HL Modifier: Intern, and Michigan's October 2026 Change
Interns and trainees deliver a real share of care in training clinics and community agencies, and every state handles their claims a little differently. HL is the federal modifier for it, and one state just started using it.
Short answer
HL is the HCPCS Level II modifier "Intern." Michigan added HL to its behavioral health code sets for state fiscal year 2027, which began October 1, 2026, as a provider credential modifier. Ohio uses its own trainee modifiers instead: U1 for psychology assistants, interns, and trainees, U7 for counselor trainees, U9 for social worker trainees, and UA for MFT trainees.
| Modifier | HCPCS descriptor | Type |
|---|---|---|
| HL | Intern | Provider credential |
Michigan: new for SFY 2027
Michigan's SFY 2027 code sets list HL as a provider credential modifier with a target implementation of SFY 2027; the update log records it as added in September 2026. Agencies reporting encounters to Michigan PIHPs should expect intern services to carry HL from the new fiscal year.
Ohio: state trainee modifiers
| Ohio practitioner | Modifier |
|---|---|
| Psychology assistant, intern, or trainee | U1 |
| Counselor trainee | U7 |
| Social worker trainee | U9 |
| Marriage and family therapist trainee | UA |
Ohio Medicaid manual Table 1-3. Supervision pricing uses HP or HT; see the HP and HT pages.
Texas: delegated psychology services
Texas bills services by a psychology intern or post-doctoral fellow under the supervising psychologist's NPI, or the legal entity employing them, with a modifier on each detail, and pays them at 50 percent of the psychologist rate. LPAs and provisionally licensed psychologists are paid at 70 percent. Claims with no modifier, or two of these modifiers on one detail, deny.
Why intern claims deny
- Billed as the supervisor. No intern or trainee modifier, so the claim reads as the licensed clinician's own service.
- Wrong state convention. HL sent to a payer that expects state trainee modifiers, or the reverse.
- Supervision not documented. The supervising clinician and supervision required by the state are missing from the record.
Related: HP, HT, associate clinician billing, all behavioral health HCPCS modifiers, and the code map in H codes in behavioral health.
Sources, read October 2026: MDHHS SFY 2027 Behavioral Health Code Charts and Provider Qualifications; Ohio Medicaid Behavioral Health Provider Manual, v1.28.1 (March 2026); Texas Medicaid Behavioral Health and Case Management Services Handbook (January 2026). Federal HCPCS descriptors are CMS public data. State manuals and plan contracts change; confirm the current edition before billing.
Frequently asked questions
What is the HL modifier?
HL is the HCPCS Level II modifier "Intern." It identifies a service rendered by an intern.
When did Michigan start using HL?
Michigan added HL to its behavioral health code sets for state fiscal year 2027, which began October 1, 2026.
How are psychology interns billed in Texas Medicaid?
Under the supervising psychologist's NPI or the employing entity's, with a modifier on each detail, at 50 percent of the psychologist rate.
Trainee claims, billed the way each state wants.
See Stable apply intern and trainee modifiers and supervision rules before claims go out.
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