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MassHealth Payment and Coverage Guideline Tools

On this web page are the MassHealth DME & OXY Payment and Coverage Guideline Tool and the ORT & PRT Payment and Coverage Guideline Tool.

If you are enrolled as an:

  • Durable Medical Equipment (DME) provider
  • Oxygen Respiratory (OXY) provider
  • Orthotics (ORT) provider
  • Prosthetics (PRT) provider

The MassHealth Durable Medical Equipment and Oxygen Payment and Coverage Guideline Tool or the MassHealth Orthotics and Prosthetics Payment and Coverage Guideline Tool will guide you to all MassHealth covered HCPCS codes and other important information.

Table of Contents

MassHealth Durable Medical Equipment and Oxygen Payment and Coverage Guideline Tool

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.

This downloadable 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.

The tool also contains links to other applicable information, such as:

  • Pricing Regulations
  • MassHealth Transmittal Letters
  • MassHealth Provider Bulletins
  • Message Texts

Subchapter 6 of the Durable Medical Equipment (DME) and Oxygen (OXY) Manuals directs providers to the MassHealth Orthotics and Prosthetics and Coverage Guidelines Tool.

Additional Resources

MassHealth Orthotics and Prosthetics Payment and Coverage Guideline Tool

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.

This downloadable 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 orthotics (ORT) and prosthetics (PRT) 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.

The tool also contains links to other applicable information, such as:

  • Pricing Regulations
  • MassHealth Transmittal Letters
  • MassHealth Provider Bulletins
  • Message Text

Subchapter 6 of the Orthotics (ORT) and Prosthetics (PRT) Manuals directs providers to the MassHealth Orthotics and Prosthetics and Coverage Guidelines Tool.

Additional Resources

Get Email Notifications When the Guideline Tools are Updated

You can sign up to receive email notifications when MassHealth updates the DME/OXY or PRT/ORT Payment and Coverage Guideline Tool. To join our notification email list please follow the link below to fill out and submit the short form.

Or you can:

Join our mailing list for Durable Medical Equipment (DME) and Oxygen (OXY) Payment and Coverage Guideline Tool, by sending a blank email from your email account to: join-masshealth_dme_oxy_guidlines@listserv.state.ma.us. You do not need to add text in the body or subject line.

Or you can:

Join our mailing list for Orthotics (ORT) and Prosthetics (PRT) Payment Coverage Guideline Tool, by sending a blank email from your email account to: masshealth_ort_prt_paymnt_coverage_guidelines_tool@listserv.state.ma.us. You do not need to add text in the body or subject line.

Additional Resources

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