Update to the Primary Care Clinician Plan & Primary Care ACO Referral Requirements – Exemption for Prosthetic and Orthotic Services

Effective August 1, 2025, MassHealth has added prosthetic and orthotic services to the list of services exempt from PCC referral requirements for members enrolled in the Primary Care Clinician (PCC) plan or a Primary Care Accountable Care Organization (Primary Care ACO). For claims with dates of service on and after August 1, 2025, prosthetic and orthotic services do not require a PCC referral for members enrolled in the PCC plan or a Primary Care ACO.

For more information and for the updated list of Exceptions to Services Requiring Referrals, please refer to All Provider Bulletin 406: Update to Certain Exceptions to Services that Require Referrals in the Primary Care Clinician Plan and Primary Care ACOs at https://www.mass.gov/lists/all-provider-bulletins.

If you have questions regarding this guidance, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.