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

                                                  MassHealth
                                                  Transmittal Letter ROC-2 
                                                  June 2012




	TO:	Radiation Oncology Centers (ROC) Participating in MassHealth

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

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


This letter transmits updates to Subchapter 6 of the Radiation Oncology Center 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.

Please Note: Two modifiers that are currently allowed by MassHealth, technical component 
(TC) and professional component (26), have also been added to Subchapter 6.

MassHealth Website

This transmittal letter, attached pages, and other resources are available on the MassHealth 
website at www.mass.gov/masshealthpubs. Click on Provider Library to access provider 
communications and resources. Then click on MassHealth Provider Manuals to download a 
copy of the new Radiation Oncology Center Manual.

Questions

If you have any questions about the information in 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.)

Radiation Oncology Center Manual

Pages vi, 6-7, and 6-8

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(The pages listed here are no longer in effect.)

Radiation Oncology Center Manual

Page vi — transmitted by Transmittal Letter ROC-1



Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Subchapter Number and Title
Table of Contents
Page
vi
Radiation Oncology Center Manual
Transmittal Letter
ROC-2
*
Date
07/01/12

6.  Service Codes and Descriptions

	Introduction						6-1
	Service Codes and Descriptions				6-1
	
Appendix A.  Directory 						A-1
Appendix B.  Enrollment Centers 				B-1
Appendix C.  Third-Party-Liability Codes 			C-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



Commonwealth of Massachusetts
MassHealth
Provider Manual Series	
Radiation Oncology Center Manual
Subchapter Number and Title
6.  Service Codes and Descriptions	
Page
6-7

Transmittal Letter
ROC-2	
Date
07/01/12


603	Modifiers

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

Modifier	Modifier Description

26		Professional Component
TC		Technical Component

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

Modifier	Modifier Description

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.











Commonwealth of Massachusetts
MassHealth
Provider Manual Series	
Radiation Oncology Center Manual

Subchapter Number and Title
6.  Service Codes and Descriptions	

Page
6-8

Transmittal Letter
ROC-2	

Date
07/01/12


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