.	
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
TRANSMITTAL LETTER POD-42
March 2003

TO:		Podiatrists Participating in MassHealth

FROM:	Douglas S. Brown, Acting Commissioner

RE:		Podiatrist Manual (Revised List of Covered Services (2003 HCPCS))

Revised Subchapter 6 (Service Codes)

This letter transmits a revised Subchapter 6 of the Podiatrist Manual.  Subchapter 6 of the Podiatrist Manual lists codes that:
•	are payable under MassHealth;
•	have special limitations or requirements, such as prior authorization, individual consideration, or attachments; 
•	are categorized as Level II HCPCS codes that are payable under MassHealth; or
•	are locally assigned codes for use exclusively for MassHealth services.

Providers should use this revised Subchapter 6 in conjunction with the American Medical Association Current Procedural Terminology (CPT) 2003 code book as the Division is no longer including the service descriptions of payable codes. 

Effective Date

The revised Subchapter 6 is effective for dates of service on or after April 1, 2003.  The new codes introduced under the CPT 2003 code book are effective for dates of service on or after April 1, 2003.  

How to Obtain a Podiatry Fee Schedule

If you wish to obtain a fee schedule, you may purchase Division of Health Care Finance and Policy regulations from either the Massachusetts State Bookstore or from the Division of Health Care Finance and Policy.  See addresses and telephone numbers below.  You must contact them first to find out the price of the publication.  The Division of Health Care Finance and Policy also has the regulations available on disk.  The regulation title for surgery and anesthesia is 114.3 CMR 16.00:  Surgery and Related Anesthesia Care.  The regulation title for radiology is 114.3 CMR 18.00:  Radiology.  

	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

NEW MATERIAL
(The pages listed here contain new or revised language.)

Podiatrist Manual

		Pages 6-1 through 6-4

OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)

Podiatrist Manual

Page 6-1 and 6-2 — transmitted by Transmittal Letter POD-40

Pages 6-3 and 6-4 — transmitted by Transmittal Letter POD-41

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES	
PAGE

6-1	

PODIATRIST MANUAL
	
TRANSMITTAL LETTER

POD-42	
DATE

04/01/03	

601  Introduction

MassHealth providers must refer to the American Medical Association’s Current Procedural Terminology (CPT) 2003 code book for the service codes and descriptions when billing for services provided to MassHealth members.

The Division pays for all codes listed in Sections 602 and 603 in effect at the time of service, subject to all conditions and limitations in the Division’s regulations at 130 CMR 424.000 and 450.000.

Podiatry services require a written referral from the member’s primary-care provider before the delivery of services.  The Division pays only for podiatry services that are certified to be necessary for the life and safety of the member.  The referral must be on the primary-care provider’s letterhead and must certify that such services are medically necessary for the life and safety of the member.  A substantiating medical explanation must also be included in the written certification. 

•	Section 602 lists service codes that are payable under MassHealth, some of which require individual consideration or prior authorization.

•	Section 603 lists locally assigned service codes and Level II HCPCS codes that are payable under MassHealth, some of which require individual consideration or prior authorization, or both.  The local codes listed in Section 603 are intended only for services provided to MassHealth members.

•	Section 604 lists service code modifiers allowed under MassHealth.

602  Payable Codes

The Division pays for services billed using the following codes.  Some of these codes require individual consideration, as indicated below.

Legend:

I.C.:	Claim requires individual consideration.  See 130 CMR 424.407 for more information.

10060
10061
10120
10121
10140
10160
10180
11000

11001
11040
11041
11042
11043
11044
11055
11056

11057 (I.C.)
11100
11101
11200
11201
11305
11306
11307

11308
11420
11421
11422
11423
11424
11426
11620

11621
11622
11623
11624
11626
11719
11720
11721

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES	
PAGE

6-2	

PODIATRIST MANUAL
	
TRANSMITTAL LETTER

POD-42	
DATE

04/01/03	

602  Payable Codes (cont.)

11730
11732
11740
11750
11752
11755
11760
11762
11765
12001
12002
12004
12005
12006
12007
12041
12042
12044
12045
13131
13132
13133
14040
14041
14060
14061
14300
14350
15000
15001
15050
15100
15101
15120
15121
15240
15241
15350
15351
15400
15401
15574
15620
15850
15851
15852
15999 (I.C.)

