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Harvard Pilgrim Health CareMedicaid · Administrative · Reimbursement · RI · PsychiatryHigh impact

Billing update for residential substance use disorder treatment

Effective date
Jan 1, 2026
Identified
Jun 20, 2026

Summary

Effective January 1, 2026, providers billing residential substance use disorder treatment for Tufts Health RITogether members must switch from UB-04 forms with POS code 21 to CMS-1500 forms with POS code 55. Claims submitted using the old format will be denied.

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What to do

Action · 4 steps
01Before January 1, 2026: Billing team must update billing system to use CMS-1500 forms with POS code 55 (Residential Treatment Facility) for all residential substance use disorder treatment claims for Tufts Health RITogether members.
02Stop using UB-04 forms with POS code 21 for these services.
03Continue using current HCPCS codes (H0018 UD for ASAM 3.1, H0010 UD for ASAM 3.5, H0011 UD for ASAM 3.7/3.7 WM).
04Claims submitted with old format will be denied.

Codes mentioned

H0018H0010H0011

Original notice

Billing update for residential substance use disorder treatment
point32health.org · Always check the source before changing claims.
View original ↗

Related policy hubs

Harvard Pilgrim Health Care policiesRI policy changesPsychiatryCode H0018Code H0010Code H0011

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