Massachusetts Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Massachusetts, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Massachusetts billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Massachusetts billing guide: how Massachusetts pays for outpatient care
MassHealth, the Massachusetts Medicaid program, pays for outpatient behavioral health through a mix of managed care options: Accountable Care Partnership Plans, Primary Care ACOs, managed care organizations (MCOs) and the Primary Care Clinician (PCC) Plan. For PCC Plan and Primary Care ACO members, behavioral health runs through MassHealth's contractor, MBHP. Partnership plans and MCOs use their own network or contracted behavioral health vendor.
Commercial coverage is regulated by the state Division of Insurance, which found no carrier out of compliance in its CY2024 parity report. Medicare Part B claims go to National Government Services (NGS), now operating as Wellpoint Federal, in Jurisdiction K.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | MassHealth, run by the Executive Office of Health and Human Services | MassHealth enrollment overview |
| Medicare Part B | National Government Services (NGS), operating as Wellpoint Federal, Jurisdiction K | CMS MAC page |
| Blue Cross Blue Shield | Blue Cross Blue Shield of Massachusetts, Inc. | See the Blue Cross section below |
Massachusetts Medicaid: MassHealth
This Massachusetts billing guide starts with Medicaid, because it decides who pays and how you file.
MassHealth is mixed. Members enroll in an Accountable Care Partnership Plan, a Primary Care ACO, an MCO or the PCC Plan, and some members remain fee-for-service. Which plans you contract with decides whose claims you can bill.
MBHP is MassHealth's behavioral health contractor for PCC Plan and Primary Care ACO members. Partnership plans and MCOs handle behavioral health authorization and claims themselves or through their contracted vendor. Check the member's plan type and behavioral health contact in the Eligibility Verification System before every visit.
| Item | What to know |
|---|---|
| Agency | Executive Office of Health and Human Services (MassHealth) |
| Fee-for-service claims | MassHealth Provider Online Service Center: billing, prior authorization, eligibility and remittance advice |
| Rates and rules | Psychologist services bulletin PSY-25 (130 CMR 411 and 101 CMR 329) |
| Work requirement | MassHealth work and education requirements start January 1, 2027, per a Mass.gov page dated 7/21/2026. They mainly affect adults 19 to 64, apply at the first 2027 renewal or coverage change, and exempt people with serious mental illness and people in substance use treatment. Source |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Accountable Care Partnership Plans | One MCO plus a primary care network. Behavioral health is covered by the plan or its contracted vendor. |
| Primary Care ACOs: Community Care Cooperative and Revere Health Choice | Behavioral health through MBHP. Revere Health Choice becomes Bookmark Care Network on 1/1/2027 (All Provider Bulletin 422). |
| MCOs: WellSense Essential MCO and Tufts Health Together | Behavioral health through the plan or its vendor. |
| PCC Plan | Uses the MassHealth network. Behavioral health through MBHP. |
Enrollment: independent practitioners billing MassHealth directly enroll as fee-for-service providers, and ordering, referring and prescribing providers enroll as ORP. Groups enroll each service location. Claims deadline: 130 CMR 450.314 sets a 90-day initial submission deadline and a 12-month limit for submission or resubmission, with exceptions.
Medicare Part B in Massachusetts
For Medicare, this Massachusetts billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | National Government Services (NGS), operating as Wellpoint Federal |
| Jurisdiction | Jurisdiction K: CT, ME, MA, NH, NY, RI and VT |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Massachusetts
This part of the Massachusetts billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. Here is who holds the Blue license in Massachusetts.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Blue Cross Blue Shield of Massachusetts, Inc. | Independent licensee; not Anthem or HCSC | Massachusetts | BCBSMA newsroom |
Other private payers and EAPs in Massachusetts
The Massachusetts billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Massachusetts. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Point32Health (Tufts Health Plan and Harvard Pilgrim family) | Billing update for annual behavioral health wellness exams for Tufts Health Together members, for dates of service on or after 9/23/2025. Eligible provider types include psychologists, LICSWs, LMFTs and LMHCs. | Official page |
| WellSense | MassHealth MCO and ACO partner plans, listed in the MassHealth ACO bulletin. | Official page |
Massachusetts billing guide: state law that changes billing
Use this section of the Massachusetts billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Massachusetts. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
The Division of Insurance cites state parity statutes M.G.L. c.175 s.47B, c.176A s.8A, c.176B s.4A and c.176G s.4M plus federal MHPAEA, and found no carrier out of compliance in its CY2024 report. Source
Telehealth coverage and payment parity
Commercial insurers must cover telehealth when the same service is covered in person, and in-network rates for behavioral health by audio-video or audio-only must be no less than in-person rates (M.G.L. c.175 s.47MM; 211 CMR 52.17). Source
Prompt payment and timely filing
MassHealth: 130 CMR 450.314 sets a 90-day initial submission deadline and a 12-month limit for submission or resubmission, with exceptions in 130 CMR 450.313 and 450.323. Source
Practitioner scope: therapists and prescribers
Nurse practitioners and psychiatric nurse mental health clinical specialists may prescribe under guidelines with a supervising professional, and independently after at least two years of supervised practice following certification (M.G.L. c.112 s.80E). Psychiatric prescriber billing (E/M plus add-on codes) differs from therapist billing (90791, 90837 and similar). Source
Not legal advice. Confirm statute details with counsel.
