MedicaidAdministrativeHigh impact
Billing update for residential substance use disorder treatment
Harvard Pilgrim Health Care·RI · Psychiatry·Reimbursement
Effective date
Jan 1, 2026
We identified it
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.
Action Required
Before 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. Stop using UB-04 forms with POS code 21 for these services. Continue 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). Claims submitted with old format will be denied.