Latest ICD-10 Update
MassHealth will implement ICD-10 on October 1, 2015. We are dedicated to ensuring a smooth transition to the new code set. We have modified our systems and business operations to comply with the federally mandated transition to the International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). Please ensure that you are ready to implement ICD-10 as required. Please click here to be directed to the Official CMS Countdown to the October 1, 2015 Compliance Date Clock.
MassHealth will no longer accept test files from providers or vendors after August 31, 2015. We will use the month of September to resolve any remaining testing issues before implementation. If you submit batch claims transactions to MassHealth, or if you use a software vendor, billing intermediary, or clearinghouse to submit transactions on your behalf, it is critical to test your ICD-10 transactions with MassHealth before implementation. Your test file must be received no later than August 31, 2015. Testing in advance of implementation will ensure that transactions will be accepted for processing on or after October 1, 2015. If transactions are not tested they may fail at implementation, which could have a financial impact to your organization.
MassHealth is currently conducting a series of ICD-10 information, education, and training sessions in-person and by webinar through early fall. These sessions provide an overview of MassHealth’s implementation plans, Provider Online Service Center (POSC) modifications, and provider preparedness for the October 1, 2015 cutover. Please visit www.masshealthtraining.com to register for one of the upcoming sessions. For live events in your community, register under the Live Events tab. (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 (ICD-10 DRAFT)
- Residential Care Home Billing Guide for the UB-04 (ICD-10 DRAFT)
- Changes to CMS-1500 and UB-04 Billing Guides (ICD-10 DRAFT)
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 (Draft 04/14)]
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 2MB file size 1MB
MassHealth Provider bulletins issued to support the implementation of 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