Massachusetts Admin. Code department-101-cmr | Code of Massachusetts Regulations, Executive Office for Health and Human Services

101 CMR, 101 CMR 1-9 Reserved

Transitional Planning Services Transitional Planning Services

101 CMR, § 10.01 Purpose

101 CMR 10.00 establishes the procedures for the appeal, modification, extension and termination of an Individual Transitional Plan established under M.G.L. c. 71B, § 12C to disabled persons who will be losing their entitlement to special education services because of age or graduation from high school.

History

Amended by Mass Register Issue 1363, eff. 4/20/2018.

101 CMR, § 10.02 Definitions

Bureau of Transitional Planning (BTP). The bureau within the Executive Office of Health and Human Services which is responsible for coordinating the development of and monitoring the implementation of an individual transitional plan.

Disabled Person. A disabled person within the meaning of M.G.L. c. 71B, § 12A.

Individual Transitional Plan (FTP). A plan for a program of habilitative services for disabled persons whose entitlement to services under special education programs has terminated or will terminate as a result of such person's graduation from high school or attainment of 22 years of age.

Transitional Advisory Committee (TAC). A committee established pursuant to M.G.L. c. 71B, § 12B which reviews and approves all ITPs. The TAC consists of the Secretary of the Executive Office of Health and Human Services or his or her designee, and representatives from the Executive Office of Labor and Workforce Development, Department of Mental Health, Department of Developmental Services, Department of Public Health, Department of Children and Families, Department of Transitional Assistance, Department of Youth Services, Massachusetts Rehabilitation Commission, Massachusetts Commission for the Deaf and Hard of Hearing, Massachusetts Commission for the Blind, and the Department of Elementary and Secondary Education.

Transitional Agency. A state agency within the Executive Office of Health and Human Services designated at the start of the transitional planning process to develop an FTP for a disabled person and to act as case coordinator to a disabled person during the transitional planning process.

History

Amended by Mass Register Issue 1363, eff. 4/20/2018.

101 CMR, § 10.03 Appeal of Individual Transitional Plan by a Disabled Person

Within 90 days following the receipt of an FTP approved by the TAC, a disabled person may appeal the FTP, in whole or in part, including the scope of services identified by the committee as necessary or appropriate to assist such person in realizing his or her potential for self-sufficiency in major life activities, the agencies responsible for providing such services (provided, however, that agency eligibility requirements are met), and the location and duration of such services, by filing a written notice of appeal to the EOHHS Secretary. The disabled person shall include with the notice of appeal documentation or other evidence in support of the appeal and shall provide a copy of the notice and accompanying documentation or evidence to the BTP. Failure to file a notice of appeal within 90 days following the receipt of an ITP approved by the TAC shall constitute a waiver of a right to an administrative appeal.

The EOHHS Secretary, or his or her designee, may receive and consider statements of position from the BTP and any state agency designated to provide services under the ITP. Within 30 days following the receipt of a notice of appeal, the EOHHS Secretary or designee shall issue a written ruling either affirming or modifying the ITP and shall provide a copy of the ruling to the disabled person, the BTP, and any state agency which has submitted a statement of position. The Secretary's decision shall be final and shall not be subject to further administrative review.

History

Amended by Mass Register Issue 1363, eff. 4/20/2018.

101 CMR, § 10.04 Appeal of the Individual Transitional Plan by a State Agency

Any state agency designated on an ITP as a service provider may appeal an ITP by requesting in writing a review by the Secretary of EOHHS within 30 days of the TAC approval of the ITP to determine whether:

(a) services to be provided are within such agency's jurisdiction or mandate,

(b) such agency is appropriately designated as the responsible state agency; and

(c) the duration of services to be provided is necessary and appropriate and within such agency's jurisdiction or mandate.

The appealing state agency shall include in its request documentation or other evidence in support of the appeal and shall provide a copy of the appeal and documentation or other evidence to the BTP and the disabled person. The Secretary's or designee's decision shall be final and shall not be subject to further administrative review.

History

Amended by Mass Register Issue 1363, eff. 4/20/2018.

101 CMR, § 10.05 Extension of the Individual Transitional Plan

Extension. The BTP may grant a request for an extension of the date for implementation of ITP beyond the projected start date for services when the person's special education termination date is changed to a later date by the local education agency, by court order, or by order of the Bureau of Special Education Appeals. A request for extension may also be granted when the services to be provided are not yet in place.

History

Amended by Mass Register Issue 1363, eff. 4/20/2018.

101 CMR, § 10.06 Termination of the Individual Transitional Plan

Termination. An ITP shall terminate when the state agencies designated on the ITP as service providers have developed an individualized service plan for the disabled person as specified on the ITP, and the services listed on the ITP are being provided. The transitional agency shall continue to act as case coordinator for the disabled person, and the BTP shall monitor the implementation of the ITP by the responsible agencies until these services are provided. Whenever the services outlined on an ITP are to be provided by more than one agency, the BTP shall appoint a chief case manager in one lead agency to oversee the coordination, implementation, and delivery of services to the disabled person by all the agencies designated on the ITP.

History

Amended by Mass Register Issue 1363, eff. 4/20/2018.

101 CMR, 101 CMR 11-13 Reserved

101 CMR, 101 CMR 14.00 [Repealed]

History

Repealed by Mass Register Issue 1356, eff. 1/12/2018.
REGULATORY AUTHORITY 101 CMR 14.00: St. 1997, c. 43, § 2, line item 4000-0175.

CRIMINAL OFFENDER RECORD CHECKS CRIMINAL OFFENDER RECORD CHECKS

101 CMR, § 15.01 Purpose

The purpose of 101 CMR 15.00 is to establish a core standardized policy and procedure for the Executive Office of Health and Human Services (EOHHS), its agencies, and vendor programs regarding the review of criminal records of candidates for employment.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.02 Policy

It is the policy of EOHHS that an individual's background, including any Criminal Offender Record Information (CORI) and other relevant information, be carefully considered so that the vulnerable populations served by EOHHS and its agencies are protected. It is also the policy of EOHHS that qualified rehabilitated offenders are given a fair opportunity to be employed and reintegrate successfully into the workforce. Further, a criminal background check should only occur, and its results considered, in those instances where a current or prospective employee shall have been deemed otherwise qualified and the content of a criminal record is relevant to the duties and qualifications of the position.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.03 Scope

(1) Upon completion of registration with the Department of Criminal Justice Information Services (DCJIS), criminal history information shall be required and only considered with respect to the following categories of applicants and employees of EOHHS, its agencies, and vendor programs:

(a) applicants and employees seeking a position that entails the potential for unsupervised contact with program clients;

(b) applicants and employees for whom a CORI is necessary to comply with other legal requirements, or for whom a CORI is otherwise deemed by EOHHS, its agencies, or vendor programs to be relevant to the duties and qualifications of the position; and

(2) Current employees in positions where a CORI is required may be subject to a criminal record review at other times in the hiring authority's discretion. Notwithstanding the foregoing, the hiring authority shall not take any action based on the CORI unless the CORI reveals criminal activity that did not appear on the prior CORI.

(3) Neither MassHealth providers nor entities or persons who are licensed by an EOHHS agency or who receive a grant from EOHHS or an EOHHS agency are subject to 101 CMR 15.00 solely by virtue of their status as MassHealth providers, EOHHS licensees, or grant recipients. Notwithstanding the foregoing, nothing in 101 CMR 15.00 should be construed to limit the MassHealth program or an EOHHS agency from considering a person's CORI or other criminal record information when determining if he or she may participate as a provider in the MassHealth program, be licensed, or receive a grant.

(4) Notwithstanding anything in 101 CMR 15.00, a CORI is not required for EOHHS and EOHHS agency employees who, as of May 1, 2009, and for vendor program employees, who, as of July 1, 2009, hold a position where a CORI would otherwise be required, but who were not previously the subject of a CORI nor required to have been so under the EOHHS or EOHHS agency regulations applicable when the employee was hired.

(5) Notwithstanding anything in 101 CMR 15.00, EOHHS, EOHHS agencies, and vendor programs, at their expense, may use convictions and pending criminal matters in other states in addition to CORI. Such information shall be reviewed in accordance with 101 CMR 15.00 and as if the crime had occurred in Massachusetts.

(6) Notwithstanding anything in 101 CMR 15.00, 101 CMR 15.00 shall not apply to applicants for positions in or employees of vendor programs licensed by the Department of Early Education and Care. Such vendor programs shall be subject to 606 CMR 14.00: Criminal Offender and Other Background Record Checks .

(7) The procedures under 101 CMR 15.06 through 15.09 shall be followed for all positions that fall within the scope of 101 CMR 15.03.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.04 Definitions

Applicant. Any person seeking employment with EOHHS or an EOHHS agency or their vendor programs, including current employees seeking new positions.

Candidate. Any person who is first determined otherwise qualified for the position and has received a conditional offer of employment subject to consideration of any criminal record information.

Client. Any person applying for or receiving EOHHS or EOHHS agency or their vendor program services.

Community Service Worker. Any individual who, as a condition of probation, is applying for a position.

CORI Cleared Employee. Any candidate hired as an employee after the hiring authority completed all requirements of 101 CMR 15.00.

CORI Coordinator. The person designated by the hiring authority to send requests and receive responses from the Department of Criminal Justice Information Services (DCJIS).

CORI Investigation. The process of requesting, receiving, and evaluating CORI related to candidates for employment.

Criminal Justice Official. Either the candidate's probation officer, parole officer, or correctional facility superintendent (or designee), depending upon whomever had the most recent responsibility for supervision of the candidate. Candidates last supervised in a correctional facility may advise the hiring authority of any employee of the correctional facility who may have specific information about the candidate that would assist the superintendent in his or her assessment process.

Criminal Offender Record Information (CORI). Information recorded as a result of criminal proceedings or any consequent related proceedings and regulated by the Department of Criminal Justice Information Services under 803 CMR 2.00: Criminal Offender Record Information (CORI) .

Department of Criminal Justice Information Services (DCJIS). The Commonwealth agency statutorily designated to, among other things, provide a public safety information system and network to support data collection, information sharing, and interoperability for the Commonwealth's criminal justice and law enforcement community and to oversee the authorized provision of Criminal Offender Record Information (CORI) to the non-criminal justice community.

Employees. Individuals holding full and part-time positions, including state employees, contract employees, individual consultants, temporary employees, volunteers, trainees, interns, or students, regardless of whether the individuals receive compensation and the source of funding for the positions. For the purposes of 101 CMR 15.04, a current client of a facility or program who provides services at that facility or program will not be considered an employee at that facility or program.

Employment. Full and part-time positions held by any person, including state employees, contract employees, individual consultants, temporary employees, volunteers, trainees, interns, or students, regardless of whether the person receives compensation and the source of funding for the positions.

EOHHS. The Executive Office of Health and Human Services.

EOHHS Agency. Any agency, department, commission, office, board, division, or other body within and subject to EOHHS under M.G.L. c. 6A, § 16, including the Office of Elder Affairs.

EOHHS Funded or Operated Program. Any program operated by EOHHS or an EOHHS agency or their vendor programs that provides health and human services for or on behalf of EOHHS or EOHHS agency clients in accordance with a contract under 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services .

Hiring Authority. The person or persons legally authorized or designated to make hiring decisions within EOHHS or an EOHHS agency or their vendor programs. Different persons may be authorized or designated as responsible for specific parts of the process in making a hiring decision.

No Record. The conclusion from a CORI search that shows no information relating to the candidate is available for release to EOHHS, an EOHHS agency, or their vendor programs. A finding of "no record" does not necessarily mean, however, that criminal information is not present in the CORI database.

Otherwise Qualified. An applicant who meets all other employment criteria and consideration for a position.

Pending. A criminal matter is considered pending if the CORI report indicates that the matter remains open and without final resolution, including that the case has been continued without a finding.

Potential Unsupervised Contact. Potential for contact with a client when no other CORI cleared employee is present. A person having only the potential for incidental unsupervised contact with clients in commonly used areas such as elevators, hallways, and waiting rooms, will not be considered to have the potential for unsupervised contact for purposes of 101 CMR 15.03. The term "commonly used areas" does not include bathrooms or other isolated areas that are separated by sight and sound from other staff.

Qualified Mental Health Professional. A psychiatrist licensed to practice medicine under M.G.L. c. 112, § 2, a psychologist licensed under M.G.L. c. 112, § 118 through 121, or an independent clinical social worker licensed under M.G.L. c. 112, § 130 through 132; provided that he or she has at least 1,000 hours of experience over a minimum of two years involving assessment, treatment, and consultation concerning individuals with behavior that presents a risk of harm to others in the community, in the workplace, in treatment settings, or in correctional facilities; provided further that he or she has not provided treatment to the candidate.

Trainee. Any person enrolled in an academic program or participating in a pre- or post-doctoral training program that is affiliated with an accredited educational institution or hospital, who receives a placement within EOHHS or an EOHHS agency or their vendor programs.

Vendor Program. A program, administered by an individual, corporation, partnership, organization, trust, association, or other entity, that provides services to EOHHS or EOHHS agency clients under a contract issued by EOHHS or an EOHHS agency in accordance with 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services . An individual or entity will not be considered a vendor program solely because they participate as a MassHealth provider or are licensed by an EOHHS agency or receive a grant from EOHHS or an EOHHS agency.

Volunteer. Any person who works in an unpaid capacity for EOHHS, an EOHHS agency, or vendor program. For the purposes of 101 CMR 15.04, a current client of a facility or program who provides unpaid services at that facility or program will not be considered a volunteer at that facility or program.

Work Release Program. A program of unpaid work performed by an individual under the custody of the state or county correctional system.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.05 Community Service and Work Release Workers

(1) Notwithstanding anything in 101 CMR 15.00, EOHHS or any EOHHS agency or their vendor programs that participate in either a criminal justice related community service program or a work release program must require all individuals who participate to disclose his or her criminal record on a form signed by the candidate's criminal justice official. No inquiry, however, may be made inconsistent with M.G.L. c. 151B, § 4, para 9 which prohibits the disclosure of:

(a) an arrest, detention, or disposition regarding any violation of law in which no conviction resulted; or

(b) a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray, or disturbance of the peace; or

(c) any conviction of a misdemeanor where the date of such conviction or the completion of any period of incarceration resulting there from, whichever date is later, occurred five or more years prior to the date of such application for employment or such request for information, unless such person has been convicted of any offense within five years immediately preceding the date of such application for employment or such request for information.

(2) In addition, as a condition of participation, the candidate's criminal justice official must conclude in writing that the candidate will not pose an unacceptable risk of harm to clients, or the community service program or work release program will take responsibility for providing physical supervision for the candidate at all times.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.06 Application Forms

(1) Disclosure of Criminal Records.

(a) No initial employment application form may ask whether an applicant has a criminal record. Only a candidate who has been first determined otherwise eligible for a position subject to a CORI and given a conditional offer of employment subject to consideration of any criminal record, may be asked to complete a supplemental form requiring the disclosure of the candidate's criminal record. No inquiry may be made inconsistent with M.G.L. c. 151B, § 4, para 9, referenced under 101 CMR 15.05(1).

(b) Any other criminal record information will be obtained in accordance with 101 CMR 15.06(2).

(2) CORI Authorization Forms and Consent.

(a) The hiring authority will ensure that a candidate provides consent to a CORI investigation and, where applicable, to the periodic conduct of further CORI investigations during the course of employment.

(b) All candidates must complete an appropriate CORI Acknowledgement Form and in accordance with 803 CMR 2.00: Criminal Offender Record Information (CORI) , the hiring authority shall verify the candidate's identity by forms of documentation as determined by DCJIS. If the hiring authority is unable to verify a subject's identity and signature in person, the subject may submit a completed CORI Acknowledgment Form acknowledged by the candidate before a notary public.

(c) The hiring authority will also inform the candidate that his or her CORI may be utilized by qualified mental-health professionals conducting themselves in conformance with 101 CMR 15.09 and by EOHHS, EOHHS agency, or vendor program personnel responsible for carrying out the provisions of 101 CMR 15.00.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.07 CORI Investigations

(1) A hiring authority will complete a CORI investigation only after determining that the person is otherwise qualified for employment and making a conditional offer of employment to a candidate, subject to consideration of any criminal record.

(2) The hiring authority will confirm an offer only after the hiring authority receives written confirmation that the criminal record investigation has resulted in a finding of "no record" or the hiring authority has complied with the requirements of 101 CMR 15.07, 15.08, and 15.09. The hiring authority will not permit any candidate to commence employment until after the candidate is cleared as a result of the CORI investigation in accordance with 101 CMR 15.00. Notwithstanding the foregoing, pending the candidate being cleared, the hiring authority may permit the candidate to commence employment on a temporary basis in a position outside the scope of 101CMR 15.03(1).

(3) All CORI investigations that result in a finding of "no record" are transmitted back to the hiring authority and provide sufficient evidence of suitability for hire for 60 business days. A "no record" finding may be valid for consideration for other positions during such 60 days.

(4) All CORI investigations that show findings of criminal records are sent immediately to the hiring authority for review and action consistent with 101 CMR 15.00.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.08 Findings from CORI Investigations - No Further Review - Outstanding Warrants

(1) If the CORI investigation reveals a conviction of a 101 CMR 15.15: Table B crime that is a felony more than ten years old, or a 101 CMR 15.15: Table B crime that is a misdemeanor more than five years old, and there are no subsequent convictions or pending cases of any kind, the hiring authority will not consider such crime. For purposes of computing the five and ten-year time periods, the time period will run from the date any court supervision, probation, or sentence was terminated.

(2) If the CORI investigation reveals an outstanding warrant for any offense, the hiring authority will inform the candidate that he or she is ineligible for employment unless the warrant is removed.

(3) Storage, retention, and destruction of all CORI reports, including those with a finding of "no record", shall be in accordance with 803 CMR 2.00: Criminal Offender Record Information (CORI) .

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.09 Findings from CORI Investigation - Crimes Subject to Review

(1) If the CORI investigation reveals a conviction of a 101 CMR 15.15: Table A crime, regardless of when it occurred, or a pending 101 CMR 15.15: Table A crime, or a conviction of a 101 CMR 15.15: Table B crime within the five- and ten-year time periods referenced under 101 CMR 15.08(1), or a pending 101 CMR 15.15: Table B crime, the hiring authority will give careful consideration to the following factors in its decision to hire or not hire the candidate:

(a) time since the conviction or pending offense;

(b) age of the candidate at the time of the offense;

(d) sentence imposed and length of any period of incarceration;

(e) relationship of the criminal act to the nature of the work to be performed;

(f) number of offenses;

(g) whether offenses were committed in association with a dependence on drugs or alcohol, from which the candidate has since recovered;

(h) any relevant evidence of rehabilitation or lack thereof, such as information about compliance with conditions of parole or probation, including orders of no contact with victims and witnesses; and the individual's conduct and experience since the time of the offense, including but not limited to educational or professional certifications obtained; and

(i) any other relevant information, including information submitted by the candidate, or requested by the hiring authority.

(2) The hiring authority, using a form prescribed by EOHHS, will also make a written determination of its decision to hire or not hire such candidate. This form will document the factors considered and the rationale for the hiring authority's decision. A copy of such written determination will be maintained by the hiring authority in a secure location, together with the CORI and criminal record disclosure information that may have been requested under 101 CMR 15.06(1)(a). Completion of the written determination form will serve to confirm that the hiring authority has carefully reviewed the CORI and other relevant information, including information provided by the candidate, so that the vulnerable populations served by EOHHS agencies are protected and candidates with criminal histories are given a fair opportunity to be employed and to reintegrate successfully into the workforce.

(3)

(a) In addition, if the hiring authority decides to hire a candidate with a CORI showing a conviction of, or pending Table A crime, the hiring authority will submit the prescribed form to the EOHHS Secretary or the EOHHS agency Commissioner or their designees. The hiring authority will not proceed to hire the candidate for five business days from the date the EOHHS Secretary or the EOHHS agency Commissioner or their designees receive the form. During such time, the EOHHS Secretary or EOHHS agency Commissioner or their designees may disapprove the hire or request additional information. Notwithstanding the foregoing, a hiring authority may proceed to hire the candidate before the expiration of the five-day period if the EOHHS Secretary or EOHHS agency Commissioner or designee, after receiving the prescribed form, informs the hiring authority that he or she does not intend to disapprove the hire or request additional information.

(b) EOHHS or an EOHHS agency may require that the hiring authority's review include the following:

a review by the candidate's criminal justice official, including a determination in writing that the candidate, within the position sought, does not pose an unacceptable risk of harm to the clients; or
if the criminal justice official has been determined by the hiring authority to be unavailable or has indicated he or she has insufficient information to render an assessment, a written determination from a qualified mental-health professional that the candidate, within the position sought, does not pose an unacceptable risk of harm to the clients. The EOHHS agency or EOHHS, if EOHHS makes the request, will bear the cost of an assessment by a qualified mental-health professional of the candidate's risk of harm.

(4) If the hiring authority does not wish to hire a candidate with a 101 CMR 15.15: Table A crime, or a 101 CMR 15.15: Table B crime within the five- and ten-year time periods referenced under 101 CMR 15.08(1), the prescribed form will be completed as outlined in 101 CMR 15.09(2) and will be maintained on file in a secure location.

(5) Before any determination or hiring decision is made on the basis of the CORI, the hiring authority will comply with all requirements of DCJIS under 803 CMR 2.00: Criminal Offender Record Information (CORI) including:

(a) providing a candidate with a copy of his or her CORI, EOHHS CORI regulations, and DCJIS information concerning the process for correcting a criminal record;

(b) notifying the candidate of the potential adverse decision based on the CORI;

(d) providing the candidate with an opportunity to dispute the accuracy and relevancy of the CORI; and

(e) upon receipt of any additional documentation received from the candidate or DCJIS, reviewing the information with the candidate and informing him or her of the decision.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.10 Post Audit and Compliance Review

(1) EOHHS or an EOHHS agency may conduct a periodic review of all documentation of compliance with 101 CMR 15.00, including written determinations of hiring decisions of candidates as required under 101 CMR 15.09(2).

(2) If such review or other relevant information obtained by EOHHS or an EOHHS agency raises concerns about the hiring authority's compliance, EOHHS or an EOHHS agency may require the hiring authority to submit documentation for all hiring decisions and provide EOHHS or an EOHHS agency five business days to disapprove any decision to hire. EOHHS or an EOHHS agency may require the hiring authority to follow such prior review process for as long a period as it determines is necessary to ensure that the hiring authority is complying.

(3) Notwithstanding 101 CMR 15.10(2), in the event of noncompliance by a vendor program with any provision under 101 CMR 15.00, EOHHS may terminate the vendor's contract or take such other action it determines appropriate

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.11 Dissemination

CORI records may be disseminated only to individuals, such as the hiring authority or CORI Coordinator, designated by the agency or vendor program to receive such information, and included in the agency or vendor's need to know list. The hiring authority will maintain a listing of persons so designated. Any further dissemination shall be accordance with 803 CMR 2.00: Criminal Offender Record Information (CORI) , and a log of such secondary dissemination shall be maintained in accordance with DCJIS regulations. Willful dissemination of CORI to unauthorized individuals is punishable by a jail sentence of up to one year and/or a fine of $5,000, or in the case of dissemination by an entity that is not a natural person, a fine of up to $50,000. Further in the case of dissemination of juvenile delinquency records such fine may be up to $7,500 and if by an entity not a natural person, up to $75,000.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.12 Incidents

If any hiring authority receives an allegation that an EOHHS, an EOHHS agency, or vendor program employee whose CORI contained a record has harmed a client, the hiring authority will immediately report the allegation to the EOHHS or EOHHS agency General Counsel. Notification will include documentation of the hiring decision of the hiring authority.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.13 Agency Regulations

101 CMR 15.00 is intended to supersede any EOHHS agency regulations on the use of CORI for employment purposes. To the extent that any agency regulation may conflict, 101 CMR 15.00 will take precedence.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.14 Severability

If any provisions of 101 CMR 15.01 through 15.15, or the applications of such provisions to any person or circumstance are held invalid or unconstitutional, the other provisions of said 101 CMR 15.01 through 15.15, or the application of such provisions to any person or circumstance other than that as to which it is held invalid or unconstitutional, shall not be affected thereby.

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

101 CMR, § 15.15 Tables of Offenses

The offenses included in 101 CMR 15.15 are to be construed as including similar violations of the law of Massachusetts, another state, the United States, or a military, territorial, or Native American tribal authority. If an offense is determined to be similar, the hiring authority will consider the offense as if it were on the same table as the included offense.

| Table A | M.G.L. | | --- | --- | | Abandon Child Younger than ten Years Old, Resulting in Death | c. 119, § 39 | | Abuse of Patient in Long Term Care Facility | c. 265, § 38 | | Animals, Cruelty to | c. 272, § 77 | | Armed Career Criminal | c. 269, § 10G | | Arson of Dwelling House | c. 266, § 1 | | Assault, Aggravated | c. 265, § 13A(b) | | Assault & Battery, Dangerous Weapon, Aggravated | c. 265, § 15A(c) | | Assault & Battery, Dangerous Weapon, Victim 60 Years of Age or Older | c. 265, § 15A(a) | | Assault & Battery on Child | c. 265, § 13J | | Assault & Battery on Elder or Person with Disability | c. 265, § 13K | | Assault & Battery, Intimidation, Race/Color/Religion | c. 265, §§ 39(a) and 39(b) | | Assault & Battery on Person With Intellectual Disability | c. 265, § 13F | | Assault with Intent to Murder or Rob, Armed | c. 265, § 18(b) | | Assault with Intent to Murder or Rob, Victim 60 Years of Age or Older, Armed | c. 265, § 18(a) | | Assault in Dwelling, Armed | c. 265, § 18A | | Assault by Dangerous Weapon, Victim 60 Years of Age or Older | c. 265, § 15B(a) | | Assault with Intent to Murder or Maim | c. 265, § 15 | | Assault with Intent to Rape | c. 265, § 24 | | Assault with Intent to Rape Child Younger than 16 Years Old | c. 265, § 24B | | Breaking and Entering Night, Bldg/Ship/Motor Vehicle, Intent to Commit Felony | c. 266, § 16 | | Carjacking, Armed | c. 265, § 21A | | Child in Nude or Sexual Act, Pose/Exhibit or Distribute Material | c. 272, §§ 29A and 29B | | Child Enticement | c. 265, § 26C | | Civil Rights Violation, Bodily Injury | c. 265, § 37 | | Criminal Harassment, Subsequent Offense | c. 265, § 43A(b) | | Drugs, Distribute to Minor | c. 94C, § 32F | | Drugs, Trafficking in Cocaine | c. 94C, § 32E(b)(1)-(b)(4) | | Drugs, Trafficking in Heroin | c. 94C, § 32E(c)(4) | | Drugs, Trafficking in Marijuana | c. 94C, § 32E(a)(4) | | Elder/Disabled, Permit Abuse on | c. 265, § 13K(a 1/2) | | Explosion, Malicious | c. 266, § 102(B) (c. 266, § 101 prior to July 15, 2010) | | Extortion | c. 265, § 25 | | Firearm, Armed Career Criminal | c. 269, § 10G | | Home Invasion | c. 265, § 18C | | Identity Fraud | c. 266, § 37E | | Incest | c. 272, § 17 | | Indecent Assault & Battery on Person 14 Years of Age or Older | c. 265, § 13H | | Indecent Assault & Battery on Child Younger than 14 Years Old | c. 265, § 13B | | Indecent Assault & Battery on Child Younger than 14 Years Old, Aggravated | c. 265, § 13B1/2 | | Indecent Assault & Battery on Child Younger than 14 Years Old, | | | Aggravated, Subsequent Event | c. 265, § 13B3/4 | | Indecent Assault & Battery on Disabled/Person 60 Years of Age or Older | c. 265, § 13K | | Indecent Assault & Battery on Retarded Person | c. 265, § 13F | | Kidnapping | c. 265, § 26 | | Kidnapping Minor by Relative, Endanger Safety | c. 265, § 26A | | Manslaughter (Voluntary or Involuntary) | c. 265, § 13 | | Mayhem | c. 265, § 14 | | Murder | c. 265, §§ 1 and 2 | | Obscene Pictures, Distributing | c. 272, §§ 28 and 29 | | Obscene Materials Harmful to Minor, Distribute or Possess with Intent to Distribute | c. 272, § 28 | | Photograph Unsuspecting Nude Person/ | | | Photograph of Unsuspecting Nude Person, Disseminate | c. 272, § 105(b) and (c) (c. 272, §§ 104(b) and (c) prior to March 7, 2014) | | Prescription; Forgery, Alter, Subsequent Offense | c. 94C, § 33(c) | | Prostitution, Derive Support from | c. 272, § 7 | | Prostitution, Derive Support from Child | c. 272, § 4B | | Prostitution, Induce Minor to | c. 272, § 4A | | Prostitution, Maintain House of | c. 272, § 6 | | Prostitution/Unlawful Sex/Abduct Person for | c. 272, § 2 | | Prostitution/Solicitation (with Person Younger than 18 Years Old); | c. 272, § 53A(b) | | Prostitution/Solicitation (with Person Younger than 14 Years Old); | | | Prior to February 19, 2012 | c. 272, § 53A(b) | | Rape | c. 265, § 22(b) | | Rape, Aggravated | c. 265, § 22(a) | | Rape & Abuse of a Child, Aggravated | c. 265, § 23A | | Rape & Abuse of a Child, Aggravated, Subsequent Event | c. 265, § 23B | | Rape of Child with Force | c. 265, § 22A | | Rape of Child with Force, Aggravated | c. 265, § 22B | | Rape of Child with Force, Aggravated, Subsequent Event | c. 265, § 22C | | Rape of Child (Statutory) | c. 265, § 23 | | Reckless Endangerment to Children | c. 265, § 13L | | Robbery, Armed | c. 265, § 17 | | Sex Offender, Failure to Register | c. 6, § 178H(a) | | Sexual Conduct with Child Younger than 18 Years Old, Pay for or for Fee; | c. 272, § 53A(b) | | Sexual Conduct with Child Younger than 14 Years Old, Pay for or for Fee; | | | Prior to February 19, 2012 | c. 272, § 53A(b) | | Sexual Intercourse, Administer Drugs for | c. 272, § 3 | | Sexual Intercourse, Induce Minor | c. 272, § 4 | | Stalking | c. 265, § 43(a) | | Stalking in Violation of Restraining Order | c. 265, § 43(b) | | Unnatural Acts with Child Younger than 16 Years Old | c. 272, § 35A | | Violate Domestic Protective Order | c. 208, § 34C | | Violation of Protective Order (209A) | c. 209A, § 7 | | Weapon of Mass Destruction | c. 266, § 102C | | Conspiracy to Commit any of the above Table A Crimes | c. 274, § 7 | | Accessory Before the Fact of any of the above Table A Crimes | c. 274, § 2 | | Attempt to Commit any of the above Table A Crimes | c. 274, § 6 |

