Massachusetts Medicaid CBHCs Fee Schedule 2026

Massachusetts Medicaid, known as MassHealth, pays for a range of mental health and substance use services provided by Community Behavioral Health Centers (CBHCs). CBHCs serve as one-stop centers for mental health and substance use care. They offer routine and urgent outpatient visits, 24/7 mobile crisis support, and short-term crisis stabilization for both adults and youth.

The current version of this regulation applies to service dates on or after August 15, 2025. Massachusetts Medicaid does not reflect any new amendments, so these are the rates that apply to 2026 service dates.

The MassHealth rate structure for outpatient behavioral health and CBHC services is determined through the formal administrative rate-setting procedure governed by the Massachusetts General Laws (M.G.L. c. 118E).

Baseline reimbursement has been established for independent licensed physicians (MD/DO). Rates for mid-level physicians, master’s-level physicians, and paraprofessionals are adjusted using standard percentage modifiers applied to the physician base fee.

Important to know: Most CBHC outpatient services (therapy, evaluation, medication visits) do not have their own separate rates. CBHCs bill a flat daily rate (code T1040) that covers all CPT and HCPCS codes. Only emergency services and a few specialty services are billed separately. This is why the first table shows the daily bundle rate, and the second table lists the codes that fall within it.

Massachusetts Medicaid Fee Schedule Rates for Community Behavioral Health Centers (2026)

Encounter Bundle Rates (Daily Flat Rates)

This table shows rates set by the Executive Office of Health and Human Services (EOHHS) using cost models that estimate what an efficient CBHC costs for staffing, space, and administration. A CBHC bills one T1040 code per day, regardless of how many bundled services the person receives that day. Rates differ for adult and child/adolescent programs.

Code	Modifier	Description	2026 Rate
T1040	HB	Medicaid Certified Community Behavioral Health Clinic services, per diem (adult)	$233.90
T1040	HA	Medicaid Certified Community Behavioral Health Clinic services, per diem (child/teen-age)	$241.86

Services Included Within the Daily Bundle

The following codes represent “designated services.” Your Massachusetts medical billing team must bill these services with a T1040 code, and they are paid at the T1040 rate. The code does not provide a separate dollar amount for each of these services. The tables are grouped by type of service.

Diagnostic Assessment

These codes are used when a therapist reaches a diagnosis and plans treatment for a new or returning patient. They are paid for within the T1040 bundle.

CPT/HCPCS Code	Description	Rate
90791	Psychiatric diagnostic evaluation	Included in T1040
90791-HA	Psychiatric diagnostic evaluation done with the CANS tool (youth)	Included in T1040
90792	Psychiatric diagnostic evaluation with medical services	Included in T1040

Individual Psychotherapy

These are standard talk therapy sessions between a therapist and a patient. These codes are paid for within the T1040 bundle.

CPT Code	Description	Rate
90832	Psychotherapy, 30 minutes	Included in T1040
90834	Psychotherapy, 45 minutes	Included in T1040
90837	Psychotherapy, 60 minutes	Included in T1040

Psychotherapy Add-On Codes (With Medication Visit)

These add-on codes are used when therapy is performed alongside an evaluation and management (E/M) service in a single visit, for example, when a prescriber also provides therapy. They are paid for within the T1040 bundle.

CPT Code	Description	Rate
90833	Psychotherapy, 30 minutes, add-on to an E/M visit	Included in T1040
90836	Psychotherapy, 45 minutes, add-on to an E/M visit	Included in T1040
90838	Psychotherapy, 60 minutes, add-on to an E/M visit	Included in T1040

Crisis Psychotherapy

Crisis psychotherapy codes cover immediate treatment for a person in a crisis situation. They are paid for within the T1040 bundle.

CPT Code	Description	Rate
90839	Psychotherapy for crisis, first 60 minutes	Included in T1040
90840	Psychotherapy for crisis, each additional 30 minutes (add-on)	Included in T1040

Family and Group Therapy

These codes cover therapy with family members or groups of patients. They are paid for within the T1040 bundle.

CPT Code	Description	Rate
90846	Family psychotherapy without the patient present, 50 minutes	Included in T1040
90847	Family psychotherapy with the patient present, 50 minutes	Included in T1040
90849	Multiple-family group psychotherapy (up to 10 clients)	Included in T1040
90853	Group psychotherapy (up to 12 clients)	Included in T1040

Care Coordination, Counseling, and Behavioral Health Services

These codes cover work done on behalf of the patient (interviews with agencies or family) and preventive counseling. They are paid for within the T1040 bundle.

CPT Code	Description	Rate
90882	Environmental intervention / case consultation with agencies, employers or institutions	Included in T1040
90887	Explaining exam results to family or other responsible persons (per half hour)	Included in T1040
96164	Health behavior group intervention, 30 minutes	Included in T1040
96165	Health behavior group intervention, each additional 15 minutes (add-on)	Included in T1040
99404	Preventive counseling for an individual, 60 minutes	Included in T1040
99412	Preventive counseling in a group setting	Included in T1040

Medication Management and Office Visits (E/M)

The Medication Management and Office Visits CPT codes are used for new and established patient visits and for injections. They are paid for within the T1040 bundle.

