Massachusetts

Last updated 08/07/2024

Consent Requirements

Under this telehealth policy, providers must always obtain the member’s consent to receive services via telehealth. This ensures that members will have the choice to decide between receiving services in-person or via telehealth. Under M.G.L. c. 118E, § 79(d), MassHealth members have a choice to decline to receive services via telehealth in order to receive such services in person. The availability of telehealth modalities does not mitigate the provider responsibility to accommodate member choice for in-person services (i.e., this language does not affect network adequacy standards for managed care plans).

Providers must adhere to the following best practices when delivering services via telehealth.   Providers are encouraged to have documented policies and procedures that incorporate these best practices.  …

• Providers must follow consent and patient information protocol consistent with those followed during in-person visits.
• Providers must obtain the member’s consent to receive services via telehealth and inform the member (a) of any relevant privacy considerations, and (b) that the member may revoke their consent to receive services via telehealth at any time.
• Providers must inform patients of the location of the provider rendering services via telehealth (i.e., distant site) and obtain the location of the patient (i.e., originating site).
• The provider must inform the patient of how the patient can see a clinician in-person in the event of an emergency or as otherwise needed.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).

Health care services provided via telehealth shall conform to the standards of care applicable to the telehealth provider’s profession and specialty. Such services shall also conform to applicable federal and state health information privacy and security standards, as well as standards for informed consent.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

Home Health Agency

Providers must obtain verbal consent from a member, and the member’s caregiver/legal guardian if applicable, before beginning home health services via telehealth. Providers must also document the consent in the member’s record. In obtaining the member’s consent, MassHealth home health agencies must provide the member with a statement explaining

• what a telehealth visit involves;
• what is expected from the member, as well as the home health provider;
• any relevant privacy considerations; and
• that the member may revoke, at any time, their consent for the rendering of services via telehealth.

SOURCE:  MassHealth Home Health Agencies, Bulletin 87, Jul. 2023, (Accessed Aug. 2024).

Adult Foster Care

Providers must get verbal consent from a member, and the member’s caregiver/legal guardian if applicable, before beginning AFC/GAFC services via telehealth. Providers must also document the consent in the member’s record.

In obtaining the member’s consent, providers must provide the member with a statement explaining

• what telehealth involves;
• what is expected from the member, as well as the AFC/GAFC provider;
• any relevant privacy considerations; and
• that the member may revoke, at any time, their consent to receive services via telehealth.

STATUS: MassHealth Adult Foster Care, Bulletin 29, Apr. 2023, (Accessed Aug. 2024).

Therapy

Live video telehealth must be used, with the member’s consent, to conduct the comprehensive evaluation or reevaluation under 130 CMR 430.601(A)(9) for members receiving therapy.

Providers must get verbal consent from a member, and the member’s caregiver or legal guardian if applicable, before starting telehealth and must document the consent in the member’s record. When requesting the member’s consent, MassHealth therapy providers must provide the member with a statement explaining

• what a telehealth visit entails;
• what is expected from the member and the therapy provider;
• any relevant privacy considerations; and
• that the member may take back their consent for telehealth services at any time.

Information provided to members should be given in their preferred method of delivery and must be documented within the member’s record.

STATUS: MassHealth Rehabilitation Center Bulletin 16, Apr. 2023; Therapist Bulletin 18, Apr. 2023; Speech and Hearing Center Bulletin 16, Apr. 2023, (Accessed Aug. 2024).

Last updated 08/07/2024

Definitions

Telehealth – the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to:

• interactive audio-video technology;
• remote patient monitoring devices;
• audio-only telephone; and
• online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

SOURCE: MA Regulations Sec. 418.402 & 101 CMR Sec. 362.02, 130 CMR 461.402 [definition found in multiple additional manual sections] (Accessed Aug. 2024).

”Telehealth”, the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

SOURCE: Massachusetts General Laws Part I, Title IV, Ch. 32A. Sec. 30 . (Accessed Aug. 2024).

Telehealth is the use of electronic communication and information technologies to provide or support clinical care at a distance. The delivery of services through telehealth involves the use of secure interactive audio and video telecommunications systems that permit two-way, real-time communication between a patient and a provider.

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Aug. 2024).

Last updated 08/07/2024

Email, Phone & Fax

“Telehealth”, the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

The rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same service delivered by other telehealth modalities.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

Under this policy, MassHealth will continue to allow MassHealth-enrolled providers to deliver a broad range of MassHealth-covered services via telehealth. MassHealth will reimburse for such services at parity with their in-person counterparts, including services provided through live-video, audio-only, or asynchronous visits that otherwise meet billing criteria, including use of required modifiers. All providers delivering services via telehealth must comply with the policy detailed in this bulletin.

This bulletin applies to members enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) Plan, a Managed Care Organization (MCO), an Accountable Care Partnership Plan (ACPP), or a Primary Care Accountable Care Organization (PCACO). Information about coverage through MassHealth Managed Care Entities (MCEs) and the Program for All-inclusive Care for the Elderly (PACE) will be issued in a forthcoming MCE bulletin.

As under All Provider Bulletin 355, Section B of this bulletin identifies specific categories of service that MassHealth has deemed inappropriate for delivery via any telehealth modality. Except for those services identified in Section B in this bulletin, and notwithstanding any regulation to the contrary, including the physical-presence requirement at 130 CMR 433.403(A)(2), a MassHealth enrolled provider may deliver medically necessary MassHealth-covered services on an outpatient basis to a MassHealth member via the telehealth modalities of audio-only, live video, and asynchronous visits, if:

• the provider has determined that it is clinically appropriate to deliver such service via telehealth, including the telehealth modality and technology employed, including obtaining member consent;
• such service is payable under that provider type;
• the provider satisfies all requirements set forth in this bulletin, including in Appendix A, and any applicable program-specific bulletin;
• the provider delivers those services in accordance with all applicable laws and regulations (including M.G.L. c. 118E, § 79 and MassHealth program regulations); and
• the provider is appropriately licensed or credentialed to deliver those services.

MassHealth will continue to monitor telehealth’s impacts on quality of care, cost of care, patient and provider experience, and health equity to inform the continued monitoring and iteration of its telehealth policy. Based on the results of this monitoring, and its analysis of relevant data and information, MassHealth may adjust its coverage policy, including by imposing limitations on the use of certain telehealth modalities for various covered services or provider types.