Table B

| Crime Name | M.G.L. | Felony or Misdemeanor | | --- | --- | --- | | Abandon Child Younger than ten Years Old | c. 119, § 39 | M | | Accessory after Fact (Variable) | c. 274, § 4 | F | | Accosting; Lewd & Lascivious Conduct; Indecent Exposure | c. 272, § 53 | M | | Affray, Subsequent Offense Affray (Prior to August 1, 2009) | c. 272, § 53 | M | | Aid Escape from Custody | c. 268, § 17 | M | | Alcoholic Beverages, Sell/Deliver to Person Younger than 21 Years Old | c. 138, § 34 | M | | Alien in Possess of Firearm | c. 140, § 131H | M | | Assault | c. 265, § 13A(a) | M | | Assault with Intent to Rob, Unarmed | c. 265, § 20 | F | | Assault & Battery | c. 265, § 13A(a) | M | | Assault & Battery on Public Servant/Police Officer | c. 265, § 13D | M | | Assault & Battery on Correctional Officer | c. 127, § 38B | F | | Assault & Battery Dangerous Weapon | c. 265, § 15A(b) | F | | Assault by Dangerous Weapon | c. 265, § 15B(b) | F | | Assault with Hypodermic Needle, Syringe | c. 265, § 15C(a) | F | | Assault & Battery with Hypodermic Needle, Syringe | c. 265, § 15C(b) | F | | Attempt to Injure Depository of Valuables | c. 266, § 16 | F | | Betting; Taking, Allowing | c. 271, § 17 | M | | Body Armor, Use of in Commission of Felony | c. 269, § 10D | F | | Bomb Scare /Hijack Threat | c. 269, § 14 | F | | Bomb/Explosives, Unlawful Possession | c. 148, § 35, | (M prior to July 15, 2010) | | c. 266, § 102 | F | | | Breaking and Entering Day, Intent to Commit Felony, Person in Fear | c. 266, § 17 | F | | Breaking and Entering Day, Intent to Commit Felony | c. 266, § 18 | F | | Breaking and Entering Railroad Car | c. 266, § 19 | F | | Breaking and Entering Truck, Intent to Commit Felony | c. 266, § 20A | F | | Breaking and Entering, Intent to Commit Misdemeanor | c. 266, § 16A | M | | Bribery of a Police Officer (State/Local Official or Member of the Judiciary) | c. 268A, § 2 | F | | Bribery/Gifts to Influence Business Affairs | c. 271, § 39 | F | | Burglarious Tools, Make or Possess | c. 266, § 49 | F | | Burglarious Tools, Motor Vehicle Master Key, Make or Possess | c. 266, § 49 | F | | Burglary, Armed | c. 266, § 14 | F | | Burglary, Unarmed | c. 266, § 15 | F | | Burning Building | c. 266, § 2 | F | | Burning Motor Vehicle or Personal Property | c. 266, § 5 | F | | Burning to Defraud Insurance Co. | c. 266, § 10 | F | | Burn Motor Vehicle, Willful & Malicious | c. 266, § 127 | F | | Civil Rights Violation, No Bodily Injury | c. 265, § 37 | M | | Compounding or Concealing Felony | c. 268, § 36 | F | | Contribute to Delinquency of Child | c. 119, § 63 | M | | Confine or Put in Fear to Steal or Attempt to Steal | c. 265, § 21 | F | | Credit Card, Larceny or Misuse of | c. 266, § 37B | M | | Credit Card, Unauthorized Use, over $250 | c. 266, § 37C | F | | Criminal Harassment | c. 265, § 43A(a) | M | | Dangerous Weapon, Carrying | c. 269, §§ 10(b) and 10(d) | F | | Dangerous Weapon, Unlawful Possession | c. 269, § 10(b) | F | | Defacement of Real or Personal Property | c. 266, § 126A | F | | Destruction of Property over $250, Malicious | c. 266, § 127 | F | | Disorderly Conduct | c. 272, § 53 | M | | Drugs, Larceny from Authorized Person | c. 94C, § 37 | F | | Drugs, Failure to Keep Records | c. 94C, § 15 | M | | Drugs, Illegal Possession Class C Substance | c. 94C, § 34 | M | | Drugs, Illegal Possession Class D Substance | c. 94C, § 34 | M | | Drugs, Illegal Possession Class E Substance | c. 94C, § 34 | M | | Drugs, Dispense Without Prescription or When Not Registered | c. 94C, § 25 | M | | Drug Paraphernalia, Distribute or Intend to Distribute | c. 94C, § 32I(a) | M | | Drug Paraphernalia, Sell to Minor | c. 94C, § 32I(b) | F | | Drugs, Manufacture/Distribute Class A Substance | c. 94C, § 32 | F | | Drugs, Manufacture/Distribute Class B Substance | c. 94C, § 32A | F | | Drugs, Manufacture/Distribute Class C Substance | c. 94C, § 32B | F | | Drugs, Manufacture/Distribute Class D Substance | c. 94C, § 32C | F | | Drugs, Manufacture/Distribute Class E Substance | c. 94C, § 32d(a) | M | | Drugs, Manufacture/Distribute/Dispense Class B Substance | c. 94C, § 32A | F | | Drugs, Manufacture/Distribute/Dispense Class A Substance in, on, or near School/Park | c. 94C, § 32J | F | | Drugs, Manufacture/Distribute/Dispense Class B Substance in, on, or near School/Park | c. 94C, § 32J | F | | Drugs, Motor Vehicle Homicide, Negligent Operation | c. 90, § 24G(b) | F | | Drugs, Possess Class A Substance | c. 94C, § 34 | M | | Drugs, Possess Class A Substance, Intent to Distribute | c. 94C, § 32(a) | M | | Drugs, Possess Class B Substance | c. 94C, § 34 | M | | Drugs, Possess Class B Substance, Intent to Distribute | c. 94C, § 32A(a) | F | | Drugs, Possess Class C Substance, Intent to Distribute | c. 94C, § 32B(a) | F | | Drugs, Possess Class C Substance, Subsequent Offense | c. 94C, § 34 | M | | Drugs, Possess Class D Substance, Intent to Distribute | c. 94C, § 32C(a) | M | | Drugs, Possess Class D Substance, Subsequent Offense | c. 94C, § 34 | M | | Drugs, Possess Class E Substance, Intent to Distribute | c. 94C, § 32D | M | | Drugs, Possess Controlled Substance with Intent to Distribute, | c. 94C, § 32(b) | F | | Subsequent Offense | | | | Drugs, Possess Counterfeit Substances with Intent to Distribute | c. 94C, § 32G | M | | Drugs, Possess Class a Substance with Intent to Distribute | c. 94C, § 32J | F | | in, on, or near School/Park | | | | Drugs, Possess Class B Substance with Intent to Distribute | c. 94C, § 32J | F | | in, on, or near School/Park | | | | Drugs, Possess Class D Substance with Intent to Distribute | c. 94C, § 32J | F | | in, on, or near School/Park | | | | Drugs, Trafficking in Cocaine in, on, or near School/Park | c. 94C, § 32J | F | | Drugs, Trafficking in Heroin in, on, or near School/Park | c. 94C, § 32J | F | | Drugs, Trafficking in Marijuana in, on, or near School/Park | c. 94C, § 32J | F | | Drugs, Unlawfully Obtaining Controlled Substance; False Prescription, | c. 94C, § 33 | F | | Fraud, False Registration | | | | Embezzlement | c. 266, §§ 51-52, 55-59 | F | | Enter Without Breaking, Bldg/Ship/Motor Vehicle, Intent to Commit | c. 266, § 17 | F | | a Felony, Person in Fear | | | | Enter Without Breaking a Dwelling in Night, Intent to Commit Felony | c. 266, § 18 | F | | Enter Without Breaking, Truck, with Intent to Commit Felony | c. 266, § 20A | F | | Escape by Prisoner | c. 268, § 16 | F | | Escape, Furlough | c. 268, § 16 | F | | Explosives, Throwing | c. 266, § 102 | F | | Explosives, Throw/Place/Explode or Possess with Intent to Injure | c. 266, § 102 | F | | Firearm, Carrying Loaded Rifle/Shotgun | c. 269, § 12D(a) | M | | Firearm, Carrying Loaded or Unloaded Firearm on a Public Way; | c. 269, § 12D(b) | F | | Unenclosed Case | | | | Firearm, Discharge Within 500 Ft. of a Building | c. 269, § 12E | M | | Firearm, Discharge Within 500 Ft. of a Dwelling or near Highway | c. 131, § 58 | M | | Firearm License/ID Card, False | c. 140, § 131I | F | | Firearm, Possess Without Fire Arms ID | c. 269, § 10(h) | M | | Firearm, Possess of, Serial/ID Number Obliterated | c. 269, § 11C | F | | Firearm, Possess of, Serial/ID Number Obliterated, Used | c. 269, § 11B | F | | in Commission or Attempted Commission of a Felony | | | | Firearm, Sell Without License | c. 140, § 128 | F | | Firearm, Shotgun, Barrel Und 18 "Sawed off", Possess, Subsequent Offense | c. 269, § 10(d) | F | | Firearm, Shotgun, Barrel Und 18 "Sawed off", Possess | c. 269, § 10(c) | F | | Firearm, Unattended | c. 269, § 10(h) | F | | Firearm, Unlawful Possession, Commission Felony | c. 265, § 18B | F | | Firearm, Shotgun, Unlawful Possession | c. 140, § 129 | M | | Firearm Violation, Carry with Ammunition | c. 269, § 10(n) | M | | Forged Instrument, Utter | c. 267, § 5 | F | | Fugitive from Justice | c. 276, § 19 | M | | Gun Permit, False Information for | c. 140, § 129 | M | | Hoax Device/Substance, Possess/Transport/Use | c. 266, § 102A1/2 | F | | c. 266, § 102 prior to July 15, 2010 | | | | Indecent Exposure | c. 272, § 53 | M | | Infernal Machine, Possess | c. 266, § 102A | F | | c. 266, § 102 prior to July 15, 2010 | | | | Kidnapping Minor by Relative | c. 265, § 26A | M | | Kill Beast, Willful & Malicious | c. 266, § 112 | F | | Larceny, Motor Vehicle or Trailer | c. 266, § 28 | F | | Larceny, Person | c. 266, § 25 | F | | Larceny, Person 65 Years of Age or Older | c. 266, § 25 | F | | Larceny by Check under $250 | c. 266, § 37 | M | | Larceny by Check over $250 | c. 266, § 37 | F | | Larceny, Firearm | c. 266, § 30 | F | | Larceny in Bldg, Ship, Vessel, or RR Car | c. 266, § 20 | F | | Larceny in Truck/Trailer | c. 266, § 20B | F | | Larceny over $250 | c. 266, § 30 | F | | Larceny under $250 | c. 266, § 30 | M | | Larceny, Bank Employee or Officer | c. 266, § 52 | F | | Leave Scene after Personal Injury, Motor Vehicle | c. 90, § 24(2)(a1/2)(1) | M | | Lewd & Lascivious Conduct | c. 272, § 53 | M | | Lewdness, Open & Gross | c. 272, § 16 | F | | Liquor, Procure for Minor | c. 138, § 34 | M | | Machine or Sawed off Shot Gun, Possession of | c. 269, § 10(c) | F | | Machine Gun, Possession of Without License | c. 269, § 10(c) | F | | Manslaughter by Operating under the Influence | c. 265, § 131/2 | F | | Medical Assistance (Medicaid) Fraud | c. 118E, § 40 | F | | Medical Assistance (Medicaid) Kickback | c. 118E, § 41 | F | | Motor Vehicle Homicide, Reckless Operation | c. 90, § 24G(b) | F | | Motor Vehicle Homicide, under Influence Drugs, Negligent or Reckless | c. 90, § 24G(a) | F | | Motor Vehicle, Use of in Commission of Felony | c. 90, § 24(2)(a) | F | | Motor Vehicle Homicide, under Influence Liquor | c. 90, § 24G(b) | F | | Motor Vehicle Homicide, under Influence Liquor, Negligent or Reckless | c. 90, § 24G(b) | F | | Motor Vehicle, Operating after License Revoked for Drunk Driving | c. 90, § 23 | M | | Motor Vehicle, Operating under Influence of Drugs, Alcohol | c. 90, § 24(1)(a)(1) | M | | Motor Vehicle, Operating under Influence of Drugs, Alcohol, 3^rd and | c. 90, § 24(1)(a)(1) | F | | Subsequent Offense | | | | Motor Vehicle, Operating under Influence of Drugs, Liquor, 3^rd and | c. 90, § 24 | F | | Subsquent Offense | | | | Motor Vehicle, Take Without Authority, Steal Parts | c. 266, § 28 | F | | Obscene Materials, Possess with Intent to Distribute | c. 272, § 29 | F | | Obscene Literature, Sell to Minor | c. 272, § 28 | F | | Obstruction of Justice | Common Law | M [ See c. 279, § 5 Re: Penalty for Common Law Crimes.] | | Perjury | c. 268, § 1 | F | | Prescription; Forgery, Alter | c. 94C, § 33(b) | F | | Prescription, Utter False | c. 94C, § 33 | F | | Prisoner, Deliver Articles to or from Inmate | c. 268, § 31 | F | | Prisoner, Deliver Drugs to | c. 268, § 28 | F | | Prostitution/Solicitation | c. 272, § 53A | M | | Prostitution, Engaging in Sex "John" | c. 272, § 53A | M | | Prostitution, Keep House of | c. 272, § 24 | M | | Prostitute, Solicit for | c. 272, § 8 | M | | Resisting Arrest | c. 268, § 32B | M | | Riot | c. 269, § 1 | M | | Robbery, Unarmed | c. 265, § 19(b) | F | | Robbery, Unarmed, Victim 60+ | c. 265, § 19(a) | F | | Shoplifting, 3^rd or Subsequent Offense | c. 266, § 30A | M | | Stolen Property, Receive, over $250 | c. 266, § 60 | F | | Stolen Motor Vehicle, Receive/buy | c. 266, § 28(a) | F | | Telecommunications Fraud | c. 166, § 42A | M | | Telephone Calls, Annoying or Obscene | c. 269, § 14A | M | | Unnatural Acts | c. 272, § 35 | F | | Vandalize Church/Synagogue/Cemetery | c. 266, § 127A | F | | Vandalize School/Church/Educational Bldg | c. 266, § 98 | F | | Witness, Intimidate or Retaliate Against | c. 268, § 13B | F | | Conspiracy to Commit any of above Table B Crimes | | | | Attempts to Commit any of the above Table B Crimes | | | | Accessory Before any of the above Table B Crimes | | |

History

Amended by Mass Register Issue 1337, eff. 4/21/2017.

Personal Data Use And Permitted Disclosures By And Among The Executive Office Of Health And Human Services And Its Agencies Personal Data Use And Permitted Disclosures By And Among The Executive Office Of Health And Human Services And Its Agencies

101 CMR, § 16.01 Applicability

101 CMR 16.00 applies to the Executive Office of Health and Human Services (EOHHS) and to all other agencies as defined in 101 CMR 16.03: Agency.

101 CMR, § 16.02 Purpose

(1)101 CMR 16.00 is promulgated pursuant to M.G.L. c. 6A, § 16 and in conformance with M.G.L. c. 66A, § 2(c) to authorize the sharing of data, including personal data by and among EOHHS and its agencies, subject to the appropriate protections for the confidentiality of client data.

(2)101 CMR 16.00 governs the use and disclosure of personal data by EOHHS and among the agencies with in it. It prescribes circumstances in which personal data shall or may be used and disclosed by and among EOHHS and EOHHS agencies.

(3) Nothing herein is intended to limit or prohibit the Secretary or agencies fromusing and disclosing personal data where otherwise permitted or required by federal and state law.

101 CMR, § 16.03 Definitions

The following terms used in 101 CMR 16.00 have the meanings given in 101 CMR 16.03 unless the context clearly requires another meaning.

Agency - the Executive Office of Health and Human Services (EOHHS) or any department, agency, commission, office, board, division, or any other body within EOHHS as set out in M.G.L. c. 6A, § 16, including the Executive Office of Elder Affairs.

Client - an applicant for, or recipient of, agency benefits or services, including services provided by the Department of Social Services or the Department of Youth Services.

Personal Data - has the same meaning as used in M.G.L. c. 66A, and includes "individually identifiable health information" within the meaning of the Health Insurance Portability and Accountability Act, 42 U.S.C. 1320d et seq .

Program Providing Benefits or Services

a state-funded program that provides cash assistance, services, or other benefits including payment for or access to services, or a program that is federally funded or federally assisted, including, but not limited to, the Food Stamp Program, 7 U.S.C. § 2011 et seq ., the Temporary Assistance to Needy Families Program, 42 U.S.C. § 601 et seq ., Medical Assistance to the States, 42 U.S.C. § 1396 et seq ., the State Children's Health Insurance Plan, 42 U.S.C. § 1397aa et seq ., the Child Welfare and Adoption Assistance Program, 42 U.S.C. § 671 et seq ., programs funded under the Older Americans Act, 12 U.S.C. 3508g, and programs funded under the Rehabilitation Act.

Secretary - the Secretary of the Executive Office of Health and Human Services who is the executive head of all EOHHS agencies pursuant to M.G.L. c. 6A, § 16.

101 CMR, § 16.04 Use or Disclosure of Personal Data by EOHHS

(1) EOHHS shallhold data, including, but not limited to, the names, addresses, and dates of birth of agency clients, as well as any other personal data or identifying information the Secretary shall determine necessary to carry out the responsibilities assigned to the Secretary and EOHHS under M.G.L. c. 6A, § 16. EOHHS shall develop policies and guidelines regarding use, disclosure, and maintenance of such data by agency employees to safeguard the confidentiality of such information.

(2) As executive head of all agencies under M.G.L. c. 6A, § 16, the Secretary shall have access to personal data of agency clients held by such agencies. The Secretary may designate others who shall b e authorized to access data in the same manner and to the same extent as the Secretary. The Secretary or his designee shall use and disclose such data only in a manner consistent with applicable federal laws, 101 CMR 16.00, and other state laws. A designee shall include, but is not limited to, an agency employee or contractor engaged in evaluative and other quality assurance activities involving agency programs and services.

101 CMR, § 16.05 Use or Disclosure of Personal Data Between and Among Agencies

Upon request of an agency or if otherwise required by law, agencies administering programs providing benefits or services shall use or disclose information regarding clients to other agencies when the use or disclosure is directly connected to the administration of an agency's program and the use or disclosure is not inconsistent with federal or state law. Activities directly connected to the administration of such programs include, but are not limited to:

(1) eligibility determinations;

(2) determination of benefit amounts;

(3) provision of services, insofar as the use or disclosure of personal data will assist the individual(s) who is the subject of the personal data in accessing needed medical, social, education, or other services, or will improve the coordination or management of services provided to the individual(s);

(4) quality assurance activities; and

(5) other activities as the Secretary or his designee may determine consistent with this provision, including those required or permitted by federal and state law.

101 CMR, § 16.06 Use and Disclosure Only Within EOHHS Agencies

Nothing herein shall be read to authorize the disclosure of personal data to entities or individuals that do not meet the definition of "agency" set forth in 101 CMR 16.03, without the written consent of the client or his legally authorized representative, except as otherwise required or permitted by federal and state law.

101 CMR, § 16.07 Safeguarding Personal Data

(1) An agency that receives personaldata as a result of a disclosure authorized by 101 CMR 16.00 shall use and hold the date in a manner consistent with federal and state laws, and shall not disclose it to another party unless legally authorized.

(2) Reasonable efforts shall be made to limit the access to and use and disclosure of personal data authorized by 101 CMR 16.00 to the minimum necessary to accomplish the purpose for which the access, use, or disclosure is required and permitted.

101 CMR, 101 CMR 17.00 Reserved

History

Reserved by Mass Register Issue 1516, eff. 3/1/2024.
REGULATORY AUTHORITY 101 CMR 17.00: M.G.L. c. 6A, § 16R.

Workplace Violence Prevention And Crisis Response Plan Workplace Violence Prevention And Crisis Response Plan

101 CMR, § 19.01 General Provisions

Scope and Purpose. 101 CMR 19.00 governs the procedures and criteria for workplace violence prevention and crisis response plans for the Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) programs.

History

Adopted by Mass Register Issue 1268, eff. 8/29/2014.

101 CMR, § 19.02 Definitions

The following terms used in 101 CMR 19.00 have the meanings given in 101 CMR 19.02, unless the context clearly requires a different meaning.

Human Service Workers - any person who works for a program. This includes, but is not limited to employees, contracted employees, interns, and volunteers.

Program - any entity operated, licensed, certified, or funded by a department, commission, office, board, division, institution, or other entity within EOHHS under M.G.L. c. 6A, § 16 that provides direct services to clients.

Workplace - any location where business is conducted, or site where the human service worker is considered "on-duty." Private vehicles used for business are included in 101 CMR 19.02: Workplace.

Workplace Violence - includes, but is not limited to physical assault or battery, or both; property damage; and intimidation or threats communicated by any means or other disruptive or aggressive behavior that causes a reasonable person to be in fear of his or her own safety or that of a colleague. Workplace violence can include actions or communications in person, by letter or note, by telephone, by fax, by electronic mail, or through social media. Incidents of workplace violence may take place between human service workers, between human service workers and clients or customers, human service workers and acquaintances, partners, or spouses, and human service workers and the general public.

History

Adopted by Mass Register Issue 1268, eff. 8/29/2014.

101 CMR, § 19.03 Program Requirements

A program must have a workplace violence prevention and crisis response plan for human service workers that meets the criteria set forth in 101 CMR 19.04. The program must update the plan at least annually. Each program must provide a copy of the current plan, which may be electronic, to any human service worker upon request and must make available a copy of the plan in a public place where all human service workers can readily access it.

History

Adopted by Mass Register Issue 1268, eff. 8/29/2014.

101 CMR, § 19.04 Workplace Violence Prevention and Crisis Response Plan Requirements

(1) All programs must develop and maintain a workplace violence prevention and crisis response plan using existing staff resources that includes the following:

(a) a clear description of procedures for reporting acts of workplace violence;

(b) a system for centrally recording all reported incidents of workplace violence against human service workers. Such records must at a minimum include the names of the involved parties, date and location of incident, description of incident, and nature of any injuries. Except as requested pursuant to 101 CMR 19.07, all records created under 101 CMR 19.04(1)(b) are confidential to the extent permitted by law;

(c) measures the program will take in response to an incident of workplace violence against human service workers, which includes both immediate crisis response and follow-up measures;

(d) information indicating where victims and perpetrators can go for help;

(e) a statement that any use of work time or workplace facilities to commit or threaten to commit acts of workplace violence is cause for discipline up to and including termination of employment or contract; and

(f) a statement that retaliation is prohibited against anyone who reports an incident of workplace violence.

(2) All programs must review their workplace violence prevention and crisis response plan at least annually, including all reported incidents and measures taken, and must modify the plan as indicated necessary by the review. Programs must conduct a risk assessment, and must identify and implement prevention methods to reduce the risk of workplace violence (e.g., enhanced building security features, emergency contact alarms, additional training, staffing plans, and program policies).

(3) If the plan includes the creation of a violence prevention and response team or committee, it must identify existing staff as the members of such response team or committee. The team or committee may monitor ongoing compliance with the violence prevention and crisis response plan, and to assist human service workers who may be victimized by or threatened with workplace violence. The members of the team or committee may monitor such compliance and assist workers who may be subjects of workplace violence.

History

Adopted by Mass Register Issue 1268, eff. 8/29/2014.

101 CMR, § 19.05 Training

(1) A program must require its human service workers to complete training developed and offered by EOHHS to educate human service workers about workplace violence and ways to reduce the risks of violence, including early recognition of individuals at risk of perpetrating workplace violence, unless the program certifies in writing that the program requires its human service workers to participate in an alternative training program that meets the minimum requirements established by EOHHS.

(2) Programs must require new human service workers to participate in such training described in 101 CMR 19.05(1) within the first three months of employment. All employees must participate in such training at least once every two years. The programs must maintain a written record of such participation.

(3) EOHHS may charge a fee for its training. Any such fee will be posted on the EOHHS website.

History

Adopted by Mass Register Issue 1268, eff. 8/29/2014.

101 CMR, § 19.06 Retaliation

Retaliation by alleged offenders or programs against a human service worker for reporting an incident of workplace violence or any other violation of 101 CMR 19.00 is prohibited.

History

Adopted by Mass Register Issue 1268, eff. 8/29/2014.

101 CMR, § 19.07 Reporting

Upon EOHHS request, each program must report to EOHHS about compliance with 101 CMR 19.00, including its workplace violence prevention and crisis response plan described in 101 CMR 19.04.

History

Adopted by Mass Register Issue 1268, eff. 8/29/2014.

Health Information Exchange Health Information Exchange

101 CMR, § 20.01 Purpose

101 CMR 20.00 contains the Executive Office of Health and Human Services' regulations specific to health information technology and the state-sponsored, statewide health information exchange (HIE), which is known as the Mass HIway. The Secretariat also publishes other documents affecting health information technology and the Mass HIway including, but not limited to, statements of policy and procedure, conditions of participation, guidelines, and bulletins.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.02 Citation

101 CMR 20.00 shall be known, and may be cited, as the "Mass HIway Regulations".

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.03 General Provisions

(1) Scope. 101 CMR 20.00 governs participation in the Mass HIway and related health information technology.

(2) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 20.00.

(3) Mass HIway Policies and Procedures. The Mass HIway Policies and Procedures, as updated from time to time, are applicable to all Mass HIway users. They include detailed policies and procedures, conditions for participation, and fees associated with the Mass HIway.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.04 Definitions

As used in 101 CMR 20.00, unless the context requires otherwise, terms have the following meanings.

Admission Discharge and Transfer Messages (ADTs). Types of messages that can track a patient's transitions in or out of a site of care such as admissions, discharges, or transfers. The focus of ADT messages is to convey data related to patient demographics and/or to health care encounters.

Business Associate. Has the meaning assigned to it in 45 CFR 160.103 (Health Insurance Portability and Accountability Act (HIPAA) regulations).

Certified Event Notification Service Vendor or Certified ENS Vendor. An ENS vendor that is certified by EOHHS.

Direct or the Direct Standard. Refers to the specifications developed by the direct project, a nationally recognized organization that develops specifications for a secure, scalable, standards-based way to establish universal health addressing and transport for participants (including providers, laboratories, hospitals, pharmacies, and patients) to send encrypted health information directly to cryptographically validated recipients over the Internet. For purposes of 101 CMR 20.00, references to direct, the direct standard, or the direct project will include any other national, open, industry standard supported by the Mass HIway.

Electronic Health Record (EHR). A digital version of a patient's paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users, often including a patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and/or laboratory and test results. EHR systems are able to share patient information with other authorized health care providers and organizations.

ENS Recipient. A provider that has a contractual relationship including, but not limited to, a business associate agreement, with a certified ENS vendor(s) for treatment or care coordination in accordance with 101 CMR 20.11.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Event Notification Service (ENS). A service that provides real-time alerts about certain patient medical service encounters, for example, at the time of hospitalization, to a permitted recipient with an existing treatment relationship to the patient, such as a primary care provider.

Health Information Exchange (HIE). The transmission of health care-related data among providers and payers of personal health records according to national standards; the reliable and secure transfer of data among diverse systems and access to and retrieval of data. HIE incorporates many forms of communication methods including, but not limited to:

(a) directed exchanges;

(b) queried exchanges; and

The Mass HIway operates a statewide health information exchange in accordance with M.G.L c. 118I, and 101 CMR 20.00. More detailed information regarding the functions and services provided by the Mass HIway can be found in the Mass HIway Policies and Procedures .

Health Information Service Provider (HISP).

(a) HISP. An entity that, as part of or all of its business, performs the following:

verifies participant identities;
issues and manages security keys;
issues direct addresses; and
processes messages to and from those addresses using the direct standard.

(b) HIway Trusted HISP. A HISP with which the Mass HIway has a direct contractual arrangement, or a HISP that belongs to a third-party organization that acts as a trust framework aggregator with which the Mass HIway has a direct contractual arrangement, to securely exchange Direct Messages, through a means typically referred to as a HISP-to-HISP connection.

(c) HISP-to-HISP Connection. A technical connection between two or more HISP systems for the purpose of delivering Direct Messages to and from authorized participants of the HISPs that contains clinical or administrative health information about a specific patient. Contractual agreements establish the HISP-to-HISP terms and may be between two HISPs or may be between a HISP and a third-party organization that acts as a trust framework aggregator.

HIway Direct Messaging. A secure method for Mass HIway users, including provider organizations, to transmit a message with information about a patient to other users, where the Mass HIway does not analyze, use, or share the contents of the message except as required to deliver it and to make it available for use by the intended recipient. HIway Direct Messaging follows the direct standard for encryption technology, or its successor standard, and provides a more secure method of transmitting information than other modes of transmission such as sending a fax, or sending information by postal mail.

HIway-facilitated Service. A service whereby the Mass HIway creates a framework for protected health information exchange through governance, promotion, certification, and/or contracts with a vendor or vendors to support treatment or care coordination.

HIway-sponsored Services. A service for HIway participants whereby the Mass HIway operates and manages a technology platform that allows the HIway to may use, analyze, and/or share protected health information and/or personally identifiable information on behalf of participants.

Mass HIway Integrator. An organization that connects HIway participants to the Mass HIway. Mass HIway integrators are business associates of participants and may include electronic health record (EHR) vendors, technical integrators, and regional health information organizations (RHIOs). Mass HIway integrators use Mass HIway for HISP services.

Mass HIway User. A user includes:

(a) HIway Participant. A provider organization, a health plan, or a business associate of either a provider organization or health plan or other entity approved by EOHHS. HIway participants must execute a Participation Agreement.

(b) Non-participant User. An organization that is granted access to the Mass HIway through a HIway trusted HISP.

Patient Matching Process. A certified ENS vendor's proprietary algorithmic process(es) used to match ADTs with patients.

Reflection or Reflect. The process certified ENS vendors use to disclose ADTs with all other certified ENS vendors for treatment or care coordination.

Statewide Event Notification Service (ENS) Framework. An event notification service framework created as a HIway-facilitated service by the EOHHS under 101 CMR 20.11.

Trust Framework Aggregator. A trust framework aggregator manages a bundle of security certificates, or "Trust Anchors", to facilitate interoperable direct exchange between HISPs in a uniform and scalable manner that is consistent with industry best practices for security and trust, thereby avoiding the need for further one-off negotiations between relying parties who are participants in the bundle.

Use Case. A narrative that describes how to accomplish a business goal and sets forth the functional requirements including scope of the activity, people and organizations involved, expected inputs and data, processing steps, and anticipated results. The use case informs the technical and process planning for development of a solution, and can be implemented between two provider organizations or multiple provider organizations based on the business need, clinical workflows, and technical and operational readiness. Categories of use cases will be detailed in the Mass HIway Policies and Procedures as updated from time to time, and may include, but not be limited to, the following categories:

(a) Provider-to-provider Communications;

(b) Payer Case Management;

(d) Public Health Reporting.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.05 Mass HIway Users and Mass HIway Access

(1) Users.

(a) HIway Participants.

All HIway participants must sign a Participation Agreement and agree to the terms of the Mass HIway Policies and Procedures.
A HIway participant may connect to the Mass HIway with the help of a Mass HIway integrator.
A HIway participant is issued a domain and direct addresses by Mass HIway or by a HIway trusted HISP.
A HIway participant and its authorized personnel may be listed in the Mass HIway statewide provider directory.
A Mass HIway user must become a HIway participant to be able to connect directly to the Mass HIway and use the Mass HIway as its HISP.
HIway-sponsored services are restricted to HIway participants, regardless of whether the HIway participant connects directly to the Mass HIway or via a HIway trusted HISP.

(b) Nonparticipant Users.

A nonparticipant user must sign a Business Associate Agreement and/or other agreement with a HIway trusted HISP, as required by the HISP to fulfill its obligations under its contractual agreement with the Mass HIway.
A nonparticipant user is issued a domain and direct addresses by the HIway trusted HISP.
A nonparticipant user is able to send messages to and receive messages from HIway participants via the HIway trusted HISP and the Mass HIway.
The Mass HIway does not perform message transformation on messages received from nonparticipant users.
Nonparticipant users do not have access to HIway-sponsored services.

Nonparticipant users are subject to the Mass HIway Policies and Procedures.

(2) HIway Trusted HISPs.

(a) To become a HIway trusted HISP, a HISP must execute a HISP-to-HISP agreement with the Mass HIway or must execute a direct contract with a third-party organization that acts as a trust framework aggregator with which the Mass HIway also has a direct contractual arrangement.

(b) A HIway trusted HISP must process HIway Direct Messages between its nonparticipant users and HIway participants in accordance with its contractual agreements.

(3) Access.

(a) Provider organizations are required to meet the requirement to connect to the Mass HIway that is described in 101 CMR 20.08.

(b) Other categories of eligible Mass HIway users may connect to the Mass HIway.

(c) Use of the Mass HIway is limited to exchanges of health information that are allowed or required by law. Unauthorized access to or disclosure of individually identifiable patient health information by or through the Mass HIway is prohibited, and violators may be subject to any penalties established under applicable state or federal law regarding the protection and privacy of personal information. The obligations of HIway users in the case of a security breach involving the Mass HIway are further described in the Mass HIway Policies and Procedures.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.06 Provider Organizations

The requirement that all providers must connect to the Mass HIway applies to provider organizations. Provider organizations include, but are not limited to, acute care hospitals, community health centers, and medical ambulatory practices, which are defined as:

(1) Acute Care Hospital. A hospital licensed under M.G.L. c. 111, § 51, and the teaching hospital of the University of Massachusetts Medical School, which contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the department. Hospitals that meet this definition of acute care hospital can be found in the Massachusetts Licensed or Certified Health Care Facility/Agency Listing, which is maintained by the Department of Public Health and is publicly available on the Department of Public Health's website.

(2) Community Health Center.

(a) An organization that is either:

A "Federally Qualified Health Center" or a "Federally Qualified Health Center look-alike" as defined by the federal Department of Health and Human Services Health Resources and Services Administration (HRSA) and operating in conformance with Section 330 of United States Public Law 95-626; or
An organization that files cost reports as a community health center, as requested by the Health Policy Commission within the Executive Office for Administration and Finance.

(b) For the purposes of 101 CMR 20.00, the following definitions of large and small community health centers apply:

Large Community Health Center. A community health center where ten or more licensed providers participate in providing health care for patients.

Small Community Health Center. A community health center where fewer than ten licensed providers participate in providing health care for patients.

(c) In Community Health Center, licensed providers are limited to include medical doctors, doctors of osteopathy, nurse practitioners, or physician assistants.

(3) Medical Ambulatory Practice.

(a) An organization in Massachusetts that includes licensed providers who provide primary or specialty outpatient health care services to patients. In a medical ambulatory practice, licensed providers are limited to include medical doctors, doctors of osteopathy, nurse practitioners, or physician assistants. Medical Ambulatory Practice does not include Community Health Center, as defined in 101 CMR 20.06(2), and does not include ambulatory practices whose primary purpose is to provide behavioral health services. In a medical ambulatory practice, "outpatient health care services" are defined as health care services that do not require an overnight stay.

(b) For the purposes of 101 CMR 20.00, the following definitions of large and medium medical ambulatory practices apply:

Large Medical Ambulatory Practice. A medical ambulatory practice where more than 50 licensed providers participate in providing health care for patients.

Medium Medical Ambulatory Practice. A medical ambulatory practice where ten to 50 licensed providers participate in providing health care for patients.

Small Medical Ambulatory Practice. A medical ambulatory practice where fewer than ten licensed providers participate in providing health care for patients. Small medical ambulatory practices includes medical ambulatory practices where only one licensed provider participates in providing health care for patients.

(4) For the purposes of 101 CMR 20.00, the applicability of the provider organization definitions shall be determined by calculating the number of licensed providers that provide health care services to patients on behalf of the provider organization in the month of June prior to that organization's initial required connection date to the Mass HIway, regardless of employment status.

(5) EOHHS may issue administrative bulletins or other issuances to define and describe additional types of provider organizations.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.07 Opt-in Opt-out Mechanism

(1) HIway Direct Messaging. Mass HIway users may transmit information via HIway Direct Messaging provided that all such transmissions shall be in compliance with applicable federal and state privacy laws and implementing regulations. Mass HIway users may implement local opt-in and/or opt-out process that applies to the use of HIway Direct Messaging by their organization, but are not required to do so.

(2) HIway-facilitated Services. HIway-facilitated services must be used in compliance with applicable federal and state privacy laws and implementing regulations. Provider organizations may implement local opt-in and/or opt-out processes that apply to the use of HIway-facilitated services by their organization, but are not required to do so.

(3) HIway-sponsored Services.

(a) Opt-in. HIway participants must provide each patient and/or their legal representatives with written notice of how the organization uses HIway-sponsored services.

Written notice shall be provided by at least one of the following methods:

a. inclusion in the HIway participant's privacy notice;

b. patient handout; or

c. letter, email, or other personal electronic communication to patients.

Written notice must be available in languages as established by EOHHS and described in the Mass HIway Policies and Procedures.
The written notice must describe the manner and means that the patient can opt-out of HIway-sponsored services.

(b) Opt-out. The Mass HIway or its designee administers a centralized opt out system. Patients and/or their authorized designees may notify the Mass HIway or its designee directly if they choose to opt-out. A HIway participant that has an established relationship with a patient must notify the Mass HIway that the patient has decided to opt-out and/or provide written instructions to its patients on how a patient or their authorized designees can notify the Mass HIway or its designee of the patient's choice to opt-out. Such notifications shall be made in the form and format determined by the Mass HIway and detailed in the Mass HIway Policies and Procedures .

(c) Local Opt-in Opt-out. In addition to the opt-in opt-out provisions described in 101 CMR 20.07(2)(a) and (b), HIway participants may choose to implement their own local opt-in and/or opt-out process that applies to the use of HIway-sponsored services by their organization, but are not required to do so. If a HIway participant does implement a local process that applies to HIway-sponsored services, it must supplement the opt-in opt-out provisions described in 101 CMR 20.07(2)(a) and (b), and shall not replace 101 CMR 20.07(2).

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.08 Connecting to the Mass HIway

(1) Provider Organizations.

(a) The requirement that all providers shall connect to the Mass HIway applies to the following provider organizations.

Acute care hospitals;
Community health centers (large and small); and
Medical ambulatory practices (large and medium).

(b) EOHHS may issue administrative bulletins or other issuances establishing Mass HIway connection dates for additional provider organizations. Such guidance will provide at least one year for affected provider organizations to connect to the Mass HIway.

(2) Health Care Systems with Multiple Provider Organizations. For health care systems that comprise multiple provider organizations, the requirements in 101 CMR 20.00 apply to provider organizations as they are defined in 101 CMR 20.04. For example, if a health care system is comprised of multiple acute care hospitals and multiple medical ambulatory practices, then each acute care hospital within that health care system is required to meet the Mass HIway connection requirements for acute care hospitals described in 101 CMR 20.08(3) and (4), and each medical ambulatory practice within that health care system is required to meet the Mass HIway connection requirement for medical ambulatory practices described in 101 CMR 20.08(3).

(3) Connection Requirement for All Provider Organizations.

(a) All provider organizations that have required Mass HIway connection dates specified in 101 CMR 20.09 or in a subsequent administrative bulletin or other issuance, shall meet the M.G.L. c. 118I, § 7 requirement to connect to the Mass HIway by sending and receiving HIway Direct Messages.

(b) The requirement to connect to the Mass HIway by sending and receiving HIway Direct Messages shall be under the following phased-in timeline.

Year 1. The provider organization shall send or receive HIway Direct Messages for at least one use case. The use case may be within any category of use cases.

Year 2. The provider organization shall send or receive HIway Direct Messages for at least one use case that is within the provider-to-provider communications category of use cases.

Year 3. The provider organization shall send HIway Direct Messages for at least one use case that is within the provider-to-provider communications category of use cases. The provider organization shall also receive HIway Direct Messages for at least one use case that is within the provider-to-provider communications category of use cases. One of these two use cases may be the use case that was used to meet the Year 2 requirement.

Year 4. The provider organization may be subject to penalties, as described in 101 CMR 20.13, if that organization has not met the requirements established in 101 CMR 20.08(3).

(c) Sending or receiving HIway Direct Messages for any category of use case in Years 1, 2 and 3 is fulfilled by a provider organization consistently using HIway Direct Messaging for that use case when it is appropriate to do so.

(d) Provider organizations must submit to EOHHS a use case narrative outlining how the Year 1, Year 2, and Year 3 requirements have been fulfilled in accordance with 101 CMR 20.08(3)(b) through (c). Use case examples and submission requirements are established in the Mass HIway Policies and Procedures.

(e) 101 CMR 20.09 provides the dates for Year 1, Year 2, Year 3, and Year 4 for different provider organizations.

(4) Connection Requirement for Acute Care Hospitals.

(a) In addition to the requirement to connect to the Mass HIway by sending and receiving HIway Direct Messaging, as described in 101 CMR 20.08(3), acute care hospitals must disclose all, consistent with their obligations under 101 CMR 20.07, and federal and state privacy laws including, but not limited to, HIPAA, 42 CFR Part 2, Human Immunodeficiency Virus, and genetic testing, ADTs or equivalent messages regarding emergency department visits and hospital admissions, discharges and transfers to at least one certified ENS vendor within the statewide event notification service framework; the recipient certified ENS vendor(s) must then reflect ADTs to all certified ENS vendors for purposes of treatment or care coordination by ENS recipients.

(b) Acute care hospitals must meet the requirement in 101 CMR 20.08(4)(a) by January 1, 2020.

(c) If an acute care hospital implements a local opt-in or local opt-out process that limits ADTs that are sent to the statewide event notification service, that provider organization must actively educate staff and inform patients about the purpose of utilizing an event notification service, and report metrics in form and format required in the Mass HIway Policies and Procedures .

(d) Penalties for not complying with 101 CMR 20.08(4)(a) through (c) take effect on July 1, 2020.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.09 Timetable for Connecting to the Mass HIway

| Schedule A: Timetable for Connecting to the Mass HIway by sending and receiving HIway Direct Messages | | | | | | --- | --- | --- | --- | --- | | Provider Organization | Year 1 | Year 2 | Year 3 | Year 4 | | Acute Care Hospitals | February 10, 2017 | January 1, 2018 | January 1, 2019 | January 1, 2020 | | Large and Medium Medical Ambulatory Practices | January 1, 2018 | January 1, 2019 | January 1, 2020 | January 1, 2021 | | Large Community Health Centers | January 1, 2018 | January 1, 2019 | January 1, 2020 | January 1, 2021 | | Small Community Health Centers | January 1, 2019 | January 1, 2020 | January 1, 2021 | January 1, 2022 |

(1) The definition of acute care hospitals is provided in 101 CMR 20.06(1).

(2) The definition of large, medium, and small medical ambulatory practices is provided in 101 CMR 20.06(3).

(3) The definition of large and small community health centers is provided in 101 CMR 20.06(2).

