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 9
	September 2003

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

FROM:	Douglas S. Brown, Acting Commissioner

RE:	Updates to Payable and Nonpayable Services Provided to MassHealth Members

Introduction	The Division has recently completed a review of payable and nonpayable services provided to MassHealth members at acute outpatient hospitals (AOHs) and hospital-licensed health centers (HLHCs).  These services are those that are billed on the UB-92 (or the electronic equivalent).  This review was in response to requests by Massachusetts hospitals.

Payable Codes	The Division has reconsidered a variety of services that previously have not been payable to AOHs and HLHCs for claims billed on the UB-92.  For dates-of-service on or after July 1, 2003, services listed in Attachment A are payable to AOHs and HLHCs.  Hospitals that have billed for any of these services with dates of service on and after July 1, 2003, and have had claims deny, may resubmit them for payment.

	Attachment A lists these services using the HCFA Common Procedural Coding System (HCPCS).  Attachment A also indicates with which revenue codes the HCPCS must be billed.  Billing combinations other than those on Attachment A will result in a denied claim.

Nonpayable 	The review also identified some services that will no longer be payable by
Codes	the Division to AOHs and HLHCs for services billed on the UB-92.  These codes will no longer be payable to AOHs and HLHCs for services provided to MassHealth members for dates of service on or after November 1, 2003.

Attachment B lists these services by HCPCS. 

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Other 				Hospitals are reminded that they will only be reimbursed for hospital
Information	services specified in Subchapter 6 of the Acute Outpatient Manual, except for services provided to MassHealth Standard members under age 21. Providers should refer to the Early and Periodic Screening, Diagnosis and Treatment regulations and the Prior Authorization regulations in the Division’s All Provider Manual at 130 CMR 450.00 et seq.

Questions	Providers with questions about this bulletin, should contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.