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MassHealth Guidelines for Medical Necessity Determination A – G

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Absorbent Products

MassHealth Guidelines for Medical Necessity Determination for Absorbent Products 

Adult Day Health (ADH)

MassHealth Guidelines for Medical Necessity Determination for Adult Day Health (ADH) 

Adult Foster Care (AFC)

Guidelines for Medical Necessity Determination for Adult Foster Care (AFC) 

Augmentative and Alternative Communication Devices

MassHealth Guidelines for Medical Necessity Determination for Augmentative and Alternative Communication Devices and Speech Generation Devices 

Bariatric Surgery

MassHealth Guidelines for Medical Necessity Determination for Bariatric Surgery 

Blepharoplasty, Upper Eyelid Ptosis, and Brow Ptosis Surgery

MassHealth Guidelines for Medical Necessity Determination for Blepharoplasty, Upper Eyelid Ptosis, and Brow Ptosis Surgery 

Botulinum Toxin in the Treatment of Hyperhidrosis

MassHealth Guidelines for Medical Necessity Determination for Botulinum Toxin in the Treatment of Hyperhidrosis 

Breast MRI

MassHealth Guidelines for Medical Necessity Determination for Breast MRI 

Breast Reconstruction

MassHealth Guidelines for Medical Necessity Determination for Breast Reconstruction 

Capsule Endoscopy

MassHealth Guidelines for Medical Necessity Determination for Capsule Endoscopy 

CardioMEMS

MassHealth Guidelines for Medical Necessity Determination for CardioMEMS 

Chromosomal Microarray Analysis

MassHealth Guidelines for Medical Necessity Determination for Chromosomal Microarray Analysis 

Cochlear Implantation

MassHealth Guidelines for Medical Necessity Determination for Cochlear Implantation 

Cranial Orthoses

MassHealth Guidelines for Medical Necessity Determination for Cranial Orthoses 

Day Habilitation

MassHealth Guidelines for Medical Necessity Determination for Day Habilitation 

Diabetes Management

MassHealth Guidelines for Medical Necessity Determination for Diabetes Management 

Enteral Nutrition and Special Medical Formulas

MassHealth Guidelines for Medical Necessity Determination for Enteral Nutrition and Special Medical Formulas 

Erectile Dysfunction

MassHealth Guidelines for Medical Necessity Determination for the Treatment of Erectile Dysfunction 

Excision of Excessive Skin and Subcutaneous Tissue

MassHealth Guidelines for Medical Necessity Determination for Excision of Excessive Skin and Subcutaneous Tissue 

Gait Trainers

Guide MassHealth Guidelines for Medical Necessity Determination for Gait Trainers 

Gender Affirming Surgery

MassHealth Guidelines for Medical Necessity Determination for Gender Affirming Surgery 

Gene Expression Profiling Tests for Breast Cancer

MassHealth Guidelines for Medical Necessity Determination for Gene Expression Profiling Tests for Breast Cancer 

Genetic Testing for Hereditary Breast and/or Ovarian Cancer

MassHealth Guidelines for Medical Necessity Determination for Genetic Testing for Hereditary Breast and/or Ovarian Cancer 
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