Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
Table of Contents  
Page
vi
Acute Outpatient Hospital Manual
Transmittal Letter
AOH-29
Date
07/01/12

6.	Service Codes

	Introduction		6-1
	Nonpayable CPT Codes 		6-1
	Payable Level II HCPCS Codes		6-11
	Modifiers			6-12

Appendix A. Directory		A-1

Appendix B. Enrollment Centers		B-1

Appendix C. Third-Party-Liability Codes		C-1

Appendix D. Utilization Management Program		D-1

Appendix E. Admission Guidelines		E-1

Appendix F. Revenue Codes		F-1

Appendix U. DPH-Designated Serious Reportable Events That Are Not Provider Preventable 
Conditions………………………………………………………………………………	U-1

Appendix V. MassHealth Billing Instructions for Provider Preventable Conditions……………….	V-1

Appendix W. EPSDT Services:  Medical and Dental Protocols and Periodicity Schedules		W-1

Appendix X. Family Assistance Copayments and Deductibles		X-1

Appendix Y. EVS Codes/Messages		Y-1

Appendix Z. EPSDT/PPHSD Screening Services Codes		Z-1