Last updated 03/14/2023
Consent Requirements
A provider is required to determine that it is clinically appropriate to deliver such service via telehealth, including the telehealth modality and technology employed, including obtaining member consent.
Providers must obtain the member’s consent to receive services via telehealth and inform the member
- of any relevant privacy considerations and
- that the member may revoke their consent to receive services via telehealth at any time.
Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
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 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 Mar. 2023).
Last updated 03/14/2023
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, (Accessed Mar. 2023).
“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 Mar. 2023).
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 Mar. 2023).
Last updated 03/14/2023
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 Mar. 2023).
MassHealth reimburses the V3 modifier which is used when providers are rendering services via audio-only telehealth.
MassHealth Guidance Regarding Telephone and Internet Connectivity
MassHealth guidance available at www.mass.gov/doc/masshealth-provider-resource-telephone- and-internet-connectivity-for-telehealth aims to help providers guide members who want to receive services via telehealth, but have concerns about limited phone and internet access. This resource includes information about the federal Lifeline program, which provides free or low-cost phone service to low-income households, and information on the Affordable Connectivity Program (ACP), which is a federal benefit program that helps ensure that households can afford broadband internet.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
Telehealth and Children’s Behavioral Health Initiative (CBHI) Services
As under All Provider Bulletin 327 (corrected), 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 via telephonic means 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.
Consistent with All Provider Bulletin 327 (corrected) and its predecessor bulletins, through September 30, 2023, MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart. Likewise, through September 30, 2023, an eligible distant-site provider delivering covered services via telehealth in accordance with this bulletin may bill MassHealth a facility fee if such a fee is permitted under the provider’s governing regulations or contracts. MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through September 30, 2023, and may change those policies after that date.
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, and 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 93 to indicate services rendered via audio-only telehealth;
- modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
Additionally, for any institutional claim, providers are allowed to use the following modifiers:
- modifier 93 to indicate services rendered via audio-only telehealth;
- modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
MassHealth will implement modifiers 95, 93, GQ, GT, FQ, and FR through an informational edit period. Thus, effective for dates of service (DOS) between April 16, 2022, and March 30, 2023, MassHealth will not deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers. Effective for DOS on or after April 1, 2023, MassHealth will discontinue this informational edit, and will deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers.
*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
Substance Use Disorder Treatment Code Revisions
Effective for dates of service beginning March 12, 2020, in accordance with All Provider Bulletins 289 and 291, this letter transmits revisions to behavioral health service codes in Subchapter 6 of the Substance Use Disorder Treatment Manual, allowing substance use disorder (SUD) treatment providers to bill for the following telephonic codes: (98966, 98967, 98968, 99441, 99442, 99443).
Please refer to All Provider Bulletins 289 and 291 for additional information and limitations on the uses of these codes.
SOURCE: Mass Health Substance Use Disorder Treatment Manual, Service Codes and Descriptions, Transmittal Letter SUD-22, page 6-9 & MassHealth Transmittal Letter SUD-22, Jun. 2022, (Accessed Mar. 2023).
Last updated 03/14/2023
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.
Coverage that reimburses a provider with a global payment 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 Mar. 2023).
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 Mar. 2023).
Access to Health Services through Telehealth Options
Through All Provider Bulletin 327 (corrected), MassHealth established rules for reimbursement of services rendered via telehealth. This bulletin amends and restates All Provider Bulletin 327 (corrected) to introduce the following changes: a new modifier for services delivered via audio-only telehealth; a new place of service (POS) code for delivery of telehealth services provided in a patient’s home; a clarification of requirements for telehealth encounters and documentation requirements; the extension of payment parity between services delivered via telehealth and their in-person counterparts through September 30, 2023; and the extension of the informational edit period for modifiers used on professional claims for services rendered via telehealth through March 30, 2023.
Pursuant to this policy, MassHealth will continue to allow MassHealth-enrolled providers to deliver a broad range of MassHealth-covered services via telehealth and, through September 30, 2023, will reimburse for such services at parity with their in-person counterparts. All providers delivering services via telehealth must comply with the policy detailed in this bulletin. This bulletin is effective until MassHealth issues superseding guidance. In addition, MassHealth may issue program-specific guidance with additional requirements and/or limitations that apply to the provision of services via telehealth by providers participating within those programs.
*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
This bulletin, which supersedes Managed Care Entity Bulletin 74, requires managed care plans to maintain a telehealth policy consistent with All Provider Bulletin 355, including but not limited to maintaining policies for coverage of telehealth services no more restrictive than those described in All Provider Bulletin 355 and through at least September 30, 2023.
SOURCE: MassHealth Managed Care Provider Bulletin 95, Jan. 2023. (Accessed Mar. 2023).
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 Mar. 2023).
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 services delivered via in-person methods; provided, that this subsection apply to providers of behavioral health services covered as required (see text for applicable behavioral health providers).
SOURCE:Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Mar. 2023).
