MedicaidCoverageMedium impact
Updates to Early Intervention coverage and billing
Harvard Pilgrim Health Care·MA · Pediatrics, Psychiatry·Reimbursement
Effective date
Nov 28, 2025
We identified it
Jun 20, 2026
Summary
Point32Health will now cover early intervention services at ABA centers for Tufts Health Together members when clinically justified, effective Nov 28, 2025. Services must be billed using T1015-TL (per 15 minutes), and telephonic codes 98966, 98967, and 98968 are no longer covered for early intervention.
Action Required
Immediately: Update billing system to use T1015-TL modifier for early intervention services at ABA centers, billing per 15-minute increments. Stop billing codes 98966, 98967, and 98968 for early intervention services. Ensure clinical documentation justifies why services must be provided at ABA center rather than community site. Resubmit any denied claims for ABA center early intervention services from Nov 28 onward.