(4) As described in 101 CMR 20.08(4)(b), acute care hospitals must meet the requirement of 101 CMR 20.08(4)(a) by January 1, 2020.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.10 Interoperable Electronic Health Record Systems

(1) Achieving Interoperability via Implementing HIway Direct Messaging. As of February 10, 2017, provider organizations that have dates for connecting to the Mass HIway must establish interoperability by implementing HIway Direct Messaging. The methods by which provider organizations may implement HIway Direct Messaging are specified in the Mass HIway Policies and Procedures.

(2) Reporting Implementation of an EHR.

(a) As of February 10, 2017, provider organizations that have dates for connecting to the Mass HIway must submit information regarding:

whether or not they have an EHR; and
how their EHR, if any, connects to the Mass HIway.

(b) The submission must be in the form and format required, and in accordance with the schedule established in the Mass HIway Policies and Procedures.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.11 Statewide Event Notification Service Framework

(1) General. The statewide event notification service framework is a HIway-facilitated service composed of EOHHS-certified ENS vendors. Certified ENS vendors must:

(a) collect ADT feeds from required submitters;

(b) reflect ADT feeds to all other certified ENS vendors;

(d) produce notifications to their respective ENS subscribers in a secure method that protects patient privacy in accordance with applicable state and federal law.

(2) ENS Certification Process. EOHHS sets reasonable objective criteria, including applicable privacy and security standards for certified ENS vendors. The certification will be for a term as specified in the certification process but in no event for more than three years, at which time the term may be renewed upon successful recertification.

(3) Reflect ADTs. A certified ENS vendor must reflect ADTs to all other certified ENS vendors for the purposes of treatment or care coordination by ENS recipients.

(a) Certified ENS vendors must match all inbound reflected ADTs using their patient matching process to determine positive or negative matches.

(b) All inbound reflected ADTs that achieve a positive result in the patient matching process must be routed to the appropriate ENS recipients in accordance with the contract between the ENS vendor and ENS recipient.

(c) All inbound reflected ADTs that achieve a negative result in the patient matching process must be destroyed in accordance with the requirements of the certification process; however, a record of the transaction must be kept, as required, to meet minimal audit standards and retention periods for audit purposes consistent with 45 CFR § 164.312(b). Certified ENS vendors must keep a log of inbound reflected ADTs in auditable information.

(4) Data Security. Data shall be transmitted and held in accordance with industry-accepted practices, which at a minimum shall include the Health Insurance Portability and Accountability Act (HIPAA) Rules, and any other requirements EOHHS may deem necessary for certification.

(5) Audit Rights. EOHHS retains the right to conduct data integrity, privacy, and security audits of certified ENS vendors to comply with the framework of 101 CMR 20.12. EOHHS, upon finding unauthorized access or disclosure of data, may suspend the certification until corrective action is taken, and/or rescind the certification.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.12 Right to Audit

(1) EOHHS may audit provider organizations on a periodic basis in order to confirm compliance with the requirements set forth in 101 CMR 20.00.

(2) Audits will be limited only to such records, personnel, and other resources as EOHHS determines are necessary to assure compliance with the requirements set forth in 101 CMR 20.00.

(3) Audits will take place during normal business hours and at mutually agreeable times.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.13 Fees

(1) Fees for using the Mass HIway apply to HIway participants and are defined in the "Participation Fees" section of the Mass HIway Policies and Procedures, as updated from time to time.

(2) Participant fees are established at different tiers for different categories of HIway participants.

(3) The Mass HIway does not charge any fees to HISPs for providing HISP-to-HISP connections, and does not pay any fees to HISPs for providing HISP-to-HISP connections.

(4) The Mass HIway does not charge any fees to nonparticipant users for their use of HIway Direct Messaging.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.14 Penalties

As required by M.G.L. c. 118I, § 8, penalties for noncompliance with the requirement to connect to the Mass HIway may be assessed by EOHHS. If a provider organization does not connect to the Mass HIway by the dates stated in 101 CMR 20.09, then the provider organization may be subject to penalty. The penalty schedules are found in 101 CMR 20.15.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.15 Penalty Schedules

| Schedule B: Penalties for not connecting to the Mass HIway via exchanging HIway Direct Messaging | | | --- | --- | | Provider Organization* | Penalty | | Acute Care Hospital | * At the Year 1 required connection date: $0 * At the Year 2 and Year 3 dates: $0 * At the Year 4 date ( i.e ., January 2020): $30,000 per year | | Large Medical Ambulatory Practice | * At the Year 1 required connection date ( i.e ., January 2018): $0 * At the Year 2 and Year 3 dates: $0 * At the Year 4 date ( i.e ., January 2021): $20,000 per year | | Medium Medical Ambulatory Practice | * At the Year 1 required connection date ( i.e ., January 2018): $0 * At the Year 2 and Year 3 dates: $0 * At the Year 4 date ( i.e ., January 2021): $5,000 per year | | Large Community Health Center | * At the Year 1 required connection date ( i.e ., January 2018): $0 * At the Year 2 and Year 3 dates: $0 * At the Year 4 date ( i.e ., January 2021): $5,000 per year | | Small Community Health Center | * At the Year 1 required connection date ( i.e ., January 2019): $0 * At the Year 2 and Year 3 dates: $0 * At the Year 4 date ( i.e ., January 2022): $1,000 per year | | * Definitions of provider organizations are provided in 101 CMR 20.06. | | | Schedule C : Penalties for Acute Care Hospitals that do not meet the ADT submission requirement | | | Provider Organization | Penalty | | Acute Care Hospital | * July 1, 2020: $30,000 per year |

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.16 Waivers

(1) Waiver Criteria. EOHHS may grant a waiver of the requirement to connect to the Mass HIway for the following situations.

(a) The provider organization does not have internet access or a computer.

(b) The provider organization does not have broadband internet access.

(c) The provider organization is unable to meet the requirement to connect to the Mass HIway due to a catastrophic event (such as a natural disaster that damages the organization's health information technology infrastructure), or due to an extenuating circumstance.

(d) The provider organization is unable to meet the requirement to fully implement a use case of sending and receiving HIway Direct Messages within the use case category of provider-to-provider communications, but the provider organization does meet the following criteria.

The provider organization must be able to demonstrate the technical capability to send and receive HIway Direct Messages with a HIway participant in order to demonstrate achieving a basic level of interoperability with provider organizations that use the Mass HIway as their HISP;
The provider organization successfully implements provider-to-provider Direct Messaging outside of the Mass HIway ( e.g ., using a non-Mass HIway HISP); and
The provider organization does not have any trading partners on the Mass HIway to implement a use case within the use case category of provider-to-provider communications.

(e) The provider organization does not have the capability to send ADT feeds.

(f) The provider organization has presented a compelling rationale for a waiver that EOHHS, in its discretion, may consider.

(2) Waiver Duration. An approved waiver is valid for 24 months from the date of issue. Provider organizations that continue to experience circumstances that require a waiver must apply for another waiver at least 30 days before the expiration of their current waiver in order to avoid a penalty.

(3) Waiver Request Review Process. After review of a provider organization's request for a waiver, the Mass HIway will notify the provider organization in writing of its decision. If the waiver request is incomplete, the Mass HIway will ask the provider organization for more information. If the provider organization does not submit the requested information to the Mass HIway within 60 days of the request, then the Mass HIway will deny the waiver request. Denial of a waiver request is not subject to appeal, but a provider organization may reapply for a waiver with new or additional information.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.17 Reconsideration and Appeals Process

(1) Applicability. The provisions set forth in 101 CMR 20.17 establish EOHHS's review process for provider organization disputes concerning penalties associated with the requirement to connect to the Mass HIway as established by M.G.L c. 118I, and 101 CMR 20.08.

(2) Notice of Penalties. EOHHS will notify the provider organization in writing of EOHHS's determination of the provider organization's failure to comply with the requirements to connect to the Mass HIway as established by 101 CMR 20.08. The notice will identify the penalty a provider organization must pay and identify the provider organization's right to review. EOHHS will notify the provider organization by letter, report, computer printout, electronic transmission, or other format. This notification is the Mass HIway Notice of Penalties.

(3) Requesting EOHHS Review of Penalties for Failure to Connect to the Mass HIway.

(a) To preserve its right to an adjudicatory hearing and judicial review, a provider organization must request EOHHS's review of the determination of a penalty as specified in the notice. A provider organization's request for review may be based on an alleged error in EOHHS's determination of the provider organization's ability to connect to the Mass HIway as required under 101 CMR 20.08. The provider organization's request for review must be made in writing and be received by EOHHS within 30 calendar days of the date appearing on the Mass HIway Notice of Penalties.

(b) A provider organization's request for review may request reconsideration of the provider organization's compliance with its selected use case(s) and penalty amounts.

identify with specificity all determinations with which the provider organization disagrees;
specify in sufficient detail the basis for the provider organization's disagreement with those determinations;
identify and address all issues in the Mass HIway Notice of Penalties with which the provider organization disagrees; and
include any documentary evidence and information that the provider organization wants EOHHS to consider.

(4) EOHHS's Final Determination.

(a) EOHHS will review a provider organization's request for agency review only if it is submitted in compliance with the requirements of 101 CMR 20.17. EOHHS is not obligated to consider any information or documents that the provider organization failed to timely submit in writing with the request for agency review and received by EOHHS within 30 calendar days of the date appearing on the Mass HIway Notice of Penalties. EOHHS will issue a final written determination of contested penalty assessments based on its review, which will state the reasons for the determination, and inform the provider organization of the provider organization's right to file a claim for an adjudicatory hearing with the Board of Hearings established under M.G.L. 118E, § 48.

(b) Any findings specified in the Mass HIway Notice of Penalties that are not specifically identified as in dispute in a provider organization's request for agency review will, without further notice, constitute EOHHS's final determination. The provider organization has no right to an adjudicatory hearing or judicial review of such findings because of the failure to exhaust its administrative remedies.

(c) If the provider organization does not submit a request for agency review, the Mass HIway Notice of Penalties constitutes EOHHS's final determination. If a provider organization requests agency review, but fails to timely comply with the requirements of 101 CMR 20.17, the request for agency review may be denied. In either case, the Mass HIway Notice of Penalties constitutes EOHHS's final determination, and the provider organization has no right to an adjudicatory hearing pursuant or judicial review because of the failure to exhaust its administrative remedies.

(5) Appeal of EOHHS's final agency action pursuant to 101 CMR 20.17(4)(a) will be permitted by filing a claim for an adjudicatory hearing with the Board of Hearings and EOHHS within 30 calendar days of the date on the final determination. A claim is considered to be filed on the date that it is actually received by both the Board of Hearings and EOHHS. Failure to file a timely claim will result in implementation of the action identified in the final determination.

History

Adopted by Mass Register Issue 1332, eff. 2/10/2017.

101 CMR, § 20.18 Severability

The provisions of 101 CMR 20.00 are severable. If any provision of 101 CMR 20.00 is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 20.00.

History

Adopted by Mass Register Issue 1401, eff. 10/4/2019.

COVID-19 Testing for Staff at Agency Facilities COVID-19 Testing for Staff at Agency Facilities

101 CMR, § 21.01 Applicability

101 CMR 21.00 applies to staff at Agency facilities.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 21.02 Purpose

The purpose of 101 CMR 21.00 is to identify staff with asymptomatic or symptomatic COVID-19 infections in order to prevent viral transmission.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 21.03 Definitions

As used in 101 CMR 21.00, unless the context requires otherwise, terms have the meanings in 101 CMR 21.03.

Agency. The Executive Office of Health and Human Services (EOHHS) or any department, agency, commission, office, board, division, or any other body within EOHHS as set out in M.G.L. c. 6A, § 16, including the Executive Office of Elder Affairs.

COVID-19. A contagious, sometimes fatal, respiratory disease caused by a newly discovered coronavirus that led to the declaration of a federal public health emergency and a state of emergency for the Commonwealth of Massachusetts.

COVID-19 Testing. The process of a collection of a specimen from an individual for the purposes of determining the presence or absence of SARS-CoV-2 viral material in said specimen at an EOHHS-approved COVID-19 testing vendor.

COVID-19 Testing Vendor. Providers of COVID-19 Tests as defined in 101 CMR 22.00.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 21.04 COVID-19 Testing for Staff at Agency Facilities

(1) Testing Requirement. Staff at the following Agency facilities will receive periodic COVID-19 tests:

(a) state hospitals;

(b) the Chelsea and Holyoke Soldiers' Homes;

(d) any other Agency facility designated by the Secretary.

(2) Staff Subject to Testing Requirement. The following staff are subject to mandatory, periodic testing for COVID-19 in accordance with implementation guidance issued by EOHHS:

(a) All persons regularly reporting, whether part-time or full-time, paid or unpaid, working, interning, or volunteering at the physical facility or site, who have the potential for exposure to patients or residents or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air;

(b) Staff (whether employed directly by or contracted by an Agency) who are potentially exposed to infectious agents that can be transmitted to and from staff and patients or residents including, but not limited to, direct care staff, clinicians, physicians, nurses, nursing assistants, therapists, technicians, dental personnel, pharmacists, laboratory personnel, students and trainees, and contractual personnel; and

(c) Staff not directly involved in patient or resident care, but potentially exposed to infectious agents that can be transmitted to and from staff and patients or residents (such as administrative, clerical, dietary, housekeeping, human resources, laundry, security, maintenance, or billing staff; chaplains; volunteers; or any other individual working at the facility).

(3) Staff Not Subject to Testing. The following staff are not subject to the testing requirement in 101 CMR 21.04(1):

(a) persons who work entirely remotely or off-site;

(b) staff on leave, such as family medical leave; or

(c) temporary staff provided by the Commonwealth (such as by an EOHHS clinical rapid response team or the Massachusetts National Guard).

(4) Failure to Comply with Testing Requirement. Agency staff who fail to comply with the testing requirement will be subject to discipline, up to and including, termination. Contracted staff will not be permitted to work at the facility.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 21.05 Implementation and Clarification

(1) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify substantive provisions of 101 CMR 21.00.

(2) Implementation Guidance. EOHHS may develop policies, guidelines, or memoranda to implement 101 CMR 21.00, including testing requirements, frequency, or other process and operational components.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 21.06 Severability

The provisions of 101 CMR 21.00 are severable. If any provisions of 101 CMR 21.00 or the applications of such provisions to any person or circumstance are held invalid or unconstitutional, the other provisions of 101 CMR 21.00, or the application of such provisions to any person or circumstance other than that as to which it is held invalid or unconstitutional, will not be affected thereby.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

Requirement to Disclose COVID-19 Test Results to EOHHS Requirement to Disclose COVID-19 Test Results to EOHHS

101 CMR, § 22.01 Applicability

101 CMR 22.00 applies to COVID-19 Testing Vendors.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 22.02 Purpose

(1) The purpose of 101 CMR 22.00 is to require COVID-19 Testing Vendors to disclose COVID-19 Test Results to EOHHS to effectively manage and coordinate the health and safety of Agency Staff, Clients, and the Commonwealth.

(2) Nothing in 101 CMR 22.00 is intended to conflict, limit, or prohibit COVID-19 Testing Vendors from disclosing COVID-19 Test Results in any other manner authorized, permitted, or required by federal or state law.

(3) Nothing in 101 CMR 22.00 is intended to conflict, limit, or prohibit the Department of Public Health or any other public health entity from receiving, using, or disclosing COVID-19 information under separate or existing authority.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 22.03 Definitions

As used in 101 CMR 22.00, unless the context requires otherwise, terms have the meanings in 101 CMR 22.03.

Applicable Law. Any other applicable federal or state law or regulation pertaining to the use, disclosure, maintenance, privacy, security, or confidentiality of personally identifiable information.

Business Associate. A term defined in 45 CFR Part 160, § 103.

Covered Entity. An entity as defined in 45 CFR Part 160, § 103.

COVID-19 Test Result. The result of a collection of a specimen from an individual for the purpose of determining the presence or absence of SARS-CoV-2 viral material in said specimen along with personally identifiable information that identifies the individual. Such result may be subject to HIPAA, FIPA, and/or Applicable Law.

COVID-19 Testing Vendor. A vendor, including a Covered Entity, Business Associate, Holder, or any other entity subject to HIPAA, FIPA, or Applicable Law, that provides COVID-19 Test Results.

FIPA. The Fair Information Practices Act, found at M.G.L. c. 66A, and its attendant regulations at 801 CMR 3.00: Privacy and Confidentiality .

HIPAA. The Health Insurance Portability and Accountability Act of 1996 and its attendant regulations at 45 CFR Parts 160, 162 and 164.

Holder. A term defined in M.G.L. c. 66A, § 1.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 22.04 Requirement to Disclose COVID-19 Test Results to EOHHS

Upon the request of EOHHS, COVID-19 Testing Vendors must disclose COVID-19 Test Results to EOHHS. EOHHS may disclose such COVID-19 Test Results to its Agencies.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 22.05 Use, Disclosure, and Safeguarding of COVID-19 Test Results

EOHHS or its Agencies may use, disclose, and safeguard COVID-19 Test Results pursuant to 101 CMR 16.00: Personal Data Use and Permitted Disclosures by and among EOHHS and Its Agencies .

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 22.06 Implementation and Clarification

(1) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify substantive provisions of 101 CMR 22.00.

(2) Implementation Guidance. EOHHS may develop policies, guidelines, or memoranda to implement 101 CMR 22.00, and which may include disclosure requirements, manner transmission, or security.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 22.07 Severability

The provisions of 101 CMR 22.00 are severable. If any provisions of 101 CMR 22.00 or the applications of such provisions to any person or circumstance are held invalid or unconstitutional, the other provisions of 101 CMR 22.00, or the application of such provisions to any person or circumstance other than that as to which it is held invalid or unconstitutional, will not be affected thereby.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

COVID-19 Vaccinations for Staff at Certain Agency Facilities COVID-19 Vaccinations for Staff at Certain Agency Facilities

101 CMR, § 23.01 Applicability

101 CMR 23.00 applies to certain agency staff.

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 23.02 Purpose

The purpose of 101 CMR 23.00 is to require certain agency staff to document they have received COVID-19 vaccination and Influenza vaccination, or have taken required mitigation measures, in order to prevent viral infection and transmission.

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 23.03 Definitions

As used in 101 CMR 23.00, unless the context requires otherwise, terms have the meanings in 101 CMR 23.03.

Agency. The Executive Office of Health and Human Services (EOHHS) or any department, agency, commission, office, board, division, or any other body or facility within EOHHS as set out in M.G.L. c. 6A, § 16, including the Executive Office of Elder Affairs.

COVID-19. Coronavirus Disease 2019, the disease caused by the SARS-CoV-2 virus.

COVID-19 Vaccination. COVID-19 vaccination means being up to date with COVID-19 vaccines as recommended by the Centers for Disease Control and Prevention (CDC).

Influenza Vaccination. Influenza vaccination means immunization by either influenza vaccine, inactivated or live; attenuated and/or other influenza vaccine. It will also mean other pandemic or novel influenza virus(es) as specified in guidelines of the Department of Public Health.

Mitigation Measures. Measures that employees who decline vaccination must take to prevent viral infection and transmission.

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 23.04 COVID-19 Vaccination and Influenza Vaccination for Certain Agency Staff

(1)

(a) Staff at state-operated hospitals, including hospitals operated by the Department of Public Health and the Department of Mental Health, are required to demonstrate that they have received COVID-19 vaccination unless the exception in 101 CMR 23.04(5) applies.

(b) Staff at state-operated hospitals, including hospitals operated by the Department of Public Health and the Department of Mental Health, are required to demonstrate that they have received the Influenza vaccination unless the exception in 101 CMR 23.04(5) applies.

(2)

(a) Staff at state-operated congregate care facilities, including those operated by the Department of Mental Health, the Department of Developmental Services, and the Department of Youth Services, are required to demonstrate that they have received COVID-19 vaccination unless the exception in 101 CMR 23.04(5) applies.

(b) Staff at state-operated congregate care facilities, including those operated by the Department of Mental Health, the Department of Developmental Services, and the Department of Youth Services, are required to demonstrate that they have received the Influenza vaccination unless the exception in 101 CMR 23.04(5) applies.

(3) Staff Subject to Vaccination Requirement. The following staff are required to document they have obtained COVID-19 vaccination and Influenza vaccination in accordance with implementation guidance issued by EOHHS: all staff regularly reporting, whether part-time or full-time, paid or unpaid, working, interning, or volunteering who physically enter onsite at the agency facility or location, whether or not they have the potential for exposure to patients, residents, clients, or the public, or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. For illustrative purposes, this includes

(a) staff who physically enter on site at an agency facility or location and who are potentially exposed to infectious agents that can be transmitted to and from staff and patients or residents, including, but not limited to, direct care staff, clinicians, physicians, nurses, nursing assistants, therapists, technicians, dental personnel, pharmacists, laboratory personnel, students and trainees, and contractual personnel; and

(b) staff not directly involved in patient or resident care who physically enter on site at an agency facility or location, whether or not such staff may be potentially exposed to infectious agents that can be transmitted to and from staff and patients or residents (such as administrative, clerical, dietary, housekeeping, human resources, laundry, security, maintenance, or billing staff; chaplains; contractual personnel; volunteers; or any other individual physically entering and working on site at the facility or location).

(4) Staff Not Subject to the COVID-19 Vaccination and Influenza Vaccination Requirement. Staff on leave, such as family medical leave, are not subject to the COVID-19 vaccination and Influenza vaccination requirement in 101 CMR 23.04.

(5) Staff Subject to an Exception from the COVID-19 Vaccination and Influenza Vaccination Requirement.

(a) Staff may decline vaccination and will be granted an exception from the COVID-19 vaccination and Influenza vaccination requirement in 101 CMR 23.04, subject to 101 CMR 23.04(5)(c).

(b) While the expectation is for all staff to receive the COVID-19 vaccination and the Influenza vaccination, any individual who declines to do so is required to take mitigation measures mandated by EOHHS, consistent with guidance from the Department of Public Health.

(c) An individual who declines the vaccination(s) must sign a statement(s) certifying they declined the vaccination(s) and they received information about the risks of declining the vaccination(s).

(6) Documents Necessary to Demonstrate Compliance with the COVID-19 Vaccination and Influenza Vaccination Requirement.

(a) A copy of a completed COVID-19 vaccination and Influenza vaccination record card, subject to verification by the Department of Public Health; or

(b) A copy of the staff member's COVID-19 vaccination and Influenza vaccination status from the Massachusetts Immunization Information System (MIIS); or

(d) A copy of the staff member's vaccination declinations.

(7) Documentation Collection and Reporting.

(a) Every facility must require and maintain for each individual proof of current vaccination against COVID-19 and influenza or the individual's declination statement.

(b) Each facility must report information regarding vaccination of staff pursuant to Executive Office of Health and Human Services guidelines.

(8) Failure to Comply with the COVID-19 Vaccination and Influenza Vaccination Requirements. Agency staff who fail to comply with the vaccination requirements, or required mitigation measures, will be subject to discipline, up to and including termination. Contracted staff who fail to comply with the vaccination requirements, or mitigation measures, will not be permitted to work at the agency facility or location.

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 23.05 Implementation and Clarification

(1) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify substantive provisions of 101 CMR 23.00.

(2) Implementation Guidance. EOHHS may develop policies, guidelines, or memoranda to implement 101 CMR 23.00, including specification of the sites subject to the vaccination requirement, vaccination schedules, documentation requirements, frequency, or other process and operational components.

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 23.06 Severability

The provisions of 101 CMR 23.00 are severable. If any provisions of 101 CMR 23.00 or the applications of such provisions to any person or circumstance are held invalid or unconstitutional, the other provisions of 101 CMR 23.00, or the application of such provisions to any person or circumstance other than that as to which it is held invalid or unconstitutional, will not be affected thereby.

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

Interagency Review of Complex Cases Interagency Review of Complex Cases

101 CMR, § 27.01 Regulatory Authority

The Executive Office of Health and Human Services (EOHHS) is authorized by M.G.L. c. 6A, § 16R to promulgate regulations in consultation with the Department of Elementary and Secondary Education (DESE) to establish processes by which EOHHS, DESE, and additional designated agencies will conduct interagency reviews of an individual who presents as a complex case, as defined in 101 CMR 27.03.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.02 Purpose

The purpose of 101 CMR 27.00 is to implement M.G.L. c. 6A, § 16R, which establishes requirements by which an interagency team will review complex cases, as defined in 101 CMR 27.03. The interagency review team was established to collaborate on complex cases only where there is a need for urgent action to address the lack of consensus or resolution between state agencies about current service needs or placement of an individual.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.03 Definition of Terms

The following terms used in 101 CMR 27.00 have the meanings given in 101 CMR 27.03 unless the context clearly requires a different meaning.

Bureau of Special Education Appeals (BSEA). The entity with jurisdiction under M.G.L. c. 71B and the federal Individuals with Disabilities Education Act to mediate and adjudicate disputes related to the provision of special education and related services to children with disabilities.

Complex Case. A case involving an individual as defined in 101 CMR 27.03, where there is a lack of consensus or resolution between state agencies as to the individual's current service needs or placement, and the individual is waiting in a hospital emergency department, a medical bed, at home or other location and in urgent need of a disposition (placement, or identifying entity responsible for payment). A complex case will not include

(a) individuals who are deemed to meet hospital level of care requiring admission to an acute care hospital or inpatient psychiatric facility inclusive of the Department of Mental Health (DMH) Adolescent Continuing Care Unit, an Intensive Residential Treatment Program (IRTP), or at a psychiatric inpatient developmentally disabled unit; or

(b) cases where there is agreement as to the services or placement necessary for the individual, including agreement as to which entity is responsible for payment, and the individual has been on the waiting list for such services or placement for less than 60 days.

DALA. The Division of Administrative Law Appeals.

DCF. The Department of Children and Families, an agency within EOHHS.

DDS. The Department of Developmental Services, an agency within EOHHS.

EEC. The Department of Early Education and Care.

DESE. The Department of Elementary and Secondary Education.

DMH. The Department of Mental Health, an agency within EOHHS.

DYS. The Department of Youth Services, an agency within EOHHS.

EOE. The Executive Office of Education.

EOHHS. The Executive Office of Health and Human Services.

EOHHS State Agency. The agencies described in M.G.L. c. 6A, § 16 as within EOHHS, including MassHealth.

IDEA. The federal Individuals with Disabilities Education Act, 20 U.S.C. §§ 1400 et seq . The IDEA and M.G.L. c. 71B govern the provision of special education to eligible Massachusetts students.

Individual. A person who

(a) is under the age of 22;

(b) is disabled or has complex behavioral health or special needs; and

(c) qualifies or may qualify for services from one or more state agencies, or for special education services through their school district.

Interagency Review Team (IRT). The group of agencies and school district(s), as applicable, which are designated pursuant to M.G.L. c. 6A, § 16R(b), to conduct reviews and issue determinations for complex cases in accordance with the requirements of 101 CMR 27.00.

Interagency Services Reserve Fund. The fund established pursuant to M.G.L. c. 29, § 2TTTTT, administered by the secretary of EOHHS to effectuate the purpose of the interagency review established through M.G.L. c. 6A, § 16R and 101 CMR 27.00.

Legal Custodian. A parent, legal guardian, or a person or entity with legal custody of the individual or the authority to consent to services or treatment and to authorize the release of information about the individual.

Medical Bed. A bed in a hospital unit to which an individual is admitted while waiting to be placed in an appropriate therapeutic setting or to be provided with appropriate evaluations and services, and not for treatment for a medical condition.

OCA. The Commonwealth of Massachusetts Office of the Child Advocate.

Referral Date. The date the co-chairs determine the referral submission is complete and the case is eligible for IRT review, as set forth in 101 CMR 27.05(3) and 101 CMR 27.06.

School District. Consistent with the definition in 603 CMR 28.02: Definitions , a Massachusetts municipal school department or regional school district, a county agricultural school, and any other Massachusetts public school established by statute, certificate, or charter, with programmatic or financial responsibility for certain children and individuals in accordance with the procedures of 603 CMR 28.10: School District Responsibility .

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.04 Interagency Review Team Membership and Roles and Responsibilities

(1) There will be an interagency review team (IRT) to review complex cases. The IRT will include the following members:

(a) the secretary of EOHHS or a designee, and the commissioner of DESE or a designee, who will serve as co-chairs of the IRT;

(b) the assistant secretary of MassHealth or a designee;

(d) the commissioner of the Department of Children and Families (DCF) or a designee;

(e) the commissioner of the Department of Developmental Services (DDS) or a designee;

(f) the commissioner of the Department of Youth Services (DYS) or a designee;

(g) the commissioner of the Department of Early Education and Care (EEC) or a designee;

(h) the secretary of the Executive Office of Education (EOE) or a designee;

(i) a representative of the OCA; and

(j) a representative from the school district or districts responsible for any aspect of the individual's education.

(2) All members of the IRT will have authorization to make decisions on behalf of their appointing entity. The co-chairs and any IRT member may perform their roles and responsibilities related to the IRT through a designee(s).

(3) The IRT will be responsible for

(a) conducting reviews of complex cases which have been confirmed eligible by the co-chairs, as described in 101 CMR 27.07;

(b) participating in IRT meetings convened by the IRT co-chairs;

(c) ordering expedited eligibility determinations by a state agency and evaluations, if necessary, to determine the individual's current service needs, provided that if an extended evaluation at special education residential school is ordered by the IRT, it is separate from any extended evaluation under 603 CMR 28.05(2)(b);

(d) providing updates and opportunities for input to the individual's parent or guardian and to the individual during the IRT review process;

(e) submitting requests for funds from the Interagency Services Reserve Fund to the cochairs, to effectuate the IRT review or for other permissible purposes described in 101 CMR 27.08;

(f) after collecting and reviewing all necessary information, issuing a consensus determination as to the services currently in place for the individual, additional services that are needed to meet the individual's current needs, which agencies will provide such services, and which agencies have fiscal responsibilities to pay for such services; and

(g) referring the case to the co-chairs in the event a consensus determination cannot be reached.

(4) The secretary of EOHHS and commissioner of DESE, as co-chairs of the IRT, will facilitate the IRT process by

(a) receiving and conducting a preliminary review of each case submitted as a referral to the co-chairs to determine if the case is eligible for IRT review;

(b) convening the IRT for the initial meeting on the complex case within the timing required in 101 CMR 27.07(2). The co-chairs may convene a subset of the IRT members according to the circumstances of the individual's case; provided, however, a representative of the OCA will be present for all team meetings;

(d) issuing the determination of the IRT, where a consensus determination could not be reached and the case is referred to the co-chairs to issue the final determination;

(e) reviewing and authorizing expenditures of the Interagency Services Reserve Fund to effectuate the purposes of the IRT review, consistent with 101 CMR 27.08;

(f) establishing protocols to inform individuals, parents, and guardians of the availability of the interagency review; and

(g) establishing data gathering and reporting requirements to document the activities of the IRT and to provide the information required for the annual report, as required in 101 CMR 27.12.

(5) The secretary of EOHHS, in addition to the responsibilities in 101 CMR 27.04(4), will issue the IRT's annual report as required in 101 CMR 27.12, summarizing the cases reviewed by the team in the previous year, the length of time spent at each stage, and the final resolutions.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.05 Referrals

(1) Parties Who May Refer Cases for Review. An individual's case may be referred to the IRT by

(a) an individual 16 years of age or older;

(b) a state agency or a representative of a state agency's ombudsman's office;

(d) a hospital or emergency service provider;

(e) a school district;

(f) an attorney representing the individual or the individual's parent or guardian;

(g) the individual's parent or guardian; or

(h) a physician or behavioral health care provider authorized to act on behalf of a parent or guardian who is seeking access to services for the individual or the individual's parent or guardian.

(2) Documentation and Consents Required to Refer to the IRT.

(a) A person or entity identified in 101 CMR 27.05(1) seeking to refer an individual's case to the IRT must provide to the co-chairs the following:

an IRT form containing key information, developed and amended as necessary by the co-chairs;
consent from the legal custodian, or from the individual if 18 years of age or older or otherwise authorized by law, authorizing the IRT, the secretary of EOHHS, the commissioner of DESE, and DALA to

a. obtain materials related to the individual's case including, but not limited to, medical records, school records, and any evaluation or assessment of the individual; and

b. discuss these materials and records related to the individual's case with one another and with other individuals directly addressing matters related to the individual's case.

documentation and any necessary description, demonstrating the individual presents a complex case; and
the reason the individual's case is being submitted to the IRT, the agencies currently involved in the case, and a requested resolution.

(b) Authorizations for the disclosure of Protected Health Information or Substance Use Treatment information submitted to the co-chairs must comply with applicable requirements of HIPAA and 42 CFR Part 2.

(c) An individual between 16 and up to 18 years of age who seeks to refer themselves to the IRT must submit all required documents, including the consents from their legal custodian or the person authorized to provide consent to release their records as required in 101 CMR 27.05(2)(a)2.

(3) The co-chairs will assess the referral submission to determine if the submission is complete and the case is eligible for IRT review. The co-chairs may request any additional records or information necessary to complete the referral submission or assess eligibility. A case is referred to the IRT only after the co-chairs determine the referral submission is complete and the case is eligible.

(4) Withdrawal of Referral. The legal custodian or, if authorized by law, the individual, may withdraw a referral at any time by notifying the co-chairs in writing.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.06 Eligibility for Review

(1) An individual's case is eligible for review by the IRT if

(a) the individual presents a complex case as defined in 101 CMR 27.03, as determined by the co-chairs;

(b) the case was referred by a party who may refer such cases, consistent with 101 CMR 27.05(1);

(d) the individual is domiciled in the Commonwealth of Massachusetts.

(2) An individual's case is ineligible for review by the IRT if

(a) the individual has an appeal pending with an EOHHS state agency, a mediation or hearing pending with the BSEA ( see 603 CMR 28.08(3)), or a court case, and the subject of such appeal, mediation, hearing, or court case is substantially related to the reason that the individual's case is being referred for review by an IRT, as determined by the co-chairs at their discretion. Once such appeal, mediation, hearing, or court case is completed, the individual's case may again be referred for review; or

(b) the individual's case is not eligible, under 101 CMR 27.06(1), including if the case is not determined to be a complex case as defined in 101 CMR 27.03. Consistent with the definition in 101 CMR 27.03, an individual's case is not a complex case and therefore ineligible for IRT review if

the individual is deemed to meet hospital level of care requiring admission to an acute care hospital or inpatient psychiatric facility inclusive of the DMH Adolescent Continuing Care Unit, an Intensive Residential Treatment Program (IRTP), or at a psychiatric inpatient developmentally disabled unit; or
there is agreement as to the services or placement necessary for the individual, including agreement as to which entity is responsible for payment, and the individual has been on the waiting list for such services or placement for less than 60 days.

(3) If the co-chairs determine based upon the referral submission that consensus or resolution may be possible at the regional level or that regional representatives have not yet been engaged, the co-chairs may refer the individual's case to the regional representatives of an interagency team currently involved in the individual's case, or which represents the region responsible or likely responsible for the individual, for investigation and resolution. If that regional team is unable to resolve the case within 20 business days, the regional team will submit the case back to the IRT co-chairs to determine eligibility for IRT review, unless the parties involved including the individual or the person legally authorized to consent on behalf of the individual, agree otherwise.

(4) The co-chairs will notify the legal custodian, or the individual if 18 years of age or older or otherwise authorized by law, in writing whether such individual's case is eligible for review by the IRT and, if applicable, will include any reasons for ineligibility. Such notification will also be provided to the referral source, if different, and if there is a valid consent for the referral source.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.07 Interagency Review Process

(1) The IRT Review.

(a) The IRT review will include, without limit, review of the referral submission, input from the individual, parent(s) or guardian(s), review of materials relevant to the individual's case, including, as applicable, medical records, education records and evaluations, any other relevant assessments of the subject individual, and any report regarding the subject individual issued from the area or regional level of state agencies involved.

(b) During the review process, the IRT must provide the individual who is the subject of an IRT review, their legal custodian, and any attorney representing the individual or the individual's parent or guardian, as applicable, with regular updates and opportunities to provide input and make decisions as the IRT deems appropriate

(c) The IRT may also accept or request input from additional sources in its review of the individual's complex case, including from

the individual's custodian, in situations where the custodian is not the parent or guardian;
relevant service providers;
an attorney representing the individual or the individual's parent or guardian;
a representative from the individual's health plan; and
representatives of juvenile probation or juvenile courts, if relevant to the case.

(d) The IRT may order expedited eligibility determinations by a state agency or an extended evaluation at a special education residential school, if the IRT deems such updated information is necessary for the IRT to make determinations about the current service needs of an individual under IRT review.

(e) The secretary of EOHHS, in consultation with the commissioner of DESE, may authorize expenditures from the Interagency Services Reserve Fund in accordance with the procedures in 101 CMR 27.08, including paying the costs of an evaluation ordered by the IRT, as necessary to complete the IRT review.

(2) Initial IRT Meeting.

(a) Timing of Initial Meeting.

The co-chairs will convene the IRT no later than five business days after the referral date, except as provided in 101 CMR 27.07(2)(a)2.
If the individual who is the subject of the complex case is waiting in a hospital emergency department or medical bed, or at home, for not less than five days, to be placed in an appropriate therapeutic setting or to be provided with appropriate evaluations and services, the co-chairs must convene the initial IRT meeting no later than one business day after the referral date.

