Commonwealth of Massachusetts 
MassHealth 
Provider Manual Series 
Subchapter Number and Title 
Table of Contents 
Page 
vi 
Psychiatric Inpatient Hospital Manual 
Transmittal Letter 
PIH-21 
Date 
12/01/12 

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 U. DPH-Designated Serious Reportable Events That Are Not Provider 


Preventable Conditionss 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 

	Z-1