MedicaidBilling CodesMedium 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
MassHealth·MA · Psychiatry, OB-GYN, Family Medicine·Medical Policy
Effective date
Sep 1, 2025
We identified it
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.
Action Required
By September 1, 2025: Billing 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. Update fee schedules to ensure rates meet minimum requirements. Verify provider qualifications meet new standards before credentialing.