Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Substance Abuse Treatment Bulletin 8 November 2007 TO: Substance Abuse Treatment Providers Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Diagnosis Code Required for All Substance Abuse Claims Background Substance abuse treatment program providers are not currently required to use diagnosis codes when submitting claims. In an effort to keep all MassHealth provider billing requirements consistent, freestanding substance abuse treatment providers will soon be required to use diagnosis codes when submitting a claim. These codes are found in the ICD-9-CM code book. New Billing Effective for dates of service on or after January 1, 2008, diagnosis codes Requirement will be required for all claims submitted with substance abuse treatment service codes. Please note that the primary diagnosis listed on the claim must be consistent with the initial reason the member was receiving the treatment. Beginning in January 2008, claims with a substance abuse service code without a corresponding diagnosis code will be denied with Error Code 131: “procedure code requires diagnosis code.” Information Available This bulletin, as well as all other MassHealth bulletins and transmittal Online letters, is available on our Web site at www.mass.gov/masshealthpubs. Click on Provider Library. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.