Point 32/Tufts for ACO and SCO Plans

Acute care billing for behavioral health services rendered by Point 32/Tufts for Accountable Care Organizations (ACO) and Senior Care Option (SCO) network providers.

BH Crisis Evaluation (Required of Hospitals)

On initial day of readiness (S9485, no modifier)

ED-Based	Med/Surg
Submit a facility claim for procedure code S9485 to Tufts Health Plan. This is limited to 1 unit per day and 1 bill per hospital stay. S9485 cannot be billed on the same DOS as a claim billed with S9485 with V1 or V2 modifiers.	Submit a facility claim for procedure code S9485 to Tufts Health Plan. This is limited to 1 unit per day and 1 bill per hospital stay. S9485 cannot be billed on the same DOS as a claim billed with S9485 with V1 or V2 modifiers.

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 facility claim for procedure code S9485 with modifier V1 or V2 to Tufts Health Plan. This is limited to 1 unit per day. S9485 cannot be billed on the same DOS as a claim billed with S9485 with no modifiers.	Submit a facility claim for procedure code S9485 with modifier V1 or V2 to Tufts Health Plan. This is limited to 1 unit per day. S9485 cannot be billed on the same DOS as a claim billed with S9485 with no modifiers.

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 facility claim for procedure code G2213 to Tufts Health Plan. This is limited to 1 unit per day per Member regardless of setting.

Recovery Support Navigator (RSN)

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

ED-Based	Med/Surg
Submit a facility claim for procedure code H2015 with modifier HF to Tufts Health Plan. This is limited to 1 bill per calendar day.	Submit a facility claim for procedure code H2015 with modifier HF to Tufts Health Plan. This is limited to 1 bill per calendar day.

Date published:	April 30, 2024