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January 2026 Top of Mind
Additional diagnostic codes are now covered for Downs syndrome ABA services
Effective Jan.1, 2026, Massachusetts requires coverage of Applied Behavior Analysis (ABA) services for all Commercial and MassHealth (Medicaid) plan members diagnosed with Down syndrome to include additional diagnostic codes/conditions. Down syndrome is a genetic condition that often results in mild to moderate intellectual disabilities and those receiving early interventions like ABA can experience improved communication and daily living skills resulting in more fulfilling independent living.
What service codes are now included in ABA coverage?
Diagnostic Code |
Condition |
Q90.0 |
Trisomy 21, non-mosaicism |
Q90.1 |
Trisomy 21, mosaicism |
Q90.2 |
Trisomy 21, translocation |
Q90.9 |
Down syndrome, unspecified |
What you need to do
Verify member benefits prior to rendering services by logging in to the Provider Express secure portal > Eligibility and Benefits or calling the customer service number on the back of the member ID card.
Use the correct service code when submitting claims.
Update Area of Expertise in your Provider Express profile. Keeping your provider profile current helps members find you when seeking ABA services.
Log in to the Provider Express secure portal > My Practice Info > Area of Expertise.
Other helpful resources
Mass General Brigham Health Plan Provider Manual Addendum - January 2026