As under All Provider Bulletin 355, MassHealth has deemed these following categories of service ineligible for delivery via any telehealth modality.

• Ambulance Services
• Ambulatory Surgery Services
• Anesthesia Services
• Certified Registered Nurse
• Anesthetist Services
• Chiropractic Services
• Hearing Aid Services
• Inpatient Hospital Services
• Laboratory Services
• Nursing Facility Services
• Orthotic Services
• Personal Care Services
• Prosthetic Services
• Renal Dialysis Clinic Services
• Surgery Services
• Transportation Services
• X-Ray/Radiology Services

Providers must include the place of service (POS) code 02 when submitting a professional claim for telehealth provided in a setting other than in the patient’s home. They must include POS code 10 when submitting a professional claim for telehealth provided in the patient’s home. Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

Telehealth and Children’s Behavioral Health Initiative (CBHI) Services

As under All Provider Bulletin 355, existing performance specifications for Children’s Behavioral Health Initiative (CBHI) services allow for the telephonic delivery of services, other than for initial assessments. Notwithstanding any requirements that initial assessments be conducted in person, where appropriate, services for new clients may be initiated by telephone or other telehealth modality. CBHI providers must use the regular CBHI codes, as well as the POS code and modifiers described above, as appropriate, when billing for CBHI services delivered via approved telehealth modalities.

Billing and Payment Rates for Services

Providers billing under an 837I/UB-04 form must include the modifier GT when submitting claims for services delivered via telehealth. Providers billing under an 837P/1500 form must include the place of service (POS) code 02 or 10 when submitting claims for services delivered via telehealth.

Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telehealth;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GQ to indicate services rendered via asynchronous telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications; and/or
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology.

Rates of payment for services delivered via telehealth will be the same as the rates of payment for services delivered via traditional (i.e., in-person) methods as set forth in the applicable regulations.

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).

Managed Care Entities:

This bulletin, which supersedes Managed Care Entity Bulletin 95 and will remain in effect until superseding guidance is issued, requires managed care entities to maintain a telehealth policy consistent with All Provider Bulletin 379, including but not limited to maintaining policies for coverage of telehealth services no more restrictive than those described in All Provider Bulletin 379.

SOURCE: MassHealth Managed Care Entity Bulletin 115 [replaced Bulletin 95], Apr. 2024, (Accessed Aug. 2024).

Telephonic codes are listed in the Substance Use Disorder Treatment Manual (98966, 98967, 98968, 99441, 99442, 99443).

SOURCE: Mass Health Substance Use Disorder Treatment Manual, Service Codes and Descriptions, Transmittal Letter SUD-22, (Accessed Aug. 2024).

Home Health Agencies

MassHealth is not imposing specific requirements for technologies used to deliver services via telehealth and will allow reimbursement for MassHealth home health services delivered through telehealth, as long as such services are medically necessary and clinically appropriate and comply with the guidelines established in this bulletin. Providers are encouraged to use appropriate technologies to communicate with individuals and should, to the extent feasible, ensure the same rights to confidentiality and security as provided in face-to-face services. Providers must inform members of any relevant privacy considerations.

Home health telehealth visits may be used for home health services that

• the member has provided consent for;
• are follow-up visits that do not require any hands-on care;
• pertain to any ongoing review of the member’s assessment, including the member’s 60-day recertification for home health services; or
• pertain to the discharge visit.

Follow-up visits do not include initial evaluations or certifications for home health services and may be conducted by telephone if appropriate, but live video is preferred.
Home health telehealth visits may not be used for

• any service that requires hands-on care;
• any start of care (SOC) assessment visit; or
• any resumption of care visit.

SOURCE:  MassHealth Home Health Agencies, Bulletin 87, Jul. 2023, (Accessed Aug. 2024).

Durable Medical Equipment

Federal regulations require that, for certain DME services, physicians or certain authorized nonphysician practitioners must document a face-to-face meeting with the Medicaid-eligible beneficiary. See 42 CFR 440.70. Through the end of the FPHE, and as described in 42 CFR 440.70 (f) (6), any required face-to-face meeting may be delivered via telehealth (including telephone and live video)according to the standards in All Provider Bulletin 314.

This is consistent with Centers for Medicare & Medicaid Services (CMS) Interim Final Rules with Comment Period (CMS-1744-IFC (April 6, 2020) and CMS-5531-IFC (May 8, 2020) which provide that the face-to-face meeting requirement does not apply for DME for the duration of the COVID-19 emergency, except for power mobility devices (PMDs) with a statutory requirement for a face-to-face meeting. For those PMDs, a telehealth face-to-face meeting may satisfy the requirement. See  CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing Question AA.

On May 12, 2023, consistent with 42 CFR 440.70, providers may use telehealth for face-to-face meetings. Providers must follow the federal DME Face-to-Face Requirements identified in 42 CFR 440.70 and maintain the required documentation in the member’s record. See 130 CMR 409.430(C) and DME Bulletin 26. All documentation, recordkeeping, and other applicable provisions of 130 CMR 450.000 and 130 CMR 409.000 apply.

STATUS: MassHealth Durable Medical Equipment, Bulletin 32, Apr. 2023, (Accessed Aug. 2024).

Oxygen and Respiratory Therapy

Federal regulations require that, for certain oxygen services, physicians or certain authorized nonphysician practitioners, must document a face-to-face meeting with the Medicaid-eligible beneficiary. See 42 CFR 440.70. Through the end of the FPHE, and as described in 42 CFR 440.70(f)(6), any required face-to-face meetings may be delivered via telehealth (including telephone and live video) according to the standards in All Provider Bulletin 314.

This is consistent with Centers for Medicare & Medicaid Services (CMS) Interim Final Rules with Comment Period (CMS-1744-IFC (April 6, 2020) and CMS-5531-IFC (May 8, 2020), which provide that the face-to-face meeting requirement does not apply for oxygen and respiratory equipment for the duration of the COVID-19 emergency, except for power mobility devices (PMDs) with a statutory requirement for a face-to-face meeting. For those PMDs, a telehealth face-to-face meeting may satisfy the requirement. See the CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing.

On May 12, 2023, consistent with 42 CFR 440.70, providers may use telehealth for face-to-face meetings. Providers must follow the federal oxygen Face-to-Face Requirements identified in 42 CFR 440.70. Providers must also maintain the required documentation in the member’s record. See Oxygen and Respiratory Therapy Equipment Provider Bulletin 17. All documentation, recordkeeping, and other applicable provisions of 130 CMR 450.000 and 130 CMR 427.000 apply.

