Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 305.00 - Rates for Behavioral Health Services Provided in Community Behavioral Health Centers
Section 305.03 - Rate Provisions

Universal Citation: 101 MA Code of Regs 101.305

Current through Register 1531, September 27, 2024

(1) Rates as Full Compensation. The rates under 101 CMR 305.00 will constitute full compensation for behavioral health services provided by community behavioral health centers to publicly aided and industrial accident patients, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Except as otherwise provided in 101 CMR 305.03(4)(c), payment rates under 101 CMR 305.00 will be the lower of

(a) the eligible provider's usual charge to the general public; or

(b) the schedule of allowable rates for services provided by community behavioral health centers as set forth in 101 CMR 305.03(4)(a).

(3) Modifiers.

(a) -HB: Adult program, non-geriatric.

(b) -HA: Child/adolescent program.

(c) -HE: Mental health program.

(d) -U1: Medicaid level of care 1.

(e) -HN: A service rendered by a provider with a bachelor's degree.

(f) -HO: A service rendered by a provider with a master's degree.

(g) -ET: Emergency services.

(4) Fee Schedule.

(a) Encounter Bundle Rates. The services incorporated into the encounter bundled rate are specified in 101 CMR 305.03(4)(a)1.
1. Providers must bill one T1040 flat rate encounter bundle code for the provision of any of the set designated services, regardless of the number of services provided to the individual on that date.

2. The encounter bundle rates are as follows.

Service Code

Modifier 1

Service Description

Payment

T1040

HB

Medicaid Certified Community Behavioral Health Clinic Services, per Diem (Adult Services)

$233.90

T1040

HA

Medicaid Certified Community Behavioral Health Clinic Services, per Diem (Child/Adolescent Services)

$241.86

3. The designated services provided below must be billed in conjunction with the appropriate encounter bundle code set forth in 101 CMR 305.03(4)2. The designated service codes for all services provided on the same date must be billed under one encounter bundle code, regardless of the number of services provided to the individual on that date. The bundled encounter rates incorporate the following designated services codes.

Service Code

Service description

90791

Psychiatric diagnostic evaluation

90791-HA

Psychiatric diagnostic evaluation performed with a CANS (Children and Adolescent Needs and Strengths)

90792

Psychiatric Diagnostic Evaluation with Medical Services

90832

Psychotherapy, 30 minutes with patient

90833

Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure). (Use this add-on code with an appropriate evaluation and management service code when medication management is also provided.)

90834

Psychotherapy, 45 minutes with patient

90836

Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) (Use this add-on code with an appropriate evaluation and management service code when medication management is also provided.)

90837

Psychotherapy, 60 minutes with patient

90838

Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure). (Use this add-on code with an appropriate evaluation and management service code when medication management is also provided.)

90839

Psychotherapy for crisis, first 60 minutes

90840

Psychotherapy for crisis, each additional 30 minutes (List separately in addition to the code for primary procedure) (Add-on code).

90846

Family psychotherapy (without the patient present), 50 minutes

90847

Family psychotherapy with patient 50 minutes

90849

Multiple-family group psychotherapy (per person session not to exceed ten clients)

90853

Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients)

90882

Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions (case consultation)

90887

Interpretation or explanation of results of psychiatric, or other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient (per one-half hour)

96164

Health behavior group intervention, 30 minutes

96165

Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (add-on code).

96372

Therapeutic prophylactic or diagnostic injection (specify substance use or drug); subcutaneous or intramuscular

99202

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date or the encounter.

99203

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 30-44 minutes of total time spent on the date of the encounter.

99204

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 45-59 minutes of total time spent on the date of the encounter

99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 60-74 minutes of total time spent on the date of the encounter.

99211

Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal.

99212

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time spent on the date of the encounter.

99213

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 20-29 minutes of total time spent on the date of the encounter.

99214

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 30-39 minutes of total time spent on the date of the encounter.

99215

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 40-54 minutes of total time spent on the date of the encounter.

99404

Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure), 60 min

99412

Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure)

H0004

Behavioral health counseling and therapy, per 15 minutes (individual counseling) (four units maximum) (per session)

H0005

Alcohol and/or drug services group counseling by a clinician (per 45-minute unit) (two units maximum)

H0033

Oral medication administration, direct observation (substance use disorder programs only)

T1006

Alcohol and/or substance abuse services; family/couple counseling (per 30 minutes, one unit maximum per day)

(b) Crisis and Specialty Services. The MassHealth agency pays for crisis and specialty services separately from the bundled encounter rate. Crisis and specialty services may be billed on the same date of service as the encounter bundle, as clinically appropriate. Crisis intervention follow up services may not be billed on the same day as the crisis intervention per diem service. The MassHealth agency will only pay an AMCI provider a single per diem rate per member per day, regardless of the location of the encounter. For AMCI and YMCI services rendered in hospital emergency departments, the MassHealth agency will not pay AMCI or YMCI providers for AMCI or YMCI services once the hospital is authorized to bill the MassHealth agency directly for the provision of crisis intervention services, as determined by EOHHS. Rates are as follows.
1. Crisis Services.

