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MassHealthMedicaid · Billing Codes · Medical Policy · MA · Psychiatry, OB-GYN, Family MedicineMedium impact

Managed Care Entity Bulletin 134: Coverage of Peer Recovery Coach for Pregnant and Postpartum Members and Recovery Support Navigator for Pregnant and Postpartum Members

Act
by Sep 1, 2025
Effective date
Sep 1, 2025
Identified
Jun 18, 2026

Summary

MassHealth now covers two new specialized services for pregnant and postpartum members with substance use disorders: Peer Recovery Coach Services and Recovery Support Navigator Services. New billing codes H2016-HM-HD and H2015-HF-HD are available with mandatory minimum reimbursement rates.

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What to do

by Sep 1, 2025 · 3 steps
01Billing team must add new HCPCS codes H2016-HM-HD (with modifiers HM and HD) for Peer Recovery Coach Services at minimum $33.16 per diem rate and H2015-HF-HD (with modifiers HF and HD) for Recovery Support Navigator Services at minimum $25.35 per 15-minute rate to billing system for MassHealth ACPPs, MCOs, and behavioral health vendor claims.
02Update fee schedules to ensure rates meet minimum requirements.
03Verify provider qualifications meet new standards before credentialing.

Codes mentioned

H2016H2015

Original notice

Managed Care Entity Bulletin 134: Coverage of Peer Recovery Coach for Pregnant and Postpartum Members and Recovery Support Navigator for Pregnant and Postpartum Members
mass.gov · Always check the source before changing claims.
View original ↗

Related changes

See all MassHealth changes →
Managed Care Entity Bulletin 135: Mental Health Center Policy UpdatesHighEffective Sep 1, 2025 · Managed CareBrowse every MassHealth change in the policy list

Related policy hubs

MassHealth policiesMA policy changesPsychiatryOB-GYNFamily MedicineCode H2016Code H2015

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