Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
Orthotics Manual 
Subchapter Number and Title 
Table of Contents 
Page 
vi 
Transmittal Letter 
ORT-23 
Date 
01/01/12 

6. Service Codes 

Introduction................................................................................................................................. 6-1 
Modifiers..................................................................................................................................... 6-1 
Service Codes.............................................................................................................................. 6-1 
Appendix A. Directory ..................................................................................................................... A-1 
Appendix B. Enrollment Centers ...................................................................................................... B-1 
Appendix C. Third-Party-Liability Codes ........................................................................................ C-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 and Messages ........................................................................................... Y-1 
Appendix Z. EPSDT/PPHSD Screening Services Codes ................................................................. Z-1