Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Medical Services)
Health Care Home
(HCH) (continued)
11-56
The Medical Code TAG recommends that interim coding as shown
below be used until new modifiers and/or condition codes can be
created at the national level to differentiate health care home
patient complexity levels. The proposed interim solution is to use
U modifiers, in addition to existing TF and TG modifiers, with the
following two S codes: S0280 – medical home program,
comprehensive care coordination and planning, initial plan; and
S0281 – medical home program, comprehensive care coordination
and planning, maintenance.
Proposed interim solution: Use U modifiers in conjunction with
medical home S codes as shown below:
Patient
Complexity
Level Modifiers
Low (no major
conditions)
Non English
Speaking
No modifier U3 U4
Basic U1 U3 U4
Intermediate TF U3 U4
Extended U2 U3 U4
Complex
(most major
conditions
TG U3 U4
Definitions of U codes
Active Mental
Health
Condition
U1 – Care coordination, basic complexity level (used with
S0280 - S0281)
U2 – Care coordination, extended complexity level (used with
S0280 - S0281)
U3 – Care coordination, supplemental factor; non-English
language (used with S0280 – S0281)
U4 – Care coordination, supplemental factor; Major Active
Mental Health Condition (used with S0280 – S0281)
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)