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 6
	March 2003

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

	FROM:	Douglas S. Brown, Acting Commissioner

	RE:	HCFA Common Procedure Coding System (HCPCS) Update

Introduction	For dates of service on or after April 1, 2003, the Division will cover the service codes listed in the attachment to this bulletin for acute outpatient hospitals.

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

Service Codes	The service codes listed in the attachment include new 2003 HCPCS. 
Attachment	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 (“P.A.”) 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 1, 2003, if the provider uses a HCPCS code that has been deleted for 2003 or earlier.

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.