Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.state.ma.us/dma 	
	MassHealth
	Acute Outpatient Hospital Bulletin 3
	November 2001

	TO:	Acute Outpatient Hospitals and Hospital Licensed Health Centers Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	 HCFA Common Procedure Coding System (HCPCS) Update 

Introduction	The Division will cover the service codes listed in the attachment to this bulletin for dates of service on or after December 1, 2001.

Providers may obtain descriptions for all service codes listed in the attachment from the American Medical Association’s (AMA) Current Procedural Terminology (CPT) manuals or, for Level II National Codes, from the Centers for Medicare and Medicaid Services (CMS).

Service Codes	Service codes listed in the attachment to this bulletin include new 2001
 		CPT and Level II codes and some CPT and Level II codes from years before 2001.  All service codes listed in the attachment are in addition to the list of covered service codes located in Subchapter 6 of the Acute Outpatient Hospital Manual.

Providers may use service codes listed in the attachment to bill on the UB‑92, the physician claim form no. 5, or both.  Providers may use these service codes to bill for:
•	the technical component of a service provided at an acute outpatient hospital;
•	the technical component of a service provided at a hospital-licensed health center; and
•	the professional component (hospital-based physician) of a service provided at an acute outpatient hospital or hospital‑licensed health center.

The attachment indicates: 
•	service codes that may be billed on the UB-92;
•	service codes that may be billed on claim form no. 5;
•	the Ambulatory Patient Group (APG) associated with each service code; and 
•	the specific revenue code or codes to bill on the UB-92.

 
Deleted	The Division will not pay any claim with a date of service on or after 
Service Codes	December 1, 2001, if the provider uses a CPT or Level II code that has 
	been deleted for 2001 by the AMA or CMS.

For Services Billed	Providers must claim payment for services billed on the UB-92 in 
on the UB-92	accordance with the billing instructions in Subchapter 5 of the Acute Outpatient Hospital Manual.

The Division will pay for services billed on the UB-92 claim form at rates determined in accordance with the Ambulatory Patient Groups (APG) methodology described in the current Acute Hospital Request for Application (RFA), except as otherwise specified in the RFA and contract.  

For Services Billed	Providers must claim physician payment for services billed on claim 
on the Physician	form no. 5 in accordance with the billing instructions in Subchapter 5
Claim Form No. 5 	of the Acute Outpatient Hospital Manual.

The Division will continue to pay for physician services according to the methodology described in the current Acute Hospital Request for Application.  Payment for the 2001 codes will be determined through the individual consideration (I.C.) process until the Division of Health Care Finance and Policy establishes specific rates and these rates are incorporated into the appropriate regulations.  The I.C. process is described in the Physician Manual at 130 CMR 433.406. 

Providers must submit all physician claims using the 2001 service codes on paper claim forms.  Providers must submit a physician’s descriptive report as described in the Physician Manual at 130 CMR 433.410 with the paper claim.  The Division will deny any electronically submitted claim that uses the new 2001 service codes. 

The Division will determine payment based on the physician’s descriptive report.  If documentation is illegible or incomplete, or if no report is submitted, the Division will deny the claim and cite the applicable error code.

Questions	Contact MassHealth Provider Services at 617‑628‑4141 or 
	1‑800‑325‑5231with any questions about this bulletin.

