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Physician Manual for MassHealth Providers

The Physician Manual guides physician providers to the regulations, administrative and billing instructions, and service codes they need.

Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR 450.000. These regulations are reproduced as Subchapters 1, 2, and 3 in this and all other manuals.

Program regulations cover matters that apply specifically to the type of provider for which the manual was prepared. For physician providers, those matters are covered in 130 CMR 433.000, reproduced as Subchapter 4 in the Physician Manual.

The Executive Office of Health and Human Services (EOHHS) establishes rates for MassHealth services. These rate regulations for physician services may be found in 101 CMR 316, 101 CMR 317, and 101 CMR 318

Table of Contents

Subchapters 1 through 3: Administrative and Billing Regulations for all MassHealth Providers

Subchapter 4: Physician Providers Regulations

Subchapter 5: Administrative and Billing Instructions for all MassHealth Providers

Subchapter 6: Physician Service Codes

Appendices for All MassHealth Providers (includes appendices A, C, T, U, V, W, X, Y, and Z)

Appendices for Physician Providers (includes appendices E, I, and K)

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