MedicaidBilling CodesMedium impact
Billing update for CHCs providing youth preventive BH services
Harvard Pilgrim Health Care·MA · Psychiatry, Pediatrics·Reimbursement
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Effective January 1, 2026, Community Health Centers providing preventive behavioral health services to Tufts Health Together members under 21 can use new billing codes T1040 and T1040-HQ, but cannot bill these codes on the same date/location as existing psychotherapy codes (90832, 90834, 90846, 90847, 90849, 90853). Incorrect claims will be reprocessed and overpayments retracted.
Action Required
Before January 1, 2026: Billing team must update system edits to prevent billing T1040 or T1040-HQ codes on the same date/location as psychotherapy codes 90832, 90834, 90846, 90847, 90849, or 90853 for Tufts Health Together members under 21. Add new billing codes T1040 and T1040-HQ to system. Train staff on new code usage for CHCs. Ensure all preventive BH claims continue to use modifier EP and appropriate ICD diagnosis codes. Review existing workflows to prevent claim reprocessing and overpayment retractions.