MassHealth COVID-19 Guidance for All Providers

This page provides MassHealth Coronavirus Disease (COVID-19) guidance and information for all MassHealth providers.

In response to COVID-19, MassHealth has taken steps to create flexibilities for providers; expand benefits, including coverage of services delivered via telehealth; and expand eligibility for residents of the Commonwealth. The following guidance applies to all MassHealth providers. 

You may also find it helpful to review DPH’s COVID-19 guidance for health care professionals.

All Provider Bulletins

• All Provider Bulletin 375: Coverage and Reimbursement Policy for Coronavirus Disease 2019 (COVID-19) Vaccines confirms coverage for newly added COVID-19 vaccine codes and also lists vaccine codes that are no longer covered by MassHealth effective April 18, 2023. PDF | Word

• All Provider Bulletin 368: Ending Prior Authorization Requirements for Certain Services effectively ends PA requirements previously suspended as a result of the pandemic (effective June 30, 2023). PDF | Word

• All Provider Bulletin 367: Coverage and Reimbursement Policy Updates for Services Related to COVID-19 after the Expiration of the Federal Public Health Emergency (Corrected) provides updated information on certain COVID-19-related services and flexibilities. PDF | Word

• All Provider Bulletin 362: Coverage and Reimbursement Policy for Vaccine Counseling supersedes All Provider Bulletin 321 and adds new procedure codes for vaccine counseling, effective for dates of service on and after February 1, 2023. PDF | Word

• All Provider Bulletin 357: Coverage and Reimbursement Policy for Coronavirus Disease 2019 (COVID19) Bivalent Vaccine Doses and Pre-exposure Prophylaxis provides codes and rates for the new Moderna and Pfizer bivalent COVID-19 vaccine doses for use in younger age groups. Rates are identical to those for other COVID-19 vaccines. It also clarifies coverage for pre-exposure prophylaxis. PDF | Word

• All Provider Bulletin 354: Coverage and Reimbursement Policy for Coronavirus Disease 2019 (COVID-19) Bivalent Vaccine Boosters (Corrected) provides codes and rates for the new Moderna and Pfizer bivalent COVID-19 vaccine boosters. Rates are identical to those for other COVID-19 vaccines. PDF | Word

• All Provider Bulletin 349: Coverage and Reimbursement Policy for Bebtelovimab provides information around future pricing of bebtelovimab, a monoclonal antibody used for the treatment of Coronavirus Disease 2019 (COVID-19). PDF | Word

• All Provider Bulletin 347: Changes to Prescription Drug Days’ Supply Limitations, Effective September 19, 2022 details that, effective September 19, 2022, MassHealth will no longer allow 90-day supplies for most brand name drugs. Only drugs designated by the MassHealth Drug List will be allowed to be dispensed in a 90-day supply. PDF | Word

• All Provider Bulletin 346: Coverage and Reimbursement Policy for Coronavirus Disease 2019 (COVID-19) Vaccines, including Pediatric Vaccines, and Vaccine Boosters confirms coverage for COVID-19 vaccine doses (ages six months through four years) for the Pfizer-BioNTech COVID-19 Pediatric Vaccine, the Moderna COVID-19 Pediatric Vaccine, the Pfizer- BioNTech COVID-19 pediatric vaccine booster doses and the Novavax COVID-19 vaccine. PDF | Word

• All Provider Bulletin 344: Update Concerning Coverage of and Payment for the Administration of (1) Remdesivir in an Outpatient Setting (2) COVID-19 Vaccines; and (3) Rapid Antigen Testing for COVID-19 for MassHealth Limited Members supersedes previous bulletins and describes an updated guidance for the three listed items. PDF | Word

• All Provider Bulletin 342: Billing Policies for Coronavirus Disease 2019 (COVID-19) Testing and Treatment Services for Uninsured Individuals and MassHealth Limited Members supersedes MassHealth All Provider Bulletin 292 and details billing policies for COVID-19 testing, treatment, and vaccine services for individuals who are uninsured and for MassHealth Limited Members. PDF | Word

• All Provider Bulletin 341: Coverage of and Payment for the Administration of (1) Tixagevimab Co-Packaged with Cilgavimab, and (2) Bebtelovimab describes a revision to the emergency use authorization (EUA) that appeared in All Provider Bulletin 336 pertaining to the administration of tixagevimab co-packaged with cilgavimab. It also details coverage for the monoclonal antibody bebtelovimab, which the FDA granted EUA for on February 11, 2022. PDF | Word

• All Provider Bulletin 338: Coverage and Reimbursement Policy for Coronavirus Disease 2019  (COVID-19) Treatment Counseling and Vaccines expands coverage detailed in All Provider Bulletin 330 to include counseling relating to the treatment of COVID-19, including counseling about oral antivirals, and introduces new codes for recently added vaccines. PDF | Word

