MedicaidBilling CodesMedium impact
Billing update for Community Health Centers using code T1015
Harvard Pilgrim Health Care·MA · OB-GYN·Reimbursement
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Effective November 1, 2025, community health centers must add the TH modifier to all T1015 claims for CNM and OB/GYN services, regardless of whether the care is prenatal, postpartum, or other medical visits. This requirement applies to all Tufts Health Plan members and aligns with MassHealth's updated coding requirements.
Action Required
Before November 1, 2025: Community health center billing teams must update billing systems to automatically append modifier TH to all T1015 claims for certified nurse midwife (CNM) and obstetrician gynecologist (OB/GYN) services. Update encounter forms and billing staff training to ensure TH modifier is included for all CNM/OB/GYN visits billed with T1015, regardless of service type. This applies to Tufts Health Together, Tufts Health Plan Senior Care Options, and Tufts Health One Care members.