Massachusetts billing guide: codes and rates
This Massachusetts billing guide lists only codes and rates confirmed on official pages.
These are the Massachusetts-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| Modifier -HA on 90791 (psychiatric diagnostic evaluation with CANS) | MassHealth psychologist rule PSY-25, effective for dates of service from 1/1/2023. Billable only by psychiatrists or psychiatric clinical nurse specialists. Source |
| Modifier -AH (doctoral-level clinician billed by a mental health center) | Added by PSY-25 effective 1/1/2023. Source |
| Telehealth place of service 02 or 10 with modifiers 95, 93, GQ, FQ and FR | MassHealth pays video, audio-only and asynchronous services at parity under APB 379. Source |
| 101 CMR 352.00 (children's behavioral health services) | MassHealth held provider listening sessions on 9/17/2026 to start a biennial rate review. Source |
Massachusetts billing guide: what changed, newest first
Check this Massachusetts billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-16 | All Provider Bulletin 422: Revere Health Choice becomes Bookmark Care Network on 1/1/2027. No service-area changes. | Source |
| 2026-09-17 | MassHealth held provider listening sessions to start the biennial review of 101 CMR 352 children's behavioral health rates. | Source |
| 2026-07-21 | Mass.gov states that MassHealth work and education requirements begin 1/1/2027. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-04-01 | National Government Services began operating as Wellpoint Federal. | Source |
| 2025-09-23 | Billing update for MassHealth annual behavioral health wellness exams for dates of service on or after 9/23/2025. | Source |
How do I bill mental health claims in Massachusetts?
These answers come from the same sources as the rest of this Massachusetts billing guide.
Start with the member's payer type. For MassHealth, check the member's plan type in the Eligibility Verification System: PCC Plan and Primary Care ACO members use MBHP, and partnership plan and MCO members use that plan. Medicare Part B goes to NGS in Jurisdiction K. Blue Cross Blue Shield of Massachusetts is the Blue licensee for commercial members.
Questions about billing in Massachusetts
Who handles behavioral health claims for MassHealth members?
It depends on the member's plan. PCC Plan and Primary Care ACO members use MBHP, while Accountable Care Partnership Plan and MCO members use that plan or its contracted vendor. Check plan type and behavioral health contact in the Eligibility Verification System before billing.
What is the MassHealth claim filing deadline?
130 CMR 450.314 sets a 90-day initial submission deadline and a 12-month limit for submission or resubmission, with exceptions in 130 CMR 450.313 and 450.323. Confirm the rule for your claim type and managed care plan.
Does Massachusetts require commercial payers to pay telehealth behavioral health the same as in person?
In-network rates for behavioral health delivered by audio-video or audio-only must be no less than the in-person rate (M.G.L. c.175 s.47MM; 211 CMR 52.17), per the Center for Connected Health Policy summary. MassHealth also pays video, audio-only and asynchronous services at parity under APB 379.
When do MassHealth work requirements start?
Mass.gov says they begin January 1, 2027 for affected adults, checked at the first 2027 renewal or when coverage changes. Exemptions include serious mental illness and certain substance use treatment participants.
Does MCM South bill for practices in Massachusetts?
MCM South serves Massachusetts. Request a quote to talk through your practice.
Sources for the Massachusetts billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- MassHealth provider enrollment overview, checked October 25, 2026
- MassHealth behavioral health providers under PCDI, checked October 25, 2026
- MassHealth PCDI guide for providers, checked October 25, 2026
- MassHealth work and education requirements, checked October 25, 2026
- MassHealth psychologist bulletin PSY-25, checked October 25, 2026
- All Provider Bulletin 422 (ACO changes 1/1/2027), checked October 25, 2026
- MA Division of Insurance CY2024 parity report, checked October 25, 2026
- 130 CMR 450.314 (Cornell LII), checked October 25, 2026
- M.G.L. c.112 s.80E, checked October 25, 2026
- Center for Connected Health Policy: Massachusetts, checked October 25, 2026
- Point32Health: MassHealth CBHI listening sessions, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- Massachusetts insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for Massachusetts
- Massachusetts Medicaid billing codes
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Connecticut insurance companies contact guide
Billing in Massachusetts? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We serve Massachusetts.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.