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 7
	September 2003

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

	FROM:	Douglas S. Brown, Acting Commissioner

	RE:	Revisions to Service and Revenue Codes

Introduction	In March 2003, the Division issued Acute Outpatient Hospital Bulletin 6  (HCFA Common Procedure Coding System (HCPCS) Update).  Three service codes and one revenue code were listed incorrectly in the bulletin.  

Corrections	The Division has identified the following service and revenue codes that need correction:

•	Service Codes 76496, 76497, and 76498 were incorrectly listed as covered services. These services are not payable by the Division.
•	Revenue code 451 appeared several times on the attachment. This was an error and all entries of 451 have been changed to revenue code 456.
			
			The Division has attached a corrected list to this bulletin.

Service Codes	For dates of service on or after April 1, 2003, the Division will cover the 
Attachment 	services for 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.

		The service codes listed in the attachment include new 2003 HCPCS. 
		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.
	
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Service Codes 	Hospitals will be reimbursed for only those hospital services specified in
Attachment	Subchapter 6 of the Acute Outpatient Hospital Manual, except for those
(cont.)		services provided to a MassHealth Standard member under age 21.  Providers should refer to the Early and Periodic Screening, Diagnosis and Treatment regulations at 130 CMR 450.000 et seq.

	The service codes on the attachment are for use on the UB‑92 (or the electronic equivalent), physician claim form no. 5 (or the electronic equivalent), 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.  
	
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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	Providers with questions about this bulletin, should contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.