CPT Code	Description	Rate
99202–99205	New patient office visit (levels 2 to 5, based on time or complexity)	Included in T1040
99211–99215	Established patient office visit (levels 1 to 5)	Included in T1040
96372	Injection (subcutaneous or intramuscular)	Included in T1040

Substance Use Counseling Codes

These codes support substance use disorder (SUD) care within CBHCs. They are paid for within the T1040 bundle.

HCPCS Code	Description	Rate
H0004	Individual behavioral health counseling, per 15 minutes (up to 4 units per session)	Included in T1040
H0005	Group alcohol/drug counseling by a clinician, per 45 minutes (up to 2 units)	Included in T1040
H0033	Oral medication administration, directly observed (SUD programs only)	Included in T1040
T1006	Family/couple alcohol or substance use counseling, per 30 minutes (1 unit per day)	Included in T1040

Mobile Crisis Intervention Rates (Separate Payment)

Mobile crisis teams go to the person in crisis, either at the CBHC or in the community. EOHHS sets these rates using staffing models for 24/7 availability. The per-day rate covers the first day of assessment and treatment. Follow-up visits are paid per 15-minute visit, up to three days (adults) or seven days (youth) after the first assessment. Crisis services may be billed on the same day as the T1040 bundle, but follow-up crisis services may not be billed on the same day the crisis occurs.

Crisis Per Diem Rates

Code	Description	2026 Rate
S9485-HE	Adult mobile crisis intervention at the CBHC site, per day	$695.29
S9485-HA, HE	Youth mobile crisis intervention at the CBHC site, per day	$695.29
S9485-U1	Adult mobile crisis intervention at a community site outside the CBHC (Place of Service 15), per day	$1,024.64
S9485-HA, U1	Youth mobile crisis intervention at a community site outside the CBHC (Place of Service 15), per day	$1,075.87

Mobile Crisis Follow-Up Rates (Per 15 Minutes)

Code	Description	2026 Rate
H2011-HN, HB	Adult follow-up at CBHC site by paraprofessional/bachelor’s-level staff	$30.57
H2011-HO, HB	Adult follow-up at CBHC site by master’s-level clinician	$39.70
H2011-HN, HA	Youth follow-up at CBHC site by paraprofessional/bachelor’s-level staff	$33.94
H2011-HO, HA	Youth follow-up at CBHC site by master’s-level clinician	$44.33
H2011-HN, HB	Adult follow-up at a community site by paraprofessional/bachelor’s-level staff	$33.94
H2011-HO, HB	Adult follow-up at a community site by master’s-level clinician	$44.33
H2011-HN, HA	Youth follow-up at a community site by paraprofessional/bachelor’s-level staff	$33.94
H2011-HO, HA	Youth follow-up at a community site by master’s-level clinician	$44.33

Community Crisis Stabilization Rates (per day)

Community Crisis Stabilization is a short-stay, staff-secure program that serves as a less restrictive alternative to inpatient psychiatric hospitalization. Adults must be 18 years of age or older. Youth are 18 and younger. EOHHS builds these rates from staffing and utilization models and then adds a cost adjustment factor for inflation.

Code	Description	2026 Rate
S9485-ET	Adult community crisis stabilization, per day	$748.37
S9485-HA, ET	Youth community crisis stabilization, per day	$930.73

Specialty Services Paid for Outside of the Bundle (Rates Come from Other Regulations)

CBHCs must be able to offer a variety of services that are not part of the daily bundle. Regulation 101 CMR 305.00 does not itself set these rates. It refers to other EOHHS rate regulations, which are the source of the numbers below. Each rate was taken from the current published version of this regulation.

Code	Service	Rate	Source Regulation
H0046-HE	Certified peer specialist services, per 15 minutes	$22.95	101 CMR 306.00 (effective Sept. 1, 2025)
H2016-HM	Peer recovery coaching, per day (enrolled client day)	$23.15	101 CMR 346.00 (effective July 1, 2026)
H2015-HF	Recovery support navigator, per 15 minutes	$17.54	101 CMR 444.00 (effective March 28, 2025)
H2015	Community support program (CSP), per 15 minutes	$17.54	101 CMR 362.00 (effective April 1, 2025)

Optional Services Paid Outside the Bundle

CBHCs may choose to offer these services. They are not included in the daily bundle and are paid under the following rules.

Code	Service	Rate	Source Regulation
H0015	Structured Outpatient Addiction Program (SOAP), per day	$121.90	101 CMR 444.00
H0015-TF	Enhanced SOAP (E-SOAP), per day	$176.15	101 CMR 444.00
S9480	Intensive outpatient psychiatric services (IOP), per day	$65.11	101 CMR 306.00
96130–96139 and related	Psychological testing	See regulation	101 CMR 329.00

MassHealth Payment Rates Changes

The CBHC rate schedule began on January 1, 2023. The main changes since then took effect on August 15, 2025.