STATUS: MassHealth Oxygen and Respiratory Therapy, Bulletin 26, Apr. 2023, (Accessed Aug. 2024).

Therapy

Live video telehealth must be used, with the member’s consent, to conduct the comprehensive evaluation or reevaluation under 130 CMR 430.601(A)(9) for members receiving therapy. Telephone-only telehealth is not permitted to conduct the comprehensive evaluation or reevaluation.

STATUS: MassHealth Rehabilitation Center Bulletin 16, Apr. 2023; Speech and Hearing Center Bulletin 16, Apr. 2023, (Accessed Aug. 2024).

Mental Health Centers

Case Consultation:  intervention, including scheduled audio-only telephonic, audio-video, or in person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

The MassHealth agency pays only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

Crisis Intervention Services:  Each center must provide clinic coverage to respond to members experiencing a crisis 24 hours per day, seven days per week. …  After hours crisis intervention services must include live telephonic access to qualified professionals and, if indicated, triage in real-time to an appropriate provider to determine whether a higher level of care and/or additional diversionary services are necessary. A pre-recorded message will not fulfill the requirement for access to a qualified professional.

SOURCE: MassHealth Mental Health Center Manual, Ch. 6, 1/1/23, (Accessed Aug. 2024).

Psychologists – Case Consultation

The MassHealth agency pays only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

The MassHealth agency pays for case consultation delivered in person or via telephonic or audio-visual methods only when written communication alone, and other non-reimbursable forms of communication, clearly will not suffice. Such circumstances must be documented in the member’s record. Such circumstances are limited to situations in which both the provider and the other party are actively involved in treatment or management programs with the member (or family members) and where a lack of direct communication would impede a coordinated treatment program

SOURCE: MassHealth Psychologist Manual, Sec. 411.405, (1/1/23), (Accessed Aug. 2024).

Substance Use Disorder Treatment 

Case Consultation: intervention, including scheduled audio-only telephonic, audio-video, or in-person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

The MassHealth agency will pay a provider only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

SOURCE: MassHealth Substance Use Disorder Treatment Manual, 418.412, (1/1/23), (Accessed Aug. 2024).

Physician

Case Consultation: The MassHealth agency pays for case consultation only when telephone contact, written communication, and other nonreimbursable forms of communication clearly will not suffice. Such circumstances must be documented in the member’s record. Such circumstances are limited to situations in which both the physician or PCNS and the other party are actively involved in treatment or management programs with the member (or family members) and where a lack of face to face communication would impede a coordinated treatment program.

Psychotherapy for Crisis Services:  This service is limited to face-to-face contacts with the member; psychotherapy for crisis service via telephone contact is not a reimbursable service.

After-Hours Telephone Service. The physician or PCNS must provide telephone coverage during the hours when the physician or PCNS is unavailable, for members who are in a crisis state.

SOURCE: MassHealth Physician Manual, 433.429, (7/7/23), (Accessed Aug. 2024).

Acute Outpatient Hospital

The MassHealth agency will pay for case consultation only when telephone contact, written communication, and other nonreimbursable forms of communication clearly will not suffice. Such circumstances must be documented in the member’s record. Such circumstances are limited to situations in which both the hospital outpatient department and the other party are actively involved in treatment or management programs with the member (or family members) and where a lack of face-to-face communication would impede a coordinated treatment program.

SOURCE: MassHealth Acute Outpatient Hospital Manual, 410.479, (7/7/23), & MassHealth Chronic Disease and Rehabilitation Hospital Manual, 410.479 (7/28/17). (Accessed Aug. 2024).

The following service code modifiers are allowed for billing under the MassHealth Acute Outpatient Hospital Manual for payable services:

93 – Services rendered via audio-only telehealth.

SOURCE: MassHealth Provider Manual Series, Acute Outpatient Hospital Manual, p. 19 (Jul. 1, 2024). (Accessed Aug. 2024).

Chronic Disease and Rehabilitation Inpatient Hospital

Screening Program for Chronic-Disease and Rehabilitation Hospitals – To initiate admission or conversion screening, the hospital must telephone the MassHealth agency or its agent prior to the proposed admission or anticipated conversion and must:

• describe the medical condition that necessitates a chronic-disease or rehabilitation hospital admission or continued stay; and
• state the anticipated length of stay

Discharge – The hospital must have written procedures for arranging posthospital services for members. At a minimum, these procedures must include frequent, systematic contacts (usually three times weekly) by telephone or in person to all nursing facilities and community-service providers within a 25-mile minimum radius of the hospital.

SOURCE: MassHealth Chronic Disease Rehabilitation Inpatient Manual, 435.408, 435.417, (4/17/15), (Accessed Aug. 2024).

Acute Inpatient Hospital 

Discharge – Whenever possible, the discharge-planning staff or primary-care team must contact the member’s family to encourage its involvement in planning the member’s discharge. To this end, family members must be informed of the discharge options and community resources available to the member and provided with lists of nursing facilities and community resources in the area. When possible, these meetings or telephone consultations with the family must be held once every two weeks until the member is discharged. The dates of these meetings and other contacts with family, matters discussed, problems identified, and agreements reached must be entered on the member’s discharge-planning record.

SOURCE: MassHealth Acute Inpatient Hospital Manual, 415.419, (1/2/15), (Accessed Aug. 2024).

Chronic Disease and Rehabilitation Hospital

Noncovered Services

• telephone conversations and consultations;

Source:  Mass Health Chronic Disease and Rehabilitation Outpatient Hospital Manual, Regs. 410.472, (1/24/22), (Accessed Aig. 2024).

Podiatry

Noncovered Services

• telephone consultations;

Source:  MassHealth Podiatrist Manual, Regs. 424.405, 8/12/16), (Accessed Aug. 2024).

Psychiatric Outpatient Hospital

Nonreimbursable Services

• telephone conversations and telephone consultations;

SOURCE: MassHealth Psychiatric Outpatient Hospital Manual, Reg. 434.406, (12/26/08), (Accessed Aug. 2024).

