer something about how or under what circumstances the service was done, without changing what the code means. Modifiers change how a claim is read and paid, not the time range of the CPT code. A place of service code is separate: it says where the visit happened. See the place of service codes guide and the complete CMS place of service list.
The rule of thumb: add a modifier only when its definition matches the visit and the note supports it, or when a payer’s written policy calls for it. Time ranges are on the Non-E/M CPT codes page and the E/M and home visit codes page. Current as of last search 9/29/26 — reconfirm on CMS.gov before publishing.
Modifiers used in mental health billing
Modifiers that change how two services are read together
These two families apply to the coding of services on the same claim. Neither depends on telehealth.
| Code | Name | Use it when | Document |
|---|---|---|---|
| 25 | Significant, separately identifiable E/M serviceSame clinician, same day, E/M plus another service. | A prescriber bills an E/M with a separate service on the same day. CMS also allows G2211 with modifier 25 alongside an annual wellness visit, vaccine administration or preventive services. | A note that shows the E/M stood on its own, apart from the other service. |
| 59 | Distinct procedural serviceTells the payer two services that an NCCI edit would bundle were truly separate. | Only when an NCCI edit bundles two codes and the note shows separate encounters, separate practitioners or another distinct circumstance. CMS says to prefer XE, XP, XS or XU when one fits. CMS also says 59 should not be appended to an E/M service. | Why the services were distinct. A different diagnosis alone is not enough. |
| XE | Separate encounterA service distinct because it happened in a separate encounter. | The two services happened at different times in separate encounters on the same date. | Times or details that show two encounters. |
| XP | Separate practitionerA service distinct because a different practitioner performed it. | Two different practitioners performed the services. | Who did each service. |
| XS | Separate structureA service distinct because it was on a separate organ or structure. | Rarely relevant to behavioral health. Listed so you recognize it. | The structure involved. |
| XU | Unusual non-overlapping serviceA service distinct because it does not overlap the usual components of the main service. | The service is separate from the usual components of the other code. | What made it non-overlapping. |
Telehealth modifiers
Medicare and private payers do not agree on these. Use the modifier a payer asks for, and only where its definition fits.
| Code | Name | Use it when | Document |
|---|---|---|---|
| 95 | Synchronous telemedicine, audio and videoReal-time interactive audio and video. | A private payer or Medicaid plan asks for it on video visits. The CMS sources checked tie 95 to specific institutional situations, such as outpatient therapy by hospital-employed therapists, not to psychotherapy claims in general. | Video visit, patient location and clinician location. |
| 93 | Synchronous telemedicine, audio-onlyReal-time audio-only, such as a phone call. | Audio-only visits where the payer or Medicare instructions call for it. First Coast lists it for patients who cannot use video or do not consent to it. HHS lists 93 and/or FQ for audio-only at FQHCs and RHCs. | Why the visit was audio-only. |
| FQ | Audio-only communication technologyUsed by rural health clinics and federally qualified health centers. | Only for RHC and FQHC audio-only visits. | The clinic type and audio-only mode. |
| GT | Interactive audio and video (older telehealth modifier)Medicare limits GT to institutional claims from critical access hospitals paid under Method II. | Do not add GT to a private-practice Medicare claim. Some older payer policies still name GT, so check. | Payer policy that calls for it. |
| GQ | Asynchronous telecommunicationsUsed for store-and-forward files in federal telemedicine demonstrations in Alaska and Hawaii. | Not used for standard mental health visits. | The demonstration program. |
Provider-type modifiers
Some payers still ask for a modifier that shows the clinician’s license type.
| Code | Name | Use it when | Document |
|---|---|---|---|
| AH | Clinical psychologistMedicare no longer requires it. | Medicare contractors were told in Transmittal 2656 (2/7/2013) not to require AH for clinical psychologists. Some Medicaid managed care plans list it, so check. | Nothing extra. Enrollment shows the license. |
| AJ | Clinical social workerMedicare no longer requires it. | Medicare contractors were told in Transmittal 2656 (2/7/2013) not to require AJ for clinical social workers. Some Medicaid managed care plans list it, so check. | Nothing extra. Enrollment shows the license. |
Medicaid and state HCPCS modifiers
These are set by each state Medicaid program and its plans. One state’s list does not carry to another. Two examples are cited so you can see how they work.
