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MassHealth Guidelines for Medical Necessity Determination A – G

Table of Contents

Absorbent Products

Adult Day Health (ADH)

Adult Foster Care (AFC)

Ambulatory Infusion Pumps (Insulin Pumps)

Augmentative and Alternative Communication Devices

Bariatric Surgery

Blepharoplasty, Upper Eyelid Ptosis, and Brow Ptosis Surgery

Breast MRI

Breast Reconstruction

Capsule Endoscopy

CardioMEMS

Chromosomal Microarray Analysis

Cranial Orthosis

Diabetes Management

Enteral Nutrition and Special Medical Formulas

Excision of Excessive Skin and Subcutaneous Tissue

Gait Trainers

Gender Affirming Surgery

Gene Expression Profiling Tests for Breast Cancer

Genetic Testing for Hereditary Breast and/or Ovarian Cancer

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