Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Transmittal Letter VIS-41 June 2012 TO: Vision Care Providers Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: Vision Care Manual (New Modifiers for Provider Preventable Conditions That Are National Coverage Determinations) This letter transmits updates to Subchapter 6 of the Vision Care 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 and attached pages are available on the MassHealth website 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.) Vision Care Manual Pages vi, 6-13, and 6-14 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Vision Care Manual Page vi — transmitted by Transmittal Letter VIS-40 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title Table of Contents Page vi Vision Care Manual Transmittal Letter VIS-41 Date 07/01/12 6. Service Codes and Descriptions Introduction 6-1 Definitions 6-1 Explanation of Abbreviations 6-2 Service Codes and Descriptions: Visual Analysis 6-2 Service Codes and Descriptions: Supplementary Testing 6-9 Service Codes and Descriptions: Contact Lenses 6-10 Service Codes and Descriptions: Contact Lens Services 6-11 Service Codes and Descriptions: Dispensing of Ophthalmic Materials: Fitting of Prescription Spectacles, Glass/Plastic Lenses 6-11 Service Codes and Descriptions: Dispensing of Ophthalmic Materials: Repairs and Replacement Parts 6-11 Service Codes and Descriptions: Miscellaneous 6-12 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 Vision Care Manual Subchapter Number and Title 6. Service Codes Page 6-13 Transmittal Letter VIS-41 Date 07/01/12 611 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. 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 Vision Care Manual Subchapter Number and Title 6. Service Codes Page 6-14 Transmittal Letter VIS-41 Date 07/01/12 This page is reserved.