Billing update for Community Health Centers using code T1015
March 2026| Tufts Health One Care| Tufts Health Plan Senior Care Options| Tufts Health Together
As you may know, MassHealth recently issued Managed Care Entity Bulletin 140 to inform providers of changes to coding requirements for services performed by certified nurse midwives (CNMs) and obstetrician gynecologists (OB/GYNs) in community health center (CHC) settings.
Effective Nov. 1, 2025, all medical visits billed by community health centers using CPT code T1015 for CNM or OB/GYN services, must be accompanied by the TH modifier. Regardless of whether the service performed was related to prenatal or postpartum care, this modifier must be used for all CNM and OB/GYN visits. Please be sure to include the TH modifier when billing for these services on behalf of Tufts Health Together, Tufts Health Plan Senior Care Options, and Tufts Health One Care members.
To reflect this change, MassHealth is updating its prior instruction (published in Managed Care Entity Bulletin 84) on the appropriate use of CPT code T1015 with modifier TH for CHCs. We’ve revised Point32Health’s All-Inclusive Clinic Visit (HCPCS Code T1015) Payment Policy to align with the state’s guidance.