Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Acute Outpatient Hospital Bulletin 14 January 2006 TO: Acute Outpatient Hospitals Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: 2006 Healthcare Common Procedure Coding System (HCPCS) Coding Update Background This bulletin announces revisions to the service codes used by acute outpatient hospitals participating in MassHealth. The Centers for Medicare and Medicaid Services (CMS) have revised the Healthcare Common Procedure Coding System (HCPCS) for 2006. For dates of service on or after January 1, 2006, service codes discontinued by the CMS and deleted by the American Medical Association Current Procedural Terminology (CPT) for 2006 will no longer be payable by MassHealth. Services described by these codes may be billed with replacement codes. Replacement codes are Level 1 HCPCS codes from any year, including 2006, that replace the 2006 “deleted” codes. MassHealth will pay only for new 2006 HCPCS code additions that are replacing the 2006 deleted codes. MassHealth will not be adopting any other 2006 HCPCS code additions at this time. MassHealth will be reviewing the remainder of the 2006 HCPCS code additions and changes and will determine coverage policies and other requirements at a later date. Providers will receive a transmittal letter and updated version of Subchapter 6 for their provider manual when the final review of 2006 HCPCS code additions is complete. The 2006 deleted codes and HCPCS additions that are payable for dates of service on or after January 1, 2006, are attached to this bulletin. Payment The 2006 HCPCS code additions attached to this bulletin are payable services in addition to the services described in Subchapter 6 of your provider manual. In accordance with MassHealth regulations, payments are subject to the terms and conditions of 130 CMR 410.000 and 450.000. Payment Requirements Payment for new lab codes, which are paid according to the most current applicable Division of Healthcare Finance and Policy (DHCFP) clinical (continued on next page) MassHealth Acute Outpatient Hospital Bulletin 14 January 2006 Page 2 Payment Requirements (cont.) laboratory services fee schedule, will be determined through individual consideration (I.C.) until DHCFP establishes specific rates and these rates are incorporated into the appropriate regulation. All claims using the service codes listed in this bulletin must be submitted with a report. Providers submitting claims electronically will receive a Claim Attachment Form (CAF). Providers must ensure that all information required to price and evaluate the claim including, but not limited to, invoices, operative notes, and reports, is submitted with the CAF. An operative report must accompany the physician’s claim for procedures designated for individual consideration. The operative report must be submitted in its entirety and must identify all procedures performed, including technical procedures, the name of the member, the date of the procedures, the preoperative diagnosis, the postoperative diagnosis, and the names of the surgeon and assistants. If the documentation is illegible or incomplete, or if no report has been submitted, MassHealth will deny the claim with the applicable error code. Questions If you have any questions about the information in this bulletin 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. (continued on next page) MassHealth Acute Outpatient Hospital Bulletin 14 January 2006 Page 3 Updates to the MassHealth List of Payable Codes for Acute Outpatient Hospitals Listed below are the service codes that replace HCPCS codes that have been deleted in 2006 and are payable by MassHealth for dates of service on or after January 1, 2006. Providers should refer to www.cms.hhs.gov for service descriptions. 01965 15365 90761 96521 01966 15366 90765 96522 15170 32503 90766 96523 15171 32504 90767 97760 15175 33925 90768 97761 15176 33926 90772 97762 15300 37718 90773 99053 15301 37722 90774 99060 15320 44180 90775 99304 15321 44186 90779 99305 15330 45499 96401 99306 15331 82271 96402 99307 15335 83700 96409 99308 15336 83701 96411 99309 15340 86355 96413 99310 15341 86357 96415 J0885 15360 86367 96416 15361 90760 96417 Discontinued Service Codes for Acute Outpatient Hospitals The following codes are deleted for 2006 and are no longer payable by MassHealth for dates of service on or after January 1, 2006. Providers should refer to www.cms.hhs.gov for service descriptions. 01964 44200 90799 15342 44201 90871 15343 44239 92510 15350 69410 95858 15351 76375 96100 16010 78160 96115 16015 78162 96117 21493 78170 96400 21494 78172 96408 31585 78455 96410 31586 82273 96412 32520 83715 96414 32522 83716 96520 32525 86064 96530 32918 86379 96545 33919 86587 97020 37720 90780 97504 37730 42325 90781 90782 97520 97703 42326 90783 99052 43638 90784 99054 43639 90788