As you may know, Point32Health covers clinically appropriate Program of Assertive Community Treatment (PACT) services for members of our Tufts Health Together and Tufts Health One Care plans, and prior authorization is not required.

In support of recent communications from MassHealth, we’re broadening this coverage to apply for Tufts Health Plan Senior Care Options members. In addition, we’ve updated our billing instructions for these services to better align with the guidance from MassHealth. When billing Point32Health for covered PACT services, please submit claims according to the following instructions: 

  • Assertive community treatment program, per diem (PACT programs with 50 slots): bill HCPCS service code H0040 U1 (Appending the U1 modifier identifies the level of care as Medicaid level of care 1.)
  • Assertive community treatment program, per diem (PACT programs with 80 slots): bill HCPCS service code H0040 U2 (This modifier indicates Medicaid level of care 2 and provides more complete information than the previously employed modifier HT.) 

The billing instructions for assertive community treatment program, per diem (forensic program) remain unchanged: continue to submit claims with HCPCS service code H0040-H9 as you do today. 

We’ve updated our Inpatient and Intermediate/Diversionary Behavioral Health/Substance Use Disorder (BH/SUD) Facility Payment Policy for Tufts Health Public Plans and our Inpatient and Intermediate Behavioral Health/Substance Use Disorder Facility Payment Policy for Senior Products to reflect this change in billing guidance.