(b) IRT Meeting Participants. The co-chairs will invite the following IRT members to the IRT meeting:

the IRT representatives from the school district or districts responsible for any aspect of the individual's education, as determined by the commissioner of DESE;
the IRT representatives from agencies involved in or necessary for the complex case review, as determined by the co-chairs;
the individual who is the subject of the IRT meeting and/or their parent or guardian, if appropriate; and
a representative of the OCA.

(c) Notification of IRT Meeting(s). While maintaining confidentiality pursuant to 101 CMR 27.11, the co-chairs will notify all IRT meeting participants of

the date, time, and location of the IRT meeting;
the reason the referral source gave for referring the individual's case; and
the individual's name, address, date of birth, and the school district(s) involved in the individual's case.

(d) Meeting Protocol. The co-chairs will lead the IRT meeting and may impose guidelines for the meeting(s).

(3) Limits on IRT Authority.

(a) The IRT does not have the authority to plan or determine services the state agency would not be required to provide for an individual under its applicable statutes or regulations or to otherwise alter agency policy and practices relating to eligibility for and delivery of services, including activities related to the maintenance of waiting lists.

(b) The IRT does not have the authority to make medical necessity determinations for MassHealth-covered services, including hospital level of care for admission to a medical or inpatient psychiatric facility, the DMH Adolescent Continuing Care Unit, an Intensive Residential Treatment Program (IRTP), or at a psychiatric inpatient developmentally disabled unit.

(c) The IRT does not have the authority to plan or determine the special education services to which an individual may be entitled under IDEA, 20 U.S.C. §§ 1400 et seq ., and M.G.L. c. 71B, or to supersede, amend, modify, or otherwise affect the authority of the IEP Team or the BSEA to mediate or adjudicate special education disputes as provided in § 1415 of the IDEA, M.G.L. c. 71B, § 3, and 603 CMR 28.08(3).

(d)101 CMR 27.00 does not affect DESE's established regulations, policies, or procedures for assigning to school districts programmatic and fiscal responsibility for individual students' special education programs. DESE issues such assignments of responsibility under federal and state special education laws and regulations including, but not limited to, 603 CMR 28.10: School District Responsibility . The IRT's determinations of fiscal or programmatic responsibility relate only to the responsibilities of state agencies.

(4) The IRT Determination.

(a) The IRT will issue a consensus determination after receiving and reviewing all necessary and updated information regarding the individual's service needs and eligibility decisions. The IRT's determination must include findings as to the following:

the services currently in place for the individual;
additional services that are needed to meet the current needs of the individual;
which agencies will provide said services, including location or placement where appropriate and ongoing case management services; and
which agencies have fiscal responsibilities to pay for such services.

(b) The IRT will record its determinations in a written report. The co-chairs will provide the IRT report to the parent(s), guardian(s), legal custodian or, if authorized by law, the individual, as well as to the representatives of the state agencies that participated in the review.

The IRT must complete its review of the individual's case and make its determinations within 30 business days of the referral date, unless an expedited IRT review is required as set forth in 101 CMR 27.07(4)(c)2.
An expedited determination is required if the individual whose case is under IRT review is waiting to be placed in an appropriate therapeutic setting or to be provided with appropriate evaluations and services for not less than five days in a hospital emergency department medical bed, or, if at home, there is a need for urgent action as determined by the IRT. An expedited review must be completed within five business days of the referral date.

(5) Additional Processes When IRT Consensus Cannot Be Reached.

(a) If the IRT does not come to a consensus determination on a complex case, in whole or in part, the case will be referred to the co-chairs for determination. The co-chairs will issue a determination consistent with 101 CMR 27.07(4), which will be the final determination of the IRT.

(b) If the IRT cannot come to resolution regarding which state agency or agencies have fiscal responsibility for the services or placements determined necessary by the IRT, the co-chairs, EOHHS and DESE, may authorize the expenditure of funds pursuant to M.G.L. c. 29, § 2TTTTT for the costs of needed services or placements. EOHHS and DESE may seek reimbursement from any state agency, school district, or other entity that is subsequently found to have been responsible for the provision of services during the time period that EOHHS and DESE assumed fiscal responsibility.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.08 Interagency Services Reserve Fund

(1) The secretary of EOHHS administers and makes expenditures from the Interagency Services Reserve Fund to effectuate the purpose of the interagency review process, in consultation with the commissioner of DESE, pursuant to M.G.L. c. 6A, § 16R and M.G.L. c. 29, § 2TTTTT. The fund may be used for the following purposes:

(a) covering the cost of providing additional evaluation for an individual as needed by the IRT to issue the required determination;

(b) covering the costs of a service or placement determined to be necessary for an individual in the IRT final determination, until a resolution regarding agency fiscal responsibility is reached; and

(c) additional costs required to facilitate the complete review of the complex case and reach final resolution among agencies to meet the individual's service needs.

(2) The secretary of EOHHS will develop procedures by which the IRT may request expenditures from the Interagency Services Reserve fund, and for how such resources will be issued if approved.

(3) The secretary of EOHHS, in consultation with the commissioner of DESE, will review all requests for expenditures from the fund and determine if the requested expenditure is an allowable use of the fund, the requested funds are available and based on the information provided, and whether to approve the request. Additional documentation or information may be requested.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.09 Appeal Process

(1) Right to Appeal to DALA. If the individual or their parent or guardian disputes the determination of the IRT, in whole or in part, such person may file an appeal with DALA, which conducts an adjudicatory proceeding in accordance with 801 CMR 1.01: Formal Rules and orders any necessary relief consistent with state or federal law.

(2) Timeliness of Appeal. Any appeal to DALA must be filed within 30 days of receipt of the IRT's written report, as applicable.

(3) Grounds for Appeal. The permissible grounds for an appeal to DALA under 101 CMR 27.00 are

(a) a dispute about the IRT's determinations issued under 101 CMR 27.07(4)(a), subject to the limitations in 101 CMR 27.07(3); or

(b) a dispute about the co-chairs' determinations issued under 101 CMR 27.07(5), if the IRT is unable to reach consensus and the co-chairs issue a determination for the IRT review, subject to the limitations in 101 CMR 27.07(3).

(4) Nonappealable Actions. The following actions do not constitute grounds for an appeal to DALA under 101 CMR 27.00:

(a) the co-chair's decision that a case is ineligible for IRT review;

(b) any decision of the co-chairs, or the secretary of EOHHS, related to expenditures from the Interagency Services Reserve Fund;

ineligibility for services provided by a state agency;
unavailability of any service that the state agency is not required to provide under its applicable statutes or regulations; or
the applicability of agency policy and practices relating to eligibility for and delivery of services, including activities related to the maintenance of waiting lists;

(d) appeals related to any MassHealth action. All such appeals must be made to the Office of Medicaid Board of Hearings pursuant to 130 CMR 610.000: MassHealth: Fair Hearing Rules . For an individual enrolled in a MassHealth managed care plan, such appeals must be made to the managed care plan directly, subject to review at the Office of Medicaid Board of Hearings in accordance with the provisions of 130 CMR 610.000. A provider's opinion or clinical determination that a service is not medically necessary does not constitute an action by the MassHealth agency and is not subject to appeal to the Office of Medicaid Board of Hearings or DALA; and

(e) appeals related to a dispute concerning the free appropriate public education or special education services to which an individual is entitled under the IDEA and M.G.L. c. 71B. All such appeals must be made to the BSEA as provided in § 1415 of the IDEA, M.G.L. c. 71B, and 603 CMR 28.08(3), or may be raised with DESE's Problem Resolution System Office in accordance with 34 C.F.R. §§ 300.151 through 300.153 and 603 CMR 28.08(2).

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.10 Implementation of Services

The state agencies represented on the IRT must work to implement in a reasonable amount of time any authorized decision by the IRT with respect to services or coordination.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.11 Confidentiality

(1) Access to Confidential Information. Notwithstanding M.G.L. chs. 66A, 112, and 119 or any other law related to the confidentiality of personal data, the IRT members assigned to a particular case, the secretary of EOHHS, the commissioner of DESE, and DALA will have access to and may discuss materials related to an individual's complex case with one another and with other individuals directly addressing matters related to the individual's case while the case is under review after

(a) the legal custodian, or, if authorized by law, the individual has consented in writing; and

(b) those with access agree in writing to keep the materials confidential.

(2) Disposition of Confidential Information. Once an IRT review is complete and the timeline for all potential legal and administrative appeals has been exhausted, all materials are returned to the originating source, or, with consent of the originating source, all materials are destroyed to the extent authorized by state law.

(3) The IRT's records and documents included as part of the IRT process are confidential and are not public records under M.G.L. c. 66.

(4) Redaction of Personal Information. Any written report produced by a IRT and any written decision produced by DALA is redacted in accordance with the confidentiality requirements applicable to the source material, including without limit M.G.L. c. 66A (FIPA), M.G.L. c. 93H, Health Information Portability and Accountability Act (HIPAA), Pub. L. 104-191, 110 Stat. 1936 (1996), and 45 CFR 164.514(B)(2)(i), and the Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g; 34 CFR Part 99.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

101 CMR, § 27.12 Annual Report

The secretary of EOHHS will publish an annual report no later than October 1^st summarizing the cases reviewed by the IRT in the prior year. Such report will include the length of time spent at each stage and the final resolution. The report will not include any personally identifiable information of an individual. The secretary of EOHHS will provide the report to the OCA and the clerks of the senate and the house of representatives.

History

Adopted by Mass Register Issue 1516, eff. 3/1/2024.

Disability Employment Tax Credit Disability Employment Tax Credit

101 CMR, § 28.01 Applicability and Effective Date

(1) Scope. 101 CMR 28.00 applies to individuals applying for certification as a qualified employee with a disability for the purposes of the Disability Employment Tax Credit and Massachusetts employers seeking to receive the Disability Employment Tax Credit.

(2) Effective Date. 101 CMR 28.00 is effective as of July 8, 2022.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.02 Purpose

101 CMR 28.00 establishes the procedures and requirements to implement the Disability Employment Tax Credit established in M.G.L. c. 62, § 6(z) and c. 63, § 38JJ. 101 CMR 28.00 defines the application process conducted by the Massachusetts Rehabilitation Commission (MRC) to certify individuals as qualified employees with disabilities for the purpose of the DETC, and the eligibility requirements for employers claiming the DETC.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.03 Definitions

As used in 101 CMR 28.00, unless the context requires otherwise, terms have the meanings in 101 CMR 28.03.

Competitive Employment Setting. A job opportunity or position in which the employee is compensated at the customary rate paid by the employer for the same or similar work performed by other employees who are not individuals with disabilities.

DETC. The Disability Employment Tax Credit as set forth in M.G.L. c. 62, § 6(z) and c. 63, § 38JJ.

DETC Certification. The written certification issued by MRC certifying that an applicant is a qualified employee with a disability.

Employer. An individual or organization that employs people and pays them for their work.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Qualified Employee with a Disability or Qualified Employee. An individual, hired after July 1, 2021, who is eligible for purposes of the Disability Employment Tax Credit by having met the following requirements.

(1) An individual with a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment, as defined by the Americans with Disabilities Act, 42 U.S.C. 12102(ADA).

(2) The individual is capable of working independently. An individual will be determined capable of working independently when they are employed in a competitive employment setting.

(3) The individual is physically or mentally impaired in a manner that constitutes or results in a substantial impediment to employment.

Primary Place of Employment in Massachusetts. The employee is primarily located in Massachusetts when working for the employer.

Primary Place of Residence in Massachusetts. The person is living in Massachusetts, with the intention of making their home in Massachusetts, with no plans to return to a former home in another state. A fixed or permanent address in Massachusetts is not required so long as the person is living and intends to live in Massachusetts.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.04 DETC General Requirements

(1) For tax years beginning on or after January 1, 2023, an employer may claim the DETC where:

(a) the employer hires a qualified employee with a disability after July 1, 2021, for a position in a competitive employment setting;

(b) the employer timely receives a copy of the qualified employee's DETC certification consistent with the requirements in 101 CMR 28.06(1);

(c) the qualified employee is employed for at least 12 consecutive months prior to and in the taxable year in which the credit is claimed. For example, if the qualified employee is employed on July 1, 2022, through June 30, 2023, the employer is entitled to claim the credit for wages paid in 2023 because the employee has been employed for 12 consecutive months both prior to and in the taxable year in which the credit is claimed;

(d) the qualified employee's primary place of employment and primary place of residence were in Massachusetts during the 12 consecutive months supporting eligibility for the DETC; and

(e) the employer meets the additional employer eligibility requirements set forth in 101 CMR 28.00.

(2) The DETC is a tax credit equal to $5,000 or 30% of the wages paid to the qualified employee with a disability in the first taxable year of employment, whichever is less.

(3) For each subsequent taxable year of employment, the DETC is $2,000 or 30% of the wages paid to the qualified employee with a disability, whichever is less.

(4) There is no limit to the number of years the DETC is available to an employer who is otherwise eligible for the credit under 101 CMR 28.00.

(5) An individual with a disability(ies) who seeks to be certified as a qualified employee with a disability may apply to MRC for DETC certification as set forth in 101 CMR 28.05. If certified, the qualified employee may present the DETC certification to prospective employers as part of an application for employment.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.05 Application Process to Be Certified by MRC as a Qualified Employee with a Disability

(1) An applicant seeking certification as a qualified employee with a disability for the DETC must submit an application in the format specified by MRC, which must include the following:

(a) proof the applicant meets the requirements to be a qualified employee with a disability;

MRC will deem an applicant a qualified employee with a disability if the applicant is receiving benefits or was determined eligible for one of the following government programs based upon the applicant's disability:

a. Vocational Rehabilitation Services, provided by MRC or the Massachusetts Commission for the Blind;

b. 504 Plan under Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 701 et. seq., with additional documentation showing substantial impairment to employment;

c. Individualized Education Plan under the Individuals with Disabilities in Education Act of 1990, 20 U.S.C. § 1400 et. seq., with additional documentation showing substantial impairment to employment;

d. Comprehensive coverage under MassHealth as a disabled adult as defined under 130 CMR 501.000: Health Care Reform: MassHealth: General Policies;

e. Emergency Aid to the Elderly, Disabled and Children (EAEDC) benefits, under 106 CMR 703.190: TAFDC Disability Exemption Process;

f. Veteran Readiness and Employment program, provided by the Veterans' Administration;

g. Supplemental Security Income (SSI) or Social Security Disability Income (SSDI); or

h. Such other government programs as EOHHS may identify that establish disability sufficient to allow MRC to deem an applicant a qualified employee with a disability under the DETC. EOHHS will issue guidance in accordance with 101 CMR 28.08 as appropriate; or

The applicant has been certified by the United States Department of Veterans Affairs as having been discharged or released from active duty in the armed forces of the United States for a service-connected disability; and

(b) proof the applicant's primary place of residence is in Massachusetts.

(2) MRC may make supplemental requests for information as necessary to complete the application.

(3) If MRC determines the applicant meets the requirements for DETC certification as a qualified employee, MRC will issue a DETC certification to the applicant. If MRC determines the applicant does not meet the requirements for DETC certification, MRC will issue written notice of this determination within 30 days of a complete DETC certification application.

(4) The DETC certification may be provided to any prospective employer to demonstrate qualified employee status for a period of three years from the date the certification is issued. After three years, the employee must request recertification from MRC by resubmitting the application described in 101 CMR 28.05 in order for the new employer to claim the DETC.

(5) At the request of the applicant, MRC will send a copy of the DETC certification to the applicant's employer.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.06 Eligibility Requirements

(1) Receipt of DETC Certification.

(a) General Guidelines. A copy of the DETC certification for the qualified employee must be received by the employer no later than the day the qualified employee begins work, unless an exception in 101 CMR 28.06(1)(b) applies.

(b) Exceptions. An employer who receives the DETC certification after the employee begins work remains eligible for the DETC in the following circumstances.

MRC issued a DETC certification prior to the employment start date.
The employee submitted an application to MRC prior to the employment start date, and MRC certifies the employee as a qualified employee with a disability based upon the application (even if the determination is made after the employment start date).
The employer hired the employee after July 1, 2021, and the application for DETC certification is submitted to MRC within 90 days of the effective date of 101 CMR 28.00.
Upon a showing of good cause, the employee provided the application for certification within 90 days from the date the employee begins work.

(2) Documentation Requirements. An employer claiming the DETC must maintain the following documentation to support eligibility for the DETC:

(a) the copy of DETC certification and proof of receipt consistent with 101 CMR 28.06(1);

(b) employment records sufficient to show the qualified employee was employed in a competitive employment setting;

(c) employment records sufficient to show a qualified employee began work after July 1, 2021, and was employed for 12 consecutive months prior to, and in the taxable year, in which the credit is claimed; and

(d) records sufficient to demonstrate the qualified employee's primary place of employment and primary place of residence were in Massachusetts during the 12 consecutive months supporting eligibility for the DETC.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.07 Verification of Primary Place of Residence for the DETC Credit

(1) The primary place of residence of the qualified employee may be verified by MRC or the employer with any of the following documents:

(a) copy of a deed or mortgage payment;

(b) utility bill or work order;

(c) copy of lease, letter from landlord specifying the rental arrangement, or rental assistance agreement ( i.e. , Section 8 agreement);

(d) homeowner's insurance agreement;

(e) postal service records;

(f) statement from homeless shelter or homeless service providers;

(g) school records (if school is private, additional documentation may be requested);

(h) nursery school or daycare records (if school is private, additional documentation may be requested);

(i) proof of enrollment of custodial dependent in public school;

(j) voter registration records;

(k) motor vehicle license or registration;

(l) other government-issued identification card reflecting current address, a photograph, or information such as name, date of birth, height, eye color, or other identifying information; or

(m) a written statement, signed by the employee, declaring where the employee lives or intends to live within Massachusetts. A written statement may only be used if the employee has no fixed address and is unable to provide proof of residence through other documentation listed in 101 CMR 28.07(1).

(2) If the employee's primary place of residence changed during the 12 months of employment supporting the DETC, MRC or the employer may rely on such documents as needed to establish the employee's primary place of residence in Massachusetts for the full 12-month period.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.08 Review of MRC Agency Decision

(1) An applicant seeking certification as a qualified employee with a disability may appeal the following agency decisions:

(a) certification under 101 CMR 28.05; and

(b) timeliness of the DETC certification application under 101 CMR 28.06(2).

(2) All appeals must be made in writing to the Commissioner of MRC, or their designee, within 30 calendar days from the date notice is issued.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.09 Implementation and Clarification

(1) Policies and Procedures. EOHHS may, in consultation with MRC and the Massachusetts Department of Revenue (DOR), establish policies and procedures to implement the DETC.

(2) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify substantive provisions of 101 CMR 28.00.

(3) Implementation Guidance. EOHHS may develop policies, guidance, or memoranda to implement 101 CMR 28.00, including identification of government programs that establish disability sufficient to deem an individual a qualified employee with a disability under the DETC.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.10 Interagency Agreement

The Secretary of EOHHS, in consultation with MRC, may establish interagency agreements among EOHHS, MRC, and the DOR in order to verify certifications of qualified employees as necessary to ensure employer compliance with DETC requirements.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

101 CMR, § 28.11 Severability

The provisions of 101 CMR 28.00 are severable. If any provisions of 101 CMR 28.00 or the applications of such provisions to any person or circumstance are held invalid or unconstitutional, the other provisions of 101 CMR 28.00, or the application of such provisions to any person or circumstance other than that as to which it is held invalid or unconstitutional, will not be affected thereby.

History

Adopted by Mass Register Issue 1473, eff. 7/8/2022.

Statewide Long-term Care Ombudsman Program Statewide Long-term Care Ombudsman Program

101 CMR, § 30.01 Scope and Purpose

101 CMR 30.00 sets forth the requirements to establish an independent statewide long-term care ombudsman program within the Executive Office of Health and Human Services pursuant to M.G.L. c. 6A, § 16CC. 101 CMR 30.00 includes the requirements for the Ombudsman Program to receive and investigate complaints from residents of long-term care facilities and assisted living residences, or their resident representative, regarding the health, safety, welfare, or quality of life of the residents, and to resolve those complaints through negotiation and mediation or by referral to an appropriate agency or organization. 101 CMR 30.00 also establishes criteria and procedures to designate local ombudsman programs and to certify ombudsman representatives to carry out the duties of the Ombudsman Program.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.02 Definitions

As used in 10 CMR 30.00, unless the context requires otherwise, these terms will have the following meanings.

Access. The authority of an ombudsman representative to enter any facility to:

(1) perform the actions and duties of the Ombudsman Program as set forth in 101 CMR 30.00;

(2) meet with residents to obtain permission to conduct an investigation of a complaint;

(3) obtain the name and contact information of all resident representatives;

(4) review medical, social, and other relevant records with the consent of the resident or the resident representative; or

(5) with the consent and approval of the State Ombudsman, review medical, social, and other records of a resident who is unable to give informed consent and has no resident representative.

Area Agency on Aging (AAA). A public agency or nonprofit organization designated by the Executive Office of Elder Affairs (EOEA) in a planning and service area under the Older Americans Act, 42 U.S.C. 3025, which is responsible for developing and administering an area plan as defined under 42 U.S.C. 3026.

Case. An inquiry brought to or initiated by the State Ombudsman or ombudsman representative on behalf of a resident or group of residents. A case includes the complaint, or multiple related complaints, the Ombudsman Program investigation, strategy for resolution, and related records.

Certification. The process by which a person associated with a local ombudsman program, or the Statewide Long-term Care Ombudsman Program, who after completing the training and other criteria set forth in 101 CMR 30.09, now qualifies to be certified and designated by the State Ombudsman to be an ombudsman representative.

Complainant. A resident, resident representative, or an individual, organization, or government agency, including the State Ombudsman or ombudsman representative, who files or initiates a complaint with the Ombudsman Program.

Complaint. A concern brought to, or initiated by, the State Ombudsman or an ombudsman representative for investigation and action on behalf of one or more residents relating to the health, safety, welfare, rights, or quality of life of one or more residents, including the failure of a facility, organization, or government agency to comply with governing statutes or regulations.

Conflict of Interest. A situation where an interest may intrude upon, interfere with, threaten to negate, or give the appearance of interfering with or undermining the impartiality of a person and their ability to act without compromise due to competing duties or obligations. A conflict of interest includes an individual or organizational conflict of interest as set forth in 101 CMR 30.16(1) and (2).

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

EOEA. The Massachusetts Executive Office of Elder Affairs established under M.G.L. c. 19A.

Facility. A long-term care facility subject to licensure by the Massachusetts Department of Public Health pursuant to M.G.L. c. 111, § 71 or 42 U.S.C. 3001 et seq ., or an assisted living residence certified by the Executive Office of Elder Affairs pursuant to M.G.L. c. 19D.

Facility Administrator. A person:

(1) who is licensed under M.G.L. c. 112, §§ 108 through 117 to administer, manage, supervise, or have general administrative charge of a long-term care facility, whether or not such individual has an ownership interest in such entity and whether his or her functions and duties are shared with one or more individuals, or a suitable and responsible person who administers, manages, supervises, or is in general administrative charge of a rest home as further defined in 105 CMR 150.002: Standards for Long-term Care Facilities; or

(2) who has general administrative charge of an assisted living residence certified pursuant to M.G.L. c. 19D and 651 CMR 12.00: Certification Procedures and Standards for Assisted Living Residences.

Host Agency. An agency designated by the State Ombudsman to house and support a local ombudsman program for a specific geographic area. Only an AAA, a public agency, or a nonprofit organization may be designated as a host agency.

Informed Consent. The process of informing a resident of the risks and benefits associated with certain actions and decisions that results in the resident's authorization or agreement to proceed. For purposes of 101 CMR 30.00, informed consent should be confirmed in writing, including through the use of auxiliary aids and services as necessary. If written consent is not possible, consent may be obtained orally or visually, including through the use of auxiliary aids and services, provided such consent is documented contemporaneously.

Local Ombudsman Program. A program operating in a designated host agency to carry out the functions of the Ombudsman Program for an assigned geographic area. A local ombudsman program comprises a local ombudsman program director and ombudsman representatives employed by or associated with the host agency and designated and certified by the State Ombudsman to act as ombudsman representatives in that geographic area.

Local Ombudsman Program Director (also known as a Local Program Director). An individual employed by or associated with a local ombudsman program as the director with the responsibility for the operation of a local ombudsman program and who is certified and designated as such by the State Ombudsman pursuant to M.G.L. c. 6A, § 16CC, and 101 CMR 30.09(1).

Ombudsman Representative. An employee or volunteer of the Ombudsman Program or a local ombudsman program, who has been certified and designated by the State Ombudsman to act as a representative of the Ombudsman Program.

Resident. A person who is receiving treatment or care in a facility including, but not limited to, application or admission, retention, confinement, commitment, period of residence, transfer, discharge, and instances directly related to such status.

Resident Representative.

(1) An individual chosen by the resident to act on the resident's behalf to support the resident in decision-making: access the resident's medical, social, or other personal information; manage financial matters; or receive notifications;

(2) A person authorized by state or federal law including, but not limited to, agents under power of attorney, health care proxy, representative payees, and other fiduciaries, to act on behalf of the resident in order to support the resident in decision-making: access the resident's medical, social, or other personal information; manage financial matters; or receive notifications;

(3) A legal representative, as used in section 712 of the Older Americans Act; or

(4) The court-appointed guardian or conservator of the resident.

(5) Nothing in this regulation is intended to expand the scope of authority of a resident representative beyond the authority specifically authorized by the resident, state or federal law, or a court of competent jurisdiction.

State Long-term Care Ombudsman (also referred to as State Ombudsman). An individual appointed by the Secretary of EOHHS pursuant to M.G.L. c. 6A, § 16CC(b) and in accordance with 42 U.S.C. 3001, et seq ., to direct the Statewide Long-term Care Ombudsman Program.

Statewide Long-term Care Ombudsman Program (also referred to as the Ombudsman Program). The statewide ombudsman program established by EOHHS for the purpose of advocating on behalf of residents, operated separately and independently from EOHHS, and directed by the State Ombudsman pursuant to M.G.L. c. 6A, § 16CC, and in accordance with 42 U.S.C. 3001 et seq . The State Ombudsman Program includes the local ombudsman programs.

Willful Interference. The actions or inactions taken by an individual in an attempt to intentionally prevent, interfere with, or attempt to impede the State Ombudsman or an ombudsman representative from performing the functions or responsibilities of the Ombudsman Program.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.03 Establishment of the Statewide Long-term Care Ombudsman Program

(1) The Secretary of EOHHS will, subject to appropriation or the receipt of federal funds, establish either directly or by contract, an independent statewide long-term care ombudsman program and appoint a State Ombudsman.

(2) EOHHS will ensure the State Ombudsman serves on a full-time basis, and that the functions, responsibilities, and duties set forth in 101 CMR 30.05 comprise the entirety of the State Ombudsman's work.

(3) EOHHS will further ensure the State Ombudsman meets minimum qualifications, which will include, but not be limited to, demonstrated expertise in:

(a) long-term services and supports or other direct services for older persons or individuals with disabilities;

(b) consumer-oriented public policy advocacy;

(d) negotiation and problem resolution skills.

(4) The State Ombudsman will establish policies and procedures, in consultation with EOHHS, to carry out the Ombudsman Program in accordance with 42 U.S.C. 3001 et seq ., M.G.L. c. 6, § 16CC, and associated federal and state regulations.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.04 Responsibilities of Agency in the Administration of the Ombudsman Program

EOHHS, as the state agency responsible for establishing and assessing the independent Ombudsman Program, will:

(1) ensure the State Ombudsman complies with all relevant provisions of 42 U.S.C. 3001 et seq , and associated regulations, including 42 U.S.C. 3058g, 45 CFR §§ 1321 and 1324, and M.G.L. c. 6, § 16CC;

(2) ensure the Ombudsman Program has sufficient authority and access to facilities, residents, and information needed to fully perform all the functions, responsibilities, and duties of the Ombudsman Program;

(3) provide training opportunities, or ensure such opportunities are available, for the State Ombudsman and ombudsman representatives, to maintain expertise to serve as effective advocates for residents;

(4) provide personnel supervision and management for the State Ombudsman and ombudsman representatives who are employees of EOHHS. Such management will include an assessment of whether the Ombudsman Program is performing all of its functions under 42 U.S.C. 3001 et seq , and associated regulations, as well as M.G.L. c. 6, § 16CC;

(5) monitor the Ombudsman Program for quality and effectiveness, as required by 45 CFR § 1321.11(b). Such monitoring will include fiscal monitoring and an assessment of whether the Ombudsman Program is performing all functions, responsibilities, and duties set forth in 45 CFR §§ 1324.13 and 1324.19. EOHHS may make reasonable requests for reports, including aggregated data regarding Ombudsman Program activities, to meet the requirements of this provision;

(6) ensure the files, records, or other information maintained by the Ombudsman Program are protected from disclosure consistent with the limitations set forth in 101 CMR 30.15, 45 CFR §§ 1324.11(e)(3), and 1324.13(e);

(7) integrate the goals and objectives of the Ombudsman Program into the state plan and coordinate the goals and objectives of the Ombudsman Program with those of other programs established under Title VII of the Older Americans Act and other state elder rights, disability rights, and elder justice programs, to promote collaborative efforts and diminish duplicative efforts;

(8) provide elder rights leadership, including by requiring the coordination of Ombudsman Program services with the activities of other elder rights programs with responsibilities relevant to the health, safety, wellbeing, or rights of older adults, including residents, as set forth in 45 CFR § 1324.13(h);

(9) provide mechanisms to prohibit and investigate allegations of willful interference, retaliation, and reprisals

(a) by a facility, other entity, or individual with respect to a resident, complainant, employee, or other person for filing a complaint with, providing information to, or otherwise cooperating with any representative of the Ombudsman Program; or

(b) by a facility, other entity, or individual against the State Ombudsman or ombudsman representatives while fulfilling their functions, responsibilities, or duties;

(10) provide for appropriate sanctions with respect to interference, retaliation, and reprisals;

(11) ensure legal counsel for the Ombudsman Program is adequate, available, has competencies relevant to the legal needs of the Ombudsman Program and residents, and is without conflict of interest; and

(12) require the State Ombudsman to maintain complete records of complaints, actions, findings, and recommendations.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.05 Functions and Responsibilities of the State Long-term Care Ombudsman

(1) The State Ombudsman is responsible for leading and managing the Statewide Long-term Care Ombudsman Program as follows.

(a) Functions. The State Ombudsman will, directly or through ombudsman representatives:

identify, investigate, and resolve complaints that

a. are made by, or on behalf of, residents; and

b. relate to action, inaction, or decisions by facilities or their staff, public agencies, or health and social service agencies that may adversely affect the health, safety, welfare, or rights of residents;

provide services to protect the health, safety, welfare, and rights of residents;
inform residents how to obtain services provided by the Ombudsman Program;
ensure residents have regular and timely access to the services provided through the Ombudsman Program, and that residents and complainants receive timely responses to requests for information and complaints from the Ombudsman Program;
ensure ombudsman representatives visit residents at one or more facility within the assigned geographic area at least once every other week, at a time which best meets the needs of the Ombudsman Program and residents, to ensure regular and timely access to Ombudsman Program services;
represent the interests of residents before governmental agencies and ensure that individual residents have access to administrative, legal, and other remedies to protect the health, safety, welfare, and rights of residents;
provide administrative and technical assistance to ombudsman representatives, host agencies, and local ombudsman programs;
analyze, comment on, and monitor the development of laws, regulations, policies, and actions to protect the health, safety, welfare, and rights of residents as set forth in 45 CFR 1324.13(a)(7);
provide information and recommendations to public and private agencies, legislators, the media, and other persons regarding problems and concerns relating to residents and the conditions of facilities;
investigate all allegations of interference, retaliation, and reprisal by an entity against a resident, complainant, ombudsman representative, the State Ombudsman, and the Ombudsman Program; and

establish state level coordination with other programs, agencies, and entities with responsibilities relevant to the protection of the health, safety, welfare, or rights of residents as set forth in 45 CFR 1324.13(h).

(b) Designation and Certification. The State Ombudsman will determine designation, and refusal, suspension, or removal of designation, of local ombudsman programs and certification of ombudsman representatives.

Local Ombudsman Programs. Where the State Ombudsman chooses to designate local ombudsman programs, the State Ombudsman will:

a. require as a condition of designation that the local ombudsman program be organizationally located within a public agency or nonprofit organization;

b. review and approve plans or contracts governing local ombudsman programs in coordination with EOHHS; and

c. monitor, on a regular basis, the performance of the local ombudsman program.

The State Ombudsman will establish certification requirements for ombudsman representatives, consistent with the requirements of 45 CFR 1324.13(c), including training and continuing education requirements.
The State Ombudsman will investigate allegations of misconduct by ombudsman representatives in the performance of Ombudsman Program duties and coordinate such investigations with EOHHS, the local ombudsman program, and the host agency, as applicable.

(c) Ombudsman Program Records. The State Ombudsman will manage the Ombudsman Program records consistent with 101 CMR 30.15 and maintain a statewide uniform reporting system to collect and analyze data relating to complaints and conditions in facilities for the purpose of identifying and resolving complaints.

(d) Fiscal Management. The State Ombudsman will determine the use of fiscal resources appropriated or otherwise available for the operation of the Ombudsman Program. The State Ombudsman will establish financial and administrative systems and procedures that comply with federal and state laws and requirements including, but not limited to, approving all budgets and expenditures of the Ombudsman Program and the local ombudsman programs as set forth in 45 CFR 1324.13(f).

(e) Annual Report. The State Ombudsman will independently develop and provide final approval of an annual report as set forth in M.G.L. c. 6, § 16CC(g)(v) and 45 CFR 1324.13(g), or as directed by the Secretary or other federal requirement.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.06 Functions and Responsibilities of Host Agencies for Local Ombudsman Programs

The responsibilities of a host agency will include, but not be limited to, the following:

(1) recruit and retain sufficient staff to serve as ombudsman representatives within an assigned geographic area;

(2) coordinate with the State Ombudsman Program regarding certification requirements for qualification as an ombudsman representative;

(3) provide personnel management, but not the programmatic oversight, of ombudsman representatives associated with the local ombudsman program, including employee and volunteer representatives;

(4) ensure personnel policies and practices do not prohibit ombudsman representatives from performing the duties of, or from adhering to, the access, confidentiality, and disclosure requirements of the Ombudsman Program;

(5) ensure ombudsman representatives have the capacity to receive, investigate, and resolve complaints;

(6) retain complete records for the local ombudsman program;

(7) comply with confidentiality requirements set forth in 101 CMR 30.15, M.G.L. c. 6, § 16CC, and 42 U.S.C. 3001 et seq .;

(8) publicize the existence and function of the local ombudsman program and the Statewide Long-term Care Ombudsman Program;

(9) ensure an ombudsman representative has appropriate Ombudsman Program identification;

(10) establish financial and administrative systems and procedures that comply with the provisions contained in 45 CFR 74 (Administration of Grants) Sub-part H (Standards for Grantee and Sub-grantee Financial Management Systems), as well as requirements developed by EOHHS, the State Ombudsman, and the federal government; and

(11) comply with regulations and policies developed by the State Ombudsman and carry out all other activities consistent with the requirements of M.G.L. c. 6A, § 16CC and 42 U.S.C. 3001 et seq .

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.07 Designation of Local Ombudsman Programs

(1) The State Ombudsman designates host agencies to house a local ombudsman program for a geographic area. Host agency designation occurs on an annual cycle determined by the State Ombudsman, for a period not to exceed one year. Designation may be renewed at the discretion of the State Ombudsman. Only AAAs, public agencies, or nonprofit organizations may be designated to host local ombudsman programs.

(2) To be designated as a host agency for a local ombudsman program, the host agency must have the ability and capacity to carry out the functions of a local ombudsman program as set forth in 101 CMR 30.06, 101 CMR 30.07, and 45 CFR 1324.19. The State Ombudsman may not designate as a host agency:

(a) an agency or organization responsible for licensing or certifying facilities;

(b) associations of facilities or their affiliates or agents; or

(3) The local ombudsman program and the ombudsman representatives must be designated by the State Ombudsman to be permitted access to residents for the purposes of performing the duties of the Ombudsman Program.

(4) Annual Designation Procedures.

(a) On an annual basis, the State Ombudsman will evaluate prospective or existing host agencies for designation.

(b) The State Ombudsman will review the application of a host agency to house a local ombudsman program to ensure:

the host agency has the capacity to comply with the Ombudsman Program rules and requirements and applicable state and federal laws and regulations, including the agency's ability to recruit sufficient ombudsman representatives to meet the coverage requirements for the assigned geographic area and otherwise meet the requirements of 101 CMR 30.06, 101 CMR 30.07, and 45 CFR 1324.19; and
the designation does not create or involve a conflict of interest.

(5) Funding and Designation. EOEA provides the funding for a local ombudsman program to the AAAs who distribute the funds to designated host agencies housing local ombudsman programs.

