Update on the Annual Behavioral Health Wellness Exam
In 2022, the MA Legislature passed the Mental Health ABC Act (Chapter 177 of the Acts of 2022), which provided a mandate that insurance (with a few exceptions) will cover for all Massachusetts residents an Annual Behavioral Health Wellness Exam without cost sharing. MCAAP leaders were involved in working groups to advise the MA Division of Insurance on appropriate screening tools for pediatric patients. Details of the covered services, which can be offered by integrated behavioral health providers, independent BH clinicians, or primary care medical providers, can be found in this DOI bulletin. The benefit became effective on April 1, 2024, and is billable with a diagnosis code of Z13.30 (Encounter for screening examination for mental health and behavioral disorders, unspecified), CPT code 90791 (Psychiatric diagnostic evaluation), and modifier 33.
Chapter leaders have been researching the different coverage issues and had planned to hold a virtual town hall on Wednesday, May 29th to cover the logistics of the exams for pediatricians, including required documentation, coding, and workflow, and to discuss how to provide value added services to help families and increase pediatrician satisfaction. After a number of meetings with practices, insurers, and experts on this issue, we realized that there are still so many unanswered questions that the Chapter will postpone the Virtual Town Hall until we have more to share with our member pediatricians.
We invite practices who are successfully implementing and being reimbursed for the MA Annual Behavioral Health Wellness Exam to share their experiences with MCAAP Executive Director Cathleen Haggerty at chaggerty@mcaap.org. Please keep your eyes out for further e-newsletters and details posted on the MCAAP website www.mcaap.org.
Mary Beth Miotto, MD, MPH, FAAP
MCAAP President
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