In accordance with MassHealth requirements, effective for dates of service beginning Sept. 1, 2025, we will be reimbursing behavioral health urgent care (BHUC) centers for a core set of outpatient services using a bundled encounter rate per member per date of service. BHUC centers are mental health centers contracted with MassHealth to meet certain requirements.
As of the Sept. 1, 2025 effective date, BHUCs must bill for services noted below using HCPCS code H2013 (Psychiatric health facility service, per diem) and one of the following modifiers to indicate whether the service is provided for an adult or child/adolescent:
- HB: Adult services
- HA: Child/adolescent services
These should be billed in conjunction with at least one of the following service (zero-pay) codes to indicate the service(s) provided.
| 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.) |
| 90834 | Psychotherapy, 45 minutes with patient |
| +90836 | Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure.) |
| 90837 | Psychotherapy, 60 minutes with patient |
| 90846 | Family psychotherapy (without the patient present), 50 minutes |
| 90847 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes |
| 90849 | Multiple-family group psychotherapy (per person per session not to exceed 10 clients) |
| 90853 | Group psychotherapy (other than of a multiple-family group) (per person per session not to exceed 12 clients) |
| 90853-EP | Group psychotherapy (other than of a multiple-family group) (per person not to exceed 12 clients) (preventive behavioral health session) |
| 90882 | Environmental intervention for medical management purposes on a psychiatric patient’s behalf with agencies, employers, or institutions |
| 90887 | 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 |
| S9480 | Intensive outpatient psychiatric services, per diem |
| 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 total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. |
| 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 low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
| 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 moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. |
| 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 high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional. |
| 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 total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. |
| 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 low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. |
| 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 moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
| 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 high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. |
| +99417 | Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service.) |
| H0046
(excluding H0046-HE) |
Mental health services, not otherwise specified (Collateral Contact) |
| H0032 | Mental health service plan development by a nonphysician (Bridge consultation inpatient/outpatient) |
| H2020 | Therapeutic behavioral services, per diem (Dialectical Behavior Therapy) |
| 99402 | Preventative Medicine Counseling, 30 minutes (Psychological Testing) |
| 99404 | Preventative Medicine Counseling, 60 minutes (Counseling and/or Risk Factor Reduction Intervention) |
As of the Sept. 1, 2025 effective date, BHUCs should no longer utilize the GJ modifier for billing for the services noted above. In addition, mental health centers that are not designated at BHUCs will no longer be able to bill the GJ modifier to receive an enhanced rate for urgent care services.
The encounter bundle does not apply for the following services that can be provided by a BHUC:
- Psychological assessment
- Neurological assessment
- Comprehensive community support services
- Certified peer specialist services
- Peer recovery coach services
- Recovery support navigator services
- Structured outpatient addiction program (SOAP)
- Enhanced structured outpatient addiction program (E-SOAP)
- Intensive Outpatient Program (IOP)
For these services, continue to bill as you do today. However, please note that BHUCs cannot bill for SOAP, E-SOAP, and IOP services on the same date of service as an encounter bundle.
For more information, please refer to Point32Health’s updated Outpatient Behavioral Health & Substance Use Disorder Payment Policies for Tufts Health Public Plans and Senior Products.