MedicaidCoverageMedium impact
Managed Care Entity Bulletin 136: Annual Behavioral Health Wellness Examinations
MassHealth·MA · Family Medicine, Internal Medicine, General Practice +2 more·Managed Care
We identified it
Jun 18, 2026
Summary
MassHealth now requires managed care entities to cover annual behavioral health wellness examinations with no member cost-sharing, provided by primary care providers or licensed mental health professionals. MCEs must develop policies to pay for these exams without prior authorization requirements.
Action Required
Immediately: Billing team must develop new policies and procedures to process annual behavioral health wellness exam claims from primary care providers and licensed mental health professionals. Update billing system to allow additional diagnosis codes on claims when conditions are discovered during exams. Ensure no prior authorization requirements are applied to these wellness exams. Reference All Provider Bulletin 408 for specific billing guidance.