Massachusetts

At A Glance

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MEDICAID REIMBURSEMENT

Live Video: Yes
Store-and-Forward: Yes
Remote Patient Monitoring: Yes* (CMS RPM Codes)
Audio Only: Yes

PRIVATE PAYER LAW

Law Exists: Yes
Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

Licensure Compacts: None
Consent Requirements: Yes

STATE RESOURCES

Medicaid Program: MassHealth
Administrator: Massachusetts Dept. of Health and Human Services
Regional Telehealth Resource Center: Northeast Regional Telehealth Resource Center

Private Payer

Last updated 08/08/2023

Definitions

“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 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Aug. 2023).

Section repeated in Civil Service, Retirement and Pensions section applying to active or retired employees of the commonwealth; Non-profit hospital service corporations; medical service corporation; health maintenance organizations; preferred provider arrangement

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Aug. 2023).

Last updated 08/08/2023

Parity

SERVICE PARITY

An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth shall provide coverage for health care services delivered via telehealth by a contracted health care provider if:

the health care services are covered by way of in-person consultation or delivery; and
the health care services may be appropriately provided through the use of telehealth

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Aug. 2023).

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Aug. 2023).

PAYMENT PARITY

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.

Insurance companies organized under this chapter 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 (see bill language for types of providers).

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Aug. 2023).

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Aug. 2023).

Last updated 08/08/2023

Requirements

the health care services are covered by way of in-person consultation or delivery; and
the health care services may be appropriately provided through the use of telehealth

An insurer 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.

A contract that provides coverage for services under this section may contain a provision for a deductible, copayment or coinsurance requirement for a health care service provided via telehealth as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation or in-person delivery of service.

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.

Evidence of coverage provided to a household upon enrollment must include a summary description of the insured’s telehealth coverage and access to telehealth services, including, but not limited to behavioral health services, chronic disease management and primary care services via telehealth, as well as the telecommunications technology available to access telehealth services.

The executive office of health and human services and the division of insurance shall report on the use of telehealth services in the commonwealth and the effect of telehealth on health care access and system cost.

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, Ch. 176O, Sec. 6 & Ch. 260, Sec. 67 (Accessed Aug. 2023).

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Aug. 2023).

Medicaid

Last updated 08/08/2023

Consent Requirements

Effective Until September 30, 2023:

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 Aug. 2023).

Effective October 1, 2023

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).

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. [continues, see Live Video section]

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.

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 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 Aug. 2023).

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. 2023).

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. 2023).

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. 2023).

Last updated 08/08/2023

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 & 101 CMR Sec. 362.02, 130 CMR 461.402 [definition found in multiple additional manual sections] (Accessed Aug. 2023).

SOURCE: Massachusetts General Laws Part I, Title IV, Ch. 32A. Sec. 30 . (Accessed Aug. 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 Aug. 2023).

Last updated 08/08/2023

Email, Phone & Fax

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. 2023).

Effective Until September 30, 2023:

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 Aug. 2023).

Effective Until September 30, 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 Aug. 2023).

Effective October 1, 2023

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.

Facility Claims: MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart as above.

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 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.

Professional and institutional claims with the aforementioned modifiers must also meet the following requirements:

modifier 93 is to be allowed only for codes listed in Appendix T of the CPT codebook; and
modifier 95 is to be allowed only with codes listed in Appendix P of the CPT codebook.

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.

Some MassHealth members may want to receive telehealth services but have concerns about phone and/or internet access. Provider guidance is available at www.mass.gov/doc/masshealth-providerresource-telephone-and-internet-connectivity-for-telehealth. This resource includes information about:

the federal Lifeline program, which provides free or low-cost phone service to low-income households; and
the Affordable Connectivity Program (ACP), a federal benefit program that helps ensure households can afford broadband internet. The ACP covers a monthly service discount and one device discount per household with broad eligibility criteria. You can find more information at www.affordableconnectivity.gov

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 2023).

Substance Use Disorder Treatment Code Revisions

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. 2023).

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. 2023).

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. 2023).

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. 2023).

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. 2023).

Last updated 08/08/2023

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.

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 Aug. 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 Aug. 2023).

Effective Until September 30, 2023:

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.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Aug. 2023).

