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 PHY-128 

January 2010 

 

 

 TO: Physicians Participating in MassHealth 

 

 FROM: Terence G. Dougherty, Medicaid Director 

 

 RE: Physician Manual (2010 HCPCS) 

 

This letter transmits revisions to the service codes in the Physician Manual. The Centers for 
Medicare & Medicaid Services (CMS) have revised the Healthcare Common Procedure Coding 
System (HCPCS) for 2010. Providers should use the revised Subchapter 6 along with the 
American Medical Association Current Procedural Terminology (CPT) 2010 code book. 
Subchapter 6 of the Physician Manual contains the following information: 

 

• CPT codes that are not ordinarily payable under MassHealth (All other numeric CPT codes 
in the CPT 2010 code book are payable, subject to all limitations and conditions of payment 
in MassHealth regulations at 130 CMR 433.000 and 450.000.); 


• CPT codes that have special limitations or requirements, such as prior authorization (PA), 
individual consideration, or attachment requirements; and 


• Level II HCPCS codes that are payable under MassHealth and have special limitations or 
requirements, such as PA, individual consideration, or attachment requirements. 




 

A physician may request PA for any medically necessary service reimbursable under the federal 
Medicaid Act in accordance with 130 CMR 450.144, 42 U.S.C. 1396d(a), and 42 U.S.C. 
1396d(r)(5) for a MassHealth Standard or CommonHealth member younger than 21 years of 
age, even if it is not designated as covered or payable in the Physician Manual. 

 

If you wish to obtain a fee schedule, you may download the Division of Health Care Finance and 
Policy (DHCFP) 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 titles are 114.3 CMR 16.00: Surgery and Related Anesthesia 
Care;114.3 CMR 17.00: Medicine; 114.3 CMR 18.00: Radiology; and 114.3 CMR 20.00: 
Laboratory. 

 

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 

 



 



Effective Date of Code Changes 

 

The changes to codes listed in Subchapter 6 are effective for dates of service on or after 
January 1, 2010. 

 

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.) 

 

Physician Manual 

 

Pages vi and 6-1 through 6-20 

 

OBSOLETE MATERIAL 

(The pages listed here are no longer in effect) 

 

Physician Manual 

 

Page vi — transmitted by Transmittal Letter PHY-121 

 

Pages 6-1 through 6-20 — transmitted by Transmittal Letter PHY-127