Commonwealth of Massachusetts 
Executive Office of Health and Human Services 
Office of Medicaid 
600 Washington Street
Boston, MA  02111
 www.mass.gov/masshealth
 
MassHealth  
Physician Bulletin 82 January 2005

     TO:       Physicians Participating in MassHealth
FROM:       Beth Waldman, Medicaid Director 

RE:       2005 Healthcare Common procedure Coding System (HCPCS) Coding Update

Introduction	The federal government has revised the Healthcare Common Procedure Coding System (HCPCS) for MassHealth billing. 
For dates of service on or after January 1, 2005, service codes discontinued by the Centers for Medicare and Medicaid Services (CMS) and deleted by the American Medical Association Current Procedural Terminology (CPT) for 2005 will no longer be payable by MassHealth.  Services described by these codes may be billed with replacement codes.  Replacement codes are Level 1 and Level 2 HCPCS codes from any year, including 2005, that replace the 2005 “deleted” codes.  MassHealth will pay only for new 2005 HCPCS code additions that are replacing the 2005 deleted codes. 
MassHealth will not be adopting any other 2005 HCPCS code additions at this time. MassHealth will be reviewing the remainder of the 2005 HCPCS code additions and changes and will determine coverage policies and other requirements at a later date.  Providers will receive a transmittal letter and updated version of Subchapter 6 of their provider manual when the final review of 2005 HCPCS code additions is completed. 
The 2005 deleted codes and HCPCS additions that are payable for dates of service on or after January 1, 2005, are attached to this bulletin. 

Payment 	
The 2005 HCPCS code additions attached to this bulletin are payable services in addition to the list of services described in Subchapter 6 of your provider manual.  In accordance with MassHealth regulations, payments are subject to the terms and conditions of 130 CMR 433.000 and 450.000. 	
Payment Requirements 	
Payment for these new codes will be determined through individual consideration (I.C.) until the Division of Health Care Finance and Policy  

(continued on back) 

MassHealth 
Physician Bulletin 82 
January 2005 
Page 2 
Payment Requirements (cont.) 	(DHCFP) establishes specific rates and these rates are incorporated into the appropriate regulation. 

All claims using the service codes listed in this bulletin may be submitted with a report. Providers submitting claims electronically will receive a Claim Attachment Form (CAF). Providers must ensure that all information required to price and evaluate the claim including, but not limited to, invoices, operative notes, and reports, is submitted with the CAF. 	
	An operative report must accompany the physician’s claim for procedures designated for individual consideration.  The operative report must be submitted in its entirety and must identify all procedures performed, including technical procedures, the name of the member, the date of the procedures, the preoperative diagnosis, the postoperative diagnosis, and the names of the surgeon and assistants.  For procedures performed in settings that do not issue formal operative reports, the accompanying documentation must be legible and contain the same information required on an operative report. 	
	For drugs administered in an office, an invoice needs to be submitted for each drug billed. Providers must indicate the name, strength and dose, units administered, and NDC number for every drug.  When more than one drug is listed on an invoice, providers must indicate which drug is being billed.  This information must be submitted as a separate attachment in addition to the invoice. 	
	If the documentation is illegible or incomplete, or if no report has been submitted, MassHealth will deny the claim with the applicable error code. 	
Questions 	If you have any questions, please contact MassHealth Provider Services at 617-628-4141 or 1-800-5231. 	

(continued on next page)

MassHealth Physician Bulletin 82 January 2005 Attachment 
Updates to MassHealth’s List of Payable Codes for Physicians 
Listed below are the service codes that replace HCPCS codes that have been deleted for 2005 and are payable by MassHealth for dates of service on or after January 1, 2005.  These service codes are covered under individual consideration until the Division of Health Care Finance and Policy (DHCFP) establishes specific rates and these rates are incorporated into the appropriate regulation.  Providers should refer to www.cms.hhs.gov for service descriptions. 
52402 	91034 	
78811 	91035 	
78812 	91037 	
78813 	91038 	
79005 	92620 	
79101 	92621 	
79445 	A9500 	
88184 	A9502 	
88185 	A9503 	
88187 	A9505 	
88188 	J3396 	
88189 		

	

Discontinued Service Codes for Physicians

The following service codes are deleted for 2005 and are no longer payable by MassHealth for dates of service on or after January 1, 2005. Providers should refer to www.cms.hhs.gov for service descriptions.
		
	35161 	79020 	
	35162 	79030 	
	35582 	79035 	
	50559 	79100 	
	50578 	79400 	
	50959 	79420 	
	50978 	79900 	
	52347 	88180 	
	78810 	91032 	
	78990 	91033 	
	79000 	92589 	
	79001 	J3395