Back to Insights and Updates for ProvidersJuly 2024

Coverage reminder – Community Behavioral Health Center services

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial  |  Tufts Health Plan Senior Care Options  |  Tufts Health Public Plans

As a reminder, Point32Health provides coverage of Community Behavioral Health Center (CBHC) Mobile Crisis Intervention (MCI) and Community Crisis Stabilization (CCS) services for Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Plan Public Plans, and Tufts Health Plan Senior Care Options (SCO) members.

Neither MCI nor CCS services require prior authorization; however, notification of admission to a CCS within a CBHC must be provided within 72 hours of the admission. Providers can submit notification through the secure Tufts Health Plan or Harvard Pilgrim Health Plan provider portals or by contacting their Behavioral Health utilization manager. To submit notification for Tufts SCO members, please call 800-208-9565.

When billing for MCI (H2011) and CCS (S9485) services, be sure to include the appropriate modifier. For additional directions and guidance, refer to the Behavioral Health and Substance Use Disorder Commercial Plans, Public Plans, and Senior Products (Senior Care Options) Payment Policies.

CBHCs were designated across Massachusetts in 2023 to provide adults and youth with 24/7 access to community-based and mobile crisis intervention services. Through the MCI program, members have access to 24/7 site- and community-based mobile crisis assessment, intervention, and stabilization. The CCS program offers 24/7, staff-secure crisis care — providing safe, short-term, medically necessary treatment in a community-based environment that is voluntary and less restrictive than inpatient psychiatric hospitalization.

Providers of CBHC services are encouraged to reach out to their assigned Provider Account Manager with questions, or contact the Provider Account Management team at [email protected].

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Ellen Gustavson, Ryan Francis, Stephen Wong,

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Production Coordinator

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