Effective October 1, 2023

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.

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 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 Aug. 2023).

Home Health Agency

Rates of payment for home health services delivered via telehealth will be the same as rates of payment for home health services delivered via traditional (e.g., in-person) methods set forth in 101 CMR 350:00: Rates for Home Health Services.

Home health agencies must include modifier “GT” when submitting claims for services delivered via telehealth.

Failure to include modifier “GT” when submitting claims for services delivered via telehealth may result in sanctions pursuant to 130 CMR 450.238-450.240.

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

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

Therapy

Rehabilitation Center providers must include modifier “GT” when submitting claims for services delivered via telehealth. Rates of payment for therapist services delivered via telehealth will be the same as rates of payment for therapist services delivered via traditional (e.g., in-person) methods set forth in 101 CMR 339.00: Rates for Restorative Services.

Failure to include modifier “GT” when submitting claims for Rehabilitation Center services delivered via telehealth may result in the imposition of sanctions pursuant to 130 CMR 450.238- 450.240. [excluded in Therapist Bulletin 18]

Important note: Although MassHealth allows reimbursement for delivering certain services through telehealth, MassHealth does not require providers to deliver services via telehealth.

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

ELIGIBLE SERVICES/SPECIALTIES

Health Care Services

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 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 Aug. 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 Aug. 2023).

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. 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 Aug. 2023).

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 Aug. 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, 1/1/23, (Accessed Aug. 2023).

CARES program providers may deliver services via live telehealth.

SOURCE: MassHealth Rates for Community Health Centers, 130 CMR Sec. 405.477 and Sec. 433.485, (Accessed Aug. 2023).

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 461.402, (Accessed Aug. 2023).

Effective Until September 30, 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.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Aug. 2023).

Effective October 1, 2023

Facility Claims: MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart as above.

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 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

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 2023).

Continuous Skilled Nursing Agency

Following the end of the FPHE, MassHealth continues to allow telehealth services for face-to-face visits through December 31, 2024.

SOURCE: MassHealth Continuous Skilled Nursing Agencies, Bulletin 12, Jul. 2023, (Accessed Aug. 2023).

Home Health Agency

Effective May 12, 2023, per the Consolidated Appropriations Act of 2023, MassHealth will continue to allow telehealth services for a face-to-face visit through December 31, 2024. The face-to-face visit may only be conducted via two-way audio-video telecommunications technology that allows for real-time interaction.

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.

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. 2023).

Hospice Agencies

Effective May 12, 2023, consistent with the federal Consolidated Appropriations Act of 2023, MassHealth continued to cover the face-to-face visit required for members entering their third hospice benefit period when appropriately provided via telehealth through December 31, 2024. Under the Consolidated Appropriations Act, the face-to-face visit may only be conducted via two-way audio-video telecommunications technology that allows for real-time interaction. See 130 CMR 437.411(C) for MassHealth’s face-to-face requirement.

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

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. 2023).

Durable Medical Equipment

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

Oxygen and Respiratory Therapy

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

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. 2023).

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

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

Community Behavioral Health Center

Adult and Youth Mobile Crisis intervention and maybe provided via telehealth.

SOURCE: MassHealth Commonwealth of Massachusetts MassHealth Provider Manual Series, Community Behavioral Health Center Manual, 1/1/23, (Accessed Aug. 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 Aug. 2023).

Effective Until September 30, 2023:

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

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Aug. 2023).

Effective October 1, 2023

Facility Claims: An eligible distant-site provider delivering covered services via telehealth in accordance with this bulletin may bill MassHealth a facility claim if such a fee is allowed under the provider’s governing regulations or contracts.

Terminology: Distant site is the site where the practitioner providing the service is located at the time the service is provided via a telehealth system. All applicable licensure and programmatic requirements apply to the delivery of the service. While the distant site must be located in the United States or its territories, there are no additional geographic or facility restrictions on distant sites for services delivered via telehealth in this bulletin.

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 2023).

Synchronous teledentistry is covered.

SOURCE: MA 101 CMR 314. 05. (Accessed Aug. 2023).

