Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	
	MassHealth
		Outpatient Hospital Bulletin 49
	July 2004

	TO:	Outpatient Hospitals and Hospital-Licensed Health Centers Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director

	RE:	Correction to Maximum Number of Units Per Day Allowed for Therapy Services for Acute Outpatient Hospitals and Hospital-Licensed Health Centers

Background	Transmittal Letter OPD-52, dated January 2004, transmitted revised regulations that require outpatient hospitals to obtain prior authorization from MassHealth before providing more than eight physical therapy (PT) visits, eight occupational therapy (OT) visits, and 15 speech/language therapy (ST) visits (including group therapy and evaluation) to a member within a 12-month period.  This policy was effective on February 1, 2004 (implementation was later delayed until April 15, 2004, to give providers time to adjust to the thresholds for therapy services before prior authorization is required).  (See Outpatient Hospital Bulletin 48.)

Transmittal Letter OPD-52 also provided instructions for billing therapy visits under these new rules.  These billing instructions, however, were incorrect for acute outpatient hospitals and hospital-licensed health centers.  This bulletin provides corrected information on how to bill for therapy services.

Note:  The billing instructions in Transmittal Letter OPD-52 related to chronic outpatient hospitals are correct.  This bulletin provides a correction for acute outpatient hospitals and hospital-licensed health centers only.

Corrected Instructions	Acute outpatient hospitals and hospital-licensed health centers should bill
	therapy services on the UB-92 or its electronic equivalent.  Revenue 
	codes and HCPCS codes are required for PT, OT, and ST services.  

	PT, OT, and ST visits are characterized by a date of service and the number of units billed for that date.  A unit is defined as a fifteen-minute interval of service.  A visit consists of up to four units per day, per therapy, regardless of the number of modalities or procedures provided.  Acute outpatient hospitals and hospital-licensed health centers may bill up to:
•	four units per day for PT (which constitutes one visit) with a total of 32 units (eight visits) in a 12-month period before prior authorization is required;

continued on back

•	
Corrected Instructions
(cont.)

four units per day for OT (which constitutes one visit) with a total of 32 units (eight visits) in a 12-month period before prior authorization is required; and
•	four units per day for ST (which constitutes one visit) and a total of 60 units (15 visits) in a 12-month period before prior authorization is required.

Revised Attachment	Transmittal Letter OPD-52 included an attachment that listed the maximum number of units for each revenue code that may be billed per day for therapy services.  Please discard the attachment to Transmittal Letter OPD-52, and instead refer to the attachment to this bulletin for determining the maximum number of units per date of service.

Information on Web	This bulletin, Outpatient Hospital Bulletin 48, and Transmittal Letter OPD‑52, as well as all other MassHealth bulletins and transmittal letters, are listed on the MassHealth Web site at www.mass.gov/masshealth.  Click on “MassHealth Regulations and Other Publications.” 

To view frequently asked questions about MassHealth’s policy on therapy services, go to www.mahealthweb.com, and click on the FAQ button.  

Questions	If you have questions about the information in this bulletin, please call MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.