MedicaidBilling CodesMedium impact
Managed Care Entity Bulletin 143: Preventive Behavioral Health Services for Members Younger than 21
MassHealth·MA · Psychiatry, Pediatrics, Family Medicine·Managed Care
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
MassHealth is updating billing codes for preventive behavioral health services for members under 21 at Community Health Centers. CHCs can now bill T1040 and T1040-HQ codes starting January 1, 2026, but cannot bill these same-day with traditional psychotherapy codes for the same member at the same location.
Action Required
By January 1, 2026: Billing team must update system to allow T1040 and T1040-HQ codes for preventive behavioral health services at Community Health Centers. Configure edits to prevent billing T1040/T1040-HQ same-day with CPT codes 90832, 90834, 90846, 90847, 90849, or 90853 for same member at same location. Ensure all preventive behavioral health claims include EP modifier and appropriate ICD diagnosis codes including Z codes when clinically appropriate.