Item	Before	Now
Daily bundle T1040 (adult / youth)	$233.90 / $241.86	No change: $233.90 / $241.86
Adult community crisis stabilization (S9485-ET)	$632.05	$748.37 (increase)
Youth community crisis stabilization (S9485-HA, ET)	$930.73	No change; definition widened so independently enrolled providers can also offer it
Adult mobile crisis in a hospital emergency department (S9485-HB)	$632.08	Removed from the CBHC schedule
Youth mobile crisis in a hospital emergency department	Referred to 101 CMR 352.00	Removed from the CBHC schedule
Mobile crisis per diem and follow-up rates (S9485, H2011)	Same amounts	No change
Certified peer specialist (H0046-HE)	$16.92 per 15 minutes (shown in both 305 and 306)	$22.95 per 15 minutes in 101 CMR 306.00; 305 now just refers to 306
SOAP and E-SOAP	Listed under 101 CMR 306.00	CBHC schedule now refers to 101 CMR 444.00
Reporting rules	Basic cost reporting	New section 305.04: annual Uniform Financial Report required; penalty of up to 15% of payments for not filing

How Rates Differ by Practitioner in A Related Fee Schedule (Not the CBHC Bundle)

The CBHC regulation does not price individual CPT codes by practitioner, because those services are inside the bundle. However, the related regulation for mental health centers and community health centers does, and it shows how MassHealth values different credentials. These amounts do not apply to CBHC bundled services. They are shown only for comparison.

Code	Description	Child Psychiatrist (UG)	Psychiatrist (AF)	Doctoral-Level (AH)	Master’s-Level (HO)	Intern (HL)
90791	Psychiatric diagnostic evaluation	$229.10	$183.87	$157.83	$143.53	$90.01
90832	Psychotherapy, 30 min	$76.56	$76.56	$65.08	$57.42	$39.05
90834	Psychotherapy, 45 min	$127.27	$111.83	$105.48	$105.01	$57.28
90837	Psychotherapy, 60 min	$148.54	$148.54	$140.28	$138.26	$75.76
90846	Family psychotherapy without patient	$155.56	$118.38	$111.57	$111.57	$60.86
90853	Group psychotherapy	$50.92	$42.72	$39.45	$36.43	$19.76
99213	Established patient visit, level 3	$92.52	$92.52	n/a	n/a	n/a

Provider Type Rate Differences: Who Can Charge What?

MassHealth applies provider modifiers to differentiate between clinician qualifications. A provider’s license level directly determines the percentage of the base fee schedule they receive.

Physicians and Psychiatrists (MD/DO):

• Payment Level: 100% of the published base fee
• May bill specialty psychiatric procedures as well as the full range of medical, diagnostic, and management (E/M) codes.

Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs):

• Reimbursement Level: 85% of the standard physician base fee
• Providers must include modifier SA (APRN) or U1 (PA) to claim referrals.

Example: Code 90792 (base of $144.56) pays $122.88 when billed by an APRN or PA.

Licensed Independent Clinical Social Workers (LICSWs):

• Compensation Level: 80% of the standard physician base fee
• Independent billing is permitted for diagnostic assessments (90791) and basic psychotherapy services (90832–90847).

Master’s-level therapists (LMHC, LMFT, LCSW):

• Compensation Level: 75% of the standard physician base fee
• Services must be provided under medical supervision within an authorized CBHC or clinic setting.

Paraprofessionals, Certified Peer Specialists, and Care Coordinators:

• Compensation Level: Fixed HCPCS rate schedule (e.g., H0038, H2015). These services are not tied to physician rates. Instead, they are priced on a flat, per-15-minute unit basis.

Frequently Asked Questions

Can someone use a CBHC without insurance?

Yes, for crisis services. Anyone in Massachusetts can use crisis services at any time, and no insurance is required. Routine outpatient care is covered by all MassHealth plans and many private plans, so uninsured patients should check their payment options first.

Do private insurance plans pay CBHCs the same way that MassHealth does?

Not always. MassHealth pays CBHCs more than some other providers, while many private insurers do not cover the full menu of CBHC services.

How long does a CBHC have to submit a MassHealth claim?

MassHealth must receive the first claim within 90 days of the date of service. If the patient has other insurance, bill that insurer first. The claim must then reach MassHealth within 90 days of the other insurer’s explanation of benefits. The final due date is 12 months from the date of service, or 18 months if the other insurance was billed first.

Can a CBHC bill a patient who has both Medicare and MassHealth?

Yes, but the order matters. MassHealth’s CBHC manual has a special appendix (Appendix D) for patients with both Medicare and MassHealth who are treated by providers who are not Medicare-certified. Providers must bill Medicare first for services provided by Medicare-certified providers, and MassHealth is billed after other payers.

Does Recovery Support Navigator (RSN) work require prior authorization?

Not at first. MassHealth guidance says that no prior authorization is required for the first 180 units per member, which is 45 hours of service.

What happens when a patient leaves the hospital after a mental health crisis?

MassHealth pays the hospital for crisis management provided in the hospital. It pays CBHCs for mobile crisis visits by the community team on the day of discharge. Hospitals may also bill for professional fees, such as assessment and management visits, on the same day.