As you may know, Point32Health covers annual behavioral health wellness exams with no member cost sharing or prior authorization required for our Tufts Health Together and Tufts Health Direct members, which may be rendered by a primary care provider or licensed mental health professional. 

We follow MassHealth’s guidance and regulations — and providers who perform annual behavioral health wellness exams for Tufts Health Together members should be aware that effective for dates of service on or after Sept. 23, 2025, MassHealth has updated the billing requirements for reimbursement of these exams. Providers impacted by this change include: 

  • Acute outpatient hospitals
  • Community health centers (CHCs)
  • Group practice organizations
  • Hospital-licensed health centers
  • Primary care practitioners (PCPs)
  • Psychologists
  • Licensed independent clinical social workers (LICSWs)
  • Licensed marriage and family therapists
  • Licensed mental health counselors

Massachusetts All Provider Bulletin 408 outlines the state’s updated billing guidance and requirement details, which vary depending on provider type. We encourage you to refer to the bulletin for the appropriate procedure codes, diagnosis codes, and modifiers to use when submitting claims for reimbursement. We’re currently updating our systems to align with this MassHealth guidance.

As a reminder, the annual behavioral health wellness examination includes an assessment or screening to identify behavioral or mental health needs and appropriate treatment resources. Details on the components of the annual behavioral health wellness examination can be found in Appendix A of the Division of Insurance Bulletin 2024-02.