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 84 December 2005 TO: Physicians Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: 2006 Healthcare Common Procedure Coding System (HCPCS) Coding Update Introduction The federal government has revised the Healthcare Common Procedure Coding System (HCPCS) that is used for MassHealth billing. For dates of service on or after January 1, 2006, service codes that have been discontinued by the Centers for Medicare and Medicaid Services (CMS) and deleted by the American Medical Association Current Procedural Terminology (CPT) for 2006 are not payable by MassHealth. Services described by these codes may be billed with replacement codes. Replacement codes are Level I and Level II HCPCS codes from any year, including 2006, that replace the 2006 "deleted" codes. MassHealth will pay only for new 2006 HCPCS code additions that are replacing the 2006 deleted codes. MassHealth is not adopting any other 2006 HCPCS code additions at this time. MassHealth will review the rest of the 2006 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 Subchapter 6 of the Physician Manual when the final review of 2006 HCPCS code additions has been completed. The 2006 deleted codes and HCPCS additions that are payable for dates of service on or after January 1, 2006, are attached to this bulletin. Payment The 2006 HCPCS code additions attached to this bulletin are payable services in addition to the list of services described in Subchapter 6 of the Physician Manual. In accordance with MassHealth regulations, payment is subject to the terms and conditions of 130 CMR 433.000 and 450.000. (continued on back) MassHealth Physician Bulletin 84 December 2005 Page 2 Payment Requirements Individual Consideration Payment for these new codes will be determined through individual consideration (I.C.) until the Division of Health Care Finance and Policy (DHCFP) establishes specific rates and these rates are incorporated into the appropriate regulation. Claim Attachment Form 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. Operative Report An operative report must accompany the physician's claim for procedures designated I.C. 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. Drugs Administered in an Office For drugs administered in an office, an invoice needs to be submitted for each drug billed. Providers must indicate the name, strength, 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. Legibility and Completeness 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 Customer Service at 1-800-841-2900, email your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. MassHealth Physician Bulletin 84 December 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 2006 and are payable by MassHealth for dates of service on or after January 1, 2006. 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. 01965 01966 15170 15171 15175 15176 15300 15301 15320 15321 15330 15331 15335 15336 15340 15341 15360 15361 15365 15366 32503 32504 33925 33926 37718 37722 44180 44186 45499 82271 83700 83701 86355 86357 86367 90760 90761 90765 90766 90767 90768 90772 90773 90774 90775 90779 96401 96402 96409 96411 96413 96415 96416 96417 96521 96522 96523 97760 97761 97762 99051 99053 99060 99304 99305 99306 99307 99308 99309 99310 99324 99325 99326 99327 99328 99334 99335 99336 99337 J0881 J0882 J0885 J0886 J1566 J1567 J1751 J1752 J3471 J3472 J7318 Discontinued Service Codes for Physicians The following service codes are deleted for 2006 and are no longer payable by MassHealth for dates of service on or after January 1, 2006. Providers should refer to www.cms.hhs.gov for service descriptions. 01964 15342 15343 15350 15351 16010 16015 21493 21494 31585 31586 32520 32522 32525 33918 33919 37720 37730 42325 42326 43638 43639 44200 44201 44239 69410 76375 78160 78162 78170 78172 78455 82273 83715 83716 86064 86379 86587 90780 90781 90782 90783 90784 90788 90799 90871 95858 96400 96408 96410 96412 96414 96520 96530 96545 97020 97504 97520 97703 99052 99054 99261 99262 99263 99301 99302 99303 99311 99312 99313 99321 99322 99323 99331 99332 99333 J0880 J1563 J1564 J1750 J7317 J7320 Q0136