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MassHealth Durable Medical Equipment and Oxygen Payment and Coverage Guideline Tool NEW

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Billing or payments of any kind are not performed on this tool. The MassHealth Payment and Coverage Guideline Tool is strictly informational and updated periodically. Users should always access the online tool version to assure the most recent version is utilized.

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About the DME OXY Tool

This online tool was designed to provide direction and assist with the practical application utilizing HCPCS codes identified in Subchapter 6 of the provider manuals. The tool provides service descriptions for all durable medical equipment (DME) and oxygen (OXY) HCPCS codes covered by MassHealth. This tool identifies and describes:

  • Applicable modifiers;
  • Place-of-service codes;
  • Prior-authorization requirements;
  • Individual consideration requirements;
  • Service limits; and

  • Fee schedule for HCPCS codes.

Use the Coverage Guideline Tool

DME and OXY Online Coverage Guideline Tool 

Supporting Regulations and Bulletins

Regulations

MassHealth DME Regulations - 130 CMR 409.000

MassHealth Oxygen Regulations - 130 CMR 427.000

Coding Specific MassHealth Transmittal Letters and Bulletins

All Provider Bulletin 256 : The Overpayment Disclosure Process

All Provider Bulletin 209: Medicaid National Correct Coding Initiative

Durable Medical Equipment Bulletin Provider Bulletin 19 : Dual Eligible MassHealth Members - Coordination of Medicare and Medicaid Coverage 

Provider Support

Optum:

CCM

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