Home Health Agency

MassHealth home health agencies may deliver clinically appropriate, medically necessary MassHealth-covered home health services to MassHealth members via telehealth (including telephone and live video), in accordance with the standards in this bulletin and notwithstanding any regulation to the contrary, including physical presence requirements in 130 CMR 403.000: Home Health Agency. Home health agencies must follow all PA requirements under 130 CMR 403.410: Prior Authorization Requirements and must meet all requirements under the MassHealth Home Health Medical Necessity Guidelines.

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

Adult Foster Care

MassHealth AFC providers and GAFC providers may deliver clinically appropriate, medically necessary MassHealth-covered AFC/GAFC services to eligible MassHealth members via telehealth (including telephone or live video), in accordance with the standards in this bulletin and notwithstanding any regulation to the contrary, including physical presence requirements in regulation at 130 CMR 408.000.

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

Clinical Social Worker

The licensed independent clinical social worker may provide therapy in any suitable location, such as an office, the member’s place of residence, other facility, or by telehealth.

SOURCE: Commonwealth of Massachusetts MassHealth Provider Manual Series, Licensed Independent Clinical Social Worker Manual, 1/1/23, p. 4, (Accessed Aug. 2023).

ELIGIBLE SITES

Effective October 1, 2023

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.

Professional and institutional claims with the aforementioned modifiers must also meet the following requirements:

modifier 93 is to be allowed only for codes listed in Appendix T of the CPT codebook; and
modifier 95 is to be allowed only with codes listed in Appendix P of the CPT codebook.

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.

See bulletin for billing instructions for the 837I/UB-04 form.

Terminology: 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 374, Jul. 2023. (Accessed Aug. 2023).

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. 2023).

GEOGRAPHIC LIMITS

Effective October 1, 2023

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 374, Jul. 2023. (Accessed Aug. 2023).

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Aug. 2023).

FACILITY/TRANSMISSION FEE

Effective Until September 30, 2023:

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Aug. 2023).

Effective October 1, 2023

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

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 2023).

Last updated 08/08/2023

Miscellaneous

Effective Until September 30, 2023:

See bulletin for specific requirements around prescribing, telehealth encounters, documentation and recordkeeping.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Aug. 2023).

Effective October 1, 2023

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, eprescribing, and/or fax. Providers must document prescriptions in the patient’s medical record consistent with in-person care.

See bulletin for additional telehealth encounter requirements and documentation and recordkeeping requirements.

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 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 Aug. 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 Aug. 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 Aug. 2023).

Home Health Agency

See bulletin for documentation requirements.

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

Adult Foster Care

See bulletin for documentation requirements.

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

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. 2023).

Last updated 08/08/2023

Out of State Providers

No Reference Found

Last updated 08/08/2023

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 updated their bulletin to largely align the state’s telehealth policy with the COVID era policies with certain exceptions. The bulletin goes into effect Oct. 1, 2023, while a previous similar bulletin expires September 30, 2023. Both are noted through this section. 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 08/08/2023

Remote Patient Monitoring

POLICY

Effective Until September 30, 2023:

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.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Aug. 2023).

Effective October 1, 2023

MassHealth expects to introduce coverage for remote patient monitoring for chronic disease management in the 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.

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 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.

SOURCE: MA Regulations, Sec. 446.03, (Accessed Aug. 2023).

CONDITIONS

Effective Until September 30, 2023:

MassHealth anticipates introducing coverage for remote patient monitoring for chronic disease management and e-consult services in the future.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Aug. 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 Aug. 2023).

PROVIDER LIMITATIONS

No reference found.

OTHER RESTRICTIONS

No Reference Found

Last updated 08/08/2023

Store and Forward

POLICY

Effective Until September 30, 2023:

MassHealth reimburses the GQ modifier which is used when providers are rendering services via asynchronous telehealth.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Aug. 2023).

Effective October 1, 2023

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.

Professional and institutional claims with the aforementioned modifiers must also meet the following requirements:

modifier 93 is to be allowed only for codes listed in Appendix T of the CPT codebook; and
modifier 95 is to be allowed only with codes listed in Appendix P of the CPT codebook.

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 374, Jul. 2023. (Accessed Aug. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Asynchronous teledentistry is covered.

SOURCE: MA 101 CMR 314. 05. (Accessed Aug. 2023).

