Issued: April 6, 2026
Partners Health Management (Partners) comprehensively reviews our rates for services on a regular basis. As part of that comprehensive review, Partners will adjust rates for the following services with dates of service July 1, 2026, forward.
What is happening?
Partners has reviewed our service utilization and is making the decision to adjust several rates with dates of service starting July 1, 2026.
What do providers need to know?
The following services are being impacted by the rate adjustment.
| Service Code | Service Description | Fund Source | Current Rate | New Rate | Effective Date |
| T2034 | Out of Home Crisis | Medicaid Direct/TP-BH-I/DD | $266.86 | $249.69 | 7/1/2026 |
| H0035 | Mental Health Partial Hospitalization | Medicaid Direct/TP-BH-I/DD | $194.40 | $171.01 |
7/1/2026 |
| H0046 | Level I Family Type | Medicaid Direct/TP-BH-I/DD | $94.88 | $86.25 | 7/1/2026 |
| T2021 | Day Supports Individual | Medicaid Direct/TP-BH-I/DD | $33.21 | $32.56 | 7/1/2026 |
| H0038 | Peer Support Individual | Medicaid Direct/TP-BH-I/DD | $17.04 | $15.50 | 7/1/2026 |
| H2015 | Community Networking | Medicaid Direct/TP-BH-I/DD | $7.46 | $7.41 | 7/1/2026 |
| S5150 | Respite: Individual | Medicaid Direct/TP-BH-I/DD | $6.02 | $5.38 | 7/1/2026 |
| H2017 | Psychosocial Rehabilitation | Medicaid Direct/TP-BH-I/DD | $3.92 | $3.69 | 7/1/2026 |
| H2015 GT | Community Networking Telehealth | Medicaid Direct/TP-BH-I/DD | $7.46 | $7.41 | 7/1/2026 |
| T2021 GT | Day Supports Individual Telehealth | Medicaid Direct/TP-BH-I/DD | $33.21 | $32.56 | 7/1/2026 |
| H0045 U4 HA | 1915(i) Respite Individual Child | Medicaid Direct/TP-BH-I/DD | $6.67 | $5.96 | 7/1/2026 |
| H0045 U4 HB | 1915(i) Respite Individual Adult | Medicaid Direct/TP-BH-I/DD | $6.67 | $5.96 | 7/1/2026 |
| H2015 CR | Community Networking (Individual) | Medicaid Direct/TP-BH-I/DD | $7.46 | $7.41 | 7/1/2026 |
| S5170 | S5170 – Meal Delivery | Medicaid Direct/TP-BH-I/DD | 8.99 | $7.99 | 7/1/2026 |
The following Service will change from a monthly rate to a per 15-minute unit rate:
| Service Code | Service Description | Fund Source | New Rate per 15-minute unit |
| T2025 | Specialized Consultative Services (SCS)* | Medicaid Direct/TP-BH-I/DD | $38.00 |
*Partners Utilization Management (UM) will transition current SCS authorizations to 15-minute units effective 7/1/2026. (1 monthly unit = 7 units for the prorated period through the end of the current authorization.)
What do providers need to do?
- Providers should bill the new rate with dates of service beginning July 1, 2026.
- Requests for Enhanced Provider Rates are not available at this time.
- If SCS units beyond 7 units/month are needed, the treatment team should meet and submit an ISP update with justification.
- Plan Based Innovations Tailored Care Management (TCM) and External TCM providers serving Innovations members will not be required to submit updates to ISPs or corrected budgets unless providers of Specialized Consultative Services (SCS) indicate a need for more than 7 units of services per month effective July 1, 2026 forward.
What is not impacted?
Partners will not be reducing rates for procedure codes listed that are billable to State Benefit. Please note that if members receive retroactive Medicaid coverage, claims will be processed at the Medicaid rate.
Who can providers contact if they have questions?
Depending on the topic/question, if providers have questions, they can:
- Email Rates@PartnersBHM.org for rate-related questions.
- Email ClaimsDepartment@PartnersBHM.org for claims questions.
- Email Provider Relations at PNRelations@partnersbhm.org.