As we communicated in the September issue of Insights and Updates for Providers, in support of MassHealth regulations, Point32Health reimburses behavioral health urgent care (BHUC) centers for a core set of outpatient services using a bundled encounter rate per member per date of service.

We’ve since updated our Outpatient Behavioral Health & Substance Use Disorder Payment Policy to include further guidance regarding BHUC services provided via telehealth. 

BHUC services provided via telehealth should be billed using the HCPCS bundled rate code H2013 (Psychiatric health facility service, per diem) on the primary claim line — with POS 11 (Office) or POS 53 (Community Mental Health Center) and only modifier HB (Adult Services) or HA (Adolescent Services) also included on the same primary claim line. 

The informational lines must include at least one applicable zero-pay service code indicating the service(s) provided, and may also include applicable telehealth POS codes and modifiers. For example, it may be appropriate to include POS 02 (Telehealth Provided Other than in Patient’s Home) or POS 10 (Telehealth Provided in Patient’s Home) on the informational lines. Please keep in mind, however, that POS 02 and 10 may not be reported on the primary claim line. 

You can find the list of eligible service codes on the updated Payment Policy, as well as in the September provider newsletter article referenced above.