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
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
(3) Modifiers.
(4) Fee Schedule.
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 |
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) |
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) |
Service Code |
Payment Rate |
Service Description |
H0046-HE |
$16.92 |
Mental health services, not otherwise specified (Certified Peer Specialist Services). |
(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.