Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
 Subchapter Number and Title 
Table of Contents 
 Page 
vi 
 
Adult Day Health Manual 
 Transmittal Letter 
ADH-25 
 Date 
03/01/10 
 
6.  Service Codes and Descriptions 
 
 Service Codes and Descriptions: Adult Day Health Services ..................................................... 6-1 
 Service Codes and Descriptions: Transportation Services .......................................................... 6-1 
 
Appendix A.  Directory............................................................................................................................. A-1 
 
Appendix B.  Enrollment Centers.............................................................................................................. B-1 
 
Appendix C.  Third Party Liability Codes................................................................................................. C-1 
 
Appendix D.  Dementia Day Services....................................................................................................... D-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 and Messages................................................................................................... Y-1 
 
Appendix Z.  EPSDT/PPHSD Screening Services Codes ........................................................................ Z-1