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BETA v.3.0

2025 HCPCS code HE

Modifier HE denotes a service provided to a participant in a mental health services program.

Refer to payer-specific guidelines for information on specific codes that require or are eligible for the HE modifier. Ensure that the use of the HE modifier aligns with program requirements and relevant regulations.

Medical necessity for the underlying service must be supported by appropriate documentation, even when the HE modifier is used. Payer guidelines may specify additional requirements for services provided through mental health programs.

In simple words: The HE modifier shows that a mental health service was provided through a special program, like one run by a state or local agency.

This modifier is used to indicate that a particular service was provided through a program specifically designed for the provision of mental health services, including those administered by state and local agencies. Use of the HE modifier may vary depending upon the program.

Example 1: A patient receives individual therapy through a county-funded mental health program. The HE modifier would be appended to the appropriate CPT code for individual therapy., A patient receives medication management services through a state-administered program for individuals with serious mental illness. The HE modifier is appended to the appropriate CPT code for medication management., A patient participates in a group therapy session offered by a community mental health center that receives local government funding. The HE modifier would be applied to the CPT code for group therapy.

Documentation should clearly indicate the patient's participation in a designated mental health program and the specific program name or identifier if applicable. Details of the service provided, including date, time, and type of service, are also required.

** The HE modifier provides important information for tracking and analyzing the utilization of mental health services provided through designated programs. It facilitates accurate reporting and reimbursement related to these programs.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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