To bill an Employee Assistance Program (EAP) session under UnitedHealthcare (managed via Optum / Provider Express), you must append the HJ modifier to your standard outpatient psychotherapy CPT codes.
Core Coding Guidelines:
Add the Modifier HJ to the primary procedure code (e.g., 90834-HJ ).
Allowed CPT Codes:
90832 (30 min individual psychotherapy) → 90832-HJ
90834 (45 min individual psychotherapy) → 90834-HJ
90846 / 90847 (Family/Couples psychotherapy) → 90846-HJ / 90847-HJ
90853 (Group psychotherapy) → 90853-HJ
Excluded Codes:
Formal diagnostic evaluations (90791 ) and extended/crisis-level psychotherapy ( 90837 ) are generally not covered under standard UHC/Optum EAP benefits.
Telehealth Sessions:
If the session is conducted via phone or video, include Place of Service (POS) 02 (or 10 where appropriate) and standard Telehealth modifiers (like 95 or GT) alongside the HJ modifier.
Diagnosis Codes:
An appropriate ICD-10 diagnosis code (frequently a Z-code or situational/mental health diagnosis) is still required on the claim.
Financial Responsibility:
EAP visits carry $0 member co-pay, deductible, or coinsurance.