2025 HCPCS code HW
(Active) Effective Date: N/A Revision Date: N/A Modifiers - Funded by state mental health agency Modifiers for HCPCS codes hcpcs-modifiers Feed
This modifier is appended to a behavioral health service code to indicate that the provider receives funding from a state mental health agency for the therapy provided to the patient.
Medical necessity for the mental health services must be established and documented, regardless of the funding source. The documentation must support the need for the specific type and frequency of therapy provided.
The healthcare provider is responsible for delivering the mental health therapy service and ensuring appropriate documentation to support the use of the HW modifier. They must ensure that the service provided aligns with the funding criteria of the state mental health agency.
In simple words: This code is used when your mental health therapy is paid for by a state mental health agency.
This modifier is used with HCPCS and CPT codes for behavioral health services when the provider receives funding from a state mental health agency for the therapy provided to patients. The medical documentation must confirm that the state mental health agency is funding the treatment service for the patient. It signifies that the agency has arranged the financing for the therapy that the patient receives, and the provider utilizes resources from the state mental health agency to offer mental and behavioral healthcare services.
Example 1: A patient receives individual therapy sessions for depression, and the sessions are funded by the state mental health agency. The provider appends the HW modifier to the CPT code for individual therapy., A child receives family therapy sessions for behavioral issues, and the sessions are funded through a program administered by the state mental health agency. The HW modifier is appended to the CPT code for family therapy., An adult receives group therapy for anxiety, and the state mental health agency covers the cost of the group therapy sessions. The provider includes the HW modifier with the CPT code for group therapy.
The medical record must clearly document that the patient's mental health services are funded by the state mental health agency. Documentation should include the name of the agency, the program name (if applicable), and any relevant authorization or referral information.
- Payment Status: Active
- Specialties:Mental health providers, including psychiatrists, psychologists, social workers, counselors, and therapists.
- Place of Service:Applicable places of service may vary based on the provider and the type of therapy provided. It can include outpatient mental health facilities, community mental health centers, private offices, and other settings where mental health services are offered.