Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MASSHEALTH TRANSMITTAL LETTER REN-12 December 2006 TO: Renal Dialysis Clinics Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: Renal Dialysis Clinic Manual (Revised Service Codes and Descriptions) This letter transmits revisions to the service codes in the Renal Dialysis Clinic Manual. The Centers for Medicare and Medicaid Services (CMS) have revised the Healthcare Common Procedure Coding System (HCPCS) for 2007. The revised Subchapter 6 is effective for dates of service on or after January 1, 2007. If you wish to obtain a fee schedule, you may download the Division of Health Care Finance and Policy regulations at no cost at www.mass.gov/dhcfp. You may also purchase a paper copy of 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 paper copy of the publication. The regulation title for Chronic Maintenance Dialysis Treatments and Home Dialysis Supplies is 114.3 CMR 37.00. Massachusetts State Bookstore Division of Health Care Finance and Policy State House, Room 116 Two Boylston Street Boston, MA 02133 Boston, MA 02116 Telephone: 617-727-2834 Telephone: 617-988-3100 www.mass.gov/sec/spr www.mass.gov/dhcfp MassHealth Web Site This transmittal letter and attached pages are available on the MassHealth Web site at www.mass.gov/masshealth. Questions If you have any questions about 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.) Renal Dialysis Clinic Manual Pages 6-1 and 6-2 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Renal Dialysis Clinic Manual Pages 6-1 and 6-2 — transmitted by Transmittal Letter REN-11 601 Service Codes and Descriptions: All-Inclusive Dialysis Treatment Service Code Service Description 90935 Hemodialysis procedure with single physician evaluation 90937 Hemodialysis procedure requiring repeated evaluation(s) with or without substantial revision of dialysis prescription 90945 Dialysis procedure other than hemodialysis (e.g., peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single physician evaluation 90947 Dialysis procedure other than hemodialysis (e.g., peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies) requiring repeated physician evaluations, with or without substantial revision of dialysis prescription 602 Service Codes and Descriptions: Training for Home Dialysis Service Code Service Description 90989 Dialysis training, patient, including helper where applicable, any mode, completed course 90993 Dialysis training, patient, including helper where applicable, any mode, course not completed, per training session 603 Service Codes and Descriptions: Prescribed Drugs Service Code Service Description J0895 Injection, deferoxamine mesylate, 500 mg (per 5 cc) Q4081 Injection, epoetin alfa, 100 units (for ESRD on dialysis) This page is reserved.