17000
17003
17004
17110
17111
17250
17270
17271
17272
17273
17274
17276
20000
20005
20200
20205
20206
20520
20525
20550
20600
20605
20612
20615
20650
20670
20680
27603
27604
27605
27606
27607
27610
27612
27613
27614
27615
27618
27619
27620
27625
27626
27630
27647
27648
27680
27681

27685
27686
27695
27696
27704
27760
27762
27766
27808
27810
27814
27816
27818
27822
27823
27840
27842
27846
27848
27860
27870
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
28030
28035
28043
28045
28046
28050
28052
28054
28060
28062
28070
28072
28080
28086
28088
28090

28092
28100
28102
28103
28104
28106
28107
28108
28110
28111
28112
28113
28114
28116
28118
28119
28120
28122
28124
28126
28130
28140
28150
28153
28160
28171
28173
28175
28190
28192
28193
28200
28202
28208
28210
28220
28222
28225
28226
28230
28232
28234
28238
28240
28250
28260
28261

28262
28264
28270
28272
28280
28285
28286
28288
28289
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
28309
28310
28312
28313
28315
28320
28322
28340
28341
28344
28345
28360 (I.C.)
28400
28405
28406
28415
28420
28430
28435
28436
28445
28450
28455

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES	
PAGE

6-3	

PODIATRIST MANUAL
	
TRANSMITTAL LETTER

POD-42	
DATE

04/01/03	

602  Payable Codes (cont.)

28456
28465
28470
28475
28476
28485
28490
28495
28496
28505
28510
28515
28525
28530
28531
28540
28545
28546
28555
28570
28575
28576
28585
28600
28605
28606
28615
28630
28635
28636
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
28740
28750
28755
28760
28800
28805
28810
28820
28825
28899 (I.C.)
29345
29355
29405
29425
29440
29445
29450
29515
29540
29550
29580
29590
29705
29730
29750
29799 (I.C.)
29891
29892
29893
29894
29895
29897
29898
29899
73590
73592
73600
73610
73620
73630
73650
73660
81000
82947
84550
85007
85014
85018
85032
85041
85048
87101
87102
87106
99070 (I.C.)
99202
99203
99204
99211
99212
99213
99214
99231
99311
99312
99321
99322
99331
99332
99341
99342
99351
99352

603  HCPCS Level II and Locally Assigned Service Codes

The locally assigned service codes and service descriptions are exclusive to MassHealth.  These local codes describe services that are not recognized in the CPT.  The local codes are intended only for services provided to MassHealth members.

Legend:

I.C.:	Claim requires individual consideration.  See 130 CMR 424.407 for more information.
	P.A.:	Service requires prior authorization.  See 130 CMR 450.303 for more information.

HCPCS Level II Service Codes

A5500
A5501
A5503
A5504
A5505
A5506
A5507
A5508
A5509
A5510
A5511
L3000
L3001
L3002
L3003
L3010
L3020
L3030
L3040
L3050
L3060
L3070
L3080
L3090
L3201
L3202
L3203
L3204
L3206
L3207
L3208
L3209
L3211
L3212
L3213
L3214
L3215
L3216
L3217
L3218

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES	
PAGE

6-4	

PODIATRIST MANUAL
	
TRANSMITTAL LETTER

POD-42	
DATE

04/01/03	

603  HCPCS Level II and Locally Assigned Service Codes (cont.)

L3219
L3221
L3222
L3223
L3230
L3250
L3251
L3252
L3253
L3254
L3255
L3257
L3260
L3265
L3300
L3310
L3320
L3330
L3332
L3334
L3340
L3350
L3360
L3370
L3380
L3390
L3400
L3410
L3420
L3430
L3440
L3450
L3455
L3460
L3465
L3470
L3480
L3485
L3500
L3510
L3520
L3530
L3540
L3550
L3560
L3570
L3580
L3590
L3595
L4210 (I.C.)

Locally Assigned Service Codes

X1705	Examination and treatment of the feet in a licensed hospital, successive members, same day
X1707	Examination and treatment of the feet in the member’s residence, successive members, same day
X1709	Examination and treatment of the feet in a licensed nursing facility, convalescent home, charitable home for the aged, or rest home, successive members, same day
X1711	Visit to member living more than 10 miles away from podiatrist’s place of business, and no podiatrist is practicing in the community in which the member lives
X1720	Other X ray (I.C.)
X3333	Injectable and infusible drugs and devices supplied in a physician’s office that require prior authorization (I.C., P.A.)

604  Modifiers

The following service code modifiers are allowed for billing under MassHealth.  See Subchapter 5 of the Podiatrist Manual for billing instructions related to the use of modifiers.  

26	Professional component
50	Bilateral procedure
51	Multiple procedures
54	Surgical care only
99	Multiple modifiers
W8	Emergency treatment in a nursing facility.  To identify a visit to a nursing facility for emergency treatment, add the modifier W8 to the end of the nursing facility visit service code.