Message Text – September 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.

09/02/2025

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - Exemption for Prosthetic and Orthotic SERVICES

Effective August 1, 2025, MassHealth has added prosthetic and orthotic services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, prosthetic and orthotic services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - Exemption for Therapist Services

Effective August 1, 2025, MassHealth has added therapist services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, therapist services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - exemption for CSN Agency Services

Effective August 1, 2025, MassHealth has added continuous skilled nursing (CSN) agency services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, CSN agency services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - exemption for Independent Nursing Services

Effective August 1, 2025, MassHealth has added independent nursing services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, independent nursing services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements - exemption for Home Health Services

Effective August 1, 2025, MassHealth has added home health services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, home health services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at All Provider bulletins.

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

Date published:	September 2, 2025