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 THP-20
November 2003

TO:       Therapists Participating in MassHealth FROM:       Beth Waldman, Acting Commissioner
RE:       Therapist Manual (Changes to Service Codes and Service Descriptions)
This letter transmits revisions to the service codes and descriptions in the Therapist Manual. These revisions are effective for dates of service on or after December 1, 2003.
The Centers for Medicare and Medicaid Services (CMS) has revised the Healthcare Common Procedure Coding System (HCPCS). New national service codes have been added, and MassHealth local codes have been removed from the Therapist Manual. In addition, some codes have been changed to reflect updates made to the Current Procedural Terminology (CPT) manual for 2003. Please note that you must use a modifier with some codes to accurately reflect the service provided. The attached Subchapter 6 contains codes with modifiers, where applicable.
Billing Guidelines
In addition to the revised Subchapter 6, you will find a table that crosswalks the obsolete MassHealth local service codes to the new national service codes and modifiers. The crosswalk provides a description of the old and new service codes as well as the new codes and their modifiers. Please note that providers must use these new codes and modifiers when billing MassHealth for therapy services provided on or after December 1, 2003.
See 130 CMR 432.400 and the attached Subchapter 6 for service limitations and payment restrictions.
Adaptive Devices
Effective for dates of service on or after December 1, 2003, the Division will no longer pay for adaptive devices (X9695 and X9677) under the therapist program. The Division will continue to pay for adaptive devices under the durable medical equipment (DME) program.
Modifiers
Please refer to the attached Subchapter 6 and crosswalk table for instructions on when and how to use modifiers. Failure to use the appropriate modifier as required for a given service will result in a denied claim. The attached crosswalk explains which modifiers must be used with each service code, and describes the function of the modifier. A list of modifier descriptions is also attached.

MASSHEALTH
TRANSMITTAL LETTER THP-20 November 2003 Page 2
Place of Service (POS) and Out-of-Office Services
For dates of service on or after December 1, 2003, providers will no longer be required to bill using the MassHealth local modifier “YU” to receive enhanced payment for certain services provided in an out-of-office location. The Division will continue to pay providers an enhanced rate for services provided out of office, in accordance with the applicable fee schedule of the Division of Health Care Finance and Policy (DHCFP). However, providers will be required to enter the appropriate place-of-service (POS) code on the claim form to indicate where the service was provided. The Division will not pay the enhanced rate for out-of-office services for services provided in the therapist’s office (POS 01 on paper claims or POS 11 on electronic claims).
See 130 CMR 432.402 for definitions of “office” and “out of office.” Please note that the CMS POS codes (used when submitting HIPAA-compliant 837 professional claims) differ somewhat from the MassHealth POS codes (used when submitting paper claims on claim form no. 9 or with proprietary EMC format). The CMS POS codes and definitions are available at http://cms.hhs.gov/states/poshome.asp.
The following table lists the allowed POS codes for the therapist program for claims submitted by paper (DMA POS code) or electronically (CMS POS code).

DMA POS Code	DMA POS Code Description	CMS POS Code	CMS POS Code Description	
01	Office, facility or
business
location	11	Office	
02	Member’s home	12	Home	
03	Hospital, inpatient	21	Inpatient hospital	
04	Hospital, outpatient	22	Outpatient hospital	
05	Emergency room	23	Emergency room-hospital	
06	Nursing home	31, 32	Skilled nursing facility, nursing facility	
07	Rest home	33	Custodial care facility	
99	Other location	99	Other place of service	
Prior Authorization
Effective for dates of service on or after December 1, 2003, providers must submit all requests for prior authorization using the revised service codes and modifiers, if applicable. The Division will not authorize therapy services for dates of service on or after December 1, 2003, for prior authorization requests that are submitted using local X codes, and will defer such requests back to the provider for correction.

MASSHEALTH
TRANSMITTAL LETTER THP-20 November 2003 Page 3
Fee Schedule for New Service Codes
If you wish to obtain a fee schedule with the new service codes, you may purchase Division of Health Care Finance and Policy (DHCFP) regulations from either the Massachusetts State Bookstore or from DHCFP (see addresses and phone numbers below). You must contact them first for the price of the publication. You may also obtain the regulations from the DHCFP Web site at www.mass.gov/dhcfp. The regulation title is 114.3 CMR 39.00: Rehabilitation Clinic Services, Audiological Services, Restorative Services.
Massachusetts State Bookstore	Division of Health Care
State House, Room 116	Finance and Policy
Boston, MA 02133	Two Boylston Street
Telephone: 617-727-2834	Boston, MA 02116
www.mass.gov/sec/spr	Telephone: 617-988-3100
www.mass.gov/dhcfp
Questions
If you have any questions about this information please contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Therapist Manual
Pages vi and 6-1 through 6-4
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Therapist Manual
Page vi — transmitted by Transmittal Letter THP-13
Pages 6-1 through 6-4 — transmitted by Transmittal Letter THP-16

