HN Modifier No Longer Needed on Authorization Requests for CPT Codes 97155 and 97156

Date: 11/12/25

Providers should no longer include the HN modifier when submitting authorization requests for CPT codes 97155 and 97156.

What to do moving forward:

When submitting an authorization: Request the total number of Protocol modification units and total number of caregiver training units needed, without the modifier codes.

When submitting claims: Separate the number of units based on who provided the service by including the modifier codes as applicable.

Example:
Provider intends to use:
97155: 200 units
97155 HN: 200 units
Provider submits prior authorization request:
97155: 400 units
Provider submits claims for:
97155: 200 units
97155 HN: 200 units

This change will help ensure smoother processing and payment of claims.

If you have questions or need help, please reach out to your Provider Engagement Account Manager (PEAM). To find your assigned PEAM, use the Find Your Account Manager tool. You can also call Provider Resources at 1-844-477-8313.

Behavior Analysis (BA) Resources

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

Provider Support: Finding the Right Contact
Provider Services: Call 1-844-477-8313
Secure Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
Claim Concerns: Resolve outstanding claims using the Claim Concerns form.
Provider News: Bookmark Provider News to keep up with the latest updates.
Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
Provider Resources: Visit Manuals, Forms and Resources to find provider manuals, important forms, scheduling standards and other resources.

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