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 DME-22
December 2002
TO:      Durable Medical Equipment Providers Participating in MassHealth
FROM:      Wendy E. Warring, Commissioner
RE:      Durable Medical Equipment Manual (Revision of Subchapter 6 to Reflect Deleted Codes)
Effective for dates of service on and after January 1, 2003, MassHealth will no longer cover the following codes when billed by durable medical equipment providers.

L0120	L0900	L1902	L8100	L8160	L8230	
L0130	L0920	L3700	L8110	L8170	L8300	
L0210	L1800	L3914	L8120	L8180	L8310	
L0500	L1810	L8000	L8130	L8190	L8320	
L0515	L1825	L8020	L8140	L8200	L8330	
L0600	L1830	L8030	L8150	L8220		
This letter transmits revised pages in Subchapter 6 of the Durable Medical Equipment Manual to reflect the deletion of these codes. These codes will remain in Subchapter 6 of the Orthotics Manual and the Prosthetics Manual. Providers billing the above codes must meet the Division’s prosthetics regulations at 130 CMR 428.000 or the Division’s orthotics regulations at 130 CMR 442.000.
DMA Web Site
This transmittal letter is also available at the Division’s Web site at www.mass.gov/dma.
Questions
If you have any questions about this transmittal letter, please contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Durable Medical Equipment Manual
Pages 6-33 and 6-34
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Durable Medical Equipment Manual
Pages 6-33 and 6-34 — transmitted by Transmittal Letter DME-20

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
DURABLE MEDICAL EQUIPMENT MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-33	

	TRANSMITTAL LETTER
DME-22	DATE
01/01/03	
601 DURABLE MEDICAL EQUIPMENT: SERVICE CODES AND DESCRIPTIONS (cont.)
Service
Code	Service Description
B4216        Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes) — home mix,
per day (I.C.) B4220        Parenteral nutrition supply kit; premix, per day (I.C.) B4222        Parenteral nutrition supply kit; home mix, per day (I.C.) B4224        Parenteral nutrition administration kit, per day (I.C.) B5000        Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes,
trace elements, and vitamins, including preparation, any strength, renal — amirosyn RF,
nephramine, renamine — premix (I.C.) B5100        Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes,
trace elements, and vitamins, including preparation, any strength, hepatic — freamine
HBC, hepatamine — premix (I.C.) B5200        Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes,
trace elements, and vitamins, including preparation, any strength, stress — branch chain
amino acids — premix (I.C.)
ENTERAL AND PARENTERAL PUMPS
B9000	Enteral nutrition infusion pump — without alarm (P.A.) (I.C.)
B9002	Enteral nutrition infusion pump — with alarm (P.A.) (I.C.)
B9004	Parenteral nutrition infusion pump, portable (I.C.)
B9006	Parenteral nutrition infusion pump, stationary (I.C.)
B9998	Not otherwise classified for enteral supplies (P.A.) (I.C.)
B9999	Not otherwise classified for parenteral supplies (I.C.)
INFUSION SUPPLIES
E0776        IV pole (I.C.)
E0779        Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater (P.A.) (I.C.)
E0781        Ambulatory infusion pump, single or multiple channels, electric or battery operated, with
administrative equipment, worn by patient (I.C.) E0782        Infusion pump, implantable, non-programmable (P.A.) (I.C.) E0783        Infusion pump system, implantable, programmable (includes all components, e.g., pump,
catheter, connectors, etc.) (P.A.) (I.C.) E0791        Parenteral infusion pump, stationary, single or multichannel (I.C.) X5381        Dynasplint system (purchase) (P.A.) X5382        Dynasplint system (rental) (P.A.) X5040        Clinician service component (I.C.)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
DURABLE MEDICAL EQUIPMENT MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-34	

	TRANSMITTAL LETTER
DME-22	DATE
01/01/03	
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