Newly Covered Service Codes for Acute Outpatient Hospitals
(All service codes in bold are new 2001 CPTs and Level II codes.)	
UB‑92	Claim Form 5	Service Code	APG Assigned	Revenue Codes for UB‑92 Billing	
Yes	No	J2770	395	636	
Yes	No	J7520	395	636	
Yes	No	J7525	395	636	
Yes	No	J8700	395	636	
Yes	No	J9160	395	636	
Yes	No	J9180	395	636	
Yes	No	J9219	395	636	
Yes	No	J9310	393	636	
Yes	Yes	15342	009	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	15343	009	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	16036	003	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	19102	002	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	19103	002	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	19295	011	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	30465	234	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	31624	055	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	35472	077	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	36870	080	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	38241	094	360. 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	43231	115	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	43232	115	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	43240	116	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	43242	116	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	43256	116	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	44370	118	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	44379	118	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	44383	118	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	44397	117	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	45327	114	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	45341	113	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	45342	113	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	45345	113	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	45387	117	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	47379	124	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	49650	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	50545	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	50947	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	50948	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	50949	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52341	135	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52342	135	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52343	135	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52344	134	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52345	135	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52346	134	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52351	135	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52352	134	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52353	135	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52354	136	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52355	134	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52400	134	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	54512	151	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	54522	151	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	54690	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	55873	137	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	57022	176	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	57023	176	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	57287	176	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	58353	176	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	62252	196	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	64614	195	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	64886	198	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	66982	214	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	67221	211	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	69714	234	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	69715	234	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	69717	234	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	69718	234	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	70336	306	610	
Yes	Yes	70496	307	351	
Yes	Yes	70498	307	351	
Yes	Yes	70542	306	351	
Yes	Yes	70543	306	610	
Yes	Yes	70544	306	610	
Yes	Yes	70545	306	610	
Yes	Yes	70546	306	610	
Yes	Yes	70547	306	610	
Yes	Yes	70548	306	610	
Yes	Yes	70549	306	610	
Yes	Yes	71275	307	352	
Yes	Yes	72191	307	352	
Yes	Yes	72195	306	610	
Yes	Yes	72197	306	610	
Yes	Yes	73206	307	350	
Yes	Yes	73218	306	610	
Yes	Yes	73219	306	610	
Yes	Yes	73222	306	610	
Yes	Yes	73223	306	610	
Yes	Yes	73706	307	350	
Yes	Yes	73718	306	610	
Yes	Yes	73719	306	610	
Yes	Yes	73722	306	610	
Yes	Yes	73723	306	610	
Yes	Yes	74175	307	352	
Yes	Yes	74182	306	610	
Yes	Yes	74183	306	610	
Yes	Yes	75635	307	352	
Yes	Yes	75894	077	320	
Yes	Yes	76005	310	320	
Yes	Yes	76012	255	320	
Yes	Yes	76013	255	352	
Yes	Yes	76005	310	320	
Yes	Yes	76393	383	610	
Yes	Yes	76819	172	402	
Yes	No	77522	252	333	
Yes	No	77525	252	333	
Yes	No	80157	354	300	
Yes	No	80173	354	300	
Yes	No	82373	348	301	
Yes	No	82945	349	301	
Yes	No	83090	346	301	
Yes	No	83663	331	301	
Yes	No	83664	331	301	
Yes	No	83921	348	301	
Yes	No	84152	349	301	
Yes	No	84591	354	301	
Yes	No	85307	348	305	
Yes	No	85536	358	305	
Yes	No	86001	343	302	
Yes	No	86146	348	302	
Yes	No	86294	344	302	
Yes	No	86300	344	302	
Yes	No	86301	344	302	
Yes	No	86304	344	302	
Yes	No	86611	344	302	
Yes	No	86666	344	302	
Yes	No	86683	343	302	
Yes	No	86696	344	302	
Yes	No	86757	344	302	
Yes	No	87046	345	306	
Yes	No	87071	345	306	
Yes	No	87073	344	306	
Yes	No	87077	344	306	
Yes	No	87107	344	306	
Yes	No	87149	345	306	
Yes	No	87152	344	306	
Yes	No	87168	345	306	
Yes	No	87169	345	306	
Yes	No	87172	345	306	
Yes	No	87185	344	306	
Yes	No	87254	344	306	
Yes	No	87273	342	306	
Yes	No	87275	342	306	
Yes	No	87277	342	306	
Yes	No	87279	342	306	
Yes	No	87281	342	306	
Yes	No	87283	342	306	
Yes	No	87300	342	306	
Yes	No	87327	342	306	
Yes	No	87336	342	306	
Yes	No	87337	342	306	
Yes	No	87339	342	306	
Yes	No	87341	342	306	
Yes	No	87400	342	306	
Yes	No	87427	342	306	
Yes	No	87451	342	306	
Yes	No	87800	341	306	
Yes	No	87801	341	306	
Yes	No	87901	341	306	
Yes	No	87903	341	306	
Yes	No	87904	341	306	
Yes	No	88400	348	312	
Yes	No	89321	332	309	
Yes	Yes	90740	374	636	
Yes	Yes	90743	374	636	
Yes	Yes	92586	194	470	
Yes	Yes	93016	071	480	
Yes	Yes	93017	071	480	
Yes	Yes	93556	076	480	
Yes	Yes	93668	272	480	
Yes	Yes	97532	297	421, 431	
Yes	Yes	97533	287	421, 431	
Yes	Yes	99195	093	360, 361, 450, 456, 459, 490, 499, 510, 519, 761