Latest ICD-10 Update
MassHealth implemented ICD-10 on October 1, 2015. Transactions that contain ICD codes submitted to MassHealth with dates of service or dates of discharge on or after October 1, 2015, must contain ICD-10 codes.
Reminder: When submitting claims transactions, please be sure to
- Include the ICD qualifier on all claims to differentiate between ICD-9 and ICD-10 claim submissions.
- Use the appropriate code set on transactions. This must be based upon the date of service or date of discharge.
- Ensure that you are using diagnosis and procedure codes that are compatible to the ICD version submitted.
- Include ICD-10 codes on all electronic and paper Prior Authorization (PA) requests.
To ensure a smooth transition to ICD-10, please use the resources below. If you experience any issues with the transition to ICD-10, please contact the MassHealth Customer Service Center at 1-800-841-2900 or via e-mail at firstname.lastname@example.org. (For previous updates listed under Provider Information, click here )
On January 16, 2009, the Department of Health and Human Services (HHS) published a final rule on the ICD-10-CM/PCS, requiring all HIPAA-covered entities to adopt the ICD-10 diagnosis and inpatient procedure codes by October 1, 2013. Because of industry readiness concerns, the final rule was modified on September 5, 2012, to delay the adoption of the code set until October 1, 2014. Subsequently, in July, 2014, the Protecting Access to Medicare Act of 2014 (H.R. 4302) mandated that HHS cannot adopt the ICD-10 code set as the standard before October 1, 2015. Effective for dates of service on or after the ICD-10 implementation date, claims submitted to MassHealth must include the ICD-10 diagnosis codes. In addition, claims for inpatient services with a date of discharge on or after the implementation date must be billed with the new ICD-10 diagnosis and inpatient procedure code set.
The following table displays the high-level differences between ICD-9, ICD-10, and PCS codes.
|Diagnosis (CM)||13,000 codes||68,000 codes|
|3-5 Digits (Numeric)||3-7 Alphanumeric characters|
|Inpatient Procedure Coding System (PCS)||3,000 codes||72,081 codes|
|3-4 Digits (Numeric)||7 Alphanumeric characters|
Please Note: While the new ICD-10 codes will provide greater specificity through the expansion of the overall code set, providers will need to adopt only those codes that are relevant to their day-to-day operations.
The MassHealth ICD-10 web page will be used to communicate key information to providers related to the ICD-10 implementation. Providers should continue to monitor this page to view important MassHealth ICD-10 information as it becomes available.
Please refer to the links below for more information about ICD-10 implementation standards.
Billing Guides for Paper Claims Submitters
MassHealth has updated the following billing guides to support ICD-10 implementation.
- CMS-1500 Billing Guide
- UB-04 Billing Guide
- Residential Care Home Billing Guide for the UB-04
- Changes to 5010 and UB-04 Billing Guides
MassHealth has made draft changes to select provider manuals to support ICD-10 implementation.
MassHealth has updated the following forms to align with ICD-10 implementation.
- MassHealth Orthotic and Prosthetic Prescription and Medical Necessity Review Form for Therapeutic Shoes, Inserts, and Modifications [ORT-D]
MassHealth has updated the following job aids to support the implementation of ICD-10.
- MMIS POSC Job Aid: Institutional Claims Submission with MassHealth
- NewMMIS Job Aid: Professional Claim Submission with MassHealth
- NewMMIS Job Aid: Submit a Residential Care Home Claim
- NewMMIS Job Aid: Submit MMQ
Payment and Coverage Guideline Tools
MassHealth has updated the following tools to support the implementation of ICD-10
- MassHealth DME and Oxygen Payment and Coverage Guidelines Tool file size 3MB file size 2MB
MassHealth Provider bulletins issued to support the implementation of ICD-10.
- All Provider Bulletin 253: Transition to ICD-10
- All Provider Bulletin 249: ICD-10 Implementation Readiness
- All Provider Bulletin 248: Information about ICD-10
- All Provider Bulletin 241: Information about ICD-10-CM/PCS
- All Provider Bulletin 228: Information about ICD-10-CM/PCS
MassHealth is committed to providing ICD-10 information and educational materials to the provider community to support the implementation of ICD-10.
- ICD-10 Implementation Readiness Checklist
- ICD-10 Provider FAQs
- ICD-10 EDI Frequently Asked Questions
- ICD-10 Key Concepts
- ICD-10 EOB Edits
- MassHealth ICD-10 Implementation Presentation
- MassHealth ICD-10 Vendor Testing
- MassHealth Previous ICD-10 Updates
- Most Common ICD-10 Trading Partner File Submission Errors
- Tips for Submitting ICD-10 Test Files to MassHealth