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Billing updates for mental health centers

Harvard Pilgrim Health Care·MA · Psychiatry·Reimbursement
Effective date
Sep 1, 2025
We identified it
Jun 26, 2026
Days to comply

Summary

Effective September 1, 2025, MassHealth is implementing a bundled encounter rate for Behavioral Health Urgent Care (BHUC) centers. BHUCs must now bill using HCPCS code H2013 with modifiers HB (adult) or HA (child/adolescent), accompanied by zero-pay service codes indicating the type of mental health service provided. The GJ modifier for enhanced urgent care rates is being discontinued for BHUCs and non-BHUC mental health centers.

Action Required

Action needed
By August 31, 2025: Billing team must update billing software to implement new bundled billing requirements for all BHUC claims with dates of service on or after September 1, 2025. (1) Configure system to require HCPCS code H2013 paired with modifier HB (adult) or HA (child/adolescent) for all eligible mental health services. (2) Set H2013 to be billed in conjunction with at least one zero-pay service code from the provided list (90791, 90792, 90832, 90833, 90834, 90836, 90837, 90846, 90847, 90849, 90853, 90853-EP, 90882, 90887, S9480, 99202-99205, 99211-99215, 99417, H0046, H0032, H2020, 99402, 99404) to indicate service type. (3) Remove or disable the GJ modifier option for all mental health billing; configure system to reject claims using GJ modifier for BHUC and non-BHUC mental health centers. (4) Create billing rules to enforce that SOAP, E-SOAP, and IOP services cannot be billed on the same date of service as encounter bundles. (5) Ensure psychological assessments, neurological assessments, community support services, peer specialist services, and peer recovery coach services continue billing under existing procedures (not bundled). Update encounter templates and provider training materials to reflect new coding requirements. Failure to implement these changes will result in claim denials for improperly coded mental health services.

Affected Billing Codes

H2013
90791
90792
90832
90833
90834
90836
90837
90846
90847
90849
90853
90882
90887
S9480
99202
99203
99204
99205
99211
99212
99213
99214
99215
99417
H0046
H0032
H2020
99402
99404