Tufts Health Together (MassHealth Medicaid)

MedicaidMA

ABA billing requirements · Source: Tufts Health Together / Point32Health — MassHealth ABA Policy

High confidence

Verified 2026-03-17

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline30 days

Unit tracking cadenceWeekly

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

BH carve-out managerCarelon

State licensure requiredLABA (MA Board of Registration of Allied Mental Health Professionals)

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis (DSM-5) with date, BCBA-signed treatment plan with measurable goals, Functional Behavior Assessment (FBA), Behavior Intervention Plan (BIP), Baseline data and target behaviors, Projected discharge criteria, Caregiver training plan with attendance records, Massachusetts LABA license number for supervising BCBA

Progress summary cadenceEvery 1 months

Policy Notes

Tufts Health Together is the MassHealth (Massachusetts Medicaid) managed care plan operated by Point32Health (formerly Tufts Health Plan). Separate from 32 Health Plan (commercial) and Harvard Pilgrim. Covers ABA for members with ASD diagnosis through age 21. Prior auth required via Carelon (AIM Specialty Health) portal. Weekly hour caps apply per MassHealth rate schedule. BCBA must hold Massachusetts licensure (LABA). Telehealth covered with modifier 95 per MassHealth telehealth policy. Coordination with MassHealth FFS rules required for dual-eligible members.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Tufts Health Together (MassHealth Medicaid).

Official policy source:Tufts Health Together / Point32Health — MassHealth ABA Policy

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Data last verified: 2026-03-17 · Confidence: High · See our methodology

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