(6) Ombudsman Program Geographic Areas. The State Ombudsman will designate local ombudsman programs sufficient to provide Ombudsman Program services in all geographic areas of the Commonwealth.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.08 Refusal, Suspension, or Removal of Local Ombudsman Program Designation

(1) The State Ombudsman may refuse to designate a host agency during the application process, or suspend or remove designation of a host agency, if the State Ombudsman determines the local ombudsman program does not meet the standards set forth in 101 CMR 30.06 or 101 CMR 30.07, or is not in compliance with the designation agreement or other federal or state laws or requirements to operate as a local ombudsman program.

(a) To effectuate the de-designation determination, the State Ombudsman will send written notice by first class mail of such determination to the host agency, with copy to the appropriate AAA, containing the information required in 101 CMR 30.08(3).

(b) The effective date of the de-designation determination must be at least 15 calendar days after the issue date of written notice, except in emergency situations as set forth in 101 CMR 30.08(2).

(c) The de-designated host agency will have the opportunity to request that the State Ombudsman reconsider the determination.

(2) If the State Ombudsman determines an action or omission by a person associated with a local ombudsman program endangers or has endangered the life, health, welfare, or safety of a resident or staff of a facility, the State Ombudsman may refuse, suspend, or remove the host agency's designation orally, effective immediately. The State Ombudsman will provide written notice of action with the information required in 101 CMR 30.08(3) to the host agency within seven calendar days of the oral notice.

(3) Notice of Action. The written notice of a determination by the State Ombudsman to refuse, suspend, or remove designation of the host agency must:

(a) state the grounds for the State Ombudsman's determination;

(b) include the termination date of the designation; and

(c) inform the host agency of the right to apply to the State Ombudsman for reconsideration of the determination within 15 calendar days of the effective date of the notice of the termination of designation.

(4) Continuity of Services. Upon refusal, suspension, or removal of designation, the State Ombudsman will work to ensure no gap in Ombudsman Program services and designate a new local ombudsman program for the geographic area as soon as practicable.

(5) Termination of Funding of a Designated Local Ombudsman Program.

(a) The funding to the local ombudsman program for the balance of the funding period will immediately terminate after refusal to redesignate or the de-designation of a local ombudsman program by the State Ombudsman.

(b) The local ombudsman program may appeal to the Secretary of EOHHS, or their designee, the termination of funding.

The appeal must be submitted to the Secretary of EOHHS within 15 calendar days of the effective date of the termination of funding.
The Secretary, or their designee, will make a decision on the appeal within 30 days of receipt of the appeal.
The decision of the Secretary, or their designee, regarding the termination of funding will be the final agency decision.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.09 Certification of Local Ombudsman Program Directors and Ombudsman Representatives

(1) Local Ombudsman Program Directors.

(a) No person will serve as the director of a local ombudsman program, by employment or association, until they are certified, or temporarily certified as a trainee, by the State Ombudsman. The State Ombudsman may refuse, suspend, or remove such certification of a local ombudsman program director.

(b) Certification Requirements. To be certified by the State Ombudsman, a local ombudsman program director must, at a minimum:

meet the qualifications of a local ombudsman program director established by the State Ombudsman;
satisfactorily complete an ombudsman basic training program conducted by the State Ombudsman as set forth in 101 CMR 30.10;
attend on a regular basis the State Ombudsman-sponsored director training or meeting sessions;
comply with all laws, regulations, policies, and procedures governing the Ombudsman Program; and
provide assurances and, if requested, documentation that they have no conflict of interest with the Ombudsman Program.

(c) De-certification. After receiving certification to serve as a director, the local ombudsman program director will remain certified until:

the State Ombudsman de-designates the local ombudsman program where the individual serves as director;
the local ombudsman program director is no longer employed as director or associated with a local ombudsman program; or
the local ombudsman program director receives a written notice of suspension or removal of certification from the State Ombudsman citing a material failure to comply with one or more of the certification requirements stated in 101 CMR 30.09(1), or fails to perform all required duties of the director of the local ombudsman program.

(2) Ombudsman Representatives.

(a) No person will serve as an ombudsman representative, by employment or association, unless they are certified by the State Ombudsman. The State Ombudsman may refuse, suspend, or remove such certification of an ombudsman representative

(b) Certification Requirements. To be certified by the State Ombudsman, the ombudsman representative must, at a minimum:

satisfactorily complete an ombudsman basic training program authorized by the State Ombudsman as set forth in 101 CMR 30.10;
comply with all relevant laws, regulations, policies, and procedures; and
provide assurances and, if requested, documentation that they have no conflict of interest with the Ombudsman Program.

(c) De-certification Requirements. After receiving certification, an ombudsman representative will remain certified until

the State Ombudsman de-designates the local ombudsman program with which the ombudsman representative is associated;
the ombudsman representative is no longer employed or associated with a local ombudsman program; or
the ombudsman representative receives a written notice of suspension or removal of certification from the State Ombudsman, citing a material failure to comply with one or more of the certification requirements stated in 101 CMR 30.09, or fails to perform all required duties of an ombudsman representative.

(3) The local ombudsman program director or the ombudsman representative may request that the State Ombudsman reconsider a decision to refuse, suspend, or remove the certification of a local ombudsman program director or ombudsman representative. The State Ombudsman will make the final determination to certify or to refuse, suspend, or remove certification under 101 CMR 30.09.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.10 Training Requirements for Ombudsmen Representatives

(1) Basic Training for Ombudsman Representatives. The State Ombudsman will develop and conduct a training program to instruct ombudsman representatives, including local ombudsman program directors, in their duties and responsibilities as ombudsman representatives.

(2) Examination for Certification. The State Ombudsman will develop and conduct a standardized written examination to measure an applicant's satisfactory completion of the ombudsman training program and their skills and knowledge necessary for certification as an ombudsman representative.

(3) Ongoing Training for Ombudsman Representatives. Local ombudsman program directors will conduct follow-up trainings for local ombudsman representatives as prescribed by the State Ombudsman.

(4) Ongoing Training for Local Ombudsman Program Directors. Local ombudsman program directors will attend the local ombudsman program director trainings scheduled by the State Ombudsman. Attendance at such trainings will be considered by the State Ombudsman in the re-designation of that local ombudsman program and the re-certification of the local ombudsman program director.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.11 Access to Facilities and Related Records

(1) Right of Entry. The State Ombudsman or their designee will have the right of entry into any facility located in Massachusetts as necessary to carry out the duties of the Ombudsman Program. An ombudsman representative will have the right of entry into any facility within the geographic area assigned to a local ombudsman program with which the representative is associated as necessary to carry out the duties of the local ombudsman program. The right of entry includes the forms of access set forth below.

(2) Access to a Resident. The State Ombudsman and an ombudsman representative will have access to a consenting resident of a facility, in private, when the State Ombudsman or ombudsman representative determines it is necessary and reasonable for the purpose of:

(a) investigating and resolving complaints;

(b) interviewing residents; or

(3) Access to a Facility. The State Ombudsman and ombudsman representatives may access a facility when they determine access is necessary and reasonable for the purpose of:

(a) investigating and resolving complaints;

(b) interviewing employees or agents of the facility;

(d) providing services authorized by law or regulation.

(4) Access to Resident Records. The State Ombudsman and ombudsman representatives will have access to a resident's records and the records of a public agency as necessary to carry out their respective duties in the Ombudsman Program, including resident medical, social, and other records relating to a resident, and records concerning complaints, provided the resident or resident representative has communicated their informed consent to the Ombudsman Program to access to such records.

(5) Access to Contact Information. The State Ombudsman or ombudsman representative will have access to a resident representative's contact information if necessary to perform the functions and duties of the Ombudsman Program.

(6) Access to Resident Records if a Resident is Unable to Give Informed Consent. The State Ombudsman and ombudsman representative will have access to the records of a resident who is unable to give informed consent if access is necessary to perform the duties of the Ombudsman Program, provided:

(a) there is no resident representative, or a resident representative refuses permission and the State Ombudsman or the ombudsman representative has reasonable cause to believe the resident representative is not acting in the best interest of the resident; and

(b) the State Ombudsman authorizes access due to the circumstances.

(7) Access to Facility Policies. The State Ombudsman and ombudsman representatives will have access to the facility's administrative records, policies, and documents, to which the residents or the general public have access.

(8) HIPAA Requirements. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule does not preclude the release of health or identifying information to the Ombudsman Program, provided the Ombudsman Program received informed consent.

(9) Visitation Procedures. The State Ombudsman and ombudsman representative will make solicited or unsolicited visits to a resident of a facility. Solicited and unsolicited visits will proceed as follows.

(a) When entering a facility, the State Ombudsman, or ombudsman representative will notify staff of their presence and produce identification upon request by the staff.

(b) The State Ombudsman or ombudsman representative will be allowed to visit common areas of the facility and the doorway thresholds of the room(s) of a resident(s) without escort by facility personnel.

(c) Prior to entering the room of a resident(s), the State Ombudsman or ombudsman representative will knock on the door or door frame, identify themselves, and explain the purpose of the visit.

(d) The State Ombudsman or ombudsman representative may not enter the room(s) of a resident(s) unless the resident gives consent orally, in writing, or by a sign of affirmation by the resident.

(e) The facility will permit the State Ombudsman or ombudsman representative to enter a consenting resident's room without escort by facility personnel.

(f) During a visit to a resident's room, the State Ombudsman or ombudsman representative will respect the rights of other residents present in the room.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.12 Complaint and Problem Resolution Procedures for the Ombudsman Program

(1) Receipt of a Complaint(s). The State Ombudsman Program or local ombudsman programs will receive complaints, both oral and written, made by or on behalf of residents, and may also initiate a complaint on their own accord.

(a) The State Ombudsman Program and local ombudsman programs will receive complaints during regular business hours, Monday through Friday, excluding holidays.

(b) All complaints initiated or received by the State Ombudsman Program or local ombudsman programs will be reduced to writing and become part of a case file.

(c) Upon receipt of a complaint, an ombudsman representative will discuss the complaint with the resident (and, if the resident is unable to communicate informed consent, the resident's representative) to:

determine the perspective of the resident (or resident representative, where applicable) regarding the complaint;
request that the resident (or resident representative, where applicable) communicate informed consent in order to investigate the complaint;
determine the resident's wishes with respect to resolution of the complaint, including whether the allegations are to be reported and, if so, whether the ombudsman representative may disclose resident identifying information or other relevant information to the facility and/or appropriate agencies;

advise the resident (and the resident's representative, where applicable) that the resident's identity will not be disclosed without the resident's permission, and specify to whom the resident's identity may be disclosed if the resident consents. Such disclosure will be made without the resident's consent if ordered by a court of competent jurisdiction;

work with the resident (or resident's representative, where applicable) to develop a plan of action for resolution of the complaint;
investigate and contact those who may be involved in a resolution to attempt to verify the facts alleged in the complaint; and
determine whether the complaint is resolved to the satisfaction of the resident (or resident representative, where applicable).

(d) If informed consent is not provided to the ombudsman representative to discuss or proceed with the complaint, the resident or the resident representative will be provided with information and/or referral sources appropriate to enable the resident to advocate on their own behalf.

(e) Where the ombudsman representative determines the resident is unable to give informed consent and has no resident representative, the ombudsman representative will take appropriate steps to investigate and work to resolve the complaint to protect the health, welfare, safety, or rights of the resident.

(f) If the ombudsman representative has reasonable cause to believe the resident representative is not acting in the best interest of the resident, the ombudsman representative will work to protect the health, welfare, safety, or rights of the resident.

(g) Where a complaint is found to be unsupported, the ombudsman representative will inform the resident or resident representative, where applicable, of this finding as soon as possible after making such determination.

(h) If an ombudsman representative observes a practice in a facility which affects the resident or a number of residents in the facility, and such practice constitutes grounds for a complaint, the ombudsman representative may investigate and attempt to resolve such complaint without the consent of individual residents.

(2) Resolution of a Supported Complaint. If an ombudsman representative has reasonable cause to believe a complaint is supported and obtains informed consent from a resident or resident representative to act, they will discuss the complaint with the appropriate staff member or contact person at the facility.

(a) If the discussion with the facility staff member or contact person resolves the complaint without further action, the ombudsman representative will notify the resident or resident representative.

(b) If the resident resides in a facility, is unable to give informed consent, and has no resident representative, the ombudsman representative will determine whether the complaint was sufficiently resolved to protect the health, welfare, safety, or rights of the resident.

(c) If an ombudsman representative is unable to resolve the complaint, if access to records is denied, or a legal referral is required, the ombudsman representative will inform the local ombudsman program director. The local ombudsman program director will work with the ombudsman representative in the investigation and resolution of the complaint.

(d) If such a complaint is referred to an attorney or a legal services organization and the Ombudsman Program is not able to resolve the complaint, the local ombudsman program will timely inform the resident or the resident representative and the State Ombudsman.

(3) Consultation with the State Ombudsman. If a local ombudsman program is unable to access records or, after investigation, is unable to resolve a complaint, said program will refer the case to the State Ombudsman or their designee. The State Ombudsman or their designee will work with the local ombudsman program in a timely manner to access records or investigate and resolve the complaint.

(a) If the State Ombudsman or their designee are unable to access records or, following investigation, determines an act, practice, or omission of the facility may adversely affect the health, safety, welfare, or rights of a resident, they will make recommendations for the elimination or correction of such act, practice, or omission to the appropriate executive at the facility involved.

(b) Upon receipt of a complaint referred from a local ombudsman program, and any time during a subsequent investigation of the complaint, the State Ombudsman or their designee may refer the complaint to an appropriate agency, including law enforcement, for investigation and resolution.

(4) Serious Violation Referrals. Local ombudsman programs will refer a complaint regarding possible serious violations of medical care, personal care, nursing care, treatment rules, fire safety regulations, or the law to the State Ombudsman, who will report it to EOHHS, the Massachusetts Department of Public Health, EOEA, or the Office of the Attorney General, as appropriate, for investigation and resolution, with the informed consent of the resident.

(5) Resolution of Complaints of Abuse, Mistreatment, or Neglect. If the State Ombudsman or an ombudsman representative has reasonable cause to believe abuse, mistreatment, or neglect of a resident may have occurred as set forth in M.G.L. c. 111, §§ 72F through 72L, they will comply with the complaint resolution procedures set forth in 101 CMR 30.12, 45 CFR 1324.19(b)(8), and 42 U.S.C. 3001 et seq .

(6) Documentation of Complaints. Local ombudsman programs will document all complaints in a format as directed by the State Ombudsman. The local ombudsman program director must ensure all complaints and other relevant information are updated in the case file not less than monthly. The State Ombudsman or their designee may review the case records, files, and other documents of the local ombudsman programs. The State Ombudsman may, at their discretion, require additional periodic reports from local ombudsman programs, which may include identification of barriers to effectively respond to complaints and patterns of significant problems relating to conditions or residents' care in facilities in its assigned geographic area.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.13 Interagency Agreement

The Secretary of EOHHS will establish an interagency agreement among EOHHS and the Office of the Attorney General to provide for a cooperative effort in meeting the needs of the facility residents. This agreement will set forth procedures by which the State Ombudsman may report their findings or conclusions where an act, practice, or omission by a facility may constitute a violation of an applicable federal or state law or regulation to the regulatory agency or agencies having jurisdiction to enforce M.G.L. c. 6A, § 16CC or 101 CMR 30.01 et seq ., or to the Office of the Attorney General. It will also set forth procedures for the coordination among the above-mentioned agencies during the pendency of a further investigatory or enforcement action.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.14 Resident Council, Family Councils, and Community Advocacy Groups

As requested by resident groups, family groups, and community advocacy organizations, the State Ombudsman and ombudsman representatives will promote, and provide technical and general support, to protect the wellbeing and rights of residents.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.15 Ombudsman Program Information, Disclosure, and Confidentiality Requirements

(1) Ombudsman Program Information. The State Ombudsman will be the custodian and manage the files, records, and other information of the Ombudsman Program (the "records"). Ombudsman Program records include records and files containing personal data concerning complaints held by State Ombudsman Program or local ombudsman programs.

(a) All requests for the disclosure of Ombudsman Program records, including personal data, other than that ordered by a court or authorized by statute or regulation, will be approved by the State Ombudsman or their designee, pursuant to 101 CMR 30.16(2) through (4).

(b) The State Ombudsman will have the sole authority to make or delegate determinations concerning the disclosure of the files, records, and other information maintained by the Ombudsman Program, subject to the prohibitions on release of certain information as set forth in 101 CMR 30.16(2).

(2) Disclosure of Identity of Complainant or Resident.

(a) The State Ombudsman may not disclose the identity of a complainant or resident, either by name or by the release of sufficient information to allow the complainant or resident's identity to be inferred, without the informed consent of the resident, the resident's representative, or order by a court of competent jurisdiction.

(b) If the resident resides in a facility, is unable to give informed consent, and has no resident representative, the State Ombudsman or an ombudsman representative will not disclose the complainant or resident's identity unless:

there is reasonable cause to believe that action, inaction, or a decision may adversely affect the health, safety, welfare, or rights of said resident and disclosure is in the best interest of the resident;
there is no evidence the resident would not wish a referral to be made, including the disclosure of their identity; and
the ombudsman representative follows the policies and procedures of the Ombudsman Program, including receipt of approval from the State Ombudsman.

(3) Confidentiality of Communications. A person associated with the Ombudsman Program, including the State Ombudsman and ombudsman representatives, will, at all times, maintain and respect the confidentiality of all communications with a resident.

(4) Right to Privacy. The Ombudsman Program will, at all times, respect the rights of residents and will not subject the resident to photographing, filming, videotaping, or audiotaping without the written permission and informed consent of the resident or resident representative.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.16 Conflict of Interest

(1) Organizational Conflict of Interest. An organizational conflict of interest includes, but is not limited to, any requirement by EOHHS or a host agency that the State Ombudsman or ombudsman representatives perform an act which conflicts with or appears to conflict with the objectives or responsibilities of the Ombudsman Program, or as otherwise specified in 42 C.F.R. 1324.21(a).

(2) Individual Conflict of Interest. An individual conflict of interest includes, but is not limited to, situations where the State Ombudsman, ombudsman representative, or their respective immediate family, holds an interest which conflicts with or appears to conflict with the objectives or responsibilities of the Ombudsman Program. An individual conflict of interest includes, but is not limited to, a personal financial interest, activity, or relationship that could impair the State Ombudsman or ombudsman representative from acting impartially and in the best interest of a resident, or as otherwise set forth in 42 C.F.R. 1324.21(c).

(3) The State Ombudsman and EOHHS will implement policies and procedures to identify and remove or remedy conflicts of interest as provided in 42 C.F.R. 1324.11(e)(4) and 1324.21. Such policies will consider both organizational and individual conflicts of interest that may impact the effectiveness and credibility of the work of the Ombudsman Program. Policies and procedures addressing actual or potential conflicts of interest will:

(a) require that no individual, or member of the immediate family of an individual, involved in the employment or appointment of the State Ombudsman is subject to a conflict of interest;

(b) require agencies hosting local ombudsman programs to have policies in place prohibiting the employment or appointment of a local ombudsman representative with a conflict of interest that cannot be adequately removed or remedied;

(c) require the State Ombudsman to take reasonable steps to refuse, suspend, or remove designation and certification of an individual who has a conflict of interest, or who has a member of the immediate family with a conflict of interest, which cannot be adequately removed or remedied;

(d) establish methods by which the Ombudsman Program and EOHHS will periodically review and identify potential conflicts of interest of the State Ombudsman, ombudsman representatives, and local ombudsman programs; and

(e) establish the actions EOHHS, the State Ombudsman, or ombudsman representatives must take in order to remedy or remove such conflicts.

(4) The State Ombudsman will report an organizational conflict of interest identified in the Ombudsman Program and describe the steps taken to remove or remedy the conflict in the annual report submitted to the National Ombudsman Reporting System.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.17 Nondiscrimination in Service Delivery

A local ombudsman program, or the host agency within which it operates, will not deny services to or otherwise discriminate in the delivery of services to a resident on the basis of race, color, religion, sex, gender identity, sexual orientation, age, national origin, ancestry, physical or mental disability, or because such a person is a recipient of federal, state, or local public assistance. A local ombudsman program must comply with all applicable provisions of:

(1) Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq .);

(2) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and the regulations promulgated thereunder (45 CFR 84);

(3) M.G.L. c. 151B, § 4(10); and

(4) Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq .).

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.18 Nondiscrimination in Employment

A local ombudsman program, or the host agency within which it operates, will not discriminate against a qualified employee or applicant for employment because of race, color, religion, sex, gender identity, sexual orientation, age, national origin, ancestry, or physical or mental disability, and must comply with the applicable provisions of all relevant state and federal laws, including but not limited to:

(1) Title VII of the Civil Rights Acts of 1964 (42 U.S.C. 2000e et seq .);

(2) M.G.L. c. 151B, §§ 4(1) and (16);

(3) Americans With Disabilities Act of 1990 (42 U.S.C. § 12101 et seq. ); and

(4) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and the regulations promulgated pursuant thereto (45 CFR 84).

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.19 Affirmative Action

A local ombudsman program, or the agency within which it operates, will have in effect, maintain, and adhere to current Affirmative Action requirements as set forth in the Governor's Executive Order Number 227, as amended.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

101 CMR, § 30.20 Severability

The provisions of 101 CMR 30.00 are severable. If any provisions of 101 CMR 30.00, or the applications of such provisions to any person or circumstance, are held invalid or unconstitutional, the remaining provisions of 101 CMR 30.00 shall not be affected thereby and shall remain in full force and effect.

History

Adopted by Mass Register Issue 1475, eff. 8/5/2022.

Administration and Enforcement of the Loan Repayment Assistance Program Administration and Enforcement of the Loan Repayment Assistance Program

101 CMR, § 31.01 General Provisions

(1) Scope and Purpose. 101 CMR 31.00 governs the administration and enforcement of the loan repayment assistance program.

(2) Administrative Bulletins and Other Written Guidance. EOHHS may issue administrative bulletins or other written guidance to clarify its policy on and understanding of substantive provisions of 101 CMR 31.00.

(3) Contracts. EOHHS may enter into contracts with one or more contractors to administer the loan repayment assistance program, and EOHHS or the contractor(s) may enter into contracts with awardees. These contracts, including guidance or instruction thereto, may include terms beyond the scope of the provisions described in 101 CMR 31.00, except to the extent that they explicitly conflict with 101 CMR 31.00 or administrative bulletins or other written guidance issued thereunder.

History

Adopted by Mass Register Issue 1499, eff. 7/7/2023.

101 CMR, § 31.02 Definitions

As used in 101 CMR 31.00, terms have the meanings set forth in 101 CMR 31.02, except where the context clearly indicates otherwise.

Awardee. An individual who applies for loan repayment for outstanding educational debt and is selected to receive a loan repayment.

Awardee Agreement. The contract, approved by EOHHS, executed between awardee and contractor that outlines the terms of the program and recoupment; details awardees responsibilities and obligations; and details contractor's responsibilities and obligations.

Commercial Loans. Loans made by banks, credit unions, savings and loan associations, insurance companies, other financial or credit institutions, and schools, which are subject to examination and supervision in their capacity as lenders by an agency of the United States or of the state in which the lender has its place of business.

Contractor. Any entity that is awarded and executes a contract or agreement with EOHHS to administer the loan repayment assistance program.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Government Loans. Loans that are made by federal, state, county, or city agencies that are authorized by law to make such loans.

Loan Repayment Assistance Program. The program or programs for loan repayment assistance to pay for authorized outstanding educational debt.

MassHealth. The medical assistance and benefit programs administered by EOHHS pursuant to Title XIX of the Social Security Act (42 U.S.C. 1396a et seq .), Title XXI of the Social Security Act (42 U.S.C. 1397aa et seq .), M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services to eligible members.

Outstanding Educational Debt. Qualifying educational loans that are government and commercial loans for actual costs paid for tuition and reasonable educational and living expenses related to the undergraduate or graduate level education of the applicant that resulted in the degree that qualifies them for this initiative. Applicants must provide a copy of all qualifying loan documentation ( e.g. , promissory notes) to the vendor, in the manner prescribed by the vendor.

Service Obligation. The specific services the awardee agreed to perform for a specified duration as described in the awardee agreement. The service obligation is a condition of receiving the loan repayment award.

History

Adopted by Mass Register Issue 1499, eff. 7/7/2023.

101 CMR, § 31.03 Administration

(1) General. The loan repayment assistance program includes the loan repayment initiative authorized under line 1599-2026 of St. 2021, c. 102, which includes $110,500,000; the loan repayment initiative authorized under line 4513-2020 of St. 2021, c. 24, which includes $5,000,000; the loan repayment initiative authorized under line 1599-2027 of St. 2021, c. 102, which includes $16,500,000; and other loan repayment initiatives authorized by the Massachusetts legislature, federal government, or other entity and administered by EOHHS, other than MassHealth initiatives eligible for federal financial participation.

(2) Use of Contractors.

(a) EOHHS may administer the loan assistance program directly or through the use of one or more contractors.

(b) EOHHS may pay for state staff or contractors to administer the loan assistance program using a portion of the funding allocation described in 101 CMR 31.03(1).

History

Adopted by Mass Register Issue 1499, eff. 7/7/2023.

101 CMR, § 31.04 Conditions of Payment

To qualify for an award, an awardee must meet all of the requirements outlined in the awardee agreement.

History

Adopted by Mass Register Issue 1499, eff. 7/7/2023.

101 CMR, § 31.05 Cancellation, Suspension, or Waiver

(1) Cancellation. Any service obligation or payment obligation of an awardee will be canceled upon the death of the awardee.

(2) Waiver or Suspension.

(a) An awardee may seek a waiver or suspension of the service or payment obligations incurred under this program by written request, setting forth the reasons, circumstances, and causes for the requested action. EOHHS may approve a request for a suspension for a period of one year. A renewal of this suspension may also be granted. Good cause for such suspension includes medical leave, parental leave, or call to duty in the United States Armed Forces or the National Guard.

(b) EOHHS may waive or suspend any service or payment obligation incurred by a participant whenever compliance by the participant

is impossible; or
would involve undue hardship to the participant, and enforcement of the service or payment obligation would be against equity and good conscience.

(d) Waiver or suspension will be at the sole discretion of EOHHS. Suspensions will extend deadlines but not eliminate the service or payment obligations.

History

Adopted by Mass Register Issue 1499, eff. 7/7/2023.

101 CMR, § 31.06 Enforcement

(1) Repayment Terms for Breach of Conditions. If an awardee breaches any of the conditions of the awardee contract, EOHHS may require the return of any or all payments, with interest. The interest rate paid by awardee on overpayments is the federal short-term rate determined under the Internal Revenue Code § 6621(b), as amended and in effect for the relevant period plus one percentage point simple interest.

(2) Time for Repayment. Any amounts owed pursuant to 101 CMR 31.06 must be repaid within one year of the default. Additional interest will accrue during periods when money is owed.

(3) Awardee Contracts. The awardee contracts may specify further terms for repayment after the breach of condition.

(4) Collection and Reporting. EOHHS may take any lawful steps to collect on amounts owed or report debts to credit reporting agencies.

History

Adopted by Mass Register Issue 1499, eff. 7/7/2023.

101 CMR, § 31.07 Severability

The provisions of 101 CMR 31.00 are severable. If any provision or subprovision of 101 CMR 31.00 or the application of such provision or subprovision of 101 CMR 31.00 is held invalid or unconstitutional, such determination will not be construed to affect the validity or constitutionality of any other provision or subprovision of 101 CMR 31.00 or the application thereof.

History

Adopted by Mass Register Issue 1499, eff. 7/7/2023.

Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services Rate And Charge Determination For Certain Intermediate Care Facilities Operated By The Department Of Developmental Services

101 CMR, § 129.01 General Provisions

(1) Scope, Purpose, and Effective Date. 101 CMR 129.00 governs the payment rates for all care and services provided to publicly-aided patients by Intermediate Care Facilities (ICFs) operated by the Department of Developmental Services. 101 CMR 129.00 shall be effective July 1, 2013.

(2) Disclaimer and Authorization of Services. 101 CMR 129.00 is neither authorization for nor approval of the program of health care and services included within 101 CMR 129.00. Governmental units that purchase health care and services under 101 CMR 129.00 are responsible for the definition, authorization, and approval of programs of care and services provided by health care facilities subject to 101 CMR 129.00.

(3) Authority. 101 CMR 129.00 is adopted pursuant to M.G.L. c.118E.

101 CMR, § 129.02 Definitions

As used in 101 CMR 129.00, unless the context requires otherwise, terms shall have the following meanings.

Base Year. The fiscal year two years prior to the rate year.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Final Inpatient Per Diem Rate. The all-inclusive inpatient rate based upon the costs from the rate year filing of the ICF Cost Reports. This final rate is set once EOHHS's review is complete, thereby replacing the initial rate.

Governmental Unit. The Commonwealth of Massachusetts and any department, agency, board, commission, division, or political subdivision of the Commonwealth.

ICF Cost Report. The cost report for ICFs beginning with fiscal year 1996.

Initial Per Diem Rate. The temporary all-inclusive inpatient rate based upon the cost from the base year filing of the ICF Cost Reports, inflated to the rate year.

Inpatient Day. HURM standard unit of measure to report care of patients admitted to a hospital including the day of admission, but not the day of discharge. If both admission and discharge occurs on the same day, the day is considered a day of admission and counts as one inpatient day.

Intermediate Care Facility (ICF). An ICF is an institution whether operated for profit or charity, advertised, announced, established, or maintained for the purpose of providing diagnostic, medical, surgical, or restorative treatment for patients within or centrally based in an institution and licensed as a hospital by the Department of Public Health under M.G.L. c. 111, § 51 and any hospital licensed under M.G.L. c. 19, § 19.

Publicly Aided Patient. A person who receives health care and services for which a governmental unit is in whole or part liable under a statutory program of public assistance.

Rate Year. The rate year is the 12-month period, July 1^st through June 30^th, to which the related rate applies.

101 CMR, § 129.03 Reporting Requirements

(1) Required Reports.

(a) On an annual basis, each ICF shall file with the Center one copy of the ICF Cost Report in portable document format, within 120 days of the close of its fiscal year. The ICF Cost Report is to be completed in accordance with the instructions set forth therein and pursuant to requirements of Administrative Bulletin 97-1 and any pertinent administrative bulletins issued by EOHHS pursuant to 101 CMR 129.09.

(b) Each ICF shall file, when required, trial balances and supplemental financial information to support the facility's ICF Cost Report filing.

(c) Each ICF shall make available all books and records relating to its operation for audit and/or screening, if requested by the Center.

(d) The CEO or CFO of an ICF shall certify all reports, schedules, reporting forms, budget information, books, and records under pains and penalties of perjury as true, correct, and accurate.

(e) The Center may, from time to time, require ICFs to submit additional data and documentation needed for calculation of MassHealth rates of payment or charges.

(f) The Center may, for cause documented in writing, extend the filing date for the submission of reports, schedules, reporting forms, budget information, books, and records.

(2) Penalties. If the ICF does not submit documents required pursuant to 101 CMR 129.03, in a timely fashion, as described above, EOHHS may determine an effective date for the rates determined under 101 CMR 129.00 that reflects the time lost for late or inadequate filing.

101 CMR, § 129.04 General Payment Provisions

(1) Reimbursement as Full Payment. Each ICF that provides services to publicly aided patients shall, as a condition of receipt of payment, accept reimbursement at rates established by EOHHS as full payment and discharge of all obligations to such individuals. There shall be no duplication or supplementation of payment for services provided to publicly assisted patients.

(2) Reimbursement Limitation. Reimbursement determined under 101 CMR 129.00 for publicly assisted patients shall not exceed that reimbursement that would result from application of the Principles of Reimbursement of Provider Costs established under 42 U.S.C. §§ 1395 et seq., the Medicare Act.

(3) Allowable Costs.

(a) Pursuant to the requirements and rate and charge determination formulas of 101 CMR 129.00, ICFs shall be reimbursed for allowable costs. These costs must be reasonable costs and must be directly related to health care and services.

(b) Except as otherwise required in 101 CMR 129.00 and the instructions to the ICF Cost Report, allowable costs for inpatient care and services shall be determined in accordance with the Principles of Reimbursement for Provider Costs under 42 U.S.C. §§ 1395 et seq. as set forth in 42 CFR 413, et seq. and the Provider Reimbursement Manual.

(c) Depreciation shall be an allowable cost provided that it is based on historical cost and is calculated by the straight line method. The useful life of assets shall be determined in accordance with the most recent version of the American Hospital Association's Estimated Useful Lives of Depreciable Hospital Assets.

(d) Costs for leased facilities and fixed equipment shall be an allowable cost to the extent that such costs do not exceed the allowable cost that would have been recognized if the ICF had purchased the equipment or facilities and to the extent that such costs do not exceed rental charges of comparable equipment or facilities.

(e) Costs for equipment and facilities leased under contractual provisions that provide a purchase option at the end of the lease term without more than nominal payment shall not be allowed. Depreciation shall be allowed pursuant to 101 CMR 129.04(3)(c).

(f) Interest expense in excess of interest income shall be an allowable cost.

(g) Administrative and general cost in excess of miscellaneous income shall be an allowable cost.

(h) Overhead expenses shall be allocated to non-patient services.

(i) Costs for consultants shall be amortized over the useful life of the asset that consultant work is related to, and the amortized cost shall be an allowable cost.

(j) Payments to professional organizations, trade associations and the like, and comprehensive health planning agencies shall be allowed.

(k) Limitation of basis for depreciation, interest, and equity. Where there has been a change of ownership on or after July 18, 1984, the allowable basis of fixed assets shall be the lower of the acquisition cost or the basis allowed the immediate prior owner reduced by the amount of actual depreciation paid to the prior owner of the facility during all years in which the prior owner participated in the MassHealth program.

(4) Excluded Costs. The following costs are excluded under 101 CMR 129.00:

(a) costs for whole blood, appliances, and patient take-home items;

(b) bad debts, charity, courtesy allowances, and free care to medically indigent persons; and

(c) costs (including legal fees, accounting and administrative costs, travel costs, and the costs of feasibility studies) attributable to the negotiation or settlement of the sale or purchase of any capital asset (by acquisition or merger) for which payment has previously been made by the MassHealth agency.

101 CMR, § 129.05 Determination of Inpatient Rate

(1) General. EOHHS shall determine an Inpatient Rate for each ICF. EOHHS shall establish an Initial Per Diem Rate using a base year ICF Cost Report inflated to the rate year pursuant to 101 CMR 129.05(3) and a Final Per Diem Rate using the rate year ICF Cost Report.

(2) Calculation of the Inpatient Per Diem.

(a) Allowable Total Patient Care Costs. Allowable Total Patient Care Costs are the sum of the ICF's Total Inpatient Routine and Ancillary Costs plus Overhead costs associated with inpatient care as reviewed and adjusted pursuant to 101 CMR 129.04.

(b) EOHHS shall divide the Allowable Total Patient Care Costs pursuant to 101 CMR 129.05(2)(a) by Total Patient Days.

(3) Cost Adjustment Factor. To calculate the Initial Inpatient Per Diem rate, EOHHS shall adjust the Allowable Base Year Total Patient Care Costs pursuant to 101 CMR 129.05(2)(a) to rate year inpatient care costs using a composite index comprised of two cost categories: labor and non-labor. EOHHS shall weight these categories according to the weights used by the Centers for Medicare and Medicaid Services (CMS) for PPS-exempt hospitals. EOHHS shall use the Massachusetts Consumer Price Index inflation proxy for the labor cost category and the CMS market basket for hospitals for the non-labor cost category.

101 CMR, § 129.06 Administrative Adjustment to Inpatient Per Diem Rate

(1) Timing. An ICF may apply for a discretionary administrative adjustment to its Inpatient Per Diem Rate based upon the grounds set forth in 101 CMR 129.06(1)(a) and (b). Adjustments shall be effective on the later of:

(a) the beginning of the quarter (July 1^st, October 1^st, January 1^st, April 1^st) in which a complete application is received; or

(b) the date the costs shall be incurred.

(2) Limitations. The following are grounds for an administrative adjustment.

(a) Mechanical Error. There has been a mechanical error in calculating the Inpatient Per Diem Rate approved under 101 CMR 129.00.

(b) Governmental Requirements. Statutory or regulatory requirements of a governmental unit or the federal government have generated a substantial change in allowable costs as adjusted pursuant to 101 CMR 129.05. Documentation shall include written certification or a copy of an official notice from the governmental unit detailing the new requirements imposed on the ICF and the verification of the costs.

(c) Disaster Losses. The ICF has incurred disaster losses in excess of insurance or extraordinary costs related to disaster losses not covered by outside sources. Documentation shall include verification of loss or extraordinary cost and the insurance or outside source payment. If, however, the loss or extraordinary cost is caused by a facility being inadequately insured according to the standards of the ICF industry, or through negligence on the part of facility management, such losses or costs shall not be approved.

(d) Determination of Need (DON) Operating Costs. An ICF has incurred or expects to incur an increase in operating costs associated with a major capital expenditure or substantial change in services that is subject to and has received a DON pursuant to M.G.L. c. 111, §§ 25B through 25G. In its application, the ICF must segregate the increased costs from other allowed operating costs and must demonstrate that the increased costs requested are reasonable. If an approved DON results in increased patient days, those increased patient days shall be added to the Total Patient Days used in the Inpatient Rate.

