Provider payment guidelines

Annual Mental Health Wellness Exams

Per MA DOI Bulletin 2024-02, we will cover an annual Mental Health Wellness Exam when billed under the medical benefit effective 4/1/2024 as follows: 

Diagnosis Code: Z13.30, Encounter for screening examination for mental health and behavioral disorders, unspecified

Service Code: 90791, Psychiatric diagnostic evaluation

Modifier: 33, Preventive Services: When the primary purpose of the service is the delivery of an evidence-based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.

Frequency Limit: Annual

Services are provided at no member cost sharing except if the member is enrolled in an HSA qualified health plan (plan name includes the word ‘HSA’).

Mass General Brigham Health Plan’s Behavioral Health partner, Optum, will update our behavioral health providers via Provider Express.

Response to ED Boarding Crisis 

Mass General Brigham Health Plan complies with regulatory guidance to ensure Hospitals are reimbursed for behavioral health crisis evaluations and stabilization services provided in the Emergency Department in response to the ED Boarding crisis.

This applies to:

• Commercial members, for dates of service 11/01/2022 and forward per MA DOI Bulletin 2022-08.
   
• Medicaid members, for dates of service 01/03/2023 through 09/30/2023, per Mass Health guidance including MCE Bulletin 93 published November 2022.
• Medicaid members, for dates of service 10/01/2023 and forward, per the MA Inpatient Acute General RFA effective 10/01/2023.

Mass General Brigham Health Plan complies with regulatory guidance to ensure Hospitals are reimbursed for behavioral health crisis evaluations and stabilization services, crisis management, recovery support navigators and the initiation of medication treatment for Opioid Use Disorders in the ED per the MA Inpatient Acute General RFA effective 10/01/2023.