Social Work

Case Consultation – intervention, including scheduled audio-only telephonic, audio-video, or in person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

Case Consultation – The MassHealth agency pays only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

Source:  MassHealth Podiatrist Manual, Regs. 462.402 & 411, 1/1/23), (Accessed Aug. 2024).

Telephone contacts are listed as a noncovered service in multiple manuals.

Last updated 08/07/2024

Live Video

POLICY

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth

The rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same service delivered by other telehealth modalities.

The division shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health service delivered via in-person methods; provided, that this subsection shall apply to providers of behavioral health services covered as required under subclause (i) of clause (4) of the second sentence of subsection (a) of section 6 of chapter 176O.

Coverage that reimburses a provider with a global payment, as defined in section 1 of chapter 6D, shall account for the provision of telehealth services to set the global payment amount. See services section below for behavioral health services specific requirements for payment.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

Telehealth is a modality of treatment, not a separate covered service. Providers are not required to deliver services via telehealth.

The bulletin does not apply to services under the Children’s Behavioral Health Initiative (CBHI) program, which may continue to be delivered via all modalities currently authorized in applicable program specifications.

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Aug. 2024).

Under this policy, MassHealth will continue to allow MassHealth-enrolled providers to deliver a broad range of MassHealth-covered services via telehealth. MassHealth will reimburse for such services at parity with their in-person counterparts, including services provided through live-video, audio-only, or asynchronous visits that otherwise meet billing criteria, including use of required modifiers. All providers delivering services via telehealth must comply with the policy detailed in this bulletin.

This bulletin applies to members enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) Plan, a Managed Care Organization (MCO), an Accountable Care Partnership Plan (ACPP), or a Primary Care Accountable Care Organization (PCACO). Information about coverage through MassHealth Managed Care Entities (MCEs) and the Program for All-inclusive Care for the Elderly (PACE) will be issued in a forthcoming MCE bulletin.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2024).

Managed Care Entities:

This bulletin, which supersedes Managed Care Entity Bulletin 95 and will remain in effect until superseding guidance is issued, requires managed care entities to maintain a telehealth policy consistent with All Provider Bulletin 379, including but not limited to maintaining policies for coverage of telehealth services no more restrictive than those described in All Provider Bulletin 379.

SOURCE: MassHealth Managed Care Entity Bulletin 115 [replaced Bulletin 95], Apr. 2024, (Accessed Aug. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

Health Care Services

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth

SOURCE:  Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

Behavioral Health Services

The division shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health service delivered via in-person methods; provided, that this subsection shall apply to providers of behavioral health services covered as required under subclause (i) of clause (4) of the second sentence of subsection (a) of section 6 of chapter 176O.

SOURCE:  Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

The commission shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health service delivered via in-person methods, provided certain conditions.  See statute.

Source: Massachusetts General Laws, Ch. 32A Sec. 30, Ch. 118E Sec. 79, Ch. 175 47MM, Ch. 176A Sec. 38, Ch. 176B Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Aug. 2024).

Unlicensed or Not Independently Licensed Staff. All professionals who are unlicensed, who are in a profession without licensure, or who are not independently licensed or certified as a peer supervisor must receive direct and continuous supervision. Direct and continuous supervision may be provided using telehealth technology

Independently Licensed and Certified Peer Supervisor Staff. All independently licensed professionals and certified peer supervisors must receive supervision in accordance with the relevant licensing requirements and program policy. Supervision may be provided using telehealth technology

The MassHealth agency will pay a provider only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

SOURCE: MA Regulations 130 CMR Sec. 418.410 and 412, (Accessed Aug. 2024).

Community Health Centers, Community Mental Health Centers, and Outpatient Substance Use Disorder providers (provider types 20, 26 and 28) may deliver the following covered services via telehealth:

• All services specified in 101 CMR 306.00 et seq.; and
• The outpatient services specified in the following categories:
• Opioid Treatment Services: Counseling;
• Ambulatory Services: Outpatient Counseling; Clinical Case Management; and
• Services for Pregnant/Postpartum Clients: Outpatient Services

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Aug. 2024).

Mental Health Centers

Satellite Clinics: All clinic locations must meet, independently of its parent clinic, all requirements set forth in 130 CMR 429. Satellite locations must be able offer in person services for up to 20 hours per week; use of telehealth is acceptable when agreed upon by the member.

Case Consultation:  intervention, including scheduled audio-only telephonic, audio-video, or in person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

The MassHealth agency pays only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

Staff Supervision:

• Unlicensed or Not Independently Licensed Staff:  All professionals who are unlicensed, who are in a profession without licensure, or who are not independently licensed or certified as a peer supervisor must receive Direct and Continuous Supervision. Direct and Continuous Supervision may be provided using telehealth technology.
• Independently Licensed and Certified Peer Supervisor Staff. All independently licensed professionals and certified peer supervisors must receive supervision in accordance with center policy. Supervision may be provided using telehealth technology.

SOURCE: MassHealth Mental Health Center Manual, Ch. 4, 1/1/23, (Accessed Aug. 2024).

Crisis Intervention:  The MassHealth agency pays for crisis intervention as defined in 130 CMR 429.402 … This service is limited to face-to-face contacts, which includes Telehealth, with the member

Group behavioral health, group medical visit, individual behavioral health visits, individual dental visit, individual medical visit, individual mental health visit, nurse-midwife medical visit, can be conducted via a clinically appropriate telehealth modality.  See manual for codes.

SOURCE: MassHealth Rates for Community Health Centers, 101 CMR Sec. 304.02 (Accessed Apr. 2024).

MassHealth lists specific codes that may be used by community health centers for services delivered through telehealth. See Transmittal Letter for details.

SOURCE: MassHealth Community Health Center Manual, Ch. 6, 1/1/23, (Accessed Aug. 2024).

CARES Team

The care manager must provide regular contact with the member and their parent/guardian (either face-to-face or by telehealth, in accordance with the preferences of the member and their parent/guardian);

In order to qualify for payment of the monthly fee, the CARES program provider must provide at least two of the CARES program services described in the regulation to that member during that calendar month, with at least one of those services including live interaction between the provider and the member and their parent/guardian, whether in person or via telehealth.

SOURCE: MassHealth Community Health Center Manual, Ch. 6, (7/7/23), (Accessed Aug. 2024).

CARES program providers may deliver services via telehealth.

SOURCE: MassHealth Rates for Community Health Centers, 130 CMR Sec. 405.477 and Sec. 433.485, & Physician Manual, 7/7/23, (Accessed Aug. 2024).