(e) Substantial Change from Base Year Costs. An ICF may request an adjustment to its Initial Per Diem Rate if the ICF has determined that there shall be a substantial variance between base year costs and rate year costs. The ICF may request that EOHHS set the Initial Per Diem Rate without the cost adjustment factor determined pursuant to 101 CMR 129.05(3). The ICF may also request that EOHHS review more recent cost and utilization data to determine a revised Initial Per Diem Rate.

(3) Submission for Administrative Adjustment.

(a) An application for administrative adjustment shall be made to the Medicaid Director of EOHHS in writing and shall contain the following:

the name and address of the ICF;
the approved Inpatient Rate and change to be reviewed and the rate or change sought by administrative adjustment;
a clear, concise statement of the reasons for the application for administrative adjustment;
a detailed statement of financial, statistical and related information in support of the application;
all information and documentation required under 101 CMR 129.03;
a citation to any statutory, regulatory or contractual requirement in support of the application.
such other books, records and information as may be required by EOHHS; and

a certification by the chief executive officer or financial officer of the ICF that the application and all information, reports, schedules, budgets, books, and records submitted are true, correct, and accurate.

(b) Requests for an administrative adjustment shall be accompanied by full and complete documentation of the request. EOHHS may deny any request for an administrative adjustment for which documentation is not submitted.

(4) Administrative Adjustment Decision. Within 60 days from receipt of a complete and satisfactory application for administrative adjustment, EOHHS shall render a decision. A written statement of reasons for the decision shall be provided upon request.

101 CMR, § 129.07 Administrative Review

(1) Purpose of Administrative Review. To ensure that an ICF facility's rates are in continuing compliance with 101 CMR 129.00, EOHHS may, at any time and upon its own motion, review an approved rate upon notice to the facility.

(2) Administrative Review of Transfers of Cost. Where an ICF has reduced costs or increased costs by transfer of those costs to other persons or entities that provide health care and services, EOHHS may modify the Inpatient Rate to reflect the change in costs. In order to give effect to a transfer of cost, each ICF must file information concerning cost, volume, and revenue 30 days prior to implementation of a proposed transfer of cost, and must submit any additional information regarding the transfer of cost that EOHHS may require.

(3) Administrative Review and Decision. Upon notice of administrative review, the ICF shall submit such books, records, documentation, and information as EOHHS may require. After review, EOHHS shall render a written decision and statement of reasons for its decision.

101 CMR, § 129.08 Appeal

An ICF that is aggrieved by any action or failure to act under 101 CMR 129.00 may file an appeal within 30 days to the Division of Administrative Law Appeals pursuant to the requirements of M.G.L. c. 118E and M.G.L. c. 7, § 4H. The pendency of an appeal does not limit EOHHS's right to undertake administrative review under 101 CMR 129.00.

101 CMR, § 129.09 Administrative Bulletins

EOHHS may, from time to time, issue administrative bulletins to clarify substantive provisions of 101 CMR 129.00. In addition, EOHHS may issue administrative bulletins that specify the information and documentation necessary to implement 101 CMR 129.00.

101 CMR, § 129.10 Severability

The provisions of 101 CMR 129.00 are hereby declared to be severable, and if such provisions or the application of such provisions to any person or any circumstances shall be held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 129.00 or the application of such provisions to ICFs or circumstances other than those held invalid.

Rates of Payment to Resident Care Facilities Rates of Payment to Resident Care Facilities

101 CMR, § 204.01 General Provisions

(1) Scope. 101 CMR 204.00 governs the payment rates for services provided by resident care facilities to publicly aided and industrial accident residents, including certain COVID-19 related costs as described in 101 CMR 204.00, and for services provided to publicly aided and industrial accident residents by residential care units in nursing facilities that do not have established rates for nursing facility services pursuant to 101 CMR 206.00: Standard Payments to Nursing Facilities . For those nursing facilities with established rates for nursing facility services pursuant to 101 CMR 206.00, payment rates for services provided by residential care units of those nursing facilities are governed by 101 CMR 206.00.

(2) Applicable Dates of Service. Rates contained in 101 CMR 204.00 apply for services provided on or after January 1, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 204.00 is not authorization for or approval of the substantive services or the time period for which rates are determined pursuant to 101 CMR 204.00. Governmental units and insurers that purchase services from eligible providers are responsible for the definition, authorization, and approval of services provided to publicly aided or industrial accident residents.

History

Amended by Mass Register Issue 1297, eff. 6/1/2015.

101 CMR, § 204.02 General Definitions

As used in 101 CMR 204.00, unless the context requires otherwise, terms have the meanings in 101 CMR 204.02.

Actual Utilization Rate. The percentage of occupancy of a resident care facility. It is calculated by dividing total resident days by maximum available bed days.

Additions. New units or enlargements of existing units that may or may not be accompanied by an increase in licensed bed capacity.

Base Year. The calendar year or portion of the calendar year that is used to compute the prospective rates as defined in 101 CMR 204.04. The base year for rates effective January 1, 2025, is 2022.

Building. The structure that houses residents. Building costs include the direct cost of construction of the shell and expenditures for service equipment and fixtures such as elevators, plumbing, and electrical fixtures that are made a permanent part of the structure. Building costs also include the cost of bringing the building to productive use, such as permits, engineering and architect's fees, and certain legal fees. Building costs include interest paid during construction, but not mortgage acquisition costs. When the fixed assets of a facility are sold, the allowable book value of all improvements will become part of the allowable basis of the building for the buyer.

Center. The Center for Health Information and Analysis (CHIA), established under M.G.L. c. 12C.

Change of Ownership. A bona fide transfer, for reasonable consideration, of all the powers and indicia of ownership. A change of ownership may not occur between related parties and must be a sale of assets of the facility rather than a method of financing. A change in the legal form of the provider does not constitute a change of ownership, unless the other criteria are met.

Community Support Facility. A resident care facility licensed by the Department in compliance with 105 CMR 150.000: Standards for Long-term Care Facilities that provides or makes arrangements to provide appropriate mental health services in addition to the minimum basic care and services required by 105 CMR 150.000 for residents who do not routinely require nursing or other medically related services.

Community Support Resident. An individual in need of resident care facility services, who is 50 years of age or older, and who, upon the written consent of the individual (if he or she is competent to give such consent) or guardian (if he or she is not competent), and a physical evaluation by a psychiatrist or other physician, and a psychiatric evaluation by a psychiatrist, is deemed appropriate by both for residency and services provided by a community support facility pursuant to 105 CMR 150.000: Licensing of Long Term Care Facilities or its most recent applicable regulation. Any exceptions and additional factors used to determine whether a resident is a community support facility resident will be in accordance with 105 CMR 150.000.

Community Support Resident Days. The number of days of occupancy by community support residents in a community support facility or a resident care facility with community support residents. Community support resident days include the day of admission, but not the day of discharge. Where admission and discharge occur on the same day, one community support resident day will be used. Those days a bed is held vacant for a publicly aided community support resident temporarily placed in a different care situation, pursuant to an agreement between the provider and the Department of Transitional Assistance in accordance with duly established policies of said Department, are included as community support resident days. Those days a bed is held vacant for a non-publicly aided resident, whether or not there is a charge for such reservation by the facility, are included as community support resident days.

Constructed Bed Capacity. A resident care facility's bed capacity (or clinical bed capacity) as defined in 105 CMR 100.100: Definitions , which states: the capacity of a building to accommodate a bed and the necessary physical appurtenances in accordance with the applicable standards imposed as a condition of operation under state law. It includes a room designed or able to accommodate a bed and necessary physical appurtenances, whether or not a bed and all such appurtenances are actually in place, with any necessary utilities ( e.g ., drinking water, sprinkler lines, oxygen, electric current, electric signals, etc .), with either outlets or capped lines within the room.

Deferred Charges. Expenditures, such as prepaid insurance, rent or licenses, not recognized as a cost of operations for the period in which they were incurred, but carried forward to be written off in one or more future periods. Deferred charges are not expenditures that can be identified with and justified as relating to physical assets that will contribute services to future operations.

Department. The Massachusetts Department of Public Health.

Department of Transitional Assistance Days (DTA Days). Days of resident care facility services provided to residents who are recipients of Emergency Assistance for the Elderly, Disabled and Children (EAEDC) or Supplemental Security Income/State Supplemental Payments (SSI/SSP) funded by DTA.

Desk Audit. A comprehensive audit performed at the Center's offices in which the auditor evaluates the accuracy of the information in the cost reports and supporting documentation in accordance with an audit program.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Equipment. Tangible fixed assets, usually moveable, that are accessory or supplemental to such larger items as buildings and structures.

Exit Conference. A conference conducted at the close of an on-site field audit at which the Center auditors present audit findings and recommendations to the provider. The provider may respond to the Center's findings and may present additional information for review. The conference may take place at a scheduled meeting or by telephone.

Field Audit. An audit performed on-site at the resident care facility in which the auditor evaluates the accuracy of the information in the cost reports and claim for reimbursement by examining the books and records of the facility by evaluating internal controls, observing the physical plant, and interviewing resident care facility staff.

Fixed Costs. Indirect resident care costs, independent of the level of occupancy, including interest associated with long-term debt; depreciation of buildings; building improvements; equipment and software; equipment; insurance on buildings and equipment; real estate taxes; rent; the non-income related portion of the Massachusetts corporate excise tax; personal property tax; and equipment rental.

Generally Available Employee Benefits. The employee benefits that are reasonable and necessary for the efficient operation of the facility including, but not limited to, insurance, pensions, bonuses, child care, and non-required but job-related education. Such benefits must be nondiscriminatory and available to all full-time employees.

Improvements. Expenditures that increase the quality of the existing building by rearranging the building layout or substituting improved components for old components so that facilities are in some way better than before the renovation. Improvements do not add to the existing building nor do they expand the square footage of the building. An improvement is measured by the facility's increased productivity, greater capacity, or longer life.

Imputed Value. An alternative cost based on a standard amount to be used by EOHHS in lieu of other costs.

Indirect Restorative Therapy. Services of physical therapists, occupational therapists, and speech, hearing, and language therapists to provide orientation programs for aides and assistants, in-service training to staff, and consultation and planning for continuing care after discharge.

Industrial Accident Resident. A person receiving resident care facility services for which an employer or an insurer is liable under M.G.L. c. 152 (the Workers' Compensation Act).

Land Costs. The purchase price plus the cost of bringing land to productive use including, but not limited to, commissions to agents, attorney's fees, demolition of buildings, clearing and grading the land, site-survey, soil investigation, streets, off-site sewer and water lines, and public utility charges necessary to service the land. Land must be necessary for the care of publicly aided residents.

Licensed Bed Capacity. A resident care facility's licensed bed capacity as defined by 105 CMR 100.100: Definitions , which states: the portion of bed capacity, by number of beds, which a provider under its license, as issued or subsequently modified, is authorized to use for patient occupancy, or in the case of a facility operated by a government agency, the number of beds approved by the Department.

Limited Life Assets. Limited life assets include software, wallpaper, and painting.

Long-term Interest Expense. Reasonable and necessary expense that is incurred for the use of legitimate loans related to the care of publicly aided residents and that is supported by allowable, depreciable fixed assets. It includes all of the costs of borrowing money including, but not limited to, interest, allowable mortgage acquisition costs, and mortgage insurance premiums.

Major Additions. A newly constructed addition to a facility that increases the licensed bed capacity of the facility by 50% or more.

Massachusetts Corporate Excise Tax. Those taxes that have been paid to the Massachusetts Department of Revenue in connection with the filing of Form 355, Business/Manufacturing Corporate Excise Return.

Maximum Available Bed-days. The total number of licensed bed-days for the calendar year, determined by multiplying the mean licensed bed capacity for the calendar year by the days in the calendar year.

Mean Licensed Bed Capacity. A facility's weighted average licensed bed capacity for the calendar year. The value is calculated by multiplying the licensed bed capacity by the number of days in the calendar year for which the facility was licensed to determine the maximum available bed-days. The maximum available bed-days is divided by the number of days in the calendar year to determine the mean licensed bed capacity.

Mortgage Acquisition Costs. Those costs, including finder's fees, points, certain legal fees, and filing fees, that are necessary to obtain long-term financing through a mortgage, bond, or other long-term debt instrument.

Nonprofit Provider. A provider either organized for charitable purposes or recognized as a nonprofit entity by the Internal Revenue Service. This includes Massachusetts corporations organized under M.G.L. c. 180; clubs, associations, organizations, or tax-exempt entities; corporations organized under M.G.L. c. 156B and granted a tax exemption under the Internal Revenue Code, § 501(c)(3); and facilities owned or operated by governmental units.

Nursing Facility. A nursing or convalescent home, infirmary maintained in a town, or charitable home for the aged, as defined in M.G.L. c. 111, § 71, or a nursing facility operating under a hospital license issued by the Department pursuant to M.G.L. c. 111, and certified by the Department for participation in the MassHealth program, or facilities licensed to operate a residential care unit within a nursing facility or those exempt from licensure under M.G.L. c. 111, § 73B.

Proprietary Provider. A provider that does not meet the criteria specified in 101 CMR 204.02: Nonprofit Provider.

Provider. A resident care facility providing care to publicly aided residents.

Prudent Buyer Concept. The assumption that a purchase price that exceeds the market price for a supply or service is an unreasonable cost.

Publicly Aided Resident. A person as to whose care in a resident care facility the Commonwealth or a political subdivision of the Commonwealth is in whole or in part financially liable.

Rate Year. The period in which the rate determined under 101 CMR 204.00 is effective.

Related Party. An individual or organization associated or affiliated with, or that has control of, or is controlled by, the provider; or any director, stockholder, trustee, partner, or administrator of the provider by common ownership or control or in a manner specified in the Internal Revenue Code of 1954, §§ 267(b), 267(c), and 318; provided, however, that 10% must be the operative factor as set out in §§ 267(b)(2) and (3). Related individuals include spouses, parents, children, spouses of children, grandchildren, siblings, fathers-in-law, mothers-in-law, brothers-in-law, and sisters-in-law.

Resident Care Facility (Facility). A facility licensed by the Department in compliance with 105 CMR 150.000: Standards for Long-term Care Facilities or exempt from licensure under M.G.L. c. 111, § 73B providing protective supervision in addition to the minimum basic care required by 105 CMR 150.000 for residents who do not routinely require nursing or other medically related services, and for purposes of 101 CMR 204.00, residential care units in nursing facilities that do not have established rates for nursing facility services pursuant to 101 CMR 206.00: Standard Payments to Nursing Facilities .

Resident Days. The number of days of occupancy by residents in a facility. Included in the computation of resident days is the day of admission, but not the day of discharge. Where admission and discharge occur on the same day, one resident day is used. Those days in which a bed is held vacant and reserved for a publicly aided resident temporarily placed in a different care situation, are included as resident days. Those days on which a bed is held vacant and reserved for a non-publicly aided resident, whether or not there is a charge for such reservation by the facility, are included as resident days.

Responsible Person. A person 21 years of age or older who has received a high school diploma, is of good moral character, and has the ability to communicate orally and in writing in English or the primary language used by residents of the facility, and who will make mature and accurate judgments regarding the care needs of the residents as required by 105 CMR 150.000: Standards for Long-term Care Facilities .

Sole Proprietor. A business enterprise other than a corporation or partnership in which the net worth belongs entirely to one individual.

Support Service Coordinator. A person who has received a BA or BS degree in a human service field of study such as psychology, nursing, or social work and who is employed by a community support facility to identify, monitor, and meet the support service needs of community support residents.

Support Services. Those services provided for the benefit of community support resident(s) in order to enhance psycho-social and physical functioning as defined by the Department in 105 CMR 150.000: Standards for Long-term Care Facilities .

Unit. Unit has the same definition as in 105 CMR 150.000: Standards for Long-term Care Facilities .

Variable Costs. Costs that change depending on the volume of occupancy. Variable costs include the allowable amounts reported in the following accounts from the cost report: administrator/responsible person salaries and benefits; clerical salaries; EDP/payroll/ bookkeeping services; office supplies; telephone, except directory advertising; motor vehicle expense; conventions and meetings; advertising, help wanted; licenses and dues, resident care related; total education and training; total employee benefits, except officers, profit sharing and other benefits; accounting services not related to appeals; total payroll taxes, except officer; nonprofit DES claims; malpractice and general liability insurance; total Workers' Compensation, except officer; total group life/health, except officer; total plant operations; total dietary; total laundry; total housekeeping; total nursing; quality assurance professional; community support coordinator; total physician services; house supplies, not resold; pharmacy consultant; social service worker; indirect therapy salaries; indirect therapy consultants; total recreation, except transportation; realty company variable add-back; management company variable and fixed cost add-back, less non-allowable self-disallowances; vending machine income; and other operating cost recoverable income.

History

Amended by Mass Register Issue 1297, eff. 6/1/2015.

101 CMR, § 204.03 General Rate Provisions

(1) General. EOHHS will determine a payment rate for dates of service on or after January 1, 2025, for each facility as follows.

(a) Preliminary Rate. The facility's preliminary rate is equal to the sum of

allowable variable costs determined under 101 CMR 204.04; and
allowable capital and other fixed costs as determined under 101 CMR 204.05.

(b) Rate Adjustments. The preliminary rate as calculated in 101 CMR 204.03(1)(a) will be adjusted as follows.

DTA Days Percentage Adjustment.

a. For each facility, calculate its DTA days percentage by dividing its DTA days by the facility's total resident days, as reported on the Resident Days schedule of the 2022 HCF-4.

b. Each facility will receive a DTA days percentage adjustment equal to $24.65 multiplied by the percentage calculated in 101 CMR 204.03(1)(b)1.a.

(c) Payment Rate. Subject to the Payment Rate Maximum Increase as described in 101 CMR 204.03(1)(d) and the Resident Care Cost Quotient as described in 101 CMR 204.03(1)(e), the facility's January 1, 2025, payment rate is equal to the greater of

the sum of the preliminary rate as determined in 101 CMR 204.03(1)(a) and the payment rate adjustments as determined in 101 CMR 204.03(1)(b), plus $4.60;
the facility's certified rate in effect on December 31, 2024; or
$105.

(d) Payment Rate Maximum Increase. If the facility's payment rate as calculated in 101 CMR 204.03(1)(c) is greater than the facility's certified rate in effect on December 31, 2024, plus $70, the facility will receive a downward adjustment such that the total payment rate effective January 1, 2025, is equal to the facility's certified rate in effect on December 31, 2024, plus $70.

(e) Resident Care Cost Quotient (RCC-Q). If the facility's RCC-Q score is less than the RCC-Q threshold established pursuant to 101 CMR 204.10(1), the facility will receive a downward adjustment as described in 101 CMR 204.10.

(f) Annualization Adjustment. For the period from January 1, 2025, through January 31, 2025, EOHHS will apply an annualization adjustment of 296.77% of the difference between the facility's January 1, 2025, rate as determined in 101 CMR 204.03(1)(c), (d), and (e) and its certified rate in effect on December 31, 2024, which accounts for the period October 1, 2024 through December 31, 2024.

(2) Other Provisions.

(a) Audits. EOHHS will establish rates after a comprehensive desk audit of the base year cost report. The Center may also, whenever possible, conduct on-site field audits to ensure the accuracy of the claims for reimbursement and consistency in reporting. EOHHS will disallow any cost for which the provider does not produce adequate documentation requested by the Center during a desk or field audit.

(b) General Cost Principles. In order to be reimbursed, a cost must

be ordinary, necessary, and directly related to the care of publicly aided residents;
be consistent with the prudent buyer concept;
be for goods and services actually provided in the resident care facility;
not have the transaction effect of circumventing 101 CMR 204.00 under the principle that the substance of the transaction must prevail over form;
actually be paid by the provider. Examples of costs that are not considered paid for purposes of reimbursement include, but are not limited to, costs that are discharged in bankruptcy; forgiven; converted to a promissory note; and accruals of self-insured costs based on actuarial estimates; and
not be paid to a related party that has not been identified on the reports.

(c) Non-allowable Costs. Rates will not include those costs that are not reimbursable, as defined at 101 CMR 204.03(2)(c), are reimbursed through an allowance, or are for services that are billed directly.

Costs that are not reimbursable include

a. bad debts, refunds, charity and courtesy allowances, and contractual adjustments to the Commonwealth and other third parties;

b. recovery of expense items, that is, expenses that are reduced or eliminated by applicable income including, but not limited to, rental of quarters to employees and others, income from meals sold to persons other than residents, telephone income, vending machine income, and medical records income. Vending machine income will be recovered against the variable cost, included in the variable cost allowance;

c. federal and state income taxes, except the non-income related portion of the Massachusetts corporate excise tax;

d. expenses that are not directly related to the provision of resident care including, but not limited to, expenses related to other business activities and fundraising, gift shop expenses, research expenses, rental expense for space not required by the Department and expenditure of funds received under federal grants for compensation paid for training personnel, and expenses related to grants or contracts for special projects;

e. compensation and fringe benefits for residents on a provider's payroll;

f. any amounts in excess of any schedule or limitation contained in 101 CMR 204.00;

g. penalties and interest incurred because of late payment of loans or other indebtedness, late filing of federal and state tax returns, or from late payment of municipal taxes;

h. any increase in compensation or fringe benefits granted as an unfair labor practice after a final adjudication by the court of last resort;

i. accrued expenses that remain unpaid more than 120 days after the close of the reporting year, excluding vacation and sick time accruals, are not included in the prospective rates. When the Center receives satisfactory evidence of payment, EOHHS may reverse the adjustment and include that cost, if otherwise allowable, in the applicable prospective rates. Except for costs that are not allowable as described at 101 CMR 204.03(2)(c), a cost must actually be paid by the provider in order to be reimbursable. Examples of costs that are not considered paid for purposes of reimbursement include, but are not limited to, costs that are discharged in bankruptcy; costs that are forgiven; costs that are converted to a promissory note; and accruals of self-insured costs that are based on actuarial estimates;

j. expenses for purchased service nursing services purchased from temporary nursing agencies that are not registered with the Department under 105 CMR 157.000: The Registration and Operation of Temporary Nursing Service Agencies ;

k. any expense or amortization of a capitalized cost relating to costs incurred prior to the opening of the facility;

l. expenses relating to the financing of or otherwise supporting political or lobbying activities regarding legislation to affect reimbursement methods; campaign contributions; and advertising to create goodwill or otherwise affect payments made by governmental units;

m. all legal expenses; and those accounting expenses and filing fees associated with any appeal process;

n. additional rental payments or charges based upon receipts or income will not be considered as additional rental expense;

o. interest payments and charges based upon the provider's receipts or income will not be considered as allowable interest expense;

p. any costs that were incurred in periods other than the base year;

q. an adjustment to base year costs to reflect the difference between the rates charged to private residents in the base year if those rates are less than the public rates certified in the base year. EOHHS will multiply the difference between the base year rate for publicly aided residents and the average rate charged private residents corresponding to the base year above. The adjustment is calculated as follows: [(private income/resident private patient days) - public base year rate per diem ] x (base year resident private patient days/base year patient days) = the per diem amount by which the publicly aided rate will be reduced. In no instances will the certified rate be lower than the lowest private rate assigned to an individual for that period;

r. any costs, including rental and leasehold expenses, for buildings and equipment that are not located at the site of the resident care facility will not be allowable as fixed costs; and

s. costs of ancillary services that are required to be billed on a direct basis to the purchasing government agency.

Other Recoverable Income. Costs reimbursed through an allowance or other specified methodology include other recoverable income. Other recoverable income will be recovered against an account in the appropriate cost group category, such as variable cost allowance and fixed costs.

Costs for Services Billed Directly. The following supplies or services must be billed directly to the purchaser in accordance with the purchaser's regulations or policies.

a. Physician. Direct physician services to individual residents, including emergency physician services required by 105 CMR 150.000: Standards for Long-term Care Facilities .

b. Medical Supplies. Direct medical services or supplies in accordance with the regulations or written policy of the governmental unit responsible for paying for such services or supplies in the per diem rates.

c. Prescriptions. Pharmacy costs related to legend drug prescriptions and prescribed legend drugs for individual residents.

d. Therapy. Direct restorative services provided upon written order of a physician.

History

Amended by Mass Register Issue 1297, eff. 6/1/2015.

101 CMR, § 204.04 Variable Cost Allowance

(1) Scope. EOHHS will include in each provider's rate a variable cost allowance to compensate for variable costs.

(2) Base Year Variable Cost Per Diem. EOHHS will calculate the base year variable cost per diem for each provider by dividing the total allowable base year variable costs by the greater of base year resident days or 90% of the mean licensed bed capacity in the base year times the days in the base year. For providers that are organized as sole proprietors, EOHHS will include an imputed amount of $121,380 for the personal services of an owner.

(3) Cost Adjustment Factor. EOHHS will apply a cost adjustment factor of 6.98% to 2022 base year costs. If there has been a change of ownership in the base year, and the rates are based on the new owner's reported base year costs, EOHHS will modify the cost adjustment factor to reflect the number of months from the midpoint of the new owner's reporting period to the midpoint of the prospective rate period.

(4) Variable Cost Allowance. The variable cost allowance equals the lower of base year variable cost per diem or $165.93, which is further adjusted by the cost adjustment factor.

(5) Special Provisions.

(a) Accrued Expenses. EOHHS will not allow accrued expenses that remain unpaid for more than 120 days after the close of the reporting year, excluding vacation and sick time accruals. If the provider submits evidence of satisfactory payment to the Center, EOHHS may reverse the adjustment and include that cost, if otherwise allowable, in the applicable rates.

(b) Accounting and Auditing Expenses. Reasonable and necessary accounting and auditing expenses in matters directly related to providing adequate care to publicly aided residents are included, provided that the books and records of the provider are maintained in accordance with generally accepted accounting principles.

(c) Staff Training Expenses. The net cost, which is the cost of required staff training activities less any reimbursement from grants, tuition, specific donations, employee contributions, or other sources is included, only if the training is

conducted within the Commonwealth of Massachusetts;

directly related to improving resident care to publicly aided residents; and

conducted by a recognized school, other authorized organization, or a qualified professional as required in 105 CMR 150.000: Standards for Long-term Care Facilities .

(d) Advertising Expenses. The reasonable and necessary expense of newspaper or other public media advertisements for the purpose of hiring necessary employees.

(e) Generally Available Employee Benefits. The extent of the facility's contribution to the cost of generally available fringe benefits are included so long as they are nondiscriminatory.

(f) Membership Dues. Reasonable and necessary membership dues are included if the organization's function and purpose are directly related to the development and operation of the facility and providing adequate resident care.

(g) Services of Volunteer Workers. Services performed under an agreement between the organization and the provider for the performance of the services without direct payment. The value of services normally provided on a voluntary basis, such as distribution of magazines and newspapers to residents, does not constitute a reasonable variable cost. The net value of services for unpaid persons in positions customarily held by paid employees, performing such services on a regular basis as unpaid members of religious or other organizations, is allowable as a variable cost if

the amount allowed does not exceed that which would be paid others for similar work;
the amount paid by the provider to the organization is identifiable in the records of the provider as a legal obligation; and
the services are performed on a regular, scheduled basis and are necessary for the provision of adequate resident care to publicly aided residents and for the efficient operation of the provider.

(h) Non-legend Drugs. The reasonable and necessary costs of providing the non-legend drugs, including non-legend drugs ordered by a doctor. Non-legend drugs must not be billed directly to any governmental unit or charged against the personal care funds of any resident.

(i) Pension Plans. Reasonable and necessary expenses incurred by a provider relating to a pension plan are included as a generally available employee benefit. Reimbursable pension plans must provide for either a fixed determinable amount to be contributed by the employer on a regular basis or for a fixed determinable benefit to be received by the employee at retirement. Reimbursement of pension costs is subject to the following specific provisions.

Required by State Statute. Providers required by enabling statute to make payments to municipal or county pension funds will be reimbursed for the compensation paid by the plan, provided that the provider submits detail of the allocations provided to the Public Employees Retirement Administration Commission, and for funded pension plans, a schedule of the individuals associated with the resident care facility, to the Center.

Not Required by State Statute. Providers not required by state statute to make payments to a municipal pension fund will be reimbursed for expenses incurred to the extent that

a. the claimed expenses represent an amount based on fair, reasonable, and necessary compensation for services performed by employees;

b. the claimed expenses are costs incurred on current year payroll and do not include payments for prior year payroll;

c. the plan does not provide for contributions by the employer based on the contingency of profit or is at the discretion of the employer;

d. the pension plan must have met the current requirements of and, if applicable, received the approval of the Internal Revenue Service. All applicable Internal Revenue Service forms documenting Internal Revenue Service approval must be filed with the Center along with copies of the plan;

e. the employer's contribution to a pension plan will be included, along with other increments in the calculation of limits to the reimbursement of individual employee compensation as referred to in 101 CMR 204.00; and

f. any forfeiture by an employee must be applied against the cost to reduce the premiums paid by the employer. A forfeiture is considered to have occurred when any employee who participated in the pension plan terminates employment prior to becoming vested. This reduction in the claim for reimbursement must be made notwithstanding the terms or lack of terms in the pension plan.

History

Amended by Mass Register Issue 1297, eff. 6/1/2015.

101 CMR, § 204.05 Capital and Other Fixed Costs

(1) Allowable Fixed Costs.

(a) Allowable fixed costs include the allowable portion of depreciation, long-term interest, real estate taxes, personal property taxes on resident care facility equipment, the non-income portion of the Massachusetts corporate excise tax, building insurance, and rental of equipment located at the facility, less any recoverable fixed cost income.

(b) EOHHS will calculate the provider's capital and other fixed costs per diem by dividing allowable fixed costs by the constructed bed capacity times the days in the rate year times the greater of 90% or the actual utilization rate in the base year.

(2) Allowable Basis of Fixed Assets.

(a) Fixed Assets. Fixed assets include land, building, improvements, equipment, and limited life assets/software.

(b) Allowable Basis.

If there has been no change of ownership, the allowable basis of fixed assets equals the reasonable construction costs.

For a newly constructed facility opening for resident care on or after January 1, 1984, the basis of such assets will be limited to reasonable, audited construction and equipment costs based upon the minimum standards and requirements of the Massachusetts Department of Public Safety. Once operations commence, interest and acquisition fees will be treated as a cost of borrowing and treated as interest expense. In no case will the allowable basis exceed the cost of construction approved in accordance with M.G.L. c. 111, § 25C. The basis of fixed assets will be limited to construction and equipment costs based upon the minimum standards and requirements of the Massachusetts Public Health Council. EOHHS will reimburse only those costs associated with meeting the above-mentioned standards.
If there has been a change of ownership, the allowable basis for fixed assets will be determined as follows.

a. Land. EOHHS will include the lower of the acquisition cost or the basis allowed the immediate prior owner.

b. Equipment. EOHHS will include the lower of the acquisition cost or the basis allowed the immediate prior owner, reduced by the amount of actual depreciation allowed to the prior owner of the facility in calculating rates of payment for publicly aided residents.

c. Building and Building Improvements. EOHHS will include the lower of the acquisition cost or the basis allowed the immediate prior owner, reduced by the amount of actual depreciation allowed to the prior owner of the facility for publicly aided residents for the years from 1968 to the date of change of ownership. The seller's allowable building improvements will become part of the new owner's allowable basis of building.

d. If the amount of actual depreciation allowed in a prior year is not known, the buyer must furnish the information to the Center. If this information is not available, EOHHS will calculate the amount using the best available information.

Allowable Additions. EOHHS will recognize fixed asset additions made by the provider if the additions are related to the care of publicly aided residents.

Forgiveness of Debt. Where, subsequent to a change of ownership, the transferor forgives or reduces the debt of the transferee, such forgiveness or reduction of debt will be retroactively applied to reduce the acquisition cost to the transferee.

Repossession by Transferor. The basis of fixed assets will be recomputed if the transferor repossesses a facility to satisfy in whole or in part the transferee's purchase obligations, becomes a direct or indirect owner, or receives an interest in the transferee's facility or company. The recomputed basis will not exceed the transferor's original allowable basis under EOHHS regulations applicable at the date of change of ownership increased by any allowable capital improvements made by the transferee since acquisition and reduced by depreciation since acquisition.

Rental and Leasehold Expense. EOHHS will allow reasonable rental and leasehold expenses for land, building, and equipment, but reimbursement is limited to the lower of the average rental or ownership costs of comparable providers, or the reasonable and necessary costs of the provider and lessor including interest, depreciation, real property taxes, and property insurance. EOHHS will not allow rent and leasehold expense, unless a realty company cost report is filed.

(3) Depreciation

(a) Depreciation Allowed. EOHHS will allow depreciation of building, building improvements, and equipment based on accepted accounting principles using as a basis the lower of the original acquisition cost of the facility, an amount based on a cost per bed for the year of construction of the facility set forth in the regulation governing the rate year of the original acquisition, or the principles set forth in 101 CMR 204.05 if a change of ownership occurred on or after January 1, 1984.

(b) Depreciation Methodology. EOHHS will use the straight-line method to calculate allowable depreciation. EOHHS will exclude depreciation on an asset upon expiration of the useful life.

| Asset | Life | Rate | | --- | --- | --- | | Building Class I or II as classified by the Dept. of Public Safety | 40 years | 2.5% | | Class III or IV as classified by the Dept. of Public Safety | 33 years | 3.0% | | Building Improvements and Leasehold Improvements | Varies | up to 5% | | Equipment, Furniture, and Fixtures | ten years | 10% | | Motor Vehicle Equipment | four years | 25% | | Limited Life Assets Acquired after December 31, 1996 | three years | 33.3% |

(d) Change of Ownership.

Building and Building Improvements. EOHHS will add building and building improvements to determine the buyer's allowable basis for building. The buyer's allowable basis will be depreciated over the remaining useful life of the building.

Equipment and Limited Life Assets. Equipment and limited life assets will be depreciated in accordance with 101 CMR 204.05(3)(c).

Depreciation on Assets. EOHHS will limit the annual amount of depreciation on transferred assets to the seller's annual allowed depreciation.

(4) Interest. A facility's rate will include reasonable and necessary interest expense determined as follows.

(a) Interest on Long-term Debt. EOHHS will include reasonable and necessary interest on allowable long-term debt, supported by depreciable fixed assets subject to 101 CMR 204.05(2). EOHHS will not reimburse long-term interest expense on debt that exceeds the allowable basis of fixed assets.

Long-term Loans. Long-term interest will be limited to an annually determined percentage of simple interest on all outstanding long-term loans, weighted by the dollar amount of the funds borrowed. For allowable long-term loans secured prior to January 1, 1984, the annually determined percentage will be the rate as stated in the debt instrument at the time of borrowing. For allowable long-term loans secured on or after January 1, 1984, the annually determined percentage will be the lower of the rate as stated in the debt instrument at the time of borrowing or the percentage equal to the monthly rate of interest on special issues of public debt obligations issued to the federal Hospital Insurance Trust Fund for the third month prior to the month in which the financing occurred, plus 3%. EOHHS will limit the allowable interest rate to 15%.

Refinancing.

a. EOHHS will recognize the refinancing of an existing allowable debt under the following circumstances.

i. Crossover. When the accumulated principal payments on the existing allowable debt exceeds the accumulated depreciation allowed by EOHHS on the allowable fixed assets financed by that debt;

ii. Demand Note. When an existing, allowable debt becomes payable on demand;

iii. Lowered Expense. When the long-term interest expense over the life of the refinanced debt is lower than it would have been under the remainder of the existing, allowable debt. The provider must submit comparative schedules showing total long-term interest expense under the existing allowable debt and the refinanced debt; or

iv. Allowable Additions. When a provider refinances for an amount greater than the existing allowable debt, and the purpose of the additional indebtedness is to finance a significant addition of allowable fixed assets. EOHHS will not reimburse long-term interest expense for additional refinancing that exceeds the amount of allowable fixed assets.

b. Allowable Interest Rate. The allowable interest rate for an allowable or partially allowable refinancing will be determined in accordance with 101 CMR 204.05(4)(b)1.

c. When a refinancing, or a portion of a refinancing, is not allowable under 101 CMR 204.05(4)(b)2., EOHHS will calculate allowable long-term interest as though the non-allowable refinancing did not occur.

(b) Other Provisions.

Interest. Interest related to the financing of newly acquired fixed assets will be allowed only if the asset acquisition and financing occur concurrently. If the provider presents documentation sufficient to demonstrate that all reasonable attempts were made to finance the asset at the time of acquisition, EOHHS will recognize financing obtained no more than 90 days after the date of acquisition of the assets.

Loans from Owner, Officer, or Related Party. Interest expense does not include interest on loans to the facility from an owner, officer, or related party.

Mortgage Acquisition Costs. Mortgage acquisition costs must be amortized over the life of the mortgage. Amortized mortgage acquisition costs are treated as long-term interest expense. For allowable long-term debts secured on or after January 1, 1984, mortgage acquisition costs are subject to the ceiling on maximum interest rates in accordance with 101 CMR 204.05(4)(b).