The division of medical assistance 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 Mar. 2023).
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 Sec. 418.412, (Accessed Mar. 2023).
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 Mar. 2023).
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, 1/1/22 & MassHealth Transmittal Letter CHC-118 Community Health Center Manual (Addition of Codes), (Accessed Mar. 2023).
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), any MassHealth-enrolled provider may deliver any medically necessary MassHealth-covered service to a MassHealth member via any telehealth modality, 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 Appendix A to this bulletin, 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 development of its telehealth policy. Based on the results of this monitoring, and its analysis of relevant data and information, MassHealth may adjust this coverage policy, including by imposing limitations on the use of certain telehealth modalities for various covered services.
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
As described above, except for these categories of services, any provider may deliver any MassHealth-covered service via any telehealth modality in accordance with the standards set forth in this bulletin, provided that such services are payable under that provider type.
*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
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 Mar. 2023).
Consistent with All Provider Bulletin 327 (corrected) and its predecessor bulletins, through September 30, 2023, MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart. Likewise, through September 30, 2023, an eligible distant-site provider delivering covered services via telehealth in accordance with this bulletin may bill MassHealth a facility fee if such a fee is permitted under the provider’s governing regulations or contracts. MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through September 30, 2023, and may change those policies after that date.
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, and 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 FR to indicate a supervising practitioner was present through a real-time two- way, audio and video communication technology
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 GT to indicate services rendered via interactive audio and video telecommunications systems
- modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
MassHealth will implement modifiers 95, 93, GQ, GT, FQ, and FR through an informational edit period. Thus, effective for dates of service (DOS) between April 16, 2022, and March 30, 2023, MassHealth will not deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers. Effective for DOS on or after April 1, 2023, MassHealth will discontinue this informational edit, and will deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers.
*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
Synchronous teledentistry is covered.
ELIGIBLE SITES
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 Mar. 2023).
GEOGRAPHIC LIMITS
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.
SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Mar. 2023).
FACILITY/TRANSMISSION FEE
Consistent with All Provider Bulletin 327 (corrected) and its predecessor bulletins, through September 30, 2023, MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart. Likewise, through September 30, 2023, an eligible distant-site provider delivering covered services via telehealth in accordance with this bulletin may bill MassHealth a facility fee if such a fee is permitted under the provider’s governing regulations or contracts. MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through September 30, 2023, and may change those policies after that date.
*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
Last updated 03/14/2023
Miscellaneous
See bulletin for specific requirements around prescribing, telehealth encounters, documentation and recordkeeping.
Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
Telehealth. Services including the prescribing of controlled substances must be in accordance with state and federal regulations.
SOURCE: MA Regulations Sec. 418.412, (Accessed Mar. 2023).
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 shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request.
SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Mar. 2023).
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 Mar. 2023).
Last updated 03/14/2023
Out of State Providers
No Reference Found
Last updated 03/14/2023
Overview
Massachusetts passed major revisions to the state’s Medicaid telehealth policy that took effect in January 2021 and established coverage for health care services, and parity for behavioral health services. MassHealth recently issued a bulletin largely aligning the state’s telehealth policy with the COVID era policies with certain exceptions through Dec. 31, 2022. The update provides for reimbursement of live video with certain limitations, and modifiers for billing asynchronous and audio-only services. It is indicated that RPM will be addressed in an upcoming bulletin.
Last updated 03/14/2023
Remote Patient Monitoring
POLICY
MassHealth anticipates introducing coverage for remote patient monitoring for chronic disease management and e-consult services in the near future. Subject to the availability of federal financial participation, MassHealth plans to publish transmittal letters that will include applicable service limitations and add appropriate codes to the relevant provider manuals.
*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
An allowable fee is listed for Remote Patient Monitoring Bundled Services. However, the manual notes that its used for COVID-19 remote patient monitoring bundled services provided through any appropriate technology or modality, including up to seven days of daily check-ins for evaluation and monitoring; multidisciplinary clinical team reviews of a member’s status and needs; appropriate physician oversight; necessary care coordination; and provision of a thermometer and pulse oximeter for remote monitoring.
CONDITIONS
MassHealth anticipates introducing coverage for remote patient monitoring for chronic disease management and e-consult services in the future.
*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
Medicine Coding Updates
Remote therapeutic monitoring
98975- Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment
98976- Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days
98977- Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days
98980- Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient or caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure)
SOURCE: The Commonwealth of Massachusetts Executive Office of Health and Human Services Administrative Bulletin 22-09, (Jan. 2022), (Accessed Mar. 2023).
PROVIDER LIMITATIONS
No reference found.
OTHER RESTRICTIONS
No Reference Found
Last updated 03/14/2023
Store and Forward
POLICY
MassHealth reimburses the GQ modifier which is used when providers are rendering services via asynchronous telehealth.
Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.
SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Mar. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Asynchronous teledentistry is covered.
SOURCE: MA 101 CMR 314. 05. (Accessed Mar. 2023).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
