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
TRANSMITTAL LETTER ADH-16
December 2002
TO:      Adult Day Health Centers Participating in MassHealth
FROM:      Wendy E. Warring, Commissioner
RE:      Adult Day Health Manual (Revisions to Service Codes and Descriptions)

This letter transmits revisions to the Adult Day Health Manual service codes and descriptions to reflect the implementation of the Healthcare Insurance Portability and Accountability Act (HIPAA) of 1996. The revised Subchapter 6 is effective for dates of service on or after February 1, 2003. Subchapter 5, Billing Instructions, will be revised at a later date.
The Centers for Medicare and Medicaid Services (CMS) have revised the Healthcare Common Procedure Coding System (HCPCS) for 2002. New national service codes have been added, and MassHealth local codes have been removed from the Adult Day Health Manual. Please note that you must use a modifier with some codes to accurately reflect the service provided. The modifier must be entered directly after the service code in Item 28 of claim form no. 9 or its electronic equivalent. The attached Subchapter 6 contains codes with modifiers, where applicable.
I.	Adult Day Health Basic Level of Care
Effective for dates of service on or after February 1, 2003, the MassHealth local service code for adult day health basic level of care (X9841) has been replaced with HCPCS code S5102, day care services, adult, per diem.
II.	Adult Day Health Complex Level of Care
Effective for dates of service on or after February 1, 2003, the MassHealth local service code for adult day health complex level of care (X9845) has been replaced with HCPCS code S5102 with modifier TG (day care services, adult, per diem, complex/high tech level of care).
III.	Adult Day Health Health Promotion and Prevention Rate
Effective for dates of service on or after February 1, 2003, the MassHealth local service code for adult day health health promotion and prevention rate (X9844) has been replaced with HCPCS code S5102 with modifier U1.
IV.	Adult Day Health Transportation
Effective for dates of service on or after February 1, 2003, MassHealth local service code for transportation furnished on a single date or consecutive dates (X0091) has been replaced with HCPCS code T2003 (nonemergency transportation; encounter/trip).

MASSHEALTH
TRANSMITTAL LETTER ADH-16 December 2002 Page 2
V.	Transitional Payment Rate
The code for the transitional payment rate (X9842) will not change for the remaining months that the code is in effect. Pursuant to 130 CMR 404.414(D)(2), the Division will not cover the transitional payment rate for dates of service on or after August 1, 2003.
VI.	Crosswalk
Please find attached a crosswalk from the obsolete MassHealth local service codes and modifiers to the new national service codes and modifiers for the revised Subchapter 6.
VII.	Informational Bulletin from the Division of Health Care Finance and Policy
If you wish to obtain a copy of the Division of Health Care Finance and Policy’s Informational Bulletin 02-14 about the conversion of these codes, submit a request to the address or phone number listed below.
Division of Health Care Finance and Policy Two Boylston Street Boston, MA 02116 Telephone: 617-988-3100
You can also view this bulletin on line at www.mass.gov/dhcfp.
VIII.	Web Site Access and Questions
This transmittal letter and the adult day health regulations are available on the Division’s Web site at www.mass.gov/dma.
If you have any questions, please call MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Adult Day Health Manual
Pages 6-1 and 6-2
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Adult Day Health Manual
Pages 6-1 and 6-2 – transmitted by Transmittal Letter ADH-15

Transmittal Letter ADH-16
January 2003
Attachment
Crosswalk of MassHealth Service Codes for Adult Day Health Providers

Current ADH Service Code	New National ADH Service Code	Description	Effective Date	
X9841	S5102	Day care services; adult; per diem (adult day health-basic level of care)	02-01-03	
X9845	S5102-TG (modifier)	Day care services; adult; per diem (adult day health-complex level of care)	02-01-03	
X9844	S5102 –U1 (modifier)	Day Care services; adult; per diem (adult day health-HPPR)	02-01-03	
X0091	T2003	Nonemergency transportation; encounter/trip (adult day health-transportation)	02-01-03	

Current ADH local
code remaining
unchanged	New National ADH Service Code		Effective Date	

	Description	
	
X9842	Same	Transitional payment rate	11-01-02	

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ADULT DAY HEALTH MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-1	

	TRANSMITTAL LETTER
ADH-16	DATE
02/01/03	
601	Service Codes and Descriptions: Per Diem Services
Service
Code - Modifier    Service Description
S5102	Day care services, adult; per diem.	(Use for adult day health-basic level of care.)
S5102-U1	Day care services, adult; per diem.	(Use for adult day health-HPPR.)
S5102-TG	Day care services, adult; per diem.	(Use for adult day health-complex level of care.)
X9842	Transitional payment rate
602	Service Codes and Descriptions: Transportation Services
(See 130 CMR 404.413.)
Service
Code - Modifier    Service Description
T2003	Nonemergency transportation; encounter/trip. (Use for transportation furnished on a
single date or on consecutive dates. Bill per one-way trip.)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
ADULT DAY HEALTH MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-2	

	TRANSMITTAL LETTER
ADH-16	DATE
02/01/03	
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