MedicaidBilling CodesHigh impact
All Provider Bulletin 408: Annual Behavioral Health Wellness Examinations
MassHealth·MA · Family Medicine, Internal Medicine, General Practice +2 more·Specialty Services
Effective date
Sep 23, 2025
We identified it
Jun 18, 2026
Summary
MassHealth updated billing requirements for annual behavioral health wellness examinations effective September 23, 2025. The policy provides specific CPT codes and modifiers for different provider types and settings, with no member cost-sharing required.
Action Required
By September 23, 2025: Billing team must update system to use CPT 90791 with diagnosis Z13.30 for standalone behavioral health wellness exams. For same-day office/preventive visits, add modifier U4 to appropriate E&M codes (99202-99215, 99381-99397). Update encounter forms to include these codes and educate providers that only one annual exam per member per year is covered with no cost-sharing.