Fee-for-Service, including members with Third Party Liability

Acute care billing instructions for behavioral health services rendered by MassHealth Fee-for-Service (FFS), including but not limited to members with Third Party Liability (TPL) network providers.

BH Crisis Evaluation (Required of Hospitals)

On initial day of readiness (S9485, no modifier)

ED-Based

Med/Surg

Submit a single institutional (837I) claim with medical charges and BH crisis evaluation (S9485) to MassHealth. S9485 will be reimbursed in addition to the covered outpatient medical charges.  There is no limitation within Behavioral Revenue Code 9xx.  For FFS members with MBHP as their managed care plan, bill MBHP directly for all behavioral health claims. Hospital must be contracted with MBHP.

Submit a professional claim (837P) with S9485 that includes MassHealth INPT (provider type 70) provider ID and Service Location, in addition to institutional (837I) claim with ED and INPT charges. Exclude from any facility/institutional claim (including Claim Types I and A) that the Hospital submits for the member’s stay.  For FFS members with MBHP as their managed care plan, bill MBHP directly for all behavioral health claims. Hospital must be contracted with MBHP.

BH Crisis Management

On days subsequent to the initial BH Crisis Evaluation for individuals experiencing a behavioral health crisis in need of ongoing behavioral health crisis supports (S9485-V1 or -V2)

ED-Based

Med/Surg

Submit a single institutional (837I) claim with medical charges and BH crisis evaluation (S9485) to MassHealth. S9485 will be reimbursed in addition to the covered outpatient medical charges. There is no   limitation within Behavioral Revenue Code 9xx.   For FFS members with MBHP as their managed care plan, bill MBHP directly for all behavioral health claims. Hospital must be contracted with MBHP.

Submit a professional claim (837P) with either S9485-V1 or -V2 as appropriate for any calendar day. Include MassHealth INPT (provider type 70) provider ID and Service Location, in addition to institutional (837I) claim with ED and INPT charges. Exclude from any facility/institutional claim (including Claim Types I and A) that the Hospital submits for the member’s stay.  For FFS members with MBHP as their managed care plan, bill MBHP directly for all behavioral health claims. Hospital must be contracted with MBHP.

MOUD Induction

For initiation of medication for opioid use disorder in the emergency department for MassHealth members who consent to initiation (G2213)

Ed- Based Only
Submit a single institutional (837I) claim with medical charges and MOUD induction claim (G2213) to MassHealth. G2213 will be reimbursed in addition to the covered outpatient medical charges.  There is no limitation within Behavioral Revenue Code 9xx.  For FFS members with MBHP as their managed care plan, bill MBHP directly for all behavioral health claims. Hospital must be contracted with MBHP.

Recovery Support Navigator (RSN)

RSN services provided in the emergency department or medical/surgical floors (H2015-HF)

ED-Based

Med/Surg

Submit a single institutional (837I) claim with medical charges and RSN claims (H2015-HF) to MassHealth. H2015-HF will be reimbursed in addition to the covered outpatient medical charges.  There is no limitation within Behavioral Revenue Code 9xx.    For FFS members with MBHP as their managed care plan, bill MBHP directly for all behavioral health claims. Hospital must be contracted with MBHP.

Submit a professional claim (837P) with code H2015-HF. Include MassHealth INPT (provider type 70) provider ID and Service Location, in addition to institutional (837I) claim with ED and INPT charges. Exclude from any facility/institutional claim (including Claim Types I and A) that the Hospital submits for the member’s stay. For FFS members with MBHP as their managed care plan, bill MBHP directly for all behavioral health claims. Hospital must be contracted with MBHP.

Date published:	April 30, 2024