Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Limited Services Clinics Bulletin 2 September 2009 TO: Limited Services Clinics Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Additional Service Codes for Limited Services Clinics Background This bulletin transmits additions to the service codes that are payable for MassHealth Limited Service Clinic (LSC) providers. These changes are effective for dates of service on or after July 1, 2009. The Massachusetts Department of Public Health (DPH) has licensed LSC providers under its regulations at 105 CMR 140.1000. Pursuant to these regulations, LSCs may not provide treatment to children younger than 24 months. MassHealth will enroll MassHealth-qualified LSCs within its nurse practitioner provider type, effective for dates of service on or after June 1, 2009. Providers who wish to enroll as a MassHealth LSC provider should contact MassHealth Customer Service at 1-800-841-2900 or by e-mail at providersupport@mahealth.net to request an enrollment package. Additional Payable Service Codes for LSCs Service codes previously authorized for payment for MassHealth LSCs are listed in Limited Services Clinics Bulletin 1, dated May 2009. The following service codes are additional payable codes for MassHealth LSC providers. Service Code Service Description 86308 Heterophile antibodies; screening 90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use (Use only for children 24-35 months of age.) 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutesare spent performing or supervising these services. (continued on next page) Vaccines Provided in an LSC MassHealth pays for the administration of vaccines if administered separately from a visit. Vaccines supplied free of charge by the DPH are not payable by MassHealth. See 130 CMR 433.413(C). Under the same provision, MassHealth also will not pay an LSC for a vaccine if its cost to the LSC is $1.00 or less. Information about the availability of DPH-supplied vaccines can be found at the following DPH Web sites: www.mass.gov/dph; and www.mass.gov/Eeohhs2/docs/dph/cdc/immunization/vaccine_availability childhood.pdf. MassHealth will pay LSCs for vaccines that are not supplied by DPH and that are listed in the previous section of this bulletin, or in Limited Services Clinics Bulletin 1. According to DPH regulations at 105 CMR 140.1000, no LSC may provide childhood immunizations (excluding influenza vaccine) unless such clinic is a satellite of, or otherwise affiliated with, a licensed health care practitioner or entity that provides primary care to the patient seeking immunization. Fee Schedule LSC service codes are paid at the current Division of Health Care Finance and Policy (DHCFP) fee schedule at 114.3 CMR 17.00: Medicine; 114.3 CMR 16.00: Surgery and Anesthesia Services; and 114.3 CMR 20.00: Clinical Laboratory Services. For 114.3 CMR 17.00, Medicine and 114.3 CMR 16.00 Surgery and Anesthesia Services, payment for services provided by eligible licensed nurse practitioners is 85% of the fees contained therein. If you wish to obtain a fee schedule, you may download the DHCFP regulations free of charge at www.mass.gov/dhcfp. You may also purchase a paper copy of the regulations from either the Massachusetts State Bookstore or from DHCFP (see addresses and telephone numbers below). You must contact them first to find out the price of the publication. The regulation titles are 114.3 CMR 17.00: Medicine; 114.3 CMR 16.00: Surgery and Anesthesia Services; and 114.3 CMR 20.00: Clinical Laboratory Services. Massachusetts State Bookstore State House, Room 116 Boston, MA 02133 Telephone: 617-727-2834 www.mass.gov/sec/spr Division of Health Care Finance and Policy Two Boylston Street Boston, MA 02116 Telephone: 617-988-3100 www.mass.gov/dhcfp (continued on next page) Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.