Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
6. Service Codes and Descriptions
Page
vi
Community Health Center Manual
Transmittal Letter
CHC-95
Date
07/01/12

6.  Service Codes and Descriptions

Introduction and Explanation of Abbreviations			6-1
Payable Radiology Service Codes 				6-1
Payable Laboratory Service Codes 				6-4
Payable Visit Service Codes					6-9
Payable Obstetrics Service Codes				6-11
Payable Surgery Service Codes					6-11
Payable Nurse-Midwife Service Codes				6-12
Payable Audiology Service Codes					6-12
Payable Early and Periodic Screening, Diagnosis and 
Treatment (EPSDT): HealthAssessment Service Codes 		6-12
Payable Early and Periodic Screening, Diagnosis and 
Treatment (EPSDT): Audiometric
Hearing and Vision Test Service Codes 				6-13
Payable Tobacco Cessation Service Codes 			6-13
Payable Medical Nutrition Therapy and Diabetes 
Self-Management Training Service Codes 				6-14
Payable Behavioral Health Screening Tool Service Codes		6-14
Modifiers							6-15

Appendix A.	Directory					A-1

Appendix B.	Enrollment Centers				B-1

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

Appendix D.	Supplemental Instructions for TPL Exceptions	D-1

Appendix E.	Utilization Management Program			E-1

Appendix F.	Admission Guidelines				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