When does this change take effect?

This change is effective Sep 23, 2025.

MedicaidBilling CodesMedium impact

Billing update for annual behavioral health wellness exams

Q: Who is affected by this change?

This affects Harvard Pilgrim Health Care Family Medicine, General Practice, Internal Medicine, Psychiatry, Pediatrics providers in MA on Medicaid plans.

Harvard Pilgrim Health Care·MA · Family Medicine, General Practice, Internal Medicine +2 more·Prior Authorization

Effective date

Sep 23, 2025

We identified it

Jun 20, 2026

Days to comply

—

Summary

MassHealth has updated billing requirements for annual behavioral health wellness exams effective September 23, 2025, affecting multiple provider types including PCPs and mental health professionals. Point32Health is updating their systems to align with these new billing guidelines which include changes to procedure codes, diagnosis codes, and modifiers.

Action Required

Action needed

Before September 23, 2025: Billing team must review MassHealth All Provider Bulletin 408 to identify updated procedure codes, diagnosis codes, and modifiers for annual behavioral health wellness exams. Update billing system with new codes and requirements specific to your provider type. Review Division of Insurance Bulletin 2024-02 Appendix A for exam components. Monitor Point32Health system updates as they align with MassHealth guidance.

Related policy hubs

Harvard Pilgrim Health Care policies MA policy changes Family Medicine General Practice Internal Medicine Psychiatry Pediatrics