CurrentMass General Brigham Health PlanPolicy N/A

Health-Related Social Needs (HRSN) services reimbursement

Governs reimbursement to contracted providers for covered, medically necessary Health-Related Social Needs (HRSN) services for MassHealth ACO members, including service definitions, billing guidance, and unit limits.

Policy Summary

PayerMass General Brigham Health Plan

PolicyHealth-Related Social Needs (HRSN) services reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2025

Next Review DateN/A

Key ActionWhen submitting claims, include required modifiers and documentation; claims are subject to audit and may be denied if services are incidental, mutually exclusive, integral, or lack required modifiers.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2025-01-01document original date

12Housing Search max units

Up to 21Meals per week

1/moFood boxes max

Thru 12/31/2027Availability timeframe

Coverage Criteria for HRSN Services

Policy Summary

PayerMass General Brigham Health Plan

PolicyHealth-Related Social Needs (HRSN) services reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2025

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage criteria for HRSN services

Covered when ALL of the following conditions are met:

ALL of the following

Member must be enrolled in a MassHealth ACO
Eligibility determined by enrollment files and the member's benefit plan
Service must be defined as a covered HRSN service for the member's benefit plan and meet MassHealth HRSN criteria

ALL of the following

Provider must be contracted with Mass General Brigham Health Plan and meet MassHealth provider qualifications for HRSN services
Provider must follow plan provider payment guidelines and documentation requirements

ALL of the following

Each reimbursable HRSN service must be billed with the listed procedure code and applicable diagnosis code(s)
When billing multiple units, providers must include date ranges for the timeframe in which services were rendered

ALL of the following

Reimbursement follows plan network/contracted rates and is subject to payment edits that are updated regularly
Coverage and payment are determined by the member's benefit plan and the provider's agreement with the plan

ALL of the following

Claims are subject to review and audit; medical records may be requested to substantiate services
Services considered incidental, mutually exclusive, integral to the primary service, or part of a global allowance are not eligible for separate reimbursement
The absence or presence of required modifiers may result in differential payment or denial

Reimbursable Codes and Unit Limits

Covered HRSN CodesmixedCovered

T2038-UD	Housing Search
HO044	Transitional Goods
T2050	Housing Navigation Services
T2050-U1	Housing Navigation Goods
S5170-U6	Medically Tailored Home Delivered Meals
S9452	Nutrition Education Classes
S9452-U2	1:1 Nutrition Education
S9452-U6	Nutrition Counseling
s9977-U6	Medically Tailored Food Boxes
S9977-U9	Medically Tailored Food Prescriptions and Vouchers

Unit definitions, limits, and frequency

T2038-UD (Housing Search)1 unit = 30 days; maximum 1 unit per 30 days; maximum 12 units total per member; available once through 12/31/2027.

HO044 (Transitional Goods)1 unit = 1 receipt for goods; multiple units allowed until member reaches MassHealth defined dollar limit or 6 months of service; when billing >1 unit include date range; available once through 12/31/2027.

T2050 (Housing Navigation Services)1 unit = 30 days; maximum 1 unit per 30 days; up to 6 units per member total; when billing >1 unit include date range; available once through 12/31/2027.

T2050-U1 (Housing Navigation Goods)1 unit = 1 receipt for goods; multiple units allowed only when member concurrently receives T2050 and until MassHealth dollar limit or Housing Navigation Services ends (six-month maximum); include date range when billing >1 unit.

S5170-U6 (Medically Tailored Home Delivered Meals)1 unit = 1 individual meal; up to 21 units per member per week; available once through 12/31/2027.

s9977-U6 (Medically Tailored Food Boxes)1 unit = 30-day supply of food boxes; maximum 1 unit per month per member.

Claims, Reimbursement, and Audit Guidance

Documentation Required

Claims review and audit — provider responsibilities

Mass General Brigham Health Plan reviews all claims to determine eligibility for payment. Services that are incidental, mutually exclusive, integral to the primary service rendered, or included in a global allowance are not eligible for separate reimbursement. All claims are subject to audit and medical records may be requested from the provider. Providers should maintain complete documentation and submit records promptly when requested to support medical necessity and correct coding.

Services considered incidental, mutually exclusive, integral to the primary service, or part of a global allowance are not reimbursable separately.
All claims are subject to audit; medical records may be requested to substantiate billing.
Maintain complete documentation and respond promptly to record requests to avoid denials or recoupment.

Billing Rule

Reimbursement determination — billing and coding requirements

Providers are reimbursed according to the plan's network or contracted rates. Claims are subject to payment edits that are updated regularly. Coverage and reimbursement depend on the member's benefit plan and the provider's agreement with Mass General Brigham Health Plan. Use the current CPT, HCPCS Level II, and ICD-10-CM code sets and apply CMS/CPT guidance for modifier usage; omission or incorrect use of modifiers may result in payment differences or denial.

Reimbursed at contracted/network rates per provider agreement.
Claims subject to regular payment edits and systems updates.
Coverage and payment depend on the member's benefit plan.
Follow current CPT, HCPCS, and ICD-10-CM code sets and CMS/CPT modifier guidance.

Definitions

HRSN Services — definition and scope

DefinitionHealth-Related Social Needs (HRSN) Services are a standard set of services developed by MassHealth to address immediate daily necessities arising from social determinants of health (e.g., lack of stable housing, healthy food, utilities, transportation, safety, education, employment, and social connection).

ScopeServices address basic needs such as food and housing and include specified service types with criteria (member eligibility, provider qualifications) and unit limits.

Effective timeframeAvailable beginning in 2025 for ACO-enrolled members per MassHealth HRSN program rules.

Service elementsEach HRSN service includes a service code, description, diagnosis code(s), and maximum units/timeframe as defined by MassHealth.