The Community Support Program (CSP) provider delivers CSP services on a mobile basis to members in any setting that is safe for the member and staff. Services may be provided via telehealth, as appropriate.

SOURCE: Massachusetts Regulations, Sec. 130 CMR 461.410, & Community Support Service Manual, 4/28/23, (Accessed Aug. 2024).

Important Note: Although MassHealth allows reimbursement for the delivery of certain services through telehealth for certain billing providers as described in this bulletin, MassHealth does not require providers to deliver services via telehealth.

As under All Provider Bulletin 355, Section B of this bulletin identifies specific categories of service that MassHealth has deemed inappropriate for delivery via any telehealth modality. Except for those services identified in Section B in this bulletin, and notwithstanding any regulation to the contrary, including the physical-presence requirement at 130 CMR 433.403(A)(2), a MassHealth enrolled provider may deliver medically necessary MassHealth-covered services on an outpatient basis to a MassHealth member via the telehealth modalities of audio-only, live video, and asynchronous visits, if:

• the provider has determined that it is clinically appropriate to deliver such service via telehealth, including the telehealth modality and technology employed, including obtaining member consent;
• such service is payable under that provider type;
• the provider satisfies all requirements set forth in this bulletin, including in Appendix A, and any applicable program-specific bulletin;
• the provider delivers those services in accordance with all applicable laws and regulations (including M.G.L. c. 118E, § 79 and MassHealth program regulations); and
• the provider is appropriately licensed or credentialed to deliver those services.

MassHealth will continue to monitor telehealth’s impacts on quality of care, cost of care, patient and provider experience, and health equity to inform the continued monitoring and iteration of its telehealth policy. Based on the results of this monitoring, and its analysis of relevant data and information, MassHealth may adjust its coverage policy, including by imposing limitations on the use of certain telehealth modalities for various covered services or provider types.

As under All Provider Bulletin 355, MassHealth has deemed these following categories of service ineligible for delivery via any telehealth modality.

• Ambulance Services
• Ambulatory Surgery Services
• Anesthesia Services
• Certified Registered Nurse
• Anesthetist Services
• Chiropractic Services
• Hearing Aid Services
• Inpatient Hospital Services1
• Laboratory Services
• Nursing Facility Services
• Orthotic Services
• Personal Care Services
• Prosthetic Services
• Renal Dialysis Clinic Services
• Surgery Services
• Transportation Services
• X-Ray/Radiology Services

Telehealth and Children’s Behavioral Health Initiative (CBHI) Services

As under All Provider Bulletin 355, existing performance specifications for Children’s Behavioral Health Initiative (CBHI) services allow for the telephonic delivery of services, other than for initial assessments. Notwithstanding any requirements that initial assessments be conducted in person, where appropriate, services for new clients may be initiated by telephone or other telehealth modality. CBHI providers must use the regular CBHI codes, as well as the POS code and modifiers described above, as appropriate, when billing for CBHI services delivered via approved telehealth modalities.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).

SOURCE:  MassHealth Hospice Agencies, Bulletin 29, Jul. 2023, (Accessed Aug. 2024).

Adult Foster Care

The Executive Office of Health and Human Services (EOHHS) is not imposing specific requirements for technologies used to deliver services via telehealth and will allow reimbursement for MassHealth-covered AFC/GAFC services delivered via telehealth, as long as such services are medically necessary and clinically appropriate and delivered in accordance with this bulletin. Providers are encouraged to use appropriate technologies to communicate with individuals and should, to the extent feasible, ensure the same rights to confidentiality and security as provided in in-person services. Providers must inform members of any relevant privacy considerations.

EOHHS does not require providers to deliver AFC/GAFC services via telehealth and may continue to provide services in-person as necessary or appropriate. AFC/GAFC providers must clearly document in the member record if the member refuses an in-person visit.

AFC and GAFC providers may use telehealth for

• Level I AFC home visit structure – telehealth may be used for up to three nonconsecutive visits in a 12-month period;
• Level II AFC home visit structure – telehealth may be used for up to six nonconsecutive visits in a 12-month period;
• GAFC home visit structure – telehealth may be used for up to three nonconsecutive visits in a 12-month period;
• Level I AFC admission visit – may be done in person/on-site or via telehealth;
• Level II AFC admission visits – for the first month of service, the first and last admission visits must be done in person/on-site, the two weekly visits in between may be conducted via telehealth;
• GAFC admission visits –for the first month of service, the first and last admission visits must be done in person/on-site, the two weekly visits in between may be conducted via telehealth; and
• Extraordinary circumstances resulting from unusual and unavoidable circumstances that substantially impede the ability of the provider to conduct a visit or other AFC/GAFC program requirement in person that can be directly addressed by use of telehealth. This may include, but is not necessarily limited to, staffing shortages due to illness and/or medical leave (such as Family Medical Leave Act absences). In these limited instances, the AFC/GAFC program director must document the approved temporary telehealth use. Further, for each use of telehealth for extraordinary circumstances, the AFC/GAFC provider must document the description of the extraordinary circumstance, the timeframe during which the extraordinary circumstances necessitated the telehealth visits, which types of visits are permitted to be conducted by telehealth, and how the use of telehealth is narrowly tailored to address this extraordinary circumstance. Such documentation must be made available upon request by EOHHS or other appropriate auditor. The AFC/GAFC provider must also document in the relevant member record each visit that occurred via telehealth in accordance with this bulletin. If telehealth use extends past three months, the AFC/GAFC provider must contact MassHealth for approval and must provide a deadline by which the use of telehealth for extraordinary circumstances will conclude. Such use of telehealth to address extraordinary circumstances cannot be used for caregiver or direct care aide assistance with activities of daily living or instrumental activities of daily living, including cueing and supervision of such activities.

Adult foster care and group adult foster care providers may not use telehealth for

• Caregiver or direct care aide assistance with activities of daily living or instrumental activities of daily living, including cueing and supervising such activities; and
• Initial evaluations and reassessments, including reassessments based on significant change.

AFC/GAFC providers must conduct both initial and annual member home inspections in person/on-site.

STATUS: MassHealth Adult Foster Care, Bulletin 29, Apr. 2023, (Accessed Aug. 2024).

