Our new Behavioral Health and Substance Use Disorder Payment Policy applies for Tufts Health Plan commercial members, effective for dates of service beginning July 1, 2023.
The policy details reimbursement for behavioral health and substance use disorder providers for medically necessary services rendered in inpatient, outpatient and acute residential settings and includes billing guidelines.
Under the new policy, when billing for behavioral health and substance use disorder services, providers must include the appropriate modifier to indicate clinician type, and reimbursement varies as noted in the chart below.
| Code | Description | Comments |
| AF | Psychiatrist | Allows 100% of the contracted allowable rate |
| AH, HP | Clinical psychologist or doctoral level (PhD, PsyD, EdD) | Allows 100% of the contracted allowable rate |
| AJ | Clinical Social Worker | Allows 75% of the contracted allowable rate |
| HL | Intern | Allows 85% of the contracted allowable rate |
| HM | Less than bachelor’s degree level | Allows 75% of the contracted allowable rate |
| HN | Bachelor’s degree level | Allows 75% of the contracted allowable rate |
| HO | Master’s degree level | Allows 75% of the contracted allowable rate |
In addition, supervised practitioners may receive reimbursement at a rate equivalent to that of the participating supervising practitioner. All claims rendered by a supervised practitioner must be submitted by the contracted supervising practitioner and must include the appropriate modifier indicating the licensure level of the supervised practitioner.
For more complete details, please refer to the Behavioral Health and Substance Use Disorder Payment Policy.
As we noted in previous communications, we made the decision to delay the insourcing of our Behavioral Health program for our Harvard Pilgrim Health Care commercial members to fall 2023. As a result, the Behavioral Health and Substance Use Disorder Payment Policy applies only for Tufts Health Plan commercial members until insourcing occurs, at which time the policy will also apply for Harvard Pilgrim commercial members. We will be sharing additional information about behavioral health insourcing for Harvard Pilgrim commercial members in future issues of the newsletter.
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