~ 


ConunoruDealth ofMossachusettsfl! Executive O.ffice ofHealth 
and Human Sen1ices

~ 

~ Division ofMedical Assistance

\l.~

. 60Q Washington Street 

Boston, MA 02111 

Medical Assistance Program 

Municipally Based Health Services 
Bulletin 2 

September 1995 

TO: Municipally Based Health Services Providers Participating in the Medical AssistanceProgram 

FROM: Bruce M. Bullen, commissioner.-e·\fI·~ 

RE: NEW SERVICE CODE AND WEEKLY RATE FOR 502.8 STUDENTS 

New Service Code and 
Rate for 502.8 
Students 

The Division has determined a rate for municipally based health 
services providers to bill for 502.8 special education students effective 
september 1, 1995. This rate is subject to future adjustment by the 
Division. The total rate for 502.8 students is $106.06 per week. 
Municipal Medicaid providers should bill for this service using the federal 
share amount of $53.03 as the "usual fee", and using Service Code 
X7668. The federal share amount is 50 percent of the weekly rate for 
Service Code X7668. 

Programs That Provide 
Services to 502.8 
Students 
This prototype represents children (as described in Section 502.8 of 
the Chapter 766 Regulations of the Department of Education (603 CMR 
28.00)) who participate in the Early Childhood Program. These early 
childhood programs fall into three subcategories: 
~ Type A programs consist of specialized services such as speech, 
physical, and occupational (fine motor) therapies provided to 
children in their homes by school personnel. 
~ Type B programs provide health related and educational services to 
children in integrated center-based programs where special 
education children make up less than 50 percent of the classroom. 
~ Type C programs provide services similar to Type B programs, yet 
do so in separate center-based programs where more than 50 
percent of the children are special education students. 

Claims Submission In order for a provider to seek reimbursement of the federal share 
amount of the total rate for students classified as Prototype 502.8, the 
student must be in attendance for a minimum of one day during the 
week claimed. The provider will bill the weekly rate by writing the Friday 
date of the claimed week in the "from" field of Item 26 of the claim form 
no. 9. Each Friday date entry will be one unit of service. 


Medical Assistance Program 
Municipally Based Health Services 

Bulletin 2 
september 1995 
Page 2 

Retroactive Billing Claims for service Code X7668 may be submitted for dates of service 
on and after september 1, 1995. Each claim must be received at 
Unisys within 24 months after the date of service. Claims received 
beyond the 24-month deadline are not eligible for reimbursement. 

Federal The federal share amount of the rate for this prototype will be returned 
Reimbursement to the city, town, or regional school district on a quarterly basis along 
with reimbursement for other claimed services. The disbursement is 
currently scheduled to occur during the fourth week of the months of 
April, July, October, and January. 

Questions If you have any questions concerning the information in this bulletin, 
please call the Provider services Unit at Unisys at (617) 628-4141 or 
1-800-325-5231 , or call the Division's Municipal Medicaid Program at 

(617) 348-5464.