MassHealth Guidelines for Medical Necessity Determination

Medical Necessity Determination Downloads

Absorbent Products (PDF)  file size 6MB

Ambulatory Infusion Pumps (Insulin Pumps) (PDF)  file size 4MB

Bariatric Surgery (PDF) 

Breast MRI (PDF)  file size 6MB

Breast Reconstruction (PDF)  file size 3MB

Breast Reduction (PDF) 

Capsule Endoscopy  file size 8MB

Cranial Orthosis (PDF)  file size 5MB

Enteral Nutrition Products (PDF)  file size 9MB

Gait Trainers (PDF)  file size 6MB

Hospital Beds (PDF) 

Mastectomy for Gynecomastia (PDF)  file size 8MB

Occupational Therapy (PDF)  file size 9MB

Organ Transplant Procedures (PDF)  file size 4MB

Panniculectomy (PDF) 

Physical Therapy (PDF)  file size 4MB

Speech and Language Therapy (PDF) 

Standers (PDF)  file size 4MB

Support Surfaces (PDF)  file size 3MB

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This information is provided by MassHealth.