Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth

                                                 MassHealth
                                                 Transmittal Letter POD-67
                                                 June 2012



	TO:	Podiatrists Participating in MassHealth

FROM:	Julian J. Harris, M.D., Medicaid Director 

	RE:	Podiatrist Manual (New Modifiers for Provider Preventable Conditions That Are 
National Coverage Determinations)

This letter transmits updates to Subchapter 6 of the Podiatrist Manual to add modifiers for 
Provider Preventable Conditions (PPCs) that are National Coverage Determinations. For more 
information about PPCs and related billing instructions, see Transmittal Letter ALL-195.

These updates are effective for dates of service on or after July 1, 2012.

MassHealth Website

This transmittal letter and attached pages are available on the MassHealth website at 
www.mass.gov/masshealth.

Questions

If you have any questions about the information on this transmittal letter, please contact 
MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to 
providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

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

Podiatrist Manual

Pages vi, 6-5, and 6-6

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(The pages listed here are no longer in effect.)

Podiatrist Manual

Pages vi, 6-5, and 6-6 — transmitted by Transmittal Letter POD-66
	MassHealth
	Transmittal Letter POD-66
	February 2012
	Page 3

Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Podiatrist Manual

Subchapter Number and Title
Table of Contents

Page
vi

Transmittal Letter
POD-67

Date
07/01/12

6.  Service Codes and Descriptions

	Introduction						6-1
	Payable CPT Codes					6-1
	Payable HCPCS Level II Service Codes for 
	Injectable Drugs Administered in the Office		6-3
	Payable HCPCS Level II Service Codes for 
	Diabetic Shoes and Orthotic Services			6-4
	Modifiers						6-5

Appendix A.  Directory						A-1
Appendix B.  Enrollment Centers					B-1
Appendix C.  Third-Party-Liability Codes			C-1
Appendix D.  (Reserved)
Appendix E.  Utilization Management Program			E-1
Appendix F.  Admission Guidelines				F-1
Appendix U.  DPH-Designated Serious Reportable Events 
	     That Are Not Provider Preventable Conditions	U-1
Appendix V.  MassHealth Billing Instructions for Provider 
	     Preventable Conditions				V-1
Appendix W.  EPSDT Services:  Medical and Dental Protocols 
	     and Periodicity Schedules				W-1
Appendix X.  Family Assistance Copayments and Deductibles	X-1
Appendix Y.  EVS Codes/Messages		Y-1
Appendix Z.  EPSDT/PPHSD Screening Services Codes		Z-1



This page is reserved.
Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
6.  Service Codes
Page
6-5
Podiatrist Manual
Transmittal Letter
POD-67
Date
07/01/12 

605  Modifiers


The following service code modifiers are allowed for billing under MassHealth.  

26	Professional component
50	Bilateral procedure
51	Multiple procedures
99	Multiple modifiers
LT	Left side (for orthotic shoes only)
RT	Right side (for orthotic shoes only)
TC	Technical component

The following modifiers are for Provider Preventable Conditions (PPCs) that are National Coverage 
Determinations.

PA	Surgical or other invasive procedure on wrong body part
PB	Surgical or other invasive procedure on wrong patient
PC	Wrong surgery or other invasive procedure on patient

For more information on the use of these modifiers, see Appendix V of your provider manual.





















This publication contains codes that are copyrighted by the American Medical Association. Certain 
terms used in the service descriptions for HCPCS codes are defined in the Physician’s Current 
Procedural Terminology (CPT) code book.




















Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
6.  Service Codes
Page
6-6
Podiatrist Manual
Transmittal Letter
POD-67
Date
07/01/12


This page is reserved.