Back to Insights and Updates for ProvidersDecember 2023

Coverage for services provided by LMFTs/LMHCs

Harvard Pilgrim Stride (HMO) Medicare Advantage  |  Tufts Health One Care  |  Tufts Health Plan Senior Care Options  |  Tufts Medicare Preferred

Point32Health wants to make sure our provider network is aware of an exciting change implemented by the Centers for Medicare and Medicaid Services (CMS) as part of its Final Rule for 2024, which will expand access to important behavioral health services.

Currently, licensed marriage and family therapist (LMFT) and licensed mental health counselor (LMHC) services are reimbursed through “incident to” billing under general supervision. Effective Jan. 1, 2024, however, CMS will recognize LMFTs and LMHCs as Medicare-eligible providers. As a result, Medicare-enrolled LMFTs/LMHCs will be able to bill independently when credentialed and receive reimbursement for covered services.

For more information on how to join our network, visit our Credentialing and Contracting Overview webpage.

Submitting behavioral health claims

For Harvard Pilgrim StrideSM (HMO/HMO-POS) members, Optum/United Behavioral Health’s electronic payer ID number is 87726. The mailing address for paper claims submission is P.O. Box 30602, Salt Lake City, UT 84130-0760.

For Tufts Health Plan members, Tuft Health Plan’s electronic payer ID number is 04298. Mailing addresses for paper claims submission are as follows:

  • Senior Products: Tufts Health Plan, P.O. Box 518, Canton, MA 02021-0518
  • Public Plans: Tufts Health Plan, P.O. Box 189, Canton, MA 02021-0189

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