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Guide MassHealth All Provider Manual Appendices

MassHealth updates the generic appendices contained in all provider manuals (Appendices A, C, T, U, V, W, X, Y, and Z) as needed.

Table of Contents

Appendix A: Directory

This appendix contains the names, addresses, and telephone numbers of units, agencies, and contractors that you may need to contact in the course of doing business with MassHealth.

Additional Resources for Appendix A: Directory

Appendix C: Third-Party-Liability Codes

This appendix contains lists of third-party-liability (TPL) coverage-type codes and carrier codes to help you identify a member's other insurance. The MassHealth Recipient Eligibility Verification System (REVS) reports TPL coverage-type and carrier codes for all applicable insurance coverage listed on file for each member.

Additional Resources for Appendix C: Third-Party-Liability Codes

Appendix T: CMSP Covered Codes

This appendix lists CMSP covered codes.

Additional Resources for Appendix T: CMSP Covered Codes

Appendix U: DPH-Designated Serious Reportable Events That Are Not Provider Preventable Conditions

This appendix lists events that are designated by the Massachusetts Department of Public Health (DPH) as “Serious Reportable Events (SREs)” in accordance with 105 CMR 130.332 (or 105 CMR 140.308, as applicable) that are not considered “Provider Preventable Conditions” (PPCs) under MassHealth. These SREs are subject to applicable MassHealth provisions on “Serious Reportable Events” set forth, in the case of DPH-licensed hospital providers, in the hospital’s agreement with MassHealth governing payment for services, or in the case of freestanding ambulatory surgery centers, in Transmittal Letter FAS-25.

Additional Resources for Appendix U: DPH-Designated Serious Reportable Events That Are Not Provider Preventable Conditions

Appendix V: MassHealth Billing Instructions for Provider Preventable Conditions

This appendix describes the MassHealth billing instructions for Provider Preventable Conditions (PPCs), as they apply to providers. The appendix is subdivided into three parts: (1) billing instructions for PPCs for inpatient hospitals; (2) billing instructions for PPCs for outpatient hospitals and freestanding ambulatory surgery centers; and (3) billing instructions for PPCs for all other MassHealth providers.

Additional Resources for Appendix V: MassHealth Billing Instructions for Provider Preventable Conditions

Appendix W: EPSDT Services Medical and Dental Protocols and Periodicity Schedules

This appendix lists the services required under the Early and Periodic Screening, Diagnosis and Treatment (EPDST) Program, and the ages at which those services must be provided.

Additional Resources for Appendix W: EPSDT Services Medical and Dental Protocols and Periodicity Schedules

Appendix X: Family Assistance Copayments and Deductibles

MassHealth will pay for certain copayments, deductibles, and coinsurance amounts for certain MassHealth Family Assistance members under age 19. This appendix describes who is eligible, the types of copayments, deductibles, and coinsurance amounts that are covered, and how to bill for these services.

Additional Resources for Appendix X: Family Assistance Copayments and Deductibles

Appendix Y: EVS Codes and Messages

This appendix lists the active Eligibility Verification System (EVS) codes and their respective service restriction messages.

If you are looking for EVS system-generated message numbers, their corresponding unique message numbers, and their respective restrictive message text for MassHealth managed care health plans effective March 1, 2018, see the EVS Codes and Restrictive Messages for Managed Care Health Plans section on the Provider PCDI Resources page. 

Additional Resources for Appendix Y: EVS Codes and Messages

Appendix Z: EPSDT/PPHSD Screening Services Codes

This appendix lists the services that are payable in addition to the EPSDT periodic visit when they are performed and interpreted in the office of the provider who furnished the visit.

Additional Resources for Appendix Z: EPSDT/PPHSD Screening Services Codes

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