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
	Diagnostic and Surgical Facility Bulletin 7
	July 2002

	TO:	Diagnostic and Surgical Facilities Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	Revised List of Service Codes and Descriptions (2001 and 2002 HCPCS)

Background	The Division of Health Care Finance and Policy has adopted rates for 
diagnostic and surgical facilities that are effective for services provided on or after April 30, 2002.  The rates for the new codes introduced under the 2002 HCPCS code book are effective for dates of service on or after
April 30, 2002.  The Division of Medical Assistance (Division) will accept either the new or the old codes for dates of service through July 28, 2002.  For dates of service on or after July 29, 2002, providers must use the new codes to receive payment.

	The Division will pay freestanding magnetic resonance imaging (MRI) 
centers only for the service codes listed in this bulletin.  Services must be provided in accordance with standards developed by the American College of Radiology (ACR).  The Division will review claims to identify whether the services were provided for the recommended clinical condition based on the ACR appropriateness criteria.

Billing Information		The Division of Health Care Finance and Policy has established a global 
rate, a professional component rate, and a technical component rate for each MRI or magnetic resonance angiography (MRA) service listed in this bulletin.  The Division will pay freestanding MRI centers either the global rate or the technical component rate of the service provided.  To bill for the technical component, add the modifier “TC” to the end of the service code on claim form no. 5.  The Division will pay the professional component of the service to physician providers only.

The Division will not pay freestanding MRI centers separately for paramagnetic contrast material (e.g., gadolinium).  Payment for paramagnetic contrast material is considered bundled into the payment for the MRI or MRA service.  

	

Individual				A number of service codes are designated as I.C. (individual 
Consideration (I.C.)		consideration) in the service descriptions of this bulletin.  A radiology 
report with the radiologist interpretation must accompany the freestanding MRI center’s claim form when billing for I.C. services.  The Division will determine appropriate payment for an individual-consideration service based on the documentation submitted to support the use of the service code.  If the documentation is illegible or incomplete, the Division will deny the claim with the appropriate denial code.

Prior 	The Division requires the physician ordering the MRI to obtain prior
Authorization (P.A.)	authorization for those services designated “P.A.” in the service 
descriptions of this bulletin.  No payment will be made for these services unless prior authorization has been obtained from the Division before the delivery of services.  The Division will not grant retroactive prior authorization requests.  A prior authorization determines only the medical necessity of the authorized service and does not establish or waive any other prerequisites for payment such as, but not limited to, member eligibility or the availability of other health-insurance payment.  To request prior authorization, physicians must follow the billing instructions in Subchapter 5 of the Physician Manual (Section 512).

Service Codes 	Freestanding MRI centers may bill the Division for either the global or 
for Freestanding	technical component of the following MRI/MRA scans.
MRI Centers	
	Service
	Code	Description 

	70336	Magnetic resonance (e.g., proton) imaging,
			temporomandibular joint(s) (P.A.)
	70540	Magnetic resonance (e.g., proton) imaging, orbit, face, and 
			neck; without contrast material(s)
	70542		with contrast material(s)
	70543		without contrast material(s), followed by contrast material(s) and further sequences
		70544	Magnetic resonance angiography, head; without contrast 
				material(s)
	70545		with contrast material(s)
	70546		without contrast material(s), followed by contrast 
			material(s) and further sequences
	
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Service Codes	Service
for Freestanding	Code	Description 
MRI Centers
(cont.)	70547	Magnetic resonance angiography, neck; without contrast 
			material(s)
	70548		with contrast material(s)
	70549		without contrast material(s), followed by contrast 
			material(s) and further sequences
70551	Magnetic resonance (e.g., proton) imaging, brain (including 
			brain stem); without contrast material
	70552		with contrast material(s)
	70553		without contrast material, followed by contrast
			material(s) and further sequences
	71555	Magnetic resonance angiography, chest (excluding 
			myocardium), with or without contrast material(s) (I.C.)
	72141	Magnetic resonance (e.g., proton) imaging, spinal canal 
			and contents, cervical; without contrast material
	72142		with contrast material(s)
	72146	Magnetic resonance (e.g., proton) imaging, spinal canal 
			and contents, thoracic; without contrast material
	72147		with contrast material(s)
	72148	Magnetic resonance (e.g., proton) imaging, spinal canal 
			and contents, lumbar; without contrast material
	72149		with contrast material(s)
	72156	Magnetic resonance (e.g., proton) imaging, spinal canal 
			and contents, without contrast material, followed by 
			contrast material(s) and further sequences; cervical
	72157		thoracic
	72158		lumbar
	72195	Magnetic resonance (e.g., proton) imaging, pelvis; without contrast 
			material(s)
	72196		with contrast material(s)
	72197		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73218	Magnetic resonance (e.g., proton) imaging, upper extremity, 
			other than joint; without contrast material(s)
	73219		with contrast material(s)
	73220		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73221	Magnetic resonance (e.g., proton) imaging, any joint of 
			upper extremity; without contrast material(s)
	73222		with contrast material(s)
	73223		without contrast material(s), followed by contrast 
			material(s) and further sequences
	
					(continued on reverse side)

												

Service Codes	Service
for Freestanding	Code	Description
MRI Centers
(cont.)	73718	Magnetic resonance (e.g., proton) imaging, lower extremity 
			other than joint; without contrast material(s)
	73719		with contrast material(s)
	73720		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73721	Magnetic resonance (e.g., proton) imaging, any joint of 
			lower extremity; without contrast material
	73722		with contrast material(s)
	73723		without contrast material(s), followed by contrast 
			material(s) and further sequences
	73725	Magnetic resonance angiography, lower extremity, with or 
			without contrast material(s) (I.C.)
	74181	Magnetic resonance (e.g., proton) imaging, abdomen; without 
			contrast material(s)
	74182		with contrast material(s)
	74183		without contrast material(s), followed by contrast material(s) 
			and further sequences
	74185	Magnetic resonance angiography, abdomen, with or 
			without contrast material(s) (I.C.)
	75552	Cardiac magnetic resonance imaging for morphology; 
			without contrast material 
	76375	Coronal, sagittal, multiplanar, oblique, three-dimensional 
			and/or holographic reconstruction of computerized axial 
tomography, magnetic resonance imaging, or other tomographic modality
	76393	Magnetic resonance guidance for needle placement (e.g., for 
			biopsy, needle aspiration, injection, or placement of 
			localization device) radiological supervision and 
			interpretation

Service Fees	If you wish to obtain a fee schedule, you may purchase Division of Health 
Care Finance and Policy regulations from either the Massachusetts State Bookstore or from the Division of Health Care Finance and Policy (see addresses and telephone numbers below).  You must contact them first to find out the price of the publication.  The Division of Health Care Finance and Policy also has the regulations available on disk.  Rates for freestanding MRI centers are found in 114.3 CMR 18.00:  Radiology.

		Massachusetts State Bookstore	
		State House, Room 116	
		Boston, MA  02133	
		Telephone:  617-727-2834	
		www.mass.gov/sec/spr
		
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Service Fees			Division of Health Care Finance and Policy
(cont.)				Two Boylston Street
		Boston, MA  02116
		Telephone:  617-988-3100
		www.mass.gov/dhcfp

Questions	If you have any questions, please call MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.