• All Provider Bulletin 337: MassHealth Pharmacy Coverage of Over-the-Counter Diagnostic Antigen Tests for SARS-CoV-2 announces that, effective January 14, 2022, the FDA approved OTC COVID-19 at-home antigen self-test kits have been added to the MassHealth Non-Drug Product List and will be covered through the MassHealth pharmacy benefit. PDF | Word

• All Provider Bulletin 336: Coverage of and Payment for the Administration of (1) Tixagevimab Co-Packaged with Cilgavimab, and (2) Remdesivir in an Outpatient Setting announces that MassHealth will cover Tixagevimab co-packaged with Cilgavimab for the pre-exposure prophylaxis of COVID-19, as well as Remdesivir administered to MassHealth members on an outpatient basis by MassHealth-enrolled acute outpatient hospitals, community health centers, and physicians. PDF | Word

• All Provider Bulletin 333: MassHealth Coverage for Coronavirus Disease 2019 (COVID-19) Vaccine Booster Doses MassHealth coverage policies for vaccinations, including boosters, and monoclonal antibody treatments. PDF | Word
• All Provider Bulletin 332: Federal COVID-19 Vaccine Mandate for Eligible Staff at Health Care Facilities Participating in the Medicare and Medicaid Programs explains the Centers for Medicare and Medicaid Services (CMS) published interim final rule requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. Facilities and providers covered by this rule must establish a policy ensuring that all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine (or have requested or been granted an exemption to the vaccination requirements) by December 5, 2021. All eligible staff must be fully vaccinated by January 4, 2022. PDF | Word
• All Provider Bulletin 330: MassHealth Coverage for Coronavirus Disease 2019 (COVID-19) Vaccines, including Pediatric Vaccines, and Monoclonal Antibodies announces that MassHealth will cover the administration if the Pfizer-BioNTech COVID-19 vaccine to children 5 through 11 years of age consistent with the EUA. PDF | Word
• All Provider Bulletin 328: Coverage for Booster Doses of Coronavirus Disease 2019 (COVID-19) Vaccines announces that MassHealth will cover booster doses of the Pfizer-BioNTech, Moderna, and Janssen COVID-19 vaccines consistent with the Emergency Use Authorizations (EUAs). PDF | Word
• All Provider Bulletin 327: Access to Health Services through Telehealth Options - Corrected provides additional guidance on telehealth as well as the successor policy, mentioned in All Provider Bulletin 324, on telehealth services and is effective for dates of service on or after October 16, 2021. PDF | Word
• All Provider Bulletin 326: Coverage for Monoclonal Antibodies for Treatment and Post-Exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) updates the coverage and payment provisions for monoclonal antibodies for treatment and post-exposure prophylaxis for COVID-19. This bulletin applies to members enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) Plan, or a Primary Care Accountable Care Organization (ACO). PDF | Word
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• All Provider Bulletin 322: Coverage for Third Dose of Pfizer-BioNTech and Moderna Coronavirus Disease 2019 (COVID-19) Vaccine for Immunocompromised Individuals announces that, effective August 12, 2021, MassHealth will cover the administration of the third dose of the Pfizer-BioNTech and Moderna COVID-19 vaccines to individuals who qualify for the additional dose and are enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) Plan, or a primary care accountable care organization (ACO). PDF | Word
• All Provider Bulletin 321: Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19) Vaccine Counseling informs providers that MassHealth is introducing additional coverage for COVID-19 vaccine counseling services effective July 26, 2021. PDF | Word
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• All Provider Bulletin 319: Coverage and Reimbursement Policy Updates for Services Related to COVID-19 After the Termination of the State of Emergency retains certain flexibilities set to expire at the end of the Massachusetts state of emergency and describes certain additional flexibilities that will continue after the end of the state of emergency. PDF | Word
• All Provider Bulletin 318: Update about Monoclonal Antibody Treatment for Coronavirus Disease 2019 (COVID-19) supplements and updates All Provider Bulletins 304 and 312 and provides an update to the payment provisions for monoclonal antibody treatment for COVID-19. PDF | Word
• All Provider Bulletin 317: Update to Authorized Providers for Coronavirus Disease 2019 (COVID-19) Vaccine Administration permits acute treatment services providers, clinical stabilization services providers and dental providers to bill MassHealth for COVID-19 vaccine administration, in addition to all provider types previously identified as eligible in prior bulletins. PDF | Word
• All Provider Bulletin 313: Updated Rates for Coronavirus Disease 2019 (COVID-19) Vaccine Administration updates the rates MassHealth will pay for COVID-19 vaccine administration for dates of service on or after April 1, 2021. PDF | Word
• All Provider Bulletin 312: Additional Authorized Vaccine Product and Antibody Treatment and Update to Authorized Providers and Coverage Policy for MassHealth Limited Members for Coronavirus Disease 2019 (COVID-19) Vaccine Administration adds the Johnson & Johnson COVID-19 vaccine as an authorized product and provides guidance on rates for the vaccine; lists additional providers who may bill MassHealth for vaccine administration, and requires providers to bill MassHealth for COVID-19 vaccines administered to MassHealth Limited members rather than billing through the federal COVID-19 Uninsured Program portal.​ PDF | Word
• All Provider Bulletin 310: Transportation for Members to Vaccination Sites for Coronavirus Disease 2019 (COVID-19) Vaccine Administration expands coverage for transportation services to COVID-19 vaccine appointments for MassHealth members in Family Assistance, CMSP, and MassHealth Limited, as well as for individuals who are HSN patients, and allows members to directly request transportation services for vaccine appointments through Customer Service.​ PDF | Word
  • Frequently Asked Questions (FAQs) on Transportation Services for MassHealth and Health Safety Net to COVID-19 Vaccine Appointments ​provides additional detail on groups who are newly eligible for transportation services to vaccine appointments and information on how members can request transportation to these appointments through MassHealth Customer Service. PDF | Word
• All Provider Bulletin 308: MassHealth Third Party Prior Authorization Administrator Temporary Suspension suspends MassHealth's prior-authorization (PA) policy for advanced imaging services, non-obstetric ultrasounds, polysomnography, and cardiology services identified in Transmittal Letters AOH-45, CHC-113, PHY-157, and IDTF-20, and instructs providers not ​to submit requests for PA for such services to eviCore. PDF | Word
• All Provider Bulletin 307: Updated Payment Rates and Authorized Providers for Coronavirus Disease 2019 (COVID-19) Vaccine Administration ​supersedes portions of All Provider Bulletin 304 to provide updated information on payment for COVID-19 vaccine administration and to list additional providers who may bill for COVID-19 vaccine administration. PDF | Word
• All Provider Bulletin 304: Coverage and Payment for Coronavirus Disease 2019 (COVID-19) Vaccine Administration, Testing, and Monoclonal Antibody Product Infusion ​provides guidance regarding coverage and payment for COVID-19 vaccines for the MassHealth and limited benefit populations. It also provides coverage and payment guidance regarding two monoclonal antibody therapies to treat COVID-19 as well as guidance on new testing codes. PDF | Word
• All Provider Bulletin 302: Hospital-Determined Presumptive Eligibility Updates during COVID-19 Emergency and Permanent Expansion of HPE for CommonHealth Children and Family Assistance Children restates the requirements described in All Provider Bulletin 299 and provides clarifications regarding HPE for specific populations including older adults seeking long-term care and children receiving the CommonHealth or Family Assistance benefit. PDF | Word
• All Provider Bulletin 301: Impact of COVID-19 on Behavioral Health and the Importance of Perinatal and Pediatric Behavioral Health Screening during the Pandemic provides a reminder to primary care physicians of the importance of behavioral health screenings for all members under the age of 21​ and perinatal women. PDF | Word
• All Provider Bulletin 299: Hospital-Determined Presumptive Eligibility (HPE) Updates during COVID-19 Emergency provides clarification to the HPE policies laid out in All Provider Bulletin 295, specifically that an individual may have up to two HPE periods within a 12 month period and that individuals receiving HPE benefits are ineligible for the eligibility protection rules set forth in Eligibility Operations Memo 20-09. PDF | Word

