Back to Insights and Updates for ProvidersNovember 2023

MassHealth nursing facility rate add-on codes

Tufts Health Plan Senior Care Options  |  Tufts Health Unify

In support of billing and reimbursement guidance from MassHealth, we will now reimburse the following nursing facility rate HCPCS add-on codes, when appropriate, for Medicaid-covered inpatient admissions for Tufts Health Plan Senior Care Options and Tufts Health Unify (soon to be Tufts Health One Care) members:

  • S0311 – Homeless add-on – facility specific
  • S0315 – Enhanced Temporary Resident add-on
  • S0316 – Temporary Resident add-on
  • S0317 – Transitional add-on
  • S0340 – Behavioral add-on
  • S0341 – SUD add-on
  • S0342 – Tracheostomy add-on
  • S0353 – Den Dialysis Service fee add-on
  • S0354 – Den Dialysis – MH FFS Treatment add-on

This coverage will be effective retroactively to Jan. 1, 2023.

Submitting claims from Nov. 1, 2023 forward

For dates of service beginning Nov. 1, 2023, you may now submit these add-on codes for reimbursement, when applicable and in accordance with MassHealth billing guidance. Claims for the add-on codes should be billed with the HCPCS code on an outpatient UB form. While prior authorization is not required, claims will be subject to post-audit.

Submitting claims from Jan. 1, 2023 through Oct. 31, 2023

If you rendered a service between Jan. 1, 2023 and Oct. 31, 2023 which would have been eligible for any of the above-referenced nursing facility rate add-on codes, you may submit an outpatient UB claim with the appropriate add-on code by Jan. 31, 2024. While such claims will initially deny for timely filing, we will be running monthly reporting to override the denials and properly reimburse those claims.

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