History

Amended by Mass Register Issue 1297, eff. 6/1/2015.

101 CMR, § 204.06 Equity and Use and Occupancy Allowance

(1) General. EOHHS will include a return on average equity capital for proprietary providers. EOHHS will include a use and occupancy allowance for nonprofit providers.

(2) Average Equity Capital Allowance. Average equity capital is the difference between the provider's allowable book value of fixed assets, including land, at the beginning and end of the year, and the provider's allowable long-term liabilities at the beginning and end of the year. The average equity capital is then multiplied by a rate of 3.00%.

(a) EOHHS will reduce average equity capital by building, improvements, equipment, and software depreciation allowed in prior years.

(b) EOHHS will not include mortgage acquisition costs, such as capitalized legal fees and prepaid interest on long-term obligations, or equity in buildings or equipment not located at the resident care facility, in average equity capital.

(c) EOHHS will not reduce average equity capital by long-term loans for which interest has been excluded as a result of debt not supported by allowable fixed assets.

(d) If a facility replaces beds, reimbursable equity will be recalculated using the newly established allowable fixed assets and allowable debt.

(e) EOHHS will calculate the per diem average equity capital by multiplying the average equity capital by a rate of 3.00% then dividing by the constructed bed capacity times the days in the rate year times the greater of 90% or the actual utilization rate in the base year.

(3) Use and Occupancy Allowance. EOHHS will increase nonprofit providers' rates to reflect the cost of use and occupancy of net allowable fixed assets. The use and occupancy allowance equals A of the allowance calculated pursuant to 101 CMR 204.06(2).

History

Amended by Mass Register Issue 1297, eff. 6/1/2015.

101 CMR, § 204.07 Reporting Requirements

(1) Required Reports.

(a) Resident Care Facility Cost Report. Each provider must complete and file a residential care cost report each calendar year with the Center, containing the facility's claim for reimbursement and the complete financial condition of the facility, including all applicable management company, central office, and real estate expenses.

(b) Realty Company Cost Report. A provider that does not own the real property of the facility, and pays rent to an affiliated or non-affiliated realty trust or other business entity, must file or cause to be filed a realty company cost report with the Center. If no report is filed, EOHHS will not reimburse the costs associated with the provider's rental expense.

(c) Management Company Cost Report. A provider that claims management or central office expenses must file a separate management company cost report with the Center for each entity for which it claims management or central office expense. If these costs are claimed for reimbursement, the provider must certify that costs are reasonable and necessary for the care of publicly aided residents in Massachusetts.

(2) General Cost Reporting Requirements.

(a) Accrual Method. Providers must complete all required reports using the accrual method of accounting.

(b) Documentation of Reported Costs. Providers must maintain accurate, detailed, and original financial records to substantiate reported costs for a period of at least five years following the submission of required reports or until the final resolution of any appeal involving a rate for the period covered by the report, whichever occurs later. Providers must maintain complete documentation of all of the financial transactions and census activity of the facility and affiliated entities including, but not limited to, the books, invoices, bank statements, canceled checks, payroll records, governmental filings, and any other records necessary to document the provider's claim for reimbursement. Providers must be able to document expenses relating to affiliated entities for which reimbursement is claimed whether or not they are related parties.

(c) Fixed Asset Ledger. Providers must maintain a fixed asset ledger that clearly identifies each asset for which reimbursement is being claimed, including its location, the date of purchase, the cost, salvage value, accumulated depreciation, and the disposition of sold, lost, or fully depreciated assets.

(d) Job Descriptions and Time Records. Providers and management companies must maintain written job descriptions including time records, qualifications, duties, and responsibilities for all positions for which reimbursement is claimed. EOHHS will not reimburse the salary and fringe benefits or the imputed amount for sole proprietors as specified in 101 CMR 204.04(2) for any individual for which the provider does not maintain a job description and time record.

(e) Other Cost Reporting Requirements.

Expenses that Generate Income. Providers must identify the expense accounts that generate income. EOHHS will offset reported ancillary income if the provider does not identify the associated expense account.

Laundry Expense. Providers must separately identify the expense associated with laundry services not provided to all residents. Providers may not claim reimbursement for such expense.

Fixed Costs.

a. Providers must allocate all fixed costs, except equipment, on the basis of square footage. Providers may elect to specifically identify equipment related to the facility. The provider must document each piece of equipment in the fixed asset ledger. If a provider elects not to identify equipment, it must allocate equipment on the basis of square footage.

b. If a provider undertakes construction to replace beds, it must write off the fixed assets that are no longer used to provide care to publicly aided residents and may not claim reimbursement for the assets.

c. Providers must separately identify fully depreciated assets. Providers must report the costs of fully depreciated assets and related accumulated depreciation on all reports unless they have removed such costs and accumulated depreciation from the provider's books and records. Providers must attach to the cost report a schedule of the cost of the retired equipment, accumulated depreciation, and the accounting entries on the books and records of the facility when the equipment is retired.

d. Providers may not report expenditures for major repair projects whose useful life is greater than one year as expenses. Providers must not report such expenditures as pre-paid expenses.

Mortgage Acquisition Costs. Providers must classify mortgage acquisition costs as other assets. Providers may not add mortgage acquisition costs to fixed asset accounts.

Related Parties. Providers must report salary expenses paid to a related party and must identify all goods and services purchased from a related party. If a provider purchases goods and services from a related party, it must disclose the related party's cost of the goods and services. EOHHS will limit reimbursement for such goods and services to the lower of the related party's cost or the cost determined using the prudent buyer concept.

Service of Non-paid Workers. The services must be fully disclosed in the footnotes and explanations section of the cost report. Both the total expense and the account(s) in which the expense is reported must be identified.

Facilities in Which Other Programs Are Operated. If a provider operates an adult day health program, an assisted living program, or provides outpatient services, the provider must not claim reimbursement for the expenses of such programs. If the provider converts a portion of the facility to another program, the provider must

a. identify existing equipment no longer used in facility operations. Such equipment must be removed from the facility's records;

b. identify the square footage of the existing building and improvement costs associated with the program, and the equipment associated with the program; and

c. allocate shared costs, including shared capital costs, using a well-documented and generally accepted allocation method. The provider must directly assign to the program any additional capital expenditures associated with the program.

(3) Filing Deadlines.

(a) General. Except as provided in 101 CMR 204.07(3)(b) and (c), or in accordance with alternative deadlines established by EOHHS or the Center through administrative bulletin or other written issuance, providers must file required cost reports for the calendar year within 60 days of the deployment of the annual Residential Care Facility Cost Report. If the 60th day falls on a weekend or holiday, the reports are due by 5:00 P.M. on the following business day.

(b) Special Provisions.

Change of Ownership. The transferor must file cost reports with the Center within 60 days after a change of ownership. The Center will notify the Department of Transitional Assistance if required reports are not filed timely for payments to be withheld or other appropriate action by that agency.

New Facilities and Facilities with Major Additions. New facilities and facilities with major additions that become operational during the rate year must file year end cost reports with the Center within 60 days after the close of the first and second rate years.

Appointment of a Resident Protector Receiver. If a receiver is appointed pursuant to M.G.L. c. 111, § 72N, the provider must file cost reports for the pre-receivership reporting period or portion thereof with the Center within 60 days of the receiver's appointment.

Closed Facilities. A facility that permanently closes is not required to file the reports cited in 101 CMR 204.07(1) for the year in which the facility closed.

(c) Extension of Filing Date. The director of the Center's pricing group may grant a request for an extension of the filing due date for a maximum of 30 calendar days. In order to receive an extension, the provider must

submit the request itself rather than through agents or other representatives;
demonstrate exceptional circumstances that prevent the provider from meeting the deadline; and
file the request no later than 15 calendar days before the due date.

(4) Incomplete Submissions. If the cost reports are incomplete, the Center will notify the provider in writing within 120 days of the receipt. The Center will specify the additional information that the provider must submit to complete the cost reports. The provider must file the necessary information within 25 days of the date of notification. If the Center fails to notify the provider within the 120-day period, the cost reports will be considered complete and deemed to be filed on the date of receipt.

(5) Additional Information. The Center may require the provider to submit additional data and documentation during a desk or field audit even if the Center has accepted the provider's cost reports. In addition, the Center may request additional information and data relating to the operations of the provider and any related party.

(6) Failure to File Timely. If the provider does not file the required cost reports by the due date, EOHHS may reduce the provider's rate for current services by 5% on the day following the date the submission is due and 5% for each month of noncompliance thereafter. The reduction accrues cumulatively such that the rate reduction equals 5% for the first month late, 10% for the second month late, and so on. The reduction will be reversed effective on the date the cost reports are filed.

History

Amended by Mass Register Issue 1314, eff. 6/3/2016.

101 CMR, § 204.08 Other Provisions

(1) Special Rate Provisions.

(a) New Facilities and Major Additions. EOHHS will calculate projected rates for new facilities and facilities with major additions in the rate year. The provider must file a projected cost report that projects the reasonably anticipated costs and anticipated resident days for a 12-month period commencing with the first date of licensure.

New Facilities and Facilities with Major Additions Becoming Operational Prior to July 1st of the Rate Year.

a. First Rate Year. EOHHS will calculate a projected rate based on the projected cost report. The effective date of the rate will be the first date of licensure through December 31^st of the first rate year that the facility becomes operational.

b. Second Rate Year. EOHHS will calculate the rate for the second rate year based on the projected cost report described in 101 CMR 204.07.

c. Third Rate Year. The rate for the third rate year is based on the first calendar year cost report of actual expenditures.

New Facilities and Facilities with Major Additions Becoming Operational on or after July 1st of the Rate Year.

a. First Rate Year. EOHHS will calculate the rates based upon the projected cost report as described in 101 CMR 204.07. The effective dates of the rate will be the first date of licensure through December 31^st of the first rate year that the facility becomes operational.

b. Second Rate Year. The rate for the second rate year is based on the same projected cost report that was used for the first rate year.

c. Third Rate Year. EOHHS will calculate the rate for the third rate year based on the cost report of actual expenditures filed for the second calendar year.

Cost Ceilings. EOHHS will use the cost reports as described in 101 CMR 204.07(1) subject to appropriately inflated ceilings and limitations for each cost center.

EOHHS will recalculate projected rates based upon actual cost data, once a provider files a cost report(s) that covers the projected rate period.

(b) Facilities Sold during the Base Year. If a provider is sold during the base year, EOHHS will use the buyer's cost reports for the buyer's period of ownership to determine allowable base year costs. If the Center determines that the buyer's period of ownership was not long enough to ensure that it is representative of annualized costs, EOHHS may determine the rate using the seller's cost report.

(c) Facilities Closed after the Base Year. If a provider closed after the base year and subsequently reopened, EOHHS will use the base year cost report to calculate the rate. If no base year cost report was filed, EOHHS will calculate the rate using the latest filed cost report and increase the variable cost allowance by an appropriate cost adjustment factor.

(d) Private Resident Care Facilities. A facility that was a private facility during the base year and subsequently signs a provider agreement to provide services to publicly aided residents must file a cost report for the latest full year prior to the date of the provider agreement. EOHHS will calculate allowable variable costs using the appropriate ceilings and cost adjustment factor. EOHHS may limit the rate to the amount of the facility's average rate charges to private patients.

(e) Facilities Purchased from a Receiver. If a facility is purchased from a receiver, the Center may use the cost report from a year different from the base year if it determines that the costs for that year more accurately reflect the reasonable and necessary costs of providing resident care, subject to approval of the Department of Transitional Assistance. In such cases, EOHHS will increase the variable cost allowance by an appropriate cost adjustment factor.

(f) Rates for Special Programs. EOHHS may include an allowance for costs and expenses to maintain a special program if the provider has received prior written approval from the purchasing agency.

(2) Administrative Adjustments.

(a) Types of Administrative Adjustments. A provider may file a petition with the Center for an administrative adjustment during the rate year for the following reasons.

Substantial Capital Expenditures. A provider may petition for an administrative adjustment for a substantial capital expenditure of at least $10,000 for improvements and limited life assets and $5,000 for equipment if it has either made, or expects to make, a substantial capital expenditure that meets the criteria set forth in 101 CMR 204.08(2)(a)1.a. through f.

a. Qualifying Expenses. The provider may petition for recognition of increased depreciation and interest expense as a result of the expenditure. The provider may not petition for mortgage acquisition costs or increased operating costs as a result of the expenditure.

b. Expenditures Not Subject to Determination of Need. For improvements, the expenditure amount must be at least 1.5 times the allowable annual base year depreciation expense of building, improvements, and limited life assets. For equipment, the expenditure amount must be at least 1.5 times the allowable base year depreciation on equipment.

c. Expenditures Subject to Determination of Need. If the expenditure is subject to determination of need approval, the provider may petition for an adjustment after the Department has determined that need exists for the project and after the time for making an appeal to the Health Facilities Appeals Board has expired or all administrative and judicial reviews of the Department's determination have been concluded. The provider may petition for an adjustment before the Department has made a determination on the project if the Commissioner of Public Health requests that EOHHS determine the appropriate amount of an adjustment before a determination of need is made with respect to the provider's proposed expenditure.

d. Limitation on Capital. The maximum amount allowed for fixed costs for a facility is described in 101 CMR 204.08(2)(a)1.d. If the provider has not yet incurred the expenses, it must submit satisfactory evidence of its commitment to incur the expenditure.

| Effective Date | Payment Amount | | --- | --- | | Prior to July 1, 2004 | $17.29 | | July 1, 2004 to December 31, 2006 | $22.56 | | January 1, 2007 to December 31, 2007 | $25.82 | | January 1, 2008 to December 31, 2012 | $27.30 | | January 1, 2013 to November 30, 2018 | $28.06 | | December 1, 2018 Forward | $37.60 |

e. EOHHS will certify a temporary administrative adjustment of up to $37.60 upon receipt of the notification of the petition request for the substantial capital expenditure, rate adjustment request, and required supporting documentation.

f. Whenever a capital petition is granted, the provider's allowable basis will be adjusted by increasing the accumulated depreciation by the amounts included in the rates from the effective date of the petition.

New Governmental Requirements. A provider may petition for an administrative adjustment if it has incurred, or presents satisfactory evidence of a commitment to incur, substantially different costs necessary to satisfy new requirements of a governmental unit of the Commonwealth or the federal government. Such requirements must be related to provision of resident care. An increase in existing government requirements is not considered a new government requirement. EOHHS will not approve a petition for costs incurred to correct Department of Public Health resident care deficiencies.

Certain Increases in Operating Costs. A provider may petition for an adjustment if it has experienced unusual or unforeseen increases in operating costs that are not reflected in the rate. Unusual and unforeseen circumstances are events of a catastrophic nature (for example, fire, flood, or earthquake). The cost increases must gravely threaten the financial stability of the provider. In measuring the financial stability of the provider, EOHHS will consider all of the provider's expenditures and revenues.

Receiver Fees. A receiver appointed under M.G.L. c. 111, § 72N may petition for a rate adj ustment to reimburse reasonable receiver compensation and payment of his or her bond.

a. The receiver must submit detailed invoices that document the hours expended, a brief description of each activity, and the hourly rate. EOHHS will limit the reimbursement to the reasonable and necessary cost to safeguard the health, safety, and continuity of care to residents and to protect them from adverse health effects of unsuitable transfer.

b. EOHHS will limit reasonable receiver compensation to the lower of actual receiver fees or $10,000 for the first 30 days, $7,500 for the second 30 days, $2,500 for the third 30 days, and $1,500 for each 30-day period thereafter. EOHHS may include additional receiver compensation if both the Department of Public Health and the Department of Transitional Assistance approve additional compensation to the receiver due to unique circumstances. EOHHS, the Department, and the Department of Transitional Assistance will evaluate such requests for additional compensation for reasonableness.

Transfer of a Facility. If a facility is transferred during the first six months of the year subsequent to the base year, the buyer may file a petition requesting that EOHHS use the buyer's cost report to determine its rate. The buyer must demonstrate that use of the seller's base year cost report is not appropriate to project rate year costs. The Center will determine whether use of the buyer's cost report is appropriate to reflect reasonable and necessary patient care costs. EOHHS will make the appropriate adjustments to reflect the use of a non-base year cost report.

(b) General. A petition for an administrative adjustment must contain the following.

A petition must include the provider's name, address, a detailed explanation, under oath, of the basis of the petition and documentation supporting the amount requested including, but not limited to, invoices, canceled checks, loan documents, any construction contracts, and the project beginning and ending dates.
The provider must submit any other information that EOHHS requires within 30 days of the request. EOHHS will not allow the petition if the provider fails to timely submit the requested information.
EOHHS will suspend review of any petition if the provider has failed to submit reports or other information required by 101 CMR 204.00 in a timely manner. If the provider fails to file the required information within 60 days after notification by EOHHS, EOHHS will dismiss the petition for administrative adjustment.
EOHHS will suspend review of any petition if the Department notifies the provider that it has identified a quality of care problem.
The Center may require that the provider demonstrate that the changes in costs have actually occurred and that the year-end cost report substantiates the financial condition stated in the petition. If the provider fails to provide evidence of such costs within 45 days of the Center request, EOHHS may retroactively reverse the adjustment.

(c) Effective Date. An administrative adjustment will be effective on the later of the date the petition is filed with EOHHS or the date on which the event that is the basis of the petition is completed.

(d) Standard of Review.

In reviewing the petition, EOHHS will consider the following:

a. whether the adjustment would result in a significant difference in the rate;

b. the costs of other providers offering the same or comparable level of care; and

c. the ability of the Department of Transitional Assistance to collect any overpayments that may result from the petition. EOHHS will notify the Department of Transitional Assistance of the petition.

EOHHS will review petitions in accordance with the criteria set forth in 101 CMR 204.00 in effect in the year in which they are received by EOHHS, notwithstanding the effective date.

(3) Notice of Proposed Rate. EOHHS will send the provider a notice of the proposed rate as follows.

(a) Desk Audit. Prior to certification of a prospective rate based upon a desk audit, EOHHS will send the provider a notice of the proposed rate and a copy of adjustments at least ten calendar days prior to the scheduled date of certification. The provider may comment, in writing, on the proposed rate and adjustments during the period between the notice and scheduled date of EOHHS action. Providers requiring additional time to respond may request that EOHHS postpone the scheduled certification.

(b) Field Audit. EOHHS will not send a notice prior to certification of a proposed rate that is based upon a field audit if the rate is amended solely to incorporate field audit adjustments that have been discussed at an exit conference. The Center will provide a copy of the field audit adjustments to the provider following the exit conference.

(4) Rate Filings. EOHHS will file certified rates of payment for resident care facilities with the Secretary of the Commonwealth.

(5) Appeals. Any provider aggrieved by a rate of payment established pursuant to 101 CMR 204.00 may file an appeal with the Division of Administrative Law Appeals, established under M.G.L. c. 7, § 4H within 30 days of the filing of any such rate with the Secretary of the Commonwealth.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify provisions of 101 CMR 204.00, which will be deemed to be incorporated in 101 CMR 204.00. EOHHS will file with the Secretary of the Commonwealth, distribute copies to providers, and make the bulletins accessible to the public at EOHHS's offices during business hours.

(7) Severability. The provisions of 101 CMR 204.00 are severable. If any provision of 101 CMR 204.00 or the application of any provision of 101 CMR 204.00 is held invalid or unconstitutional, such provision will not be construed to affect the validity or constitutionality of any other provision of 101 CMR 204.00 or the application of any other provision.

History

Amended by Mass Register Issue 1314, eff. 6/3/2016.

101 CMR, § 204.09 Certain COVID-19-related Costs Add-on Payment Provisions

(1) General Provision. Resident care facilities eligible under 101 CMR 204.09 will receive an add-on payment that must be used to reimburse for costs related to COVID-19 in accordance with St. 2022, c. 268. This add-on payment, which is to be made in accordance with St. 2022, c. 268, is intended to be made in calendar year 2024 and represents approximately half of the payments intended to be made to resident care facilities with rates established in 101 CMR 204.00.

(2) Calculation of Certain COVID-19 Related Costs Add-on Payment. EOHHS will calculate the add-on payment for each facility as follows.

(a) Determine the total number of resident care beds as of June 7, 2023, that are

in resident care facilities licensed by DPH;
in resident care facilities that are not subject to licensure pursuant to M.G.L. c. 111, §73B, and had SSI/SSP or EAEDC days in calendar year 2021; or
in facilities that are licensed by DPH as nursing facilities, but where such facility has a majority of resident care beds over nursing beds, and where such facility has not otherwise received payments for either resident care or nursing beds pursuant to 101 CMR 206.00.

(b) Divide $14,334,990 by the total number of DPH-licensed beds identified pursuant to 101 CMR 204.09(2)(a).

(c) Multiply the quotient determined by the methodology described at 101 CMR 204.09(2)(b) by the number of DPH-licensed beds for the facility as of the date identified at 101 CMR 204.09(2)(a).

(3) Permissible Uses of Certain COVID-19 Related Costs Add-on Payments. Facilities may use the add-on payments made in accordance with 101 CMR 204.09 only for COVID-19-related costs including, but not necessarily limited to, investments to support the direct care workforce; COVID-19 preparedness efforts or measures including, but not limited to, increasing uptake of the COVID-19 vaccine, infection control and quality improvement, and personal protective equipment; capital improvements to improve the health, safety, and care of residents; and other COVID-19 related costs.

(4) Further Guidance. EOHHS may, by administrative bulletin or other written issuance, clarify substantive provisions of 101 CMR 204.09, update permissible uses of certain COVID-19 related costs add-on payments, or establish additional reporting or recordkeeping requirements with respect to COVID-19 related costs add-on payments.

History

Adopted by Mass Register Issue 1429, eff. 8/1/2020.

101 CMR, § 204.10 Resident Care Cost Quotient

(1) Beginning July 1, 2022, residential care facilities must have a Resident Care Cost Quotient (RCC-Q) that meets or exceeds a threshold of 80%. For the rate year beginning in SFY2024, a residential care facility's rate may be subject to a downward adjustment if the facility fails to be at or above the specified RCC-Q threshold in the previous state fiscal year.

(2) The RCC-Q will be calculated by dividing certain resident care expenses by the facility's total revenue, excluding the revenue for non-residential care facility lines of business, and excluding endowment income. EOHHS may further identify or clarify these certain resident care expenses by administrative bulletin or other written issuance. A multiplier may be applied to certain resident care expenses related to one or more resident care workforce position types. EOHHS may establish the workforce position types eligible for any multiplier, details related to application of such multiplier, and the magnitude of such multiplier in calculating the RCC-Q, by administrative bulletin or other written issuance.

(3) All resident care facilities, including facilities described in 101 CMR 204.10(5), will be required to submit an interim compliance report by March 1^st of each year and a final compliance report by September 1^st of each year. The interim report will be used to inform facilities if they are on track to meet the RCC-Q threshold in the reporting period. The final compliance report will be used for determining whether the facility met that threshold and whether a downward adjustment will be applied to the facility's rate in the following rate year.

(4) The downward adjustment to the rate will be applied in the following rate year to facilities that failed to meet the RCC-Q threshold or failed to submit the final report by the final compliance report due date. Such downward adjustment will be applied as follows.

(a) For every 1% below the 80% RCC-Q threshold, a 0.5% downward adjustment will be applied to the facility's rate.

(b) The maximum downward adjustment calculated in accordance with 101 CMR 204.10(4)(a) may be no more than 5% of the facility's rate. EOHHS may apply the maximum downward adjustment of 5% in the following rate year for facilities that fail to submit the final report by the due date established in 101 CMR 204.10(3).

(5) Residential care facilities that have fewer than 1,700 SSI/SSP and EAEDC days (also known as DTA days), based on the most recent cost report data available to CHIA, for a particular state fiscal year, starting the state fiscal year of July 1, 2022, through June 30, 2023, except for the facilities that failed to submit the final compliance report by September 1^st in accordance with 101 CMR 204.10(3) immediately following the end of the particular state fiscal year, will be exempt from the downward adjustment established at 101 CMR 204.10(4). For purposes of 101 CMR 204.10(5), the RCC-Q minimum paid DTA days will be established by EOHHS by administrative bulletin or other written issuance.

(6) EOHHS may issue an administrative bulletin or other written issuance to clarify provisions of 101 CMR 204.10, and as otherwise provided at 101 CMR 204.10.

(7) EOHHS or the Center may audit facilities or otherwise require the provider to submit data, documentation, or other materials to support or otherwise demonstrate costs as an audit of the RCC-Q reporting that a facility submitted, or failed to submit, in accordance 101 CMR 204.10(3), or to confirm the validity of the RCC-Q determined pursuant to 101 CMR 204.10. In addition, EOHHS may request additional information and data relating to the operations of the facility and any related party concerning the RCC-Q in accordance with 101 CMR 204.10. After this audit, if EOHHS determines that the facility did not meet the RCC-Q threshold established pursuant to 101 CMR 204.10(1), but the full and appropriate downward adjustment was not applied to the applicable facility rates pursuant to 101 CMR 204.10(4), EOHHS, in its sole authority and discretion, may apply one or more of the following actions, as appropriate:

(a) apply the downward adjustment for the full or partial period of the rate year to which the downward adjustment should have been applied pursuant to 101 CMR 204.10(4);

(b) apply a negative annualization adjustment to one or more prospective payments to account for the period the facility was paid at a rate to which the downward adjustment should have been applied pursuant to 101 CMR 204.10(4);

(c) notwithstanding the maximum downward adjustment described in 101 CMR 204.10(4), apply the downward adjustment that should have been applied to the applicable rate year to the rate for the subsequent rate year in accordance with the parameters described at 101 CMR 204.10(4) in addition to any applicable downward adjustment pursuant to 101 CMR 204.10(4) that would otherwise be applicable for the subsequent rate year;

(d) require the facility to refund the overpayments that account for the difference between the rate paid and the rate that should have been paid after application of the downward adjustment that should have been applied pursuant to 101 CMR 204.10(4); or

(e) take another appropriate action.

History

Adopted by Mass Register Issue 1463, eff. 2/4/2022 (EMERGENCY).

Standard Payments to Nursing Facilities Standard Payments to Nursing Facilities

101 CMR, § 206.01 Scope and Purpose

101 CMR 206.00 governs the payments beginning October 1, 2024, for services rendered to publicly aided and industrial accident residents by nursing facilities including residents in a residential care unit of a nursing facility. 101 CMR 206.00 does not govern nursing facility payments pursuant to a contract with the Office of Medicaid.

History

Amended by Mass Register Issue 1285, eff. 1/1/2015.

101 CMR, § 206.02 General Definitions

As used in 101 CMR 206.00, unless the context requires otherwise, terms have the following meanings.

Administrative and General Costs. Administrative and general costs include the amounts reported in the following accounts: administrator salaries; payroll taxes - administrator; worker's compensation - administrator; group life/health - administrator; administrator pensions; other administrator benefits; clerical; EDP/payroll/bookkeeping services; administrator-in-training; office supplies; phone; conventions and meetings; help wanted advertisement; licenses and dues, resident-care related; education and training - administration; accounting - other; insurance -malpractice; other operating expenses; realty company variable costs; management company allocated variable costs; and management company allocated fixed costs.

Administrator in Training. A person registered with the Board of Registration of Nursing Home Administrators and involved in a course of training as described in 245 CMR: Board of Registration of Nursing Home Administrators .

Audit. An examination of the provider's cost report and supporting documentation to evaluate the accuracy of the financial statements and identification of Medicaid patient-related costs.

Base Year. The calendar year used to compute the standard payments.

Body Mass Index (BMI). A person's weight divided by their height.

Capital Costs. Capital costs include depreciation expenses on building, improvements, equipment, software, and other limited life assets; long-term interest expense; building insurance; real estate tax; non-income portion of Massachusetts Corporate Excise Taxes; personal property taxes on nursing facility equipment; other rental expenses for fixed costs; and other fixed costs.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Centers for Medicare and Medicaid Services (CMS). The federal agency under the U.S. Department of Health and Human Services that is responsible for administering the Medicare and Medicaid programs.

Department of Public Health (DPH). An agency of the Commonwealth of Massachusetts, established under M.G.L. c. 17, § 1.

Direct Restorative Therapy. Services of physical therapists, occupational therapists, and speech, hearing, and language therapists provided directly to individual residents to reduce physical or mental disability and to restore the resident to maximum functional level. Direct restorative therapy services are provided only upon written order of a physician, physician assistant, or nurse practitioner who has indicated anticipated goals and frequency of treatment to the individual resident. Direct restorative therapy services include supervisory, administrative, and consulting time associated with provision of the services. These include, but are not limited to, reviewing preadmission referrals, informally communicating with families, scheduling treatments, completing resident care documentation including MDS documentation, screening of patients, writing orders, meeting with aides to discuss patients, consulting with physicians and nurse practitioners, managing equipment, and assessing equipment needs of patients.

Equipment. A fixed asset, usually moveable, accessory or supplemental to the building, including such items as beds, tables, and wheelchairs.

Executive Office of Health and Human Services (EOHHS). The executive department of the Commonwealth of Massachusetts established under M.G.L. c. 6A, § 2 that, through the Executive Office of Elder Affairs, the MassHealth program, and other agencies within EOHHS, as appropriate, operates and administers the programs of medical assistance and medical benefits under M.G.L. c. 118E and that serves as the single state agency under § 1902(a)(5) of the Social Security Act.

Financing Contribution. Payment for the use of necessary capital assets whether internally or externally funded.

Generally Available Employee Benefits. Employee benefits that are nondiscriminatory and available to all full-time employees.

Hospital-based Nursing Facility. A separate nursing facility unit or units located in a hospital building licensed for both hospital and nursing facility services in which the nursing facility licensed beds are less than a majority of the facility's total licensed beds and the nursing facility patient days are less than a majority of the facility's total patient days. It does not include freestanding nursing facilities owned by hospitals.

Improvements. Expenditures that increase the quality of the building by rearranging the building layout or substituting improved components for old components so that the provider is in some way better than it was before the renovation. Improvements do not add to or expand the square footage of the building. An improvement is measured by the provider's increased productivity, greater capacity, or longer life.

Indirect Restorative Therapy. Indirect restorative therapy services consist only of services of physical therapists, occupational therapists, and speech, hearing, and language therapists to provide the following: orientation programs for aides and assistants; in-service training to staff; consultation and planning for continuing care after discharge; preadmission meetings with families; quality improvement activities such as record reviews, analysis of information and writing reports; personnel activities including hiring, firing, and interviewing; rehabilitation staff scheduling; and attending team meetings including quality improvement, falls, skin team, daily admissions, interdisciplinary, departmental staff, discharge planning, and family meetings when resident is not present.

Induction Period. Days that a nursing facility patient is transported to an Opioid Treatment Program by a nursing facility direct care staff for the purpose of induction on medication assisted treatment at the Opioid Treatment Program.

Industrial Accident Resident. A person receiving nursing facility services for which an employer or an insurer is liable under the Workers' Compensation Act, M.G.L. c. 152.

Management Minute Questionnaire (MMQ). A method of measuring resident care intensity, or case mix, by discrete care giving activities or the characteristics of residents found to require a given amount of care.

Massachusetts Corporate Excise Tax. Those taxes that have been paid to the Massachusetts Department of Revenue in connection with the filing of Form 355A, Massachusetts Corporate Excise Tax Return.

Medication for Addiction Treatment. Use of a medication approved by the federal Food and Drug Administration (FDA) for the treatment of a substance use disorder.

Minimum Data Set (MDS). A CMS-provided standardized assessment tool for nursing facilities to determine a nursing facility patient's Patient Driven Payment Model (PDPM) case mix category.

Mortgage Acquisition Costs. Those costs (such as finder's fees, certain legal fees, and filing fees) necessary to obtain long-term financing through a mortgage, bond, or other long-term debt instrument.

Nursing Costs. Nursing costs include the reported costs for director of nurses, registered nurses, licensed practical nurses, nursing aides, nursing assistants, orderlies, nursing purchased services, and the workers compensation expense, payroll tax expense, and fringe benefits, including pension expense, associated with those salaries.

Nursing Facility. A nursing or convalescent home; an infirmary maintained in a town; a charitable home for the aged, as defined in M.G.L. c. 111, § 71; or a nursing facility operating under a hospital license issued by the Department of Public Health pursuant to M.G.L. c. 111, and certified by the Department of Public Health for participation in MassHealth. It includes facilities that operate a licensed residential care unit within the nursing facility.

Operating Costs. Operating costs include, but are not limited to, the following reported costs: plant, operations and maintenance; dietary; laundry; housekeeping; ward clerks and medical records librarian; medical director; advisory physician; Utilization Review Committee; employee physical exams; other physician services; house medical supplies not resold; pharmacy consultant; social service worker; indirect restorative and recreation therapy expense; other required education; job related education; quality assurance professionals; Management Minute Questionnaire nurses; staff development coordinator; motor vehicle expenses including, but not limited to, depreciation, mileage payments, repairs, insurance, excise taxes, finance charges, and sales tax; and administrative and general costs.

Opioid Treatment Program (OTP). A program that provides opioid treatment services. An opioid treatment program must be federally certified by the Substance Abuse Mental Health Services Administration (SAMHSA) and must be licensed as an opioid treatment program by the Department of Public Health under 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs . Opioid treatment programs must conform to the federal opioid treatment standards in 42 CFR 8.12: Federal Opioid Treatment Standards .

Opioid Treatment Services. Supervised assessment and treatment of an individual using FDA-approved medications (including methadone, buprenorphine, buprenorphine/naloxone, and naltrexone), along with a comprehensive range of medical and rehabilitative services, when clinically necessary, to alleviate the adverse medical, psychological or physical effects incident to opioid use disorder. Opioid Treatment Services encompasses withdrawal management services and maintenance treatment.

Patient Days. The total number of days of occupancy by residents in the facility. The day of admission is included in the computation of patient days; the day of discharge is not included. If admission and discharge occur on the same day, one resident day is included in the computation. It includes days for which a provider reserves a vacant bed for a publicly aided resident temporarily placed in a different care situation, pursuant to an agreement between the provider and the MassHealth agency. It also includes days for which a bed is held vacant and reserved for a non-publicly aided resident.

Patient Driven Payment Model (PDPM). The case mix classification system provided by CMS to classify nursing facility patients into payment groups.

Patient Driven Payment Model (PDPM) Nursing Case Mix. One of the five case-mix adjusted components of the CMS Patient Driven Payment Model.

Private Nursing Facility. A nursing facility that formerly served only non-Medicaid residents and does not have a provider agreement with the MassHealth agency to provide services to public residents.

Provider. A nursing facility providing care to publicly aided residents or industrial accident residents.

Prudent Buyer Concept. The assumption that a purchase price that exceeds the market price for a supply or service is an unreasonable cost.

Publicly Aided Resident. A person for whom care in a nursing facility is in whole or in part subsidized by the Commonwealth or a political subdivision of the Commonwealth. Publicly aided residents do not include residents whose care is in whole or in part subsidized by Medicare.

Rate Year. The 12-month period from October 1^st through September 30^th.

Related Party. An individual or organization associated or affiliated with, or that has control of, or is controlled by, the provider; or is related to the provider, or any director, stockholder, trustee, partner, or administrator of the provider by common ownership or control or in a manner specified in §§ 267(b) and (c) of the Internal Revenue Code of 1954 provided, however, that 10% is the operative factor as set out in §§ 267(b)(2) and (3). Related individuals include spouses, parents, children, spouses of children, grandchildren, siblings, fathers-in-law, mothers-in-law, brothers-in-law, and sisters-in-law.

Replacement Facility. A nursing facility that replaces its entire building with a newly constructed facility pursuant to an approved determination of need under 105 CMR 100.000: Determination of Need . A facility that renovates a building previously licensed as a nursing facility is not a replacement facility.

Reported Costs. All costs reported in the cost report.

Required Education. Educational activities, conducted by a recognized school or authorized organization, required to maintain a professional license of employees that provide care to publicly aided residents. Required education also includes training for nurses' aides.

Residential Care. The minimum basic care and services and protective supervision required by the Department of Public Health in accordance with 105 CMR 150.000: Licensing of Long-term Care Facilities for residents who do not routinely require nursing or other medically related services.

Residential Care Unit. A unit within a nursing facility licensed by the Department of Public Health to provide residential care.

State Fiscal Year (SFY). The 12-month period from July 1^st through June 30^th.

Unit. A unit is an identifiable section of a nursing facility such as a wing, floor, or ward as defined in 105 CMR 150.000: Licensing of Long-term Care Facilities .

History

Amended by Mass Register Issue 1285, eff. 1/1/2015.

101 CMR, § 206.03 General Payment Provisions

(1) General. Nursing facility payments are prospective rates based on reported costs for a prior base year.

(a) The nursing standard payments and the operating cost standard payments are established in 101 CMR 206.04. The base year for the nursing standard payments and the operating cost standard payments beginning October 1, 2024, is 2019. The nursing and operating payments are increased from the base year by a cost adjustment factor of 23.50%.

(b) The capital payments are established in 101 CMR 206.05. The base year for the capital payments beginning October 1, 2024, is 2019. The capital payments are increased from the base year by a cost adjustment factor of 8.02%.