| Code | Name | Use it when | Document |
|---|---|---|---|
| HN | Bachelor’s degree levelUsed in some state programs to show clinician education level. | Only if the state Medicaid manual or plan says to. | Clinician education level, per state rules. |
| HO | Master’s degree levelUsed in some state programs to show clinician education level. | Only if the state Medicaid manual or plan says to. | Clinician education level, per state rules. |
| HP | Doctoral degree levelNamed in one Louisiana Medicaid plan notice from 2016. | Only if the state Medicaid manual or plan says to. That plan document is old, so treat it as an example. | Clinician education level, per state rules. |
| HQ | Group settingUsed in some state programs for group services. | Only if the state Medicaid manual or plan says to. | Group setting and session details. |
Which modifier to check for which situation
Start with the situation. Then confirm the rule with the payer.
| Situation | Modifier to check | Confirm first |
|---|---|---|
| A prescriber bills an E/M and another service on one date | 25 | Medicare: MLN006764. Private payers: their policy. |
| An NCCI edit bundles two codes that were separate | XE, XP, XS, XU or 59 | Prefer the specific X modifier. Never on an E/M. |
| Private payer wants a telehealth modifier on video | 95 (often) | Verify with each payer. |
| Audio-only visit | 93; FQ at RHC and FQHC | Check payer and Medicare audio-only rules. |
| Medicaid plan asks for clinician level or group setting | HN, HO, HP, HQ | Use only what the state Medicaid manual lists. |
Six modifier mistakes that cause denials
Adding 59 to an E/M
CMS says modifier 59 should not be appended to an E/M service. If the E/M was separate, use 25.
Using 59 when an X modifier fits
CMS prefers XE, XP, XS or XU when one describes the situation.
Adding 95 to every Medicare claim
The CMS sources checked tie 95 to specific institutional claims. Add it when a payer asks.
Using 25 to force a payment
Modifier 25 needs a significant, separately identifiable E/M with its own note.
Using GT, GQ or FQ outside their settings
GT is for CAH Method II institutional claims. GQ is for Alaska and Hawaii demonstrations. FQ is for RHC and FQHC.
Assuming a Medicaid modifier works in another state
HN, HO, HP, HQ and other H modifiers are set by each state and plan. Check the state manual.
CPT modifiers: frequently asked questions
What is a CPT modifier?
A CPT modifier is a two-character code added to a CPT or HCPCS code to show that the service was done under special circumstances. It does not change the code’s definition or time range.
When do I use modifier 25 on a mental health claim?
Use modifier 25 when the same clinician bills a significant, separately identifiable E/M service and another service on the same date. The note has to show the E/M stood on its own. Source: CMS, Evaluation and Management Services (MLN006764, May 2026).
Does Medicare require modifier 95 on psychotherapy claims?
The CMS sources checked do not say so. They tie modifier 95 to specific institutional situations, such as outpatient therapy by hospital-employed therapists. Many private payers still require it on video visits, so verify with each payer.
What is the difference between modifier 95 and GT?
Modifier 95 means a real-time audio and video telemedicine service. Modifier GT is an older telehealth modifier that Medicare limits to critical access hospital Method II institutional claims. Check each payer’s policy for which one it wants. Source: First Coast Service Options, Telehealth service modifiers (updated 2/17/26).
Do modifiers AH and AJ still matter?
Medicare stopped requiring them. In Transmittal 2656 (2/7/2013), CMS told contractors not to require AH for clinical psychologists or AJ for clinical social workers. Some Medicaid managed care plans still list them, so check the plan.
Where this information comes from
- CMS, Evaluation and Management Services (MLN006764, May 2026)
- CMS, Proper Use of Modifiers 59, XE, XP, XS and XU (MLN1783722, April 2026)
- First Coast Service Options, Telehealth service modifiers (updated 2/17/26)
- Telehealth.HHS.gov, Billing and coding Medicare fee-for-service claims
- CMS, Telehealth & Remote Monitoring (MLN901705, December 2025)
- CMS, Transmittal 2656 (2/7/2013)
- AHCCCS (Arizona Medicaid), Modifiers reference (1/13/2021)
- AmeriHealth Caritas Louisiana, behavioral health modifiers notice (2/2/2016)
Current as of last search 9/29/26 — reconfirm before publishing. First Coast is a Medicare Administrative Contractor, not CMS itself. The Arizona and Louisiana documents are examples of state programs and are dated. Operational guidance for a billing service, not legal advice.
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