Message Text – May 2025

MassHealth Provider Remittance Advice

The messages listed below may be general All Provider messages, applicable to several provider types or services, or provider specific. 

You can request a copy of a prior message by:

• Emailing [e-mail]
• Sending a letter to

  MassHealth Customer Service
  P.O. Box 278
  Quincy, MA 02171

• Calling MassHealth Customer Services at [phone],
  Hours: Monday through Friday 8 a.m. to 5 p.m.

05/27/2025

October 2024 HCPCS Code Updates to the Subchapter 6 Durable Medical Equipment Manual

The Centers for Medicare & Medicaid Services (CMS) has published the HCPCS codes for October 2024. MassHealth updated Subchapter 6 of the Durable Medical Equipment (DME) Manual to incorporate the October 2024 HCPCS service code updates.

Please reference Transmittal Letter DME-49 at 2025 MassHealth transmittal letters for more information.

Additionally, the MassHealth Durable Medical Equipment and Oxygen & Respiratory Payment and Coverage Guideline Tool was updated and posted on the MassHealth website. Please refer to the tool at MassHealth Payment and Coverage Guideline Tools for HCPCS codes effective 10/1/24 and for instructions regarding coverage, limits, and prior authorization requirements.

If you have questions about this change, please contact the LTSS Provider Service Center at [e-mail] or call [phone].

October 2024 HCPCS Code Update to the Subchapter 6 Orthotics and Prosthetics Manual

The Centers for Medicare & Medicaid Services (CMS) has published the HCPCS codes for October 2024. MassHealth has updated Subchapter 6 of the Orthotic (ORT) and Prosthetic (PRT) Manual to incorporate the October 2024 HCPCS service code updates.

Please reference Transmittal Letter ORT-29 and Transmittal Letter PRT-30 at 2025 MassHealth transmittal letters for more information.

Additionally, the MassHealth Orthotics and Prosthetics Payment and Coverage Guideline Tool has been updated and posted on the MassHealth website. Please refer to the MassHealth Payment and Coverage Guideline Tools for HCPCS codes effective 10/1/24 and for instructions regarding coverage, limits, and prior authorization requirements.

If you have questions regarding this change, please contact the LTSS Provider Service Center at [e-mail] or call [phone].

Reinstatement of Primary Care Referral Requirements

On March 20, 2020, as part of MassHealth’s COVID-19 response, the Executive Office of Health and Human Services suspended referral requirements for MassHealth covered services for the Primary Care Accountable Care Organizations (ACO) and the Primary Care Clinician (PCC) Plan.

Effective August 1, 2025, MassHealth will reinstate referral requirements for services provided to members in the PCC plan or a Primary Care ACO, as outlined in 130 CMR 450.118(J): Referral for Services and 130 CMR 450.119(I): Referral for Services.

For more information, please review All Provider Bulletin 403: Ending the Suspension of Primary Care Clinician Plan & Primary Care ACO Referrals and Updating Referral Requirements for Urgent Care Services.

Claims submitted to MassHealth for services that require a referral must include an authorized referring provider’s national provider identifier (NPI). The referring provider must also be enrolled with MassHealth for the claim to be payable. When the PCC and Primary Care ACO referrals are reinstated on August 1, 2025, billing providers must include the NPI of an authorized referring provider who is enrolled with MassHealth. This NPI must appear on every claim with a service that requires a referral for the claim to be payable

For questions or concerns:

LTSS providers, please contact the LTSS Provider Service Center at [phone] or [e-mail].

All other providers, please contact MassHealth at [phone] or [e-mail].

05/13/2025

Update to Licensed Independent Clinical Social Worker Provider Manual

Effective April 25, MassHealth now uses the title Licensed Independent Behavioral Health Clinician (LIBHC) to designate certain provider types. This now includes Licensed Independent Clinical Social Workers (LICSW), Licensed Marriage and Family Therapists (LMFT), and Licensed Mental Health Counselors (LMHC). The provider regulations and manuals for Licensed Independent Clinical Social Workers (LICSW) have been amended to reflect the title LIBHC, and those subsequent provider types. LICSW providers can still locate their regulations and provider manuals in the same place on Mass.gov and will not be adversely affected by billing under the LICSW provider type. Please see MassHealth Provider Manuals for more information.

If you have questions, please contact MassHealth at [e-mail] or [phone].

Provider Enrollment & Credentialing (PEC) Self-Service Tools for MassHealth Providers - Updated

MassHealth is working to improve the provider experience through the increased use of electronic self-service tools. Effective 5/1/2025, a new tool is available on Mass.gov, allowing providers and their credentialing staff to submit certain provider file updates electronically. You will be able to update provider file information including link/unlink, address/contact information, and submit required documents like the MA W-9 and FRDF via a secure document upload. This will eliminate the need for fax, mail, or unsecure emails. The new web-based tools are available on the MassHealth Provider Self-Service page.

MassHealth is hosting informational sessions to introduce the tool and review other recently released provider enrollment and credentialing tools such as Check Enrollment Status, Request an Application, and Check Application Status.

• Tuesday, May 13, 2025, at 1:00 PM EDT
• Wednesday, May 21, 2025, at 10:00 AM EDT

Please register for the webinar.

Please note: These tools will not display information on Dental, Long-Term Services & Supports (LTSS), or Managed Care Entity (MCE) Only providers.

For questions or concerns, please contact MassHealth at [phone] or [e-mail].

05/06/2025

Medicare adjustments on certain outpatient claims

Medicare recently notified MassHealth that it will be adjusting certain Outpatient Prospective Payment System (OPPS) claims to correct the coinsurance amounts apportioned to revenue code 636 and J-code lines. Adjustments only apply to multi-day outpatient claims received from January 3, 2024, to February 4, 2025.

Outpatient providers are reminded that Medicare claim adjustments do not automatically cross over to MassHealth. Providers should adjust the crossover claim previously paid by MassHealth and include the revised Medicare adjudication information on the claim.

If you have questions, please contact MassHealth at [e-mail] or [phone].

Provider Enrollment & Credentialing (PEC) self-service tools for MassHealth providers

MassHealth is working to improve the provider experience through the increased use of electronic self-service tools. Effective 5/1/2025, a new tool is available on Mass.gov, allowing providers and their credentialing staff to submit certain provider file updates electronically. You will be able to update provider file information including link/unlink, address/contact information, and submit required documents like the MA W-9 and FRDF via a secure document upload. This will eliminate the need for fax, mail, or unsecure emails. The new web-based tools are available on the MassHealth Provider Self-Service page.

MassHealth is hosting informational sessions to introduce the tool and review other recently released provider enrollment and credentialing tools such as Check Enrollment Status, Request an Application, and Check Application Status.

• Thursday, May 8, 2025, at 10:00 AM EDT
• Tuesday, May 13, 2025, at 1:00 PM EDT

Please register for the webinar. 

Please note: These tools will not display information on Dental, Long-Term Services & Supports (LTSS), or Managed Care Entity (MCE) Only providers.

For questions or concerns, please contact MassHealth at [phone] or [e-mail].

Date published:	May 5, 2025