Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	
	MassHealth
	Acute Outpatient Hospital Bulletin 5
	March 2002

	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	For dates of service on or after April 30, 2002, the Division will cover the service codes listed in the attachment to this bulletin.

For the descriptions of all the service codes listed on the attachment, providers should consult the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) manuals.

Service Codes	The service codes listed in the attachment include new 2002 HCPCS 
Attachment	codes and some HCPCS codes from before 2002.   The service codes
		on the attachment are not an exhaustive list; they are an addition to the list of covered service codes located in Subchapter 6 of the Acute Outpatient Hospital Manual.

The service codes on the attachment are for use on the UB‑92, physician claim form no. 5, or both.  Providers should 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, including an indicator (“PA”) if the service requires prior authorization from the Division;
•	the Ambulatory Patient Group (APG) associated with each service code; and 
•	the specific revenue code or codes to bill on the UB-92.

 
Deleted Service Codes	The Division will not pay any claim with a date of service on or after April 30, 2002, if the provider uses a HCPCS code that has been deleted for 2002.

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

The Division will pay for these services 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.  

Services Billed	For physician services billed on claim form no. 5, providers must claim 
on Physician	payment 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.

Questions	For questions about this bulletin, providers should contact MassHealth Provider Services at 617‑628‑4141 or 1‑800‑325‑5231.

Service Codes Added to Subchapter 6 of the Acute Outpatient Hospital Manual
Effective for claims with dates of service on or after April 30, 2002
(All Service Codes in bold are new 2002 HCPCS codes.)	
UB‑92	Claim Form 5	Service Code	APG Assigned	Revenue Codes for UB‑92 Billing	
Yes	Yes	10021	002	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	10022	002	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	11981	003	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	11982	006	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	11983	006	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	20526	035	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	20551	035	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	20552	035	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	20553	035	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	24300	031	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	24332	022	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	24343	002	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	24344	021	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	24345	021	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	24346	021	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25001	024	360. 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25024	022	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25025	022	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25259	031	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25275	021	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25394	023	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25430	023	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25431	030	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25651	030	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25652	030	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	25671	030	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	26340	030	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29086	028	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29805	025	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29806	025	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29807	025	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29824	025	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29900	025	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29901	025	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29902	025	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	29999	025	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	35647	080	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	35685	080	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	35686	080	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	38220	002	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	38221	002	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	44204	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	44205	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	45136	122	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	46020	421	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	47370	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	47371	123	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	47382	122	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	49491	119	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	49492	119	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52001	135	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	52347	135	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	53431	137	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	53444	138	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	53446	138	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	53448	138	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	53853	138	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	54162	154	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	54163	154	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	54164	154	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	54406	153	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes/PA	54408	153	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes/PA	54410	153	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes/PA	54411	153	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	54415	153	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes/PA	54416	153	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes/PA	54417	153	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	57155	177	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	58346	177	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	59001	171	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	64561	197	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	64581	197	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	64821	198	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	64822	198	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	64823	198	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	67225	217	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	69799	235	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	76645	305	402	
Yes	No	77336	333	333	
Yes	Yes	77427	421	333	
Yes	No	82274	421	301	
Yes	No	83950	331	301	
Yes	No	86141	348	302	
Yes	No	87198	344	306	
Yes	No	87199	344	306	
Yes	No	87802	344	306	
Yes	No	87803	344	306	
Yes	No	87804	334	306	
Yes	No	87902	344	306	
Yes	No	88380	331	311	
Yes	Yes	90473	376	771	
Yes	Yes	90474	376	771	
Yes	No	90939	255	821	
Yes	Yes	91123	121	750	
Yes	Yes	92136	211	510, 519	
Yes	Yes	92973	077	480	
Yes	Yes	92974	253	480	
Yes	Yes	93025	385	730	
Yes	Yes	93555	076	481	
Yes	Yes	93613	421	480	
Yes	Yes	93701	385	921	
Yes	Yes	95250	348	309	
Yes	Yes	96400	092	331	
Yes	Yes	96408	092	335	
Yes	Yes	96410	092	335	
Yes	Yes	96412	091	335	
Yes	Yes	96414	091	335	
Yes	Yes	96520	092	335	
Yes	Yes	96530	092	335	
Yes	Yes	96545	421	335	
Yes	Yes	96549	092	335	
Yes	Yes	99195	093	360, 361, 450, 456, 459, 490, 499, 510, 519, 761	
Yes	Yes	99218	422	762	
Yes	Yes	99219	422	762	
Yes	Yes	99220	422	762	
Yes	Yes	99291	422	450, 456, 459	
Yes	Yes	99292	422	420, 456, 459