Durable Medical Equipment

Federal regulations require that, for certain DME services, physicians or certain authorized nonphysician practitioners must document a face-to-face meetingwith the Medicaid-eligible beneficiary. See 42 CFR 440.70. Through the end of the FPHE, and as described in 42 CFR 440.70 (f) (6), any required face-to-face meeting may be delivered via telehealth (including telephone and live video)according to the standards in All Provider Bulletin 314.

This is consistent with Centers for Medicare & Medicaid Services (CMS) Interim Final Rules with Comment Period (CMS-1744-IFC (April 6, 2020) and CMS-5531-IFC (May 8, 2020) which provide that the face-to-face meeting requirement does not apply for DME for the duration of the COVID-19 emergency, except for power mobility devices (PMDs) with a statutory requirement for a face-to-face meeting. For those PMDs, a telehealth face-to-face meeting may satisfy the requirement. See  CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing Question AA.

On May 12, 2023, consistent with 42 CFR 440.70, providers may use telehealth for face-to-face meetings. Providers must follow the federal DME Face-to-Face Requirements identified in 42 CFR 440.70 and maintain the required documentation in the member’s record. See 130 CMR 409.430(C) and DME Bulletin 26. All documentation, recordkeeping, and other applicable provisions of 130 CMR 450.000 and 130 CMR 409.000 apply.

STATUS: MassHealth Durable Medical Equipment, Bulletin 32, Apr. 2023, (Accessed Aug. 2024).

Oxygen and Respiratory Therapy

Federal regulations require that, for certain oxygen services, physicians or certain authorized nonphysician practitioners, must document a face-to-face meeting with the Medicaid-eligible beneficiary. See 42 CFR 440.70. Through the end of the FPHE, and as described in 42 CFR 440.70(f)(6), any required face-to-face meetings may be delivered via telehealth (including telephone and live video) according to the standards in All Provider Bulletin 314.

This is consistent with Centers for Medicare & Medicaid Services (CMS) Interim Final Rules with Comment Period (CMS-1744-IFC (April 6, 2020) and CMS-5531-IFC (May 8, 2020), which provide that the face-to-face meeting requirement does not apply for oxygen and respiratory equipment for the duration of the COVID-19 emergency, except for power mobility devices (PMDs) with a statutory requirement for a face-to-face meeting. For those PMDs, a telehealth face-to-face meeting may satisfy the requirement. See the CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing.

On May 12, 2023, consistent with 42 CFR 440.70, providers may use telehealth for face-to-face meetings. Providers must follow the federal oxygen Face-to-Face Requirements identified in 42 CFR 440.70. Providers must also maintain the required documentation in the member’s record. See Oxygen and Respiratory Therapy Equipment Provider Bulletin 17. All documentation, recordkeeping, and other applicable provisions of 130 CMR 450.000 and 130 CMR 427.000 apply.

STATUS: MassHealth Oxygen and Respiratory Therapy, Bulletin 26, Apr. 2023, (Accessed Aug. 2024).

Therapy

After the FPHE ends, consistent with the federal Consolidated Appropriations Act of 2023, MassHealth will continue to cover therapy appropriately provided by telehealth services until December 31, 2024, or when specified by MassHealth via regulation or Congress. See Consolidated Appropriations Act, 2023, H.R.2617, Sec. 4113, 117th Cong. (2022).

Services must meet all requirements under the MassHealth Guidelines for Medical Necessity Determination for Speech and Language Therapy, Physical Therapy, and Occupational Therapy [MassHealth Guidelines for Medical Necessity Determination for Speech and Language Therapy].

MassHealth is not imposing specific requirements for technologies used to deliver services via telehealth and will allow reimbursement for MassHealth therapist services delivered through telehealth, as long as such services

• are medically necessary;
• are clinically appropriate;
• meet requirements within 130 CMR 430.000 [432.00 and 413.000] 130 CMR 450.000; and
• meet all additional requirements of the therapy telehealth guidance in this bulletin.

Providers are encouraged to use appropriate technologies to communicate with individuals and should, to the extent possible, ensure the same rights to confidentiality and security as provided in face-to-face services. Providers must inform members of any relevant privacy considerations.

Therapy telehealth visits may be used for therapist services that

• require the member’s consent, documented as described below; and
• are follow-up visits that do not require any hands-on care.

Follow-up visits do not include evaluations or re-evaluations and may be conducted by telephone if appropriate, but live video is preferred

STATUS: MassHealth Rehabilitation Center Bulletin 16, Apr. 2023; Therapist Bulletin 18, Apr. 2023; Speech and Hearing Center Bulletin 16, Apr. 2023, (Accessed Aug. 2024).

Therapy telehealth visits may not be used for any therapy specifically requiring hands-on care.

STATUS: MassHealth Therapist Bulletin 18, Apr. 2023; (Accessed Aug. 2024).

Community Behavioral Health Center

Several services listed as allowed to be provided via telehealth.  Supervision, in some cases, can also be provided using telehealth technology.  See manual.

SOURCE: MassHealth Commonwealth of Massachusetts MassHealth Provider Manual Series, Community Behavioral Health Center Manual, 1/1/23, (Accessed Aug. 2024).

Mobile Crisis Intervention:  Services may be provided via telehealth.

SOURCE: MA Admin Code Sec. 352.02, (Accessed Aug. 2024).

Managed Care Entity and PACE Organizations

Some specialized community support program services are appropriate to deliver via telehealth.  See bulletin.

SOURCE: MassHealth Managed Care Entity Bulletin 99, Mar. 2023, (Accessed Aug. 2024).

Community Support Provider

The CSP provider delivers CSP services on a mobile basis to members in any setting that is safe for the member and staff. Services may be provided via telehealth, as appropriate.

SOURCE: MassHealth Commonwealth of Massachusetts MassHealth Provider Manual Series, Community Support Program Services Manual, 4/28/23, (Accessed Aug. 2024).

Continuous Skilled Nursing Agencies

If clinically appropriate, the 14-day RN supervisory visit may be performed using two-way audio-video telecommunications technology that allows for real-time interaction between the RN and the patient, and representative as needed. If a CSN agency determines that a member’s clinical needs require in-person supervision, the RN supervisor must perform the supervisory visit in person and in the member’s home. MassHealth will update the CSN agency provider regulations to reflect this clarification. The 60-day supervisory visits under 130 CMR 438.415(C)(5)(c) cannot be performed using telecommunications technology.