(2) Ancillary Costs. Unless a provider participates in the Ancillary Pilot Program with the MassHealth agency, or a provider's payments include ancillary services pursuant to the regulations or written policy of the purchasing agency, the provider must bill ancillary services directly to the purchaser in accordance with the purchaser's regulations or policies.

(3) Disclaimer of Authorization of Services. 101 CMR 206.00 is not authorization for or approval of the substantive services, or lengths of time, for which rates are determined pursuant to 101 CMR 206.00. Governmental units that purchase services from eligible providers are responsible for the definition, authorization, and approval of services and lengths of time provided to publicly aided individuals. Information concerning substantive program requirements must be obtained from purchasing governmental units.

History

Amended by Mass Register Issue 1285, eff. 1/1/2015.

101 CMR, § 206.04 Nursing Standard Payments and Operating Cost Standard Payments

(1) Nursing Standard Payments.

(a) Nursing Standard Payment Calculation. Beginning October 1, 2024, nursing facilities will receive the following nursing standard payments:

| PDPM Nursing HIPPS Code (Acuity Level) | PDPM Nursing Case Mix Index (2022) | Nursing Standard Payment | | --- | --- | --- | | A (ES3) | 3.95 | $ 395.75 | | B (ES2) | 2.99 | $ 299.57 | | C (ES1) | 2.85 | $ 285.54 | | D (HDE2) | 2.33 | $ 233.44 | | E (HDE1) | 1.94 | $ 194.37 | | F (HBC2) | 2.18 | $ 218.41 | | G (HBC1) | 1.81 | $ 181.34 | | H (LDE2) | 2.02 | $ 202.38 | | I (LDE1) | 1.68 | $ 168.32 | | J (LBC2) | 1.67 | $ 167.32 | | K (LBC1) | 1.39 | $ 139.26 | | L (CDE2) | 1.82 | $ 182.35 | | M (CDE1) | 1.58 | $ 158.30 | | N (CBC2) | 1.51 | $ 151.29 | | O (CA2) | 1.06 | $ 106.20 | | P (CBC1) | 1.30 | $ 130.25 | | Q (CA1) | 0.91 | $ 91.17 | | R (BAB2) | 1.01 | $ 101.19 | | S (BAB1) | 0.96 | $ 96.18 | | T (PDE2) | 1.53 | $ 153.29 | | U (PDE1) | 1.43 | $ 143.27 | | V (PBC2) | 1.19 | $ 119.23 | | W (PA2) | 0.69 | $ 69.13 | | X (PBC1) | 1.10 | $ 110.21 | | Y (PA1) | 0.64 | $ 64.12 |

(b) Nursing Standard Payment Adjustment. Beginning October 1, 2024, eligible nursing facilities will receive adjustments to their standard nursing payments at 101 CMR 206.04(1)(a), which will be calculated and determined as follows.

Calculate each facility's average nursing standard payment rate in effect as of September 30, 2024, weighted by the facility's average PDPM nursing case mix during the period of October 1, 2023, through March 31, 2024. For each facility, add this value to the facility's average Nursing Standard Payment Adjustment in effect as of September 30, 2024, weighted by the facility's average PDPM nursing case mix during the period of October 1, 2023, through March 31, 2024.

Calculate each facility's average proposed nursing standard payment rate, beginning October 1, 2024, using the nursing rates as defined in 101 CMR 206.04(1)(a) and weighted by the facility's average PDPM nursing case mix during the period of October 1, 2023, through March 31, 2024.
To determine a facility's eligibility for the Nursing Standard Payment Adjustment

a. First, determine whether the facility is a pediatric facility. If the facility is a pediatric facility, then

i. Determine whether the value calculated in 101 CMR 206.04(1)(b)2. is less than the value calculated in 101 CMR 206.04(1)(b)1.

ii. If the value calculated in 101 CMR 206.04(1)(b)2. is less than the value calculated in 206.04(1)(b)1., then calculate an "average nursing rate adjustment" such that the sum of this adjustment and the value calculated in 101 CMR 206.04(1)(b)2. will be equal to the value calculated in 101 CMR 206.04(1)(b)1.

iii. Divide the "average nursing rate adjustment" by the value calculated in 101 CMR 206.04(1)(b)2. The resulting percentage, rounded to the nearest hundredth of a percent, will be the Nursing Standard Payment Adjustment.

b. If the facility is not a pediatric facility, then determine whether the facility is a High Medicaid facility. For the purposes of the Nursing Standard Payment Adjustment, a High Medicaid facility is defined as a facility for which Massachusetts Medicaid days are at least 75.00% of its total resident days, as reported on quarterly User Fee Assessment Forms for the period April 1, 2023, through March 31, 2024. If the facility is a High Medicaid facility, then

i. Determine whether the value calculated in 101 CMR 206.04(1)(b)2. is less than the value calculated in 206.04(1)(b)1.

ii. If the value calculated in 101 CMR 206.04(1)(b)2. is less than the value calculated in 101 CMR 206.04(1)(b)1., then calculate an "average nursing rate adjustment" such that the sum of this adjustment and the value calculated in 101 CMR 206.04(1)(b)2. will be equal to the value calculated in 101 CMR 206.04(1)(b)1.

For eligible facilities, the Nursing Standard Payment Adjustment will be applied as an upward adjustment to the nursing standard payment rate at each PDPM nursing case mix category.

(2) Operating Cost Standard Payments. Beginning October 1, 2024, nursing facilities will receive operating cost standard payments of $125.41.

History

Amended by Mass Register Issue 1285, eff. 1/1/2015.

101 CMR, § 206.05 Capital Payments

(1) Nursing Facility Capital Payments. Beginning October 1, 2024, nursing facilities will receive capital payments calculated as follows, with exceptions as described in 101 CMR 206.05(2) through 101 CMR 206.05(5).

(a) Calculate the sum of the allowable portion of capital costs during the base year, less any recoverable fixed cost income. Apply a cost adjustment factor as described in 101 CMR 206.03(1)(b).

(b) Multiply the number of beds by the number of days in the rate year and then multiply the product by the greater of 90% or the actual utilization rate in the base year.

(c) EOHHS will calculate the provider's capital payment by dividing the result of 101 CMR 206.05(1)(a) by the result of 101 CMR 206.05(1)(b), subject to the limitations described in 101 CMR 206.05(4).

(2) Nursing Facility Capital Payment Adjustments. Beginning October 1, 2024, nursing facilities will receive capital payment adjustments calculated as follows.

(a) If a nursing facility's capital payment as calculated in 101 CMR 206.05(1) is less than 90% of its capital payment as of September 30, 2021, the facility will receive the capital payment listed in 101 CMR 206.05(1), plus an upward adjustment equal to the difference between the capital payment as calculated in 101 CMR 206.05(1) and 90% of the facility's capital payment as of September 30, 2021, subject to the limitations described in 101 CMR 206.05(4).

(b) If a nursing facility's capital payment as calculated in 101 CMR 206.05(1) is greater than 150% of its capital payment as of September 30, 2021, the facility will receive the capital payment calculated in 101 CMR 206.05(1), less a downward adjustment equal to the difference between the capital payment as calculated in 101 CMR 206.05(1) and 150% of the facility's capital payment as of September 30, 2021.

(3) Revised Capital Payment.

(a) General Notification Requirements. All providers must notify the Center when they open, add new beds, renovate, or reopen beds. The notification must contain the provider's name, address, vendor payment number, date of bed change, type of change, and description of project.

(b) Request for Revised Capital Payment. Eligible providers may request a revised capital payment for capital costs associated with the change or renovation of licensed beds. Facilities that may request a revised capital payment include

new facilities that open pursuant to a determination of need and facilities with newly licensed beds that are added pursuant to a determination of need;
facilities with renovations made pursuant to a determination of need;

facilities that submitted detailed architectural or engineering plans for, or evidence of, applications made to local government agencies for planning, zoning, or building permits or other regulatory approvals, including approvals required by the Department of Public Health, required in connection with conversion of rooms with three or more residents to one- and two-bedded rooms or two-bedded rooms to one-bedded rooms.

(c) Eligibility Requirements. A nursing facility specified in 101 CMR 206.05(3)(b)2. will be eligible for a revised capital payment if the facility has expended at least 50% of the maximum capital expenditure for an approved determination of need, or in the instance of a second request, at least 25% additional from the previous approved request and in the instance of a third request, only upon completion of the project.

(d) Required Documentation. Providers meeting the criteria in 101 CMR 206.05(3)(b) must submit the following to the Center with its request for a revised capital payment, as well as any additional information that EOHHS determines necessary to calculate a revised capital payment:

a copy of the approved determination of need and any approved amendments, or, in the case of capital projects that do not require a determination of need, a detailed description of the project;
a copy of the construction contract;
a listing of construction costs;
copies of invoices and cancelled checks for construction costs;
a copy of the Department of Public Health's licensure notification associated with the increase or decrease in licensed beds, as applicable;
a copy of the mortgage or financing obtained;
a copy of the calculation of the requested increase, the format of which may be specified by EOHHS; and
a listing of any assets such as land, building, improvements, or equipment that are either destroyed or no longer used for patient care.

(e) Revised Capital Payment Calculation. Nursing facilities that meet the criteria listed in 101 CMR 206.05(3)(b) and that have submitted all required documentation under 101 CMR 206.05(3)(d) will be eligible for a revised capital payment in place of the capital rates calculated under 101 CMR 206.05(1), subject to the limitations of 101 CMR 206.05(4):

Adding the following costs:

a. the allowed capital expenses associated with a project described in 101 CMR 206.05(3)(b), subject to the divisor described in 101 CMR 206.05(1)(b) adjusted for any increase or decrease in licensed beds; and

b. the lesser of the following costs, subject to the divisor described in 101 CMR 206.05(1)(b) adjusted for any increase or decrease in licensed beds,

i. 101 CMR 206.05(1); or

ii. The sum of the amount calculated in 101 CMR 206.05(1) and the amount calculated in 101 CMR 206.05(2).

The revised capital payment must be the total calculated in 101 CMR 206.05(3)(c), and must be the new capital rate, in place of the rate calculated under 101 CMR 206.05(1) or 101 CMR 206.05(2), effective on the later of the date the facility submits their request for the revised capital payment, including all required documentation, or the effective date of the change in licensed beds.

(4) Maximum Capital Payment. Capital payments must not exceed $50.00.

(5) New or Relocated Nursing Facilities. A nursing facility that becomes operational on or after October 1, 2023, an existing nursing facility that replaces its current building on or after October 1, 2023, or an existing nursing facility that fully relocates to a newly constructed location on or after October 1, 2023, will be eligible for a capital payment in the amount of $50.00. Such facility will not be eligible for additional capital payments as listed 101 CMR 206.05(1) or for an adjustment to its capital payment as described in 101 CMR 206.05(2).

(6) Licensed Bed Changes. A nursing facility will not receive an adjustment to its capital payment rate solely because of an increase or decrease in its number of licensed beds, except as described in 101 CMR 206.05(3)(b)3.

(7) Rate Adjustments. EOHHS may adjust any capital payment upon EOHHS's determination that there was a material error in the calculation of the payment or in the facility's documentation of its capital costs.

History

Amended by Mass Register Issue 1285, eff. 1/1/2015.

101 CMR, § 206.06 Adjustments to Standard Nursing Facility Rates

(1) Certification of Public Expenditures of a Nursing Facility Owned and Operated by a Municipality.

(a) Within 60 days after the filing of its Medicare CMS-2540 cost report, a nursing facility, which is owned and operated by a municipality, may submit a request for Certified Public Expenditures (CPE) to EOHHS. This CPE will account for its public expenditures of providing Medicaid services to eligible Medicaid members. The submission will be based on the inpatient routine service cost reported on the CMS-2540 Medicare cost report.

(b) Following review of the nursing facility's submission, EOHHS will, within 60 days of the submission, approve, deny, or revise the amount of the CPE request based upon its evaluation of the reported costs and payments. The final approved amount will be equal to the difference between the Medicaid interim payments and the total allowable Medicaid costs as determined by EOHHS. This final determined amount will be certified by the municipality as eligible for federal match.

(d) EOHHS will determine total allowable Medicaid costs based on the Medicare CMS-2540 Cost Report and will determine a per diem rate calculated as follows.

Medicaid Allowable Skilled Nursing Facility Costs. Total allowable costs (Worksheet B, Part I, Line 30, Col 18), divided by total days (Worksheet S-3, Line 1, Col 7), times Medicaid days (worksheet S-3, Line 1, Col 5).

Medicaid Allowable Nursing Facility Costs. Total allowable costs (Worksheet B, Part I, Line 31, Col 18), divided by total days (Worksheet S-3, Line 3, Col 7), times Medicaid days (Worksheet S-3, Line 3, Col 5).

Total Allowable Medicaid Costs. The sum of the amount determined in 101 CMR 206.06(1)(d)1. and 2.

(e) EOHHS will calculate an interim reconciliation based on the difference between the interim payments and total allowable Medicaid costs from the as-filed CMS-2540 Cost Report. The nursing facility must notify EOHHS immediately if the CMS-2540 is reopened or an audit is completed. Within 60 days after receiving notification of the final Medicare settlement EOHHS will retroactively adjust the final settlement amount.

(2) Quality Adjustments. Beginning October 1, 2024, a nursing facility may be eligible for a quality adjustment in the form of an increase or decrease applied to the facility's nursing standard rate and operating standard rate at each PDPM nursing case mix category. The quality adjustment will be equal to the sum of the percent increase or decrease assessed for performance on each of the following four quality measures: Quality Achievement Based on CMS Score, Quality Improvement Based on CMS Score, Quality Achievement Based on DPH Score, and Quality Improvement based on DPH Score.

(a) Quality Achievement Based on CMS Score. The quality adjustment a nursing facility will incur under the measure "Quality Achievement Based on CMS Score" will be based on the facility's overall rating on the Centers for Medicare and Medicaid Services Nursing Home Compare 5-Star Quality Rating Tool as of June 2023, as described in the table below. Facilities that CMS has designated as not rated due to a history of serious quality issues ( i.e ., Special Focus Facilities) will be considered to have a score of 1 for the purposes of this quality adjustment.

| CMS Overall Score as of June 2023 | Adjustment Percentage | | --- | --- | | 1 | -1.00% | | 2 | -0.75% | | 3 | 0.00% | | 4 | 0.75% | | 5 | 1.00% |

(b) Quality Improvement Based on CMS Score. The quality adjustment a nursing facility will incur under the measure "Quality Improvement Based on CMS Score" will be based on the facility's overall rating on the Centers for Medicare and Medicaid Services Nursing Home Compare 5-Star Quality Rating Tool, as follows. If a facility has a score of 5 Stars as of June 2023, its adjustment for this measure will be 2.0%, regardless of whether it meets any other criteria in the following table. If a facility meets the criteria for "CMS Chronic Low Quality," its adjustment for this measure will be -3.0%, regardless of whether it meets any other criteria in the following table. Facilities that CMS has designated as not rated due to a history of serious quality issues ( i.e. , Special Focus Facilities) will be considered to meet the criteria for "CMS Chronic Low Quality" for the purposes of this quality adjustment.

| Criteria Based on CMS Rating | Adjustment Percentage | | --- | --- | | Facility has a score of five Stars as of June 2023 | 2% | | Facility experienced an increase of two or more Stars from June 2022, to June 2023 | 1.5% | | Facility experienced an increase of one Star from June 2022, to June 2023 | 1% | | Facility experienced no change to its Star rating from June 2022, to June 2023 | 0% | | Facility experienced a decrease of one Star from June 2022, to June 2023, and had a score of five Stars as of June 2022 | 0% | | Facility experienced a decrease of one Star from June 2022, to June 2023, and did not have a score of five Stars as of June 2022 | -2% | | Facility experienced a decrease of two or more Stars from June 2022, to June 2023 | -2.5% | | CMS Chronic Low Quality: The average of a facility's scores as of June 2020, June 2021, June 2022, and June 2023 is less than or equal to 1.5 Stars | -3% |

(c) Quality Achievement Based on DPH Score. The quality adjustment a nursing facility will incur under the measure "Quality Achievement Based on DPH Score" will be based on the facility's performance on the Department of Public Health's Nursing Facility Survey Performance Tool (DPH NFSPT) as of July 1, 2023, as follows:

| DPH NFSPT Score as of July 1, 2023 | Adjustment Percentage | | --- | --- | | 110 or less | -1.00% | | 111 - 115 | -0.75% | | 116 - 119 | 0.00% | | 120 - 123 | 0.75% | | 124+ | 1.00% |

(d) Quality Improvement Based on DPH Score. The quality adjustment a nursing facility will incur under the measure "Quality Improvement Based on DPH Score" will be based on the facility's performance on the DPH NFSPT, as follows. If a facility has a DPH NFSPT score of 124 or higher as of July 1, 2023, its adjustment for this measure will be 2.0%, regardless of whether it meets any other criteria in the following table. If a facility meets the criteria for "DPH Chronic Low Quality," its adjustment for this measure will be -3.0%, regardless of whether it meets any other criteria in the following table.

| Criteria based on DPH FSPT Score | Adjustment Percentage | | --- | --- | | Facility has a score of 124 or higher as of July 1, 2023 | 2.0% | | Facility experienced an increase of four or more points from July 1, 2022, to July 1, 2023 | 1.5% | | Facility experienced an increase of one, two, or three points from July 1, 2022, to July 1, 2023 | 1.0% | | Facility experienced no change to its score from July 1, 2022, to July 1, 2023 | 0.0% | | Facility experienced a decrease of one, two, or three points from July 1, 2022, to July 1, 2023, and had a score of 124 or higher as of July 1, 2022 | 0.0% | | Facility experienced a decrease of one, two, or three points from July 1, 2022, to July 1, 2023, and did not have a score of 124 or higher as of July 1, 2022 | -2.0% | | Facility experienced a decrease of four or more points from July 1, 2022, to July 1, 2023 | -2.5% | | DPH Chronic Low Quality: Facility had a score of less than 100 as of each of the following dates: July 1, 2021; July 1, 2022; and July 1, 2023 | -3% |

(3) Kosher Food Services. Nursing facilities with kosher kitchen and food service operations may receive an add-on of up to $5 per day to reflect the additional costs of these operations.

(a) Eligibility. To be eligible for this add-on, the nursing facility must

maintain a fully kosher kitchen and food service operation that is, at least annually, rabbinically approved or certified; and in accordance with all applicable requirements of law related to kosher food and food products including, but not limited to, M.G.L. c. 94, § 156;
provide to the Center a written certification from a certifying authority, including the complete name, address, and phone number of the certifying authority, that the applicant's nursing facility maintains a fully kosher kitchen and food service operation in accordance with Jewish religious standards. For purpose of 101 CMR 206.06(3)(a)2., the phrase "certifying authority" will mean a recognized kosher certifying organization or rabbi who has received Orthodox rabbinical ordination and is educated in matters of Orthodox Jewish law;
provide a written certification from the administrator of the nursing facility that the percentage of the nursing facility's residents requesting kosher foods or products prepared in accordance with Jewish religious dietary requirements is at least 50%; and
upon request, provide the Center with documentation of expenses related to the provision of kosher food services, including but not limited to, invoices and payroll records.

(b) Payment Amounts.

To determine the add-on amount, EOHHS will determine the statewide median dietary expense per day for all facilities. The add-on equals the difference between the eligible nursing facility's dietary expense per day and the statewide median dietary expense per day, not to exceed $5 per day. In calculating the per day amount, EOHHS will include allowable expenses for dietary and dietician salaries, payroll taxes and related benefits, food, dietary purchased service expense, dietician purchased service expense, and dietary supplies and expenses. The days used in the denominator of the calculation will be the higher of the nursing facility's actual days or 96% of available bed days.
EOHHS will compare the sum of the add-on amounts multiplied by each nursing facility's projected annual rate period Medicaid days to the state appropriation. In the event that the sum exceeds the state appropriation, each nursing facility's add-on will be proportionally adjusted.

(5) Leaves of Absence. If a purchasing agency pays for leaves of absence, the payment rate for a leave of absence day is $80.10 per day, unless otherwise determined by the purchasing agency.

(6) Nursing Cost. Eligible facilities will receive an $91.79 per diem add-on to reflect the difference between the standard payment amounts and actual base year nursing spending. To be eligible for such payment, the Department of Public Health must certify to EOHHS that over 75% of the nursing facility's residents have a primary diagnosis of multiple sclerosis.

(7) Pediatric Nursing Facilities.

(a) Beginning October 1, 2024, EOHHS will determine payments to facilities licensed to provide pediatric nursing facility services using allowable reported operating costs, excluding administrative and general costs, from the nursing facility's 2019 Cost Report. EOHHS will include an administrative and general payment capped at the 85^th percentile of the 2019 statewide administrative and general costs. EOHHS will apply an appropriate cost adjustment factor to operating, and administrative and general costs.

(b) The operating component of the rate is increased by a cost adjustment factor of 23.50%.

(c) Facilities licensed to provide pediatric nursing facility services will receive the operating rate which is the greater of

the rates calculated as described in 101 CMR 206.06(7)(a) and 101 CMR 206.06(7)(b); or
the Operating Cost Standard rate as listed in 101 CMR 206.04(2).

(9) Receiverships. EOHHS may adjust a nursing facility's standard rates if a receiver has been appointed under M.G.L. c. 111, § 72N solely to reflect the reasonable costs, as determined by EOHHS and the MassHealth agency, associated with the court-approved closure or sale of the nursing facility or other appropriate situation.

(10) Residential Care Beds. Beginning October 1,2024, the total payment for nursing and other operating costs for residential care beds in a dually licensed nursing facility is $140.41.

(11) State-operated Nursing Facilities. A nursing facility operated by the Commonwealth will be paid at the nursing facility's reasonable cost of providing covered Medicaid services to eligible Medicaid members.

(a) EOHHS will establish an interim per diem rate using a base year CMS-2540 cost report inflated to the rate year using the cost adjustment factor calculated pursuant to 101 CMR 206.06(11)(b) and a final rate using the final rate year CMS-2540 cost report.

(b) EOHHS will determine a cost adjustment factor using a composite index using price level data from the CMS Nursing Home without capital forecast, and regional health care consumer price indices, and the Massachusetts-specific consumer price index (CPI), optimistic forecast. EOHHS will use the Massachusetts CPI as proxy for wages and salaries.

(c) EOHHS may retroactively adjust the final settled amount when the Medicare CMS-2540 cost report is reopened or for audit adjustments.

(12) Low Occupancy Adjustment. Effective October 1, 2022, a nursing facility may be subject to a Low Occupancy Adjustment to its payment rate, according to the following methodology:

(a) Each facility's occupancy is calculated as follows:

Determine the facility's total resident days as reported on quarterly User Fee Assessment Forms covering the period of July 1, 2021, through June 30, 2022;

Determine the facility's total number of licensed beds as of June 30, 2022, minus licensed Level IV beds. Multiply the result by the number of days in the year.
Calculate the facility's occupancy by dividing the result of 101 CMR 206.06(12)(a)1. by the result of 101 CMR 206.06(12)(a)2. and rounding the result to the nearest hundredth of a percent.

(b) Based on the occupancy calculated in 101 CMR 206.06(12)(a), a facility may face a reduction to its nursing standard rate and operating rate, applied at each management minute category as follows:

Except as described in 101 CMR 206.06(12)(b)2., the reduction is applied in accordance with the following chart:

| Occupancy Rate | Low Occupancy Penalty | | --- | --- | | Occupancy below 80.00% | -3.0% | | Occupancy of at least 80.00%, but below 84.00% | -2.0% | | Occupancy of at least 84.00%, but below 88.00% | -1.0% | | Occupancy of at least 88.00% | 0.0% |

For the rate year running from October 1, 2022, through September 30, 2023, the downward adjustment for nursing facilities with occupancy rates at 80.00% or higher shall be waived and the downward adjustment for nursing facilities with occupancy rates below 80.00% shall be -2%.

(c) A nursing facility will be eligible for a one-time reconsideration of its Low Occupancy Adjustment as determined in 101 CMR 206.06(12)(b) to be applied beginning February 1, 2023, if the nursing facility

reduces by any amount its number of licensed beds from the number of licensed beds in the facility as of June 30, 2022, by January 1, 2023; and

submits a completed Low Occupancy Adjustment Request form, along with supporting documentation indicated on the form to EOHHS by January 1, 2023.

(d) Upon receiving a completed Low Occupancy Adjustment Request form and supporting documentation from a nursing facility as described in 206.06(12)(c)2, EOHHS will recalculate the facility's occupancy, as follows:

determine the facility's total resident days as reported on quarterly User Fee Assessment Forms covering the period July 1, 2021, through June 30, 2022;

determine the facility's total number of licensed beds as of January 1, 2023, minus licensed Level IV beds. Multiply the result by the number of days in the year; and
calculate the facility's occupancy rate by dividing the result of 101 CMR 206.06(12)(d)1. by the result of 101 CMR 206.06(12)(d)2. and rounding the result to the nearest hundredth of a percent.

(e) The facility's new occupancy rate, as calculated in 206.06(12)(d)3., will be used to redetermine the amount or applicability of the Low Occupancy Adjustment, as described 206.06(12)(b). Any changes to a facility's Low Occupancy Adjustment as a result of a new occupancy rate will apply solely prospectively, beginning February 1, 2023.

(f) EOHHS will not adjust any Low Occupancy Adjustment solely because a facility under-reported total resident days on its quarterly User Fee Assessment Form.

(13) Direct Care Add-on.

(a) General. Beginning October 1, 2024, a nursing facility will be eligible for an upward adjustment of 3.177% applied to its nursing standard rate and operating standard rate at each PDPM nursing case mix category. Facilities must use the funds from this direct care add-on solely for direct care staff wages, benefits, incentive payments, or other direct care compensation.

(b) Reporting.

Each facility will be required to report to EOHHS on the ways in which it uses its received direct care add-on funds. The required reporting will be incorporated in the interim or final DCC-Q reports that facilities are required to submit by March 1, 2025, and July 31, 2025, respectively, in accordance with 101 CMR 206.12(3). Failure to complete the required supplemental payment reporting on the interim or final DCC-Q reports, as specified and required by MassHealth through administrative bulletin or other written issuance, failure to timely submit the interim or final DCC-Q reports, or failure to use direct care add-on funds on anything other than direct care staff wages, benefits, incentive payments, or other direct care compensation may result in partial or full recoupment of direct care add-on funds as an overpayment under 130 CMR 450.237: Overpayments: Determination .
All information included in the reports regarding the direct care add-on funds is subject to verification and audit by MassHealth. Failure to submit the required reporting or comply with audits or document requests with respect to the requirements herein may result in partial or full recoupment of the direct care add-on funds as overpayments under 130 CMR 450.237: Overpayments: Determination , or sanctions under 130 CMR 450.238: Sanctions: General .

(14) High Medicaid Adjustment. Beginning October 1, 2024, a nursing facility may be eligible for a High Medicaid Adjustment to its payment rate, based on the proportion of the facility's total resident days which are Massachusetts Medicaid days, as reported on the facility's quarterly User Fee Assessment Forms covering the period April 1, 2023, through March 31, 2024. For the purpose of determining eligibility for the High Medicaid Adjustment, the proportion of the facility's total resident days which are Massachusetts Medicaid days will be rounded to the nearest hundredth of a percent.

(a) A facility for which its Massachusetts Medicaid days are at least 75.00% and less than 90.00% of its total resident days will receive a 7% upward adjustment applied to its nursing standard rate and operating standard rate at each PDPM nursing case mix category.

(b) A facility for which Massachusetts Medicaid days are at least 90.00% of its total resident days will receive a 9% upward adjustment applied to its nursing standard rate and operating standard rate at each PDPM nursing case mix category.

(c) EOHHS will not adjust any High Medicaid Adjustment solely because a facility under-reported Massachusetts Medicaid days in its quarterly User Fee Assessment Form.

(15) Maximum Change Adjustment. Beginning October 1, 2024, a nursing facility will be subject to an adjustment to its total standard nursing facility per diem rate at each PDPM nursing case mix category established through 101 CMR 206.04, 101 CMR 206.05, 101 CMR 206.06(2) through (14), and 101 CMR 206.12(4), if a facility's proposed total average per diem rate, beginning October 1, 2024, calculated using the facility's average PDPM nursing case mix in the period October 1, 2023, through March 31, 2024, is greater than 130% of the facility's total average per diem standard nursing facility rate that was in effect on September 30, 2023, calculated using the facility's average MMQ case mix in rate year 2022. The adjustment will be calculated as follows:

(a) determine the facility's proposed total average per diem rate, calculated using the facility's average PDPM nursing case mix in the period October 1, 2023, through March 31, 2024, pursuant to 101 CMR 206.04, 101 CMR 206.05, 101 CMR 206.06(2) through (14), and 101 CMR 206.12(4);

(b) determine 130% of the facility's average per diem rate that was in effect on September 30, 2023, calculated using the facility's average MMQ case mix in rate year 2022;

(d) divide the amount calculated in 101 CMR 206.06(15)(c) by the amount calculated in 101 CMR 206.06(15)(a);

(e) the percentage calculated in 101 CMR 206.06(15)(d) will be applied as a downward adjustment to the total proposed standard nursing facility per diem rate, as established through 101 CMR 206.04, 101 CMR 206.05, 101 CMR 206.06(2) through (14), and 101 CMR 206.12(4), at each PDPM nursing case mix category.

History

Amended by Mass Register Issue 1285, eff. 1/1/2015.

101 CMR, § 206.07 Payments for Individuals in a Disaster Struck Nursing Facility

(1) Payment to a Disaster Struck Nursing Facility for individuals that must be temporarily evacuated to another facility (Resident Accepting Nursing Facility) may continue for up to 30 days after the disaster event.

(2) Payment will be the same as if the individual was residing in the Disaster Struck Nursing Facility. No other payment will be made to either the Disaster Struck Nursing Facility or the Resident Accepting Nursing Facility for evacuated individuals. The Disaster Struck Nursing Facility must meet the following conditions in order to receive payment for evacuated individuals:

(a) The Disaster Struck Nursing Facility must have a contract with the Resident Accepting Nursing Facility. The contract must include:

terms of payment and mechanisms to resolve any contract disputes;
protocols for sharing care and treatment information between the two facilities; and
requirements that both facilities meet all conditions of Medicaid participation, as determined by the MassHealth agency.

(b) The Disaster Struck Nursing Facility must notify the MassHealth agency of the disaster event, maintain records of all evacuated individuals that include each individual's name, date of evacuation, and Resident Accepting Nursing Facility, and update the MassHealth agency on the status of any necessary repairs.

(c) The Disaster Struck Nursing Facility must determine within 15 days of the disaster event whether evacuated individuals will be able to return to the facility within 30 days of the disaster event. If the Disaster Struck Nursing Facility determines that it is not able to reopen within 30 days, it must discharge all evacuated individuals and work with them to choose admission to other facilities or alternative placements. Nothing precludes an evacuated individual from asking to be discharged and admitted to another facility or alternative placement. Payment to the Disaster Struck Nursing Facility will cease when an individual is discharged from the facility.

History

Amended by Mass Register Issue 1310, eff. 10/1/2015.

101 CMR, § 206.08 Reporting Requirements

(1) Required Cost Reports.

(a) Nursing Facility Cost Report. Each provider must complete and file a Nursing Facility Cost Report (SNF-CR) each calendar year with the Center. The Nursing Facility Cost Report must contain the complete financial condition of the provider, including all applicable management company, central office, and real estate expenses. If a provider has closed on or before November 30^th, the provider is not required to file an SNF-CR report.

(b) Realty Company Cost Report. A provider that does not own the real property of the nursing facility and pays rent to an affiliated or nonaffiliated realty company, trust, or other business entity must file or cause to be filed a separate Realty Company Cost Report with the Center.

(c) Management Company Cost Report. A provider must file a separate Management Company Cost Report with the Center for each entity for which it reports management or central office expenses related to the care of Massachusetts publicly aided residents. If the provider identifies such costs, the provider must certify that costs are reasonable and necessary for the care of publicly aided residents in Massachusetts.

(d) Financial Statements. If a provider or its parent organization is required or elects to obtain independent audited financial statements for purposes other than filing an annual Nursing Facility Cost Report in accordance with 101 CMR 206.00, the provider must file a complete copy of these financial statements with the Center, that most closely correspond to the provider's Nursing Facility Cost Report fiscal period. If the Provider or its parent organization does not obtain audited financial statements, the Provider must file with the Center a complete copy of its unaudited financial statements that most closely correspond to the Nursing Facility cost report fiscal period. Nothing in 101 CMR 206.08(1)(d) will be construed as an additional requirement that nursing homes complete audited financial statements solely to comply with the Center's annual cost reporting requirements.

(e) Clinical Data. EOHHS may require providers to submit patient level data for the purpose of measuring clinical performance in a format specified by EOHHS. EOHHS may designate required data, data specifications, and other data collection requirements by administrative bulletin.

(f) CMS-2540 Reports. State operated nursing facilities that meet the definition in 42 CFR 433.50(a)(i) must file a CMS-2540 report with the Center annually. The state-operated nursing facility must report the final disposition made by the Medicare intermediary.

(2) General Cost Reporting Requirements.

(a) Accrual Method. Providers must complete all required reports using the accrual method of accounting.

(b) Documentation of Reported Costs. Providers must maintain accurate, detailed, and original financial records to substantiate reported costs for a period of at least five years following the submission of required reports or until the final resolution of any appeal of a rate for the period covered by the report, whichever is later. Providers must maintain complete documentation of all of the financial transactions and census activity of the provider and affiliated entities including, but not limited to, the books, invoices, bank statements, canceled checks, payroll records, governmental filings, and any other records necessary to document the provider's reported costs. Providers must be able to document expenses relating to affiliated entities for which it has identified costs related to the care of Massachusetts publicly aided residents whether or not they are related parties.

(c) Fixed Asset Ledger. Providers must maintain a fixed asset ledger that clearly identifies each asset for which expenses are reported, including location, date of purchase, cost, salvage value, accumulated depreciation, and the disposition of sold, lost, or fully depreciated assets.

(d) Job Descriptions and Time Records. Providers and management companies must maintain written job descriptions including qualifications, duties, responsibilities, and time records such as time cards for all positions that the provider identifies as related to the care of Massachusetts publicly aided residents. Facilities organized as sole proprietors or partnerships in which the sole proprietor or partner functions as administrator with no reported administrator salary or benefits must maintain documentation to support the provision of administrator services by the sole proprietor or partner.

(e) Indirect Restorative Therapy Services Record. Providers must maintain a record of indirect restorative therapy services documented by a written summary available for inspection in the nursing facility as required by 105 CMR 150.010(F): Records and Reports .

(f) Other Cost Reporting Requirements.

Administrative Costs.

a. The following expenses must be reported as administrative:

i. all compensation, including payroll taxes and benefits, for the positions of administrator, assistant administrator, administrator-in-training, business manager, secretarial and clerical staff, bookkeeping staff, and all staff or consultants whose duties are primarily administrative rather than directly related to the provision of on-site care to residents or to the on-site physical upkeep of the nursing facility;

ii. expenses related to tasks performed by persons at a management level above that of an on-site provider department head, that are associated with monitoring, supervising, and/or directing services provided to residents in a nursing facility as well as legal, accounting, financial, and managerial services or advice including computer services and payroll processing; and

iii. expenses related to policy making, planning, and decision making activities necessary for the general and long-term management of the affairs of a nursing facility, including but not limited to the following: the financial management of the provider, including the cost of financial accounting and management advisory consultants, the establishment of personnel policies, the planning of resident admission policies, and the planning of the expansion and financing of the provider.

b. Providers must report the cost of administrative personnel to the appropriate account. The cost of administrative personnel includes all expenses, fees, payroll taxes, fringe benefits, salaries, or other compensation.

c. Providers may allocate administrative costs among two or more accounts. The provider must maintain specific and detailed time records to support the allocation.

Draw Accounts. Providers may not report or claim proprietorship or partnership drawings as salary expense.

Expenses that Generate Income. Providers must identify the expense accounts that generate income.

Fixed Costs.

a. Additions. If the square footage of the building is enlarged, providers must report all additions and renovations as building additions.

b. Allocation. Providers must allocate all fixed costs, except equipment, on the basis of square footage. A provider may elect to specifically identify equipment related to the nursing facility. The provider must document each piece of equipment in the fixed asset ledger. If a provider elects not to identify equipment, it must allocate equipment on the basis of square footage.

c. Replacement of Beds. If a provider undertakes construction to replace beds, it must write off the fixed assets that are no longer used to provide care to publicly aided residents and may not identify associated expenses as related to the care of Massachusetts publicly aided residents.

d. Fully Depreciated Assets. Providers must separately identify fully depreciated assets. Providers must report the costs of fully depreciated assets and related accumulated depreciation on all cost reports unless they have removed such costs and accumulated depreciation from the provider's books and records. Providers must attach a schedule of the cost of the retired equipment, accumulated depreciation, and the accounting entries on the books and records of the provider to the cost report when equipment is retired.

e. Major Repair Projects. Providers must report all expenditures for major repair projects whose useful life is greater than