Primary diagnosis restrictions removed for certain Community Support Programs

MassHealth has removed primary diagnosis restrictions for two MassHealth Specialized Community Support Programs: Chronically Homeless Individuals  and Tenancy Preservation Program. This means members experiencing housing transitions or at risk of homelessness or eviction can now access these programs regardless of their primary diagnosis. 

These specialized services address health-related social needs involving housing instability, homelessness and criminal justice involvement. Services are provided by community-based, mobile paraprofessional staff to members with behavioral health disorder diagnoses that interfere with their ability to access essential medical services or other basic needs.

Updated billing requirements

Claims with dates of service prior to Jan. 1, 2025, are processed and billed following the primary diagnosis.  For dates of service on or after Jan. 1, 2025, claims should be billed as follows:

Chronically Homeless Individuals

Use H2016 + HE/HK Modifier 

Requires Z59.0 (Homelessness, unspecified) to be billed in secondary diagnosis position

Tenancy Preservation Program 

Use H2016 + HE modifier

Requires Z59.811 (housing instability; housed with risk of homelessness) to be billed in secondary diagnosis position

Note: Providers must have an active contract with the Department of Housing and Community Development or Mass Housing to provide tenancy preservation program services

Help members find you

To add your Area of Expertise for Community Support Programs, you’ll need to log in to the Provider Express secure portal. You can attest to your care expertise under My Practice Info > Clinician Information.

Not sure who qualifies for CSP?  Review the MassHealth Guidelines for Medical Necessity Determination.