SOURCE: MassHealth Continuous Skilled Nursing Agencies Bulletin 15, Aug. 2023, (Accessed Aug. 2024).

The MassHealth agency pays for medically necessary doula services including perinatal visits and labor and delivery support provided in-person or via telehealth.

SOURCE: MA Admin Code Sec. 463.407, & Doula Services Manual, 12/8/23, (Accessed Aug. 2024).

Psychologists – Case Consultation

The MassHealth agency pays only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

The MassHealth agency pays for case consultation delivered in person or via telephonic or audio-visual methods only when written communication alone, and other non-reimbursable forms of communication, clearly will not suffice. Such circumstances must be documented in the member’s record. Such circumstances are limited to situations in which both the provider and the other party are actively involved in treatment or management programs with the member (or family members) and where a lack of direct communication would impede a coordinated treatment program.

The MassHealth agency does not pay the provider for court testimony.

SOURCE: MassHealth Psychologist Manual, Sec. 411.405, (1/1/23), (Accessed Aug. 2024).

Substance Use Disorder Treatment 

Telehealth: Telehealth. Services including the prescribing of controlled substances must be in accordance with state and federal regulations.

Case Consultation: intervention, including scheduled audio-only telephonic, audio-video, or in-person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

The MassHealth agency will pay a provider only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

The MassHealth agency will pay for case consultation only when written communication, and other non-reimbursable forms of communication clearly, will not suffice. Such circumstances must be documented in the member’s record. Such circumstances are limited to situations in which the program and the other party are actively involved in the treatment or management programs with the member (or family members) and where a lack of face-to-face communication would impede a coordinated treatment program.

Staff Supervision Requirements.

• Unlicensed or Not Independently Licensed Staff. All professionals who are unlicensed, who are in a profession without licensure, or who are not independently licensed or certified as a peer supervisor must receive direct and continuous supervision. Direct and continuous supervision may be provided using telehealth technology.
• Independently Licensed and Certified Peer Supervisor Staff. All independently licensed professionals and certified peer supervisors must receive supervision in accordance with the relevant licensing requirements and program policy. Supervision may be provided using telehealth technology.

SOURCE: MassHealth Substance Use Disorder Treatment Manual, 418.412, (1/1/23), (Accessed Aug. 2024).

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ELIGIBLE PROVIDERS

Coverage shall not be limited to services delivered by third-party providers.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

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ELIGIBLE SITES

Originating site is the location of the member at the time the service is being provided. While the originating site must be located in the United States or its territories, there are no additional geographic or facility restrictions on originating sites in this bulletin. A member may receive telehealth services while located within their own home, or any other appropriate site, provided that the provider complies with all applicable laws and regulations, including those related to privacy and data security.

Providers must include the place of service (POS) code 02 when submitting a professional claim for telehealth provided in a setting other than in the patient’s home. They must include POS code 10 when submitting a professional claim for telehealth provided in the patient’s home. Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).

A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth; provided, however, that a patient may decline receiving services via telehealth in order to receive in-person services.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

Psychologists

The MassHealth agency pays for medically necessary services provided in any suitable location, such as the psychologist’s office, the member’s place of residence, other facility, or by telehealth.

SOURCE: MassHealth Psychologist Manual, Sec. 411.405, (1/1/23), (Accessed Aug. 2024).

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GEOGRAPHIC LIMITS

Originating site is the location of the member at the time the service is being provided. While the originating site must be located in the United States or its territories, there are no additional geographic or facility restrictions on originating sites in this bulletin. A member may receive telehealth services while located within their own home, or any other appropriate site, provided that the provider complies with all applicable laws and regulations, including those related to privacy and data security.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).

A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth; provided, however, that a patient may decline receiving services via telehealth in order to receive in-person services.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

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FACILITY/TRANSMISSION FEE

Last updated 08/07/2024

Miscellaneous

A provider may prescribe medications via telehealth as otherwise described in this bulletin and in accordance with the following requirements.

• Providers must comply with all applicable state and federal statutes and regulations governing medication management and prescribing services when delivering these services via telehealth.
• Providers who deliver prescribing services via telehealth must maintain policies for providing patients with timely and accurate prescriptions by use of mail, phone, e-prescribing, and/or fax. Providers must document prescriptions in the patient’s medical record consistent with in-person care.

Providers must adhere to the following best practices when delivering services via telehealth.   Providers are encouraged to have documented policies and procedures that incorporate these best practices.

• Providers must properly identify the patient using, at a minimum, the patient’s name, date of birth, and MassHealth ID.
• Providers must disclose and validate the provider’s identity and credentials, such as the provider’s license, title, and, if applicable, specialty and board certifications.
• For an initial appointment with a new patient, the provider must review the patient’s relevant medical history and any available medical records with the patient before initiating the delivery of the service.
• For existing provider-patient relationships, the provider must review the patient’s medical history and any available medical records with the patient during the service.
• Before each patient appointment, the provider must ensure that the provider is able to deliver the service to the same standard of care and in compliance with licensure regulations and requirements, programmatic regulations, and performance specifications related to the service (e.g., accessibility and communication access) using telehealth, as is applicable to the delivery of the services in person. If the provider cannot meet this standard of care or other requirements, the provider must direct the patient to seek in-person care.
• To the extent feasible, providers must ensure the same rights to confidentiality and security as provided in face-to-face services.
• Providers must follow consent and patient information protocol consistent with those followed during in-person visits.
• Providers must obtain the member’s consent to receive services via telehealth and inform the member (a) of any relevant privacy considerations, and (b) that the member may revoke their consent to receive services via telehealth at any time.
• Providers must inform patients of the location of the provider rendering services via telehealth (i.e., distant site) and obtain the location of the patient (i.e., originating site).
• The provider must inform the patient of how the patient can see a clinician in-person in the event of an emergency or as otherwise needed.

Documentation and Recordkeeping

Providers delivering services via telehealth must meet all health records standards required by the applicable licensing body, as well as any applicable regulatory and program specifications required by MassHealth. This includes storage, access, and disposal of records.

In addition to complying with all applicable MassHealth regulations pertaining to documentation of services, providers must include a notation in the medical record that indicates that the service was provided via telehealth.

MassHealth may audit provider records for compliance with all regulatory requirements, including recordkeeping and documentation requirements, and may apply appropriate sanctions to providers who fail to comply.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).

Telehealth. Services including the prescribing of controlled substances must be in accordance with state and federal regulations.