Service Code

Payment Rate

Service Description

S9485 - ET

$632.05

Crisis intervention mental health services, per diem. (Adult Community Crisis Stabilization per day rate)

S9485 - HA, ET

$930.73

Crisis intervention mental health services, per diem. (Youth Community Crisis Stabilization Per day rate)

S9485 - HB

$632.08

Crisis intervention mental health services, per diem. (Adult Mobile Crisis Intervention provided at hospital emergency department. Inclusive of initial evaluation and all follow-up intervention. Use Place of Service code 23.)

S9485 - HE

$695.29

Crisis intervention mental health services, per diem. (Adult Mobile Crisis Intervention provided at CBHC site. Inclusive of initial evaluation and first day crisis interventions.)

S9485 - HA, HE

$695.29

Crisis intervention mental health services, per diem. (Youth Mobile Crisis Intervention provided at CBHC site. Inclusive of initial evaluation and first day crisis interventions.)

S9485 - U1

$1,024.64

Crisis intervention mental health services, per diem. (Adult Mobile Crisis Intervention provided at community-based sites of service outside of the CBHC site. Inclusive of initial evaluation and first day crisis interventions. Use Place of Service 15.)

S9485 - HA, U1

$1,075.87

Crisis intervention mental health services, per diem. (Youth Mobile Crisis Intervention provided at community-based sites of service outside of the CBHC site. Inclusive of initial evaluation and first day crisis interventions Use Place of Service code 15.)

H2011 - HN, HB

$30.57

Crisis intervention service, per 15 minutes. (Adult Mobile Crisis Intervention provided at CBHC site by a Paraprofessional or Bachelor's level staff. Follow-up interventions provided up to the third day following initial evaluation.)

H2011 - HN, HA

$33.94

Crisis intervention service, per 15 minutes. (Youth Mobile Crisis Intervention provided at CBHC site by a Paraprofessional or Bachelor's level staff. Follow-up interventions provided up to the seventh day following initial evaluation.)

H2011 - HO, HB

$39.70

Crisis intervention service, per 15 minutes. (Adult Mobile Crisis Intervention provided at CBHC site by a Master's level Clinician. Follow-up interventions provided up to the third day following initial evaluation.)

H2011 - HO, HA

$44.33

Crisis intervention service, per 15 minutes. (Youth Mobile Crisis Intervention provided at CBHC site by a Master's level clinician. Follow-up interventions provided up to the seventh day following initial evaluation.)

H2011 - HN, HB

$33.94

Crisis intervention service, per 15 minutes. (Adult Mobile Crisis Intervention provided at a community-based site of service outside of the CBHC site by a Paraprofessional or Bachelor's level staff. Follow-up interventions provided up to the third day following initial evaluation. Use Place of Service code 15)

H2011 - HN, HA

$33.94

Crisis intervention service, per 15 minutes. (Youth Mobile Crisis Intervention at a community-based site of service outside of the CBHC site by a Paraprofessional or Bachelor's level staff. Follow-up interventions provided up to the seventh day following initial evaluation. Use Place of Service code 15)

H2011 - HO, HB

$44.33

Crisis intervention service, per 15 minutes. (Adult Mobile Crisis Intervention provided at a community-based site of service outside of the CBHC site by a Master's level clinician. Follow-up interventions provided up to the third day following initial evaluation. Use Place of Service code 15)

H2011 - HO, HA

$44.33

Crisis intervention service, per 15 minutes. (Youth Mobile Crisis Intervention provided at a community-based site of service outside of the CBHC site by a Master's level clinician. Follow-up interventions provided up to the seventh day following initial evaluation. Use Place of Service code 15)

2. Specialty Services.
a. Required Services. A center must have the capacity to provide the following services. These required services are not included in the encounter bundled rate and will be paid at the rates set forth below or in the referenced regulations.

b. The rates for certified peer specialist services are as follows.

Service Code

Payment Rate

Service Description

H0046-HE

$16.92

Mental health services, not otherwise specified (Certified Peer Specialist Services).

c. For YMCI services at an Emergency Department site of service, refer to 101 CMR 352.00: Rates of Payment for Certain Children's Behavioral Health Services.

d. For community support programs, refer to 101 CMR 362.00: Rates for Community Support Program Services.

e. For recovery coaching services, refer to 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs.

f. For recovery support navigator services, refer to 101 CMR 444.00: Rates for Certain Substance Use Disorder Services.

(c) Optional Services. The following services are allowed but not required to be provided by the center. These optional services are not included in the encounter bundled rate. Providers are referred to the following regulations for applicable rates.
1. For psychological testing rates, refer to 101 CMR 329.00: Rates for Psychological and Independent Clinical Social Work Services.

2. For enhanced structured outpatient addiction program (E-SOAP) services, refer to 101 CMR 306.00: Rates for Mental Health Services Provided at Community Health Centers and Mental Health Centers.

3. For intensive outpatient program (IOP) services, refer to 101 CMR 306.00: Rates for Mental Health Services Provided at Community Health Centers and Mental Health Centers.

4. For structured outpatient addiction program (SOAP) services, refer to 101 CMR 306.00: Rates for Mental Health Services Provided at Community Health Centers and Mental Health Centers.

(5) Billing. Each center shall bill the governmental unit according to the appropriate fee schedule on a prescribed form. Each specific service must be separately enumerated on the bill.

Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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