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
	Municipally Based Health Services
 		Bulletin 9
	October 2003
	
	TO:	Municipally Based Health Service Providers Participating in MassHealth

	FROM:	Beth Waldman, Acting Commissioner

	RE:	Services Provided to Special Education Students

A Reminder About	Every local educational authority participating in the Municipal Medicaid 
Agreement Compliance	Program must adhere to its provider agreement with the Division of Medical Assistance.  As part of that agreement, participants must comply with its terms and conditions, including applicable federal and state laws and regulations.

Documentation of 	Municipal Medicaid providers must document health-related services 
Services	provided to those students for whom the provider claims payment under its Municipal Medicaid Agreement.  Documentation must be completed monthly using the Municipal Medicaid Service Documentation Form.  (See the attached Documentation Form and sample.)

Documentation requirements are effective October 1, 2003, and must be completed for all Special Education health-related services.  A licensed professional must supervise all services provided by an assistant and must co-sign their documentation forms.

It is the responsibility of the Municipal Medicaid provider to ensure that all subcontractors, including private school placements, maintain this documentation.

Revisions to the 	The Centers for Medicare and Medicaid Services (CMS) has revised the
Service Codes	Healthcare Common Procedure Coding System (HCPCS) for 2003.  New national service codes have been added to replace the MassHealth local codes for the Municipal Medicaid Program.  You must use a modifier with some codes to accurately reflect the service provided.

The attached crosswalk contains the new national service codes with modifiers and the obsolete MassHealth local codes.  Please note that the new national codes for nursing services are in units of 15-minute increments. These revisions are effective for dates of service on or after October 1, 2003.

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Questions	If you have any questions about this bulletin, please call MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.  This bulletin is available on the Division’s Web site at www.mass.gov/dma.

Municipal Medicaid Program
Service Code Crosswalk
Effective October 1, 2003

Obsolete Code	Obsolete Code Description	New Code – Modifier	New Code Description	Modifier Description	Service Code Rate	
X7660	Home assessment 	T1028-TM	Assessment of home, physical and family environment, to determine suitability to meet patient’s medical needs	Individualized education program (IEP)	$76.75/encounter	
X7661	Team meeting
	T1024-TM	Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter	Individualized education program (IEP)	$30.70/encounter	
X7663	Public day program (.1, .2, .3)	T1018-U1	School-based individualized education program (IEP) services, bundled	Use for levels 502.1- 502.3, full or partial inclusion program	$12.41/day	
X7664	.4 Separate placement	T1018-U2	School-based individualized education program (IEP) services, bundled	Use for level 502.4, substantially separate classroom	$26.95/day	
X7665	.5 Day placement	T1018-U3	School-based individualized education program (IEP) services, bundled	Use for level 502.5, day school	$50.62/day	
X7666	.6 Residential placement and .5 cost share 	T1018-U4	School-based individualized education program (IEP) services, bundled	Use for level 502.6, residential school, PL1 only or PL2 documenting cost-shared residential placement	$52.67/day	
X7668	Early childhood	T1018-U5	School-based individualized education program (IEP) services, bundled	Use for level 502.8, home-based or center-based early childhood program	$120.79/week	
X7670	RN agency (one patient)	T1002-U6	RN services, up to 15 minutes	Agency-based nursing	$8.73/15 minutes	
X7671	RN individual (one patient)	T1002-U7	RN services, up to 15 minutes	Individual nurse	$7.43/15 minutes	
X7672	Private duty nursing RN agency (two patients)	T1002-U6	RN services, up to 15 minutes	Agency-based nursing	$8.73/15 minutes	
X7673	RN individual (two patients)	T1002-U7	RN services, up to 15 minutes	Individual nurse	$7.43/15 minutes	
X7674	Private duty nursing LPN agency (one patient)	T1003-U6	LPN/LVN services, up to 15 minutes	Agency-based nursing	$6.56/15 minutes	
X7675	LPN individual (one patient)	T1003-U7	LPN/LVN services, up to 15 minutes	Individual nurse	$5.58/15 minutes	
X7676	LPN agency (two patients)	T1003-U6	LPN/LVN services, up to 15 minutes	Agency-based nursing	$6.56/15 minutes	
X7677	LPN agency (two patients)	T1003-U7	LPN/LVN services, up to 15 minutes	Individual nurse	$5.58/15 minutes