MedicaidBilling CodesHigh impact
Community Health Center Bulletin 125: Preventive Behavioral Health Services for Members Younger than 21
MassHealth·MA · Psychiatry, Pediatrics·Specialty Services
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
MassHealth updated billing instructions for preventive behavioral health services for members under 21 at Community Health Centers. Effective January 1, 2026, providers should primarily use new codes T1040 and T1040-HQ, with restrictions on billing multiple behavioral health codes on the same date at the same location.
Action Required
By January 1, 2026: Billing team must update system to use T1040 (individual) and T1040-HQ (group) as primary codes for preventive behavioral health services for members under 21. Configure system to prevent billing multiple behavioral health codes (T1040, T1040-HQ, 90832, 90834, 90846, 90847, 90849, 90853) for same member on same date at same location. Ensure all claims include modifier EP and appropriate ICD diagnosis codes including Z codes when clinically appropriate.