Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 306.00 - Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers
Section 306.03 - Rate Provisions
Current through Register 1531, September 27, 2024
(1) Rates as Full Compensation. The rates under 101 CMR 306.00 shall constitute full compensation for mental health services provided by community health centers and mental 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 306.03(5)(c), payment rates under 101 CMR 306.00 shall be the lower of:
(3) Child and Adolescent Needs and Strengths (CANS): Psychiatric Diagnostic Interview Examination for Children and Adolescents Younger than 21 Years Old. Eligible clinicians who complete the CANS for a MassHealth child or adolescent younger than 21 years old during a psychiatric diagnostic interview examination, must use procedure code 90791 accompanied by a modifier -HA to bill for the service.
(4) Modifiers.
(5) Fee Schedule.
Service Code |
Payment Rate for service codes performed by a psychiatrist (Modifier -AF) |
Payment Rate for service codes performed by a doctor level clinician (Modifier - AH) |
Payment Rate for service codes performed by a Master level clinician (Modifier -HO) |
Payment Rate for service codes performed by an intern (Modifier -HL) |
Service Description |
90791 |
$160.45 |
136.38 |
130.48 |
81.83 |
Psychiatric diagnostic evaluation |
90791-HA |
$175.45 |
151.38 |
145.48 |
90.83 |
Psychiatric diagnostic evaluation performed with a CANS (Children and Adolescent Needs and Strengths) |
90832 |
$69.60 |
59.16 |
52.20 |
35.50 |
Psychotherapy, 30 minutes with patient |
90833 |
$63.83 |
54.26 |
47.87 |
32.56 |
Psychotherapy, 30 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.) |
90834 |
$95.46 |
95.46 |
95.46 |
57.28 |
Psychotherapy, 45 minutes with patient |
90836 |
$82.90 |
82.90 |
82.90 |
49.74 |
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.) |
90837 |
$135.04 |
125.69 |
125.69 |
75.41 |
Psychotherapy, 60 minutes with patient |
90839 |
$171.13 |
171.13 |
171.13 |
102.68 |
Psychotherapy for crisis, first 60 minutes |
90840 |
$85.57 |
85.57 |
85.57 |
51.34 |
Psychotherapy for crisis, each additional 30 minutes (List separately in addition to the code for primary procedure) |
90846 |
$101.43 |
101.43 |
101.43 |
60.86 |
Family psychotherapy (without the patient present), 50 minutes |
90847 |
$101.43 |
101.43 |
101.43 |
60.86 |
Family psychotherapy (conjoint psychotherapy) (with patient present) 50 minutes |
90849 |
$32.16 |
27.69 |
27.69 |
16.61 |
Multiple-family group psychotherapy (per person per session not to exceed 10 clients) |
90853 |
$30.31 |
30.31 |
30.31 |
18.19 |
Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients) |
90853-EP |
$30.31 |
30.31 |
30.31 |
18.19 |
Group psychotherapy (other than of a multiple-family group) (per person not to exceed 12 clients) (preventive behavioral health session) |
90882 |
$71.80 |
71.80 |
71.80 |
43.08 |
Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions |
90887 |
$79.19 |
67.31 |
59.40 |
40.39 |
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 |
90840-GJ |
$98.41 |
98.41 |
98.41 |
59.04 |
Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service) |
90846-GJ |
$116.64 |
116.64 |
116.64 |
69.99 |
Family psychotherapy (without the patient present), 50 minutes |
90847-GJ |
$116.64 |
116.64 |
116.64 |
69.99 |
Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes |
90849-GJ |
$36.98 |
31.84 |
31.84 |
19.10 |
Multiple-family group psychotherapy (per person session not to exceed 10 clients) |
90853-GJ |
$34.86 |
34.86 |
34.86 |
20.92 |
Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients) |
90853-EP-GJ |
$34.86 |
34.86 |
34.86 |
20.92 |
Group psychotherapy (other than of a multiple-family group)(per person not to exceed 12 clients) (preventive behavioral health session) |
90882-GJ |
$82.57 |
82.57 |
82.57 |
49.54 |
Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions |
90887-GJ |
$91.07 |
77.41 |
68.31 |
46.45 |
Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient |
90889-GJ |
$49.66 |
49.66 |
49.66 |
29.80 |
Preparation of report of patient's psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers |
Service Code |
Payment Rate |
Service Description |
S9480-GJ |
$65.11 |
Intensive outpatient psychiatric services, per diem |
H0015-GJ |
$71.59 |
Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Structured Outpatient Addiction Program) |
H0015-TF-GJ |
$113.82 |
Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Enhanced Structured Outpatient Addiction Program) |
H0046-HE-GJ |
$16.92 |
Mental health services, not otherwise specified (Certified Peer Specialist) |