SOURCE: MA Regulations Sec. 418.412, (Accessed Aug. 2024).

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth; provided, however, that Medicaid contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered to have an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request. Coverage shall not be limited to services delivered by third-party providers.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2024).

Behavioral Health Services

A provider may prescribe Schedule II controlled substances via telehealth only after conducting an initial in-person examination of the patient. Ongoing in-person examinations are required every three months for the duration of the prescription.

SOURCE: MassHealth All Provider Bulletin 281, p. 2, Jan. 2019. (Accessed Aug. 2024).

Home Health Agency

See bulletin for documentation requirements.

SOURCE:  MassHealth Home Health Agencies, Bulletin 87, Jul. 2023, (Accessed Aug. 2024).

Adult Foster Care

See bulletin for documentation requirements.

STATUS: MassHealth Adult Foster Care, Bulletin 29, Apr. 2023, (Accessed Aug. 2024).

Therapy

See bulletin for documentation requirements.

STATUS: MassHealth Rehabilitation Center Bulletin 16, Apr. 2023; Therapist Bulletin 18, Apr. 2023; Speech and Hearing Center Bulletin 16, Apr. 2023, (Accessed Aug. 2024).

Last updated 08/07/2024

Out of State Providers

No Reference Found

Last updated 08/07/2024

Overview

MassHealth updated their telehealth policies, effective Oct. 1, 2023 to align with most COVID era policies.  They now reimburse for live video, asynchronous, and audio-only delivery modalities with certain exceptions for noncovered services.  They state that reimbursement for remote patient monitoring will be announced at a future date.

 

Last updated 08/07/2024

Remote Patient Monitoring

POLICY

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CONDITIONS

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PROVIDER LIMITATIONS

No reference found.

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OTHER RESTRICTIONS

No Reference Found

Last updated 08/07/2024

Store and Forward

POLICY

Under this policy, MassHealth will continue to allow MassHealth-enrolled providers to deliver a broad range of MassHealth-covered services via telehealth. MassHealth will reimburse for such services at parity with their in-person counterparts, including services provided through live-video, audio-only, or asynchronous visits that otherwise meet billing criteria, including use of required modifiers. All providers delivering services via telehealth must comply with the policy detailed in this bulletin.

This bulletin applies to members enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) Plan, a Managed Care Organization (MCO), an Accountable Care Partnership Plan (ACPP), or a Primary Care Accountable Care Organization (PCACO). Information about coverage through MassHealth Managed Care Entities (MCEs) and the Program for All-inclusive Care for the Elderly (PACE) will be issued in a forthcoming MCE bulletin.

Providers must include the place of service (POS) code 02 when submitting a professional claim for telehealth provided in a setting other than in the patient’s home. They must include POS code 10 when submitting a professional claim for telehealth provided in the patient’s home. Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

Billing and Payment Rates for Services

Providers billing under an 837I/UB-04 form must include the modifier GT when submitting claims for services delivered via telehealth. Providers billing under an 837P/1500 form must include the place of service (POS) code 02 or 10 when submitting claims for services delivered via telehealth.

Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telehealth;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GQ to indicate services rendered via asynchronous telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications; and/or
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology.

Rates of payment for services delivered via telehealth will be the same as the rates of payment for services delivered via traditional (i.e., in-person) methods as set forth in the applicable regulations.

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).

Managed Care Entities:

This bulletin, which supersedes Managed Care Entity Bulletin 95 and will remain in effect until superseding guidance is issued, requires managed care entities to maintain a telehealth policy consistent with All Provider Bulletin 379, including but not limited to maintaining policies for coverage of telehealth services no more restrictive than those described in All Provider Bulletin 379.

SOURCE: MassHealth Managed Care Entity Bulletin 115 [replaced Bulletin 95], Apr. 2024, (Accessed Aug. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

As under All Provider Bulletin 355, Section B of this bulletin identifies specific categories of service that MassHealth has deemed inappropriate for delivery via any telehealth modality. Except for those services identified in Section B in this bulletin, and notwithstanding any regulation to the contrary, including the physical-presence requirement at 130 CMR 433.403(A)(2), a MassHealth enrolled provider may deliver medically necessary MassHealth-covered services on an outpatient basis to a MassHealth member via the telehealth modalities of audio-only, live video, and asynchronous visits, if:

• the provider has determined that it is clinically appropriate to deliver such service via telehealth, including the telehealth modality and technology employed, including obtaining member consent;
• such service is payable under that provider type;
• the provider satisfies all requirements set forth in this bulletin, including in Appendix A, and any applicable program-specific bulletin;
• the provider delivers those services in accordance with all applicable laws and regulations (including M.G.L. c. 118E, § 79 and MassHealth program regulations); and
• the provider is appropriately licensed or credentialed to deliver those services.

MassHealth will continue to monitor telehealth’s impacts on quality of care, cost of care, patient and provider experience, and health equity to inform the continued monitoring and iteration of its telehealth policy. Based on the results of this monitoring, and its analysis of relevant data and information, MassHealth may adjust its coverage policy, including by imposing limitations on the use of certain telehealth modalities for various covered services or provider types.

As under All Provider Bulletin 355, MassHealth has deemed these following categories of service ineligible for delivery via any telehealth modality.

• Ambulance Services
• Ambulatory Surgery Services
• Anesthesia Services
• Certified Registered Nurse
• Anesthetist Services
• Chiropractic Services
• Hearing Aid Services
• Inpatient Hospital Services1
• Laboratory Services
• Nursing Facility Services
• Orthotic Services
• Personal Care Services
• Prosthetic Services
• Renal Dialysis Clinic Services
• Surgery Services
• Transportation Services
• X-Ray/Radiology Services

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).

Asynchronous teledentistry is in a list of eligible service codes.

SOURCE: MA 101 CMR 314. 05. (Accessed Aug. 2024).

Acute Outpatient Hospital

The following service code modifiers are allowed for billing under the MassHealth Acute Outpatient Hospital Manual for payable services:

GQ – Services rendered via asynchronous telehealth.

SOURCE: MassHealth Provider Manual Series, Acute Outpatient Hospital Manual, p. 19 (Jul. 1, 2024). (Accessed Aug. 2024).

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GEOGRAPHIC LIMITS

No Reference Found

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TRANSMISSION FEE

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Aug. 2024).