Effective October 1, 2023

Facility Claims: MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart as above.

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 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

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

Effective October 1, 2023

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

SOURCE: MassHealth All Provider Bulletin 374, Jul. 2023. (Accessed Aug. 2023).

Professional Requirements

Last updated 08/09/2023

Cross State Licensing

Does Massachusetts have a special license for telemedicine? No, you must apply for a full license.

SOURCE: Board of Registration in Medicine, General Physician Licensing Questions, (Accessed Aug. 2023).

“The Board deems a physician to be practicing medicine in Massachusetts when the patient is physically located in Massachusetts. A physician licensed by the Board whose license does not restrict practice to a particular location may engage in the practice of medicine with respect to patients in Massachusetts irrespective of whether the physician is physically located in Massachusetts. A physician licensed by the board whose license does restrict practice to a particular location may engage in the practice of medicine with respect to patients in Massachusetts only from the location identified on his or her license.”

SOURCE: Commonwealth of Massachusetts Board of Registration in Medicine, (Oct. 6, 2022). (Accessed Mar. 2023).

Last updated 08/08/2023

Definitions

“Telehealth” shall mean 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: MA General Laws, Part 1, Title XVI, Ch. 112, Sec. 5O . (Accessed Aug. 2023).

Telemedicine means the provision of services to a patient by a physician from a distance by electronic communication in order to improve patient care, treatment or services.

SOURCE: 243 CMR 2.01. (Accessed Aug. 2023).

Last updated 08/08/2023

Licensure Compacts

No Reference Found

Last updated 08/08/2023

Miscellaneous

The board shall allow a physician licensed by the board to obtain proxy credentialing and privileging for telehealth services with other health care providers, as defined in Section 1 of chapter 111, or facilities that comply with the federal Centers for Medicare and Medicaid Services’ conditions of participation for telehealth services. Applicable providers in Section 1, Chapter 111 include:

any doctor of medicine, osteopathy, or dental science
registered nurse
social worker
doctor of chiropractic
psychologist

SOURCE: Massachusetts General Laws Part I, Title XVI, Ch. 112, Sec. 5O & Title XVI, Chapter 111, Section 1, Massachusetts General Laws (Accessed Aug. 2023).

Involuntary Commitment

The requirement for examination may be satisfied through utilization of telemedicine or other technology pursuant to protocols approved by the Department. See regulation for details.

SOURCE: 104 Code of Massachusetts Regulations (CMR) 27, (Accessed Aug. 2023).

Last updated 08/08/2023

Online Prescribing

The practice of medicine shall not require a face-to-face encounter between the physician and the patient prior to health care delivery via telemedicine. The standard of care applicable to the physician is the same whether the patient is seen in-person or through telemedicine.

SOURCE: “Policy on Telemedicine,” Board of Registration in Medicine. Oct. 6, 2022. (Accessed Aug. 2023).

To be valid, a prescription must be issued in the usual course of the physician’s professional practice, and within a physician-patient relationship that is for the purpose of maintaining the patient’s well-being. In addition, the physician must conform to certain minimum standards of patient care, such as taking an adequate medical history, doing a physical and/or mental status examination and document the findings. This rule applies to any prescription, issued by any means, including the Internet or other electronic process.

SOURCE: “Internet Prescribing,” MA Board of Registration in Medicine. Dec. 17, 2003 & Prescribing Practices Policy and Guidelines Policy 15-05 (Adopted Oct. 8, 2015), (Amended June 15, 2023). (Accessed Aug. 2023).

Cannabis Control Commission

Clinical Visit means an in-person or telehealth visit during which a Certifying Healthcare Provider establishes a Bona Fide Healthcare Provider Patient Relationship and conducts a full assessment of the Patient’s medical history and current medical condition, including the Debilitating Medical Condition, and explains the potential benefits and risks of Marijuana use. A Clinical Visit for an initial Certificate of Registration shall be performed in-person.

SOURCE: MA Regulations, Cannabis Control Commission, Ch. 935 CMR 501.002. (Accessed Aug. 2023).

Last updated 08/08/2023

Professional Boards Standards

Board of Medicine

SOURCE: 243 CMR 2.01. (Accessed Aug. 2023).