Service Code |
Payment Rate for service codes performed by a psychiatrist (Modifier -AF) |
Payment Rate for service codes performed by a doctoral level clinician (Modifier -AH) |
Payment Rate for service codes performed by a Master level clinician (Modifier -HO) |
Payment Rate for service codes performed by an intern (Modifier -HL) |
Service Description |
90791-GJ |
$184.52 |
156.84 |
150.05 |
94.10 |
Psychiatric diagnostic evaluation |
90791-HA-GJ |
$201.77 |
174.09 |
167.30 |
104.45 |
Psychiatric diagnostic evaluation performed with a CANS (Children and Adolescent Needs and Strengths) |
90832-GJ |
$80.04 |
68.03 |
60.03 |
40.83 |
Psychotherapy, 30 minutes with patient |
90833-GJ |
$73.40 |
62.40 |
55.05 |
37.44 |
Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) |
90834-GJ |
$109.78 |
109.78 |
109.78 |
65.87 |
Psychotherapy, 45 minutes with patient |
90836-GJ |
$95.34 |
95.34 |
95.34 |
57.20 |
Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) |
90837-GJ |
$155.30 |
144.54 |
144.54 |
86.72 |
Psychotherapy, 60 minutes with patient |
90839-GJ |
$196.80 |
196.80 |
196.80 |
118.08 |
Psychotherapy for crisis; first 60 minutes |
90840-GJ |
$98.41 |
98.41 |
98.41 |
59.04 |
Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service) |
90846-GJ |
$116.64 |
116.64 |
116.64 |
69.99 |
Family psychotherapy (without the patient present), 50 minutes |
90847-GJ |
$116.64 |
116.64 |
116.64 |
69.99 |
Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes |
90849-GJ |
$36.98 |
31.84 |
31.84 |
19.10 |
Multiple-family group psychotherapy (per person session not to exceed 10 clients) |
90853-GJ |
$34.86 |
34.86 |
34.86 |
20.92 |
Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients) |
90853-EP-GJ |
$34.86 |
34.86 |
34.86 |
20.92 |
Group psychotherapy (other than of a multiple-family group)(per person not to exceed 12 clients) (preventive behavioral health session) |
90882-GJ |
$82.57 |
82.57 |
82.57 |
49.54 |
Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions |
90887-GJ |
$91.07 |
77.41 |
68.31 |
46.45 |
Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient |
90889-GJ |
$49.66 |
49.66 |
49.66 |
29.80 |
Preparation of report of patient's psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers |
Service Code |
Payment Rate |
Service Description |
S9480-GJ |
$65.11 |
Intensive outpatient psychiatric services, per diem |
H0015-GJ |
$71.59 |
Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Structured Outpatient Addiction Program) |
H0015-TF-GJ |
$113.82 |
Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Enhanced Structured Outpatient Addiction Program) |
H0046-HE-GJ |
$16.92 |
Mental health services, not otherwise specified (Certified Peer Specialist) |
Service Code |
Payment Rate for service codes performed by a psychiatrist (Modifier -AF) |
Payment Rate for service codes performed by a doctor level clinician (Modifier -AH) |
Payment Rate for service codes performed by a Master level clinician (Modifier -HO) |
Payment Rate for service codes performed by an intern (Modifier -HL) |
Service Description |
90791 |
$160.45 |
136.38 |
130.48 |
81.83 |
Psychiatric diagnostic evaluation |
90832 |
$69.60 |
59.16 |
52.20 |
35.50 |
Psychotherapy, 30 minutes with patient |
90833 |
$63.83 |
54.26 |
47.87 |
32.56 |
Psychotherapy, 30 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) |
90834 |
$95.46 |
95.46 |
95.46 |
57.28 |
Psychotherapy, 45 minutes with patient |
90836 |
$82.90 |
82.90 |
82.90 |
49.74 |
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.) |
90839 |
$171.13 |
171.13 |
171.13 |
102.68 |
Psychotherapy for crisis first 60 minutes |
90840 |
$85.57 |
85.57 |
85.57 |
51.34 |
Psychotherapy for crisis, each additional 30 minutes (List separately in addition to the code for primary procedure) |
90847 |
$101.43 |
101.43 |
101.43 |
60.86 |
Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes |
90849 |
$32.16 |
27.69 |
27.69 |
16.61 |
Multiple family group psychotherapy |
90853 |
$30.31 |
30.31 |
30.31 |
18.19 |
Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients) |
90853-EP |
$30.31 |
30.31 |
30.31 |
18.19 |
Group psychotherapy (other than of a multiple-family group) (per person not to exceed 12 clients) (preventive behavioral health session) |
90882 |
$71.80 |
71.80 |
71.80 |
43.08 |
Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions |
90887 |
$79.19 |
67.31 |
59.40 |
40.39 |
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 |
(6) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list:
(7) Billing. Each clinic 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.