All primary-care providers (PCPs) serving MassHealth-enrolled children under the age of 21 should use Service Code 96110, "Developmental testing; limited," when submitting a claim for the administration and scoring of a standardized behavioral-health screening tool. Reimbursement for the administration and scoring is in addition to the reimbursement for the visit. PCPs should submit their claims for services to the enrolled-member's managed-care organization (MCO) or MassHealth as appropriate.

The use of a modifier is required. Claims submitted for dates of service on or after July 1, 2011 without a modifier will be denied.

The servicing provider-specific modifier is based on the clinician's interpretation of the findings. "Behavioral-health need identified" means that the provider administering the screening tool, in her or his professional judgment, identifies a child with a potential behavioral-health services need.

MassHealth will pay for the administration and scoring of the behavioral-health tools listed at this Web site and in the EPSDT Services Medical Protocol and Periodicity Schedule (Appendix W in all MassHealth provider manuals) when administered by physicians; independent nurse practitioners; independent nurse midwives; and nurse practitioners, nurse midwives and physician assistants under a physician's supervision. Physicians, independent nurse practitioners, independent nurse midwives, community health centers, and hospital outpatient departments can submit claims for reimbursement for the administration and scoring of the standardized behavioral-health screening tools.

Contact the member's MCO or the MassHealth Customer Service Center for more information on how to bill for EPSDT/PPHSD services, including the administration and scoring of a standardized behavioral-health screening tool. For contact information, www.mass.gov/masshealth/childbehavioralhealth.


This information is provided by MassHealth.