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Physician Provider Publications

Find related MassHealth publications for Physician (PHY) providers below.
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Publications for Physician Providers

130 CMR 433.000: Physician Services 

This regulation establishes MassHealth requirements for providers of physician services.

Bulletins 

Provider bulletins are issued to communicate procedures, reminders, and other information.

Manual 

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

Transmittal Letters 

Transmittal letters summarize a change to a provider manual, contain revised pages, and tell providers how to update their manuals with the new pages.

Publications for All MassHealth Providers

Bulletins 

Provider bulletins are issued to communicate procedures, reminders, and other information.

Forms 

These forms are used to conduct business with MassHealth.

Manual Appendices 

These appendices are in every provider manual.

MassHealth and EOHHS Regulations 

Policy regulations, rate regulations, administration bulletins, and more.

Transmittal Letters 

Transmittal letters summarize a change to a provider manual, contain revised pages, and tell providers how to update their manuals with the new pages.

Guidelines for Medical Necessity Determination

These guidelines identify the clinical information MassHealth needs to determine medical necessity for certain products and services that require prior authorization.

All Guidelines for Medical Necessity Determination 
Bariatric Surgery 
Blepharoplasty, Upper Eyelid Ptosis, and Brow Ptosis 
Botulinum Toxin in the Treatment of Hyperhidrosis 
Breast MRI 
Breast Reconstruction 
Capsule Endoscopy 
CardioMEMS 
Chromosomal Microarray Analysis 
Gender Affirming Surgery 
Genetic Testing for Hereditary Breast and/or Ovarian Cancer 
Hair Removal 
Knee Arthroplasty 
Knee Anthroscopy 
Mastectomy for Gynecomastia 
Occupational Therapy 
Organ Transplant Procedures 
Physical Therapy 
Reduction Mammoplasty 
Rhinoplasty and Septoplasty 
Skin Substitutes 
Speech and Language Therapy 

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