Resources

• HRSA Provider Relief Fund: The U.S. Department of Health and Human Services (HHS) is distributing $175 billion through the Provider Relief Fund to eligible providers, including those that participate in state Medicaid and Children’s Health Insurance Program's (CHIP's). general distribution. For more information, visit https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html
• COVID-19 Health Care Provider Financial Relief Package​ will support health care providers impacted by and responding to the COVID-19 public health emergency. Through MassHealth, the Baker-Polito Administration is distributing over $800 million in critical stabilization funding to the Commonwealth’s vital providers. PDF | Word
• On September 15, following consultation with CMS, Massachusetts updated its MAGI-based verification plan addendum​, which outlines certain the policies and procedures during the COVID-19 national emergency. 
• MassHealth Provider Resource: How Members Can Request PPE: When medically necessary, MassHealth members can access gloves through the Durable Medical Equipment benefit, and Personal Care Attendant (PCA) consumers with COVID-19 can request additional PPE resources. More information on how requesting PPE can be found in this document: PDF | Word Spanish: PDF | Word
• MassHealth Provider Resource: Connecting Your Patients with Food Resources: ​During the COVID-19 public health emergency, a growing number of families across Massachusetts face food insecurity, many for the first time. This guide will help providers identify patients with food insecurity and connect them with resources in the community. PDF | Word  Spanish: PDF | Word. 
  You can also visit https://www.mass.gov/lists/covid-19-food-assistance​ for more information on food assistance available during COVID-19. 
• MassHealth Provider Resource: Telephone and Internet Connectivity for Telehealth aims to help providers guide members who want to receive services via telehealth during the COVID-19 emergency, but have concerns about limited phone and internet access. PDF| Word

Last updated:	May 26, 2023