Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street Boston, MA  02111 www.state.ma.us/dma
MassHealth
Community Health Center Bulletin 47 April 2001
TO:   Community Health Centers Participating in MassHealth FROM:   Wendy E. Warring, Commissioner RE:   HCFA Common Procedure Coding System (HCPCS) Update

Introduction

The federal government has revised the HCFA Common Procedure Coding System (HCPCS) for MassHealth billing.
The purpose of this bulletin is to inform community health centers that the Division will cover the service codes listed later in this bulletin for dates of service provided on or after May 1, 2001. Descriptions for these service codes must be obtained using the American Medical Association’s 2001 Current Procedural Terminology (CPT) manual.

Payment

These covered services are in addition to the list of covered services located in Subchapter 6 of the Community Health Center Manual. In accordance with Division regulations, payments are subject to the terms and conditions of 130 CMR 405.000 and 450.000.

Payment Requirements

Payment for these new codes will be determined through individual consideration (I.C.) until the Division of Health Care Finance and Policy establishes specific rates and these rates are incorporated into the appropriate regulation. All claims using the service codes listed in this bulletin must be submitted on paper with a report. The Division will deny any claims submitted electronically because payment is determined from the physician’s descriptive report. If the documentation is illegible or incomplete, or if no report is submitted, the Division will deny the claim with the applicable error code.

MassHealth
Community Health Center Bulletin 47
April 2001
Page 2

Payment
Requirements
(cont.)

A radiology report with the radiologist interpretation must accompany the claim for procedures designated for individual consideration. The Division will determine the appropriate payment based on the documentation that is submitted to support the use of the service code. If the documentation is illegible or incomplete, or if no report is submitted, the Division will deny the claim with the applicable error code.

Questions	If you have any questions, please contact the MassHealth Provider
Services Department at (617) 628-4141 or 1-800-325-5231.

MassHealth
Community Health Center Bulletin 47
April 2001
Page 3
2001 MassHealth Service Code Additions
The following service codes are covered under individual consideration until the Division of Health Care Finance and Policy establishes specific rates and these rates are incorporated into the appropriate regulation. Refer to the 2001 American Medical Association’s Current Procedural Terminology manual for service code descriptions.

70496	70547	73206	73719	75952	
70498	70548	73218	73722	75953	
70542	70549	73219	73723	76012	
70543	71275	73222	74175	76013	
70544	72191	73223	74182	76393	
70545	72195	73706	74183	76819	
70546	72197	73718	75635