In support of ongoing efforts to meet the growing behavioral health needs of members in community-based settings, effective March 1, 2024, MassHealth has updated the minimum rates for certain services provided by mental health centers (MHCs), as outlined in Table 1 of MCE Bulletin 108. When billing for these services, MHCs must use Place of Service 53 to indicate status as a community mental health center.
MHCs are providers enrolled with MassHealth as Provider Type 26 (mental health centers) that meet 130 CMR 429 criteria or are otherwise defined by the Executive Office of Health and Human Services (EOHHS).
Also effective March 1, 2024, mental health centers that are not designated as behavioral health urgent care centers (BHUCs) may bill for the services outlined in Table 2 of the bulletin using the GJ modifier, when they complete at least one of the following:
- A diagnostic evaluation for a new patient within one calendar day of the patient’s request for an appointment, when initial intake indicates that the patient is presenting with an urgent behavioral health need
- An appointment for an existing patient with an urgent behavioral health need within one calendar day of the appointment request
- A psychopharmacology appointment and a medication for addiction treatment evaluation within 72 hours of an initial diagnostic evaluation, when a need is indicated by psychosocial assessment
Urgent behavioral health needs are characterized by MassHealth as changes in behavior or thinking, role dysfunction, and emerging intent of self-injury or threats to others without immediate risk of harm to self or others. Prior authorization for urgent care services is not required.
Non-BHUC MHC providers who bill for a service with the GJ modifier must also use Place of Service 53 to indicate status as a community mental health center — and include the following within their clinical documentation: the time of the patient’s request for the appointment and/or the time of the initial diagnostic evaluation; the time of the appointment; and the urgent behavioral health need of the patient.
Non-BHUC MHC providers who bill for eligible services using modifier GJ and Place of Service 53 will receive an increased rate of reimbursement. Refer to Point32Health’s updated Outpatient Behavioral Health & Substance Use Disorder Payment Policy for additional billing details.
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