Massachusetts: Updated mental health wellness exam coverage

Effective Jan. 1, 2024, Massachusetts law requires UnitedHealthcare to provide coverage an annual mental health wellness exam. The mental health wellness exam is defined as consisting of a screen or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment.

The exam may be provided by the primary care provider as part of an annual preventive visit. For details on the mental health wellness exam components, please refer to the Massachusetts Division of Insurance Bulletin 2024-02.

Billing codes

We’ve updated our billing system so health care professionals can process claims for the annual behavioral health wellness examination using the following codes:

• Procedural code: 90791
  • Integrated biopsychosocial assessment, including history, mental status and recommendations
• Diagnosis code: Z13.30
  • Encounter for screening examination for mental health and behavioral disorders, unspecified
• Modifier: 33
  • Indicates the evaluation is for preventive purposes, not an initial evaluation due to a particular presenting issue/illness and it is not subject to cost-sharing

For most plans, the mental health wellness exam is covered with no out-of-pocket costs for members when performed by a network licensed mental health professional or primary care provider. Some plans, such as those governed by the Federal Internal Revenue Code (health savings accounts) may require copayments, coinsurance or deductible be applied.

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