MassHealth Therapist Service Code Crosswalk
Effective December 1, 2003

MassHealth
November 2003
Attachment
Page 1

Obsolete Code	Obsolete Code Description	New Code	Modifier	New Code Description	Modifier Required?	Use the modifier to:	Guidelines	
X9686	Physical therapy evaluation for children age 21 and under (per hour, with a maximum of three hours)	97001	HA	Physical
therapy
evaluation	Yes	indicate that patient is a child (age 21 and under) (child/adolescent program)	Per hour, with a maximum of three hours.	
X9695	Adaptive device						Code deleted. Service can be purchased as durable medical equipment (DME).	
X9700	Therapy evaluation (age 22 and older) for mentally retarded and developmentally disabled adults (per hour, with a maximum of three hours)	97001	TF	Physical
therapy
evaluation	Yes	indicate that patient is mentally
retarded/developmentally disabled (intermediate level of care)	Per hour, with a maximum of three hours.	

	97003	TF	Occupational
therapy
evaluation	Yes	indicate that patient is mentally
retarded/developmentally disabled (intermediate level of care)	Per hour, with a maximum of three hours.	
X9689	Group physical therapy session (up to 30 minutes) (each member, 2 to 6 persons)	97150	GP	Therapeutic procedure(s), group (two or more individuals)	Yes	indicate that this is a physical therapy group session (services delivered under an outpatient physical therapy plan of care)	Bill in 15-minute increments up to one hour.	
X9690	Group physical therapy session (31 to 45 minutes) (each member, 2 to 6 persons)	97150	GP	Therapeutic procedure(s), group (two or more individuals)	Yes	indicate that this is a physical therapy group session (services delivered under an outpatient physical therapy plan of care)	Bill in 15-minute increments up to one hour.	
X9691	Group physical therapy session (46 to 60 minutes) (each member, 2 to 6 persons)	97150	GP	Therapeutic procedure(s), group (two or more individuals)	Yes	indicate that this is a physical therapy group session (services delivered under an outpatient physical therapy plan of care)	Bill in 15-minute increments up to one hour.	
X9638	Occupational therapy evaluation for children age 21 and under (per hour, with maximum of three hours)	97003	HA	Occupational
therapy
evaluation	Yes	indicate that patient is a child (age 21 and under) (child/adolescent program)	Per hour, with a maximum of three hours.	
X9677	Adaptive device						Code deleted. Service can be purchased as durable medical equipment (DME).	
X9671	Group occupational therapy session (up to 30 minutes) (each member, 2 to 6 persons)	97150	GO	Therapeutic procedure(s), group (two or more individuals)	Yes	indicate that this is an occupational therapy group session (services delivered under an outpatient occupational therapy plan of care)	Bill in 15-minute increments up to one hour.	

MassHealth Therapist Service Code Crosswalk
Effective December 1, 2003

MassHealth
November 2003
Attachment
Page 2

Obsolete Code	Obsolete Code Description	New Code	Modifier	New Code Description	Modifier Required?	Use the modifier to:	Guidelines	
X9672	Group occupational therapy session (31 to 45 minutes) (each member, 2 to 6 persons)	97150	GO	Therapeutic procedure(s), group (two or more individuals)	Yes	indicate that this is an occupational therapy group session (services delivered under an outpatient occupational therapy plan of care)	Bill in 15-minute increments up to one hour.	
X9673	Group occupational therapy session (46 to 60 minutes) (each member, 2 to 6 persons)	97150	GO	Therapeutic procedure(s), group (two or more individuals)	Yes	indicate that this is an occupational therapy group session	Bill in 15-minute increments up to one hour.	
92525	Evaluation of swallowing and oral function for feeding (per hour, with maximum of one hour)	92610		Evaluation of oral and pharyngeal swallowing function	No		Replaced per CPT 2003. Per hour, maximum of one hour.	
X9653	Speech/language therapy evaluation for children (age 21 and younger) (per hour, with maximum of three hours)	92506	HA	Evaluation of
speech,
language,
voice,
communication,
auditory
processing,
and or aural
rehabilitation
status	Yes	indicate that patient is a child (age 21 and under) (child/adolescent program)	Per hour, with a maximum of four hours.	
X9642	Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); group, each additional 15 minutes (maximum of 30 minutes; can be used only in conjunction with service code 92508)	92508		Treatment of
speech,
language,
voice,
communication
and /or auditory
processing
disorder
(includes aural
rehabilitation),
group, two or
more
individuals	No		Bill in 15-minute increments up to one hour, one unit=15 minutes.	

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
THERAPIST MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-1	

	TRANSMITTAL LETTER
THP-20	DATE
12/01/03	
601 Prior-Authorization Requirements and Definitions
 (A)	Prior-Authorization Requirements. For prior-authorization requirements, please see 130 CMR 432.417.
 (B)	Definitions. The following is the definition for “unit.” For additional definitions please refer to 130 CMR 432.402.
Unit — a specified period of time to be used when billing on the Division’s claim form or when requesting services on the Division’s prior-authorization form. A unit may equal 15 minutes or one hour, depending upon the particular service code.
602 Service Codes and Descriptions: Physical Therapy
When providing therapy services in an out-of-office location, use the appropriate place of service when billing for physical therapy services. Note: Unless otherwise indicated, the maximum allowable number of units for therapeutic treatment is four per therapy visit (e.g., one hour per member per visit per day). A visit can include a combination of therapeutic procedures and modalities not to exceed one hour per visit per day.
Service
Code       Modifier     Service Description
97001	Physical therapy evaluation (per hour with a maximum of two hours)
97001      HA	Physical therapy evaluation, child/adolescent program (for children aged 21 and
under) (per hour with a maximum of three hours)
97001      TF	Physical therapy evaluation, intermediate level of care (for mentally retarded and
developmentally disabled adults, aged 22 and older, per hour with a maximum of
three hours)
97010	Application of a modality to one or more areas; hot or cold packs
97012	traction, mechanical
97014	electrical stimulation (unattended)
97016	vasopneumatic devices
97018	paraffin bath
97020	microwave
97024	diathermy
97026	infrared
97028	ultraviolet
97032	Application of a modality to one or more areas; electrical stimulation (manual), (each
15 minutes)
 97033	iontophoresis, each 15 minutes
 97034	contrast baths, each 15 minutes
 97035	ultrasound, each 15 minutes

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
THERAPIST MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-2	

	TRANSMITTAL LETTER
THP-20	DATE
12/01/03	
603 Service Codes and Descriptions: Physical Therapy (cont.)
Service
Code       Modifier     Service Description

97039 97110
97112
97116 97124
97139 97140
97530
97150

GP

Unlisted modality (specify type and time if constant attendance) Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities (each 15 minutes)
gait training (includes stair climbing) (each 15 minutes) massage, including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) (each 15 minutes) Unlisted therapeutic procedure (specify) (each 15 minutes) Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic
drainage, manual traction), one or more regions, each 15 minutes Therapeutic activities, direct (one-on-one) patient contact by the provider (use of
dynamic activities to improve functional performance), each 15 minutes Therapeutic procedure(s), group (two or more individuals) (each 15 minutes) (Use modifier GP to denote group physical therapy.) (services delivered under an outpatient physical therapy plan of care) (maximum four units per visit)

604 Service Codes and Descriptions: Occupational Therapy
When providing therapy services in an out-of-office location, use the appropriate place of service when billing for occupational therapy services. Note: Unless otherwise indicated, the maximum allowable number of units for individual therapeutic treatment is four per therapy visit (that is, one hour per member per visit per day).

Service		
Code	Modifier	
97003		
97003	HA	
97003	TF	
97520		
97530		
97535

Service Description
Occupational therapy evaluation (per hour, with maximum of two hours) Occupational therapy evaluation (child/adolescent program) (for children aged 21 and
under; per hour, with maximum of three hours) Occupational therapy evaluation (intermediate level of care) (for mentally retarded
and developmentally disabled adults (aged 22 and older); per hour, with
maximum of three hours) Prosthetic training, upper and/or lower extremities, each 15 minutes Therapeutic activities, direct (one-on-one) patient contact by the provider (use of
dynamic activities to improve functional performance), each 15 minutes Self-care/home management training (e.g., activities of daily living (ADL) and
compensatory training, meal preparation, safety procedures, and instructions in
use of assistive technology devices/adaptive equipment) direct one-on-one
contact by provider, each 15 minutes

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
THERAPIST MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-3	

	TRANSMITTAL LETTER
THP-20	DATE
12/01/03	

604	Service Codes and Descriptions: Occupational Therapy (cont.)
Service
Code       Modifier     Service Description
97150      GO	Therapeutic procedure(s), group (two or more individuals) (each 15 minutes)
(services delivered under an outpatient occupational therapy plan of care) (Use modifier GO to denote group occupational therapy.) (maximum 4 units)
605	Service Codes and Descriptions: Speech/Language Therapy
When providing therapy services in an out-of-office location, use the appropriate place of service when billing for speech therapy services. Note: Unless otherwise indicated, the maximum allowable number of units for individual therapeutic treatment is four per therapy visit (e.g., one hour per member per visit per day).
Service
Code       Modifier     Service Description
92506 92610 92506      HA
92507
92508 92526
Evaluation of speech, language, voice, communication, auditory processing, and/or
aural rehabilitation status (per hour, with maximum of three hours) Evaluation of oral and pharyngeal swallowing function (per hour, maximum of one
hour) Evaluation of speech, language, voice, communication, auditory processing, and/or
aural rehabilitation status (child/adolescent program) (for children aged 21 and
younger) (per hour, with maximum of four hours) Treatment of speech, language, voice, communication, and/or auditory processing
disorder (includes aural rehabilitation); individual (15 minutes)
group, two or more individuals (each 15 minutes, maximum four units per visit) Treatment of swallowing dysfunction and/or oral function for feeding (each 15
minutes)
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 Current Procedural Terminology (CPT) code book.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
THERAPIST MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-4	

	TRANSMITTAL LETTER
THP-20	DATE
12/01/03	
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