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Submitted URL: http://www.mass.gov/service-details/masshealth-payment-and-coverage-guideline-tools
Effective URL: https://www.mass.gov/info-details/masshealth-payment-and-coverage-guideline-tools
Submission: On September 10 via manual from IN — Scanned from DE
Effective URL: https://www.mass.gov/info-details/masshealth-payment-and-coverage-guideline-tools
Submission: On September 10 via manual from IN — Scanned from DE
Form analysis 3 forms found in the DOM
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</form>Name: header-search — https://search.mass.gov/
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1.
2. Health & Social Services
3. …
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levels are currently hidden. Use this button to show and access all levels.
4. MassHealth
5. MassHealth Initiatives
6. The MassHealth Community Case Management (CCM) Program
7. Durable Medical Equipment, Prosthetics, Orthotics, Oxygen & Respiratory
(DMEPOS)
8. MassHealth Payment and Coverage Guideline Tools
* This page, MassHealth Payment and Coverage Guideline Tools, is offered by
* MassHealth
* show more
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.
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TABLE OF CONTENTS
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Table of Contents Hide Table of contents×
* MassHealth Durable Medical Equipment and Oxygen Payment and Coverage
Guideline Tool
* MassHealth Orthotics and Prosthetics Payment and Coverage Guideline Tool
* Get Email Notifications When the Guideline Tools are Updated
Show More Table of contents
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Table of Contents
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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
Open XLSX file, 1.2 MB, MassHealth DME and OXY Payment and Coverage Guideline
Tool (V.43) (English, XLSX 1.2 MB)
Open PDF file, 3.44 MB, MassHealth DME and OXY Payment and Coverage Guideline
Tool (V.43) (English, PDF 3.44 MB)
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
Open XLSX file, 986.23 KB, MassHealth ORT and PRT Payment and Coverage
Guideline Tool (V.21) (English, XLSX 986.23 KB)
Open PDF file, 1.2 MB, MassHealth ORT and PRT Payment and Coverage Guideline
Tool (V.21) (English, PDF 1.2 MB)
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 this link to fill out and
submit the short form: MassHealth Payment Guideline Tools Email Sign Up
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.
RELATED
* MassHealth Payment and Coverage Guideline Tools Email Sign Up
* MassHealth Provider Manuals
RELATED
* MassHealth Payment and Coverage Guideline Tools Email Sign Up
* MassHealth Provider Manuals
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