MassHealth All Provider Manual Appendices

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.

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.

This appendix lists CMSP covered codes.

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.

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.

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.

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.

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. 

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.