Changes to Billing Provider Eligibility for Supportive Services

Regional Accountable Entities:

This transmittal serves as official notification that, as part of the Department of Health Care Policy and Financing’s (HCPF’s) Supportive Services Sustainability Strategy actions, effective August 1, 2026, Provider Type 25 – Non-Physician Practitioner Group (PT 25) and Provider Type 16 – Clinic Practitioner (PT 16) will no longer be able to bill for behavioral health supportive services and team-based behavioral health services, as outlined in the list of procedure codes below.

The PT 25 and PT 16 enrollments do not allow HCPF to differentiate between providers who primarily deliver behavioral health services, compared to those who primarily deliver medical or integrated care services. To address this, HCPF created Provider Type 77 – Behavioral Health Group (PT 77), effective January 1, 2024, to create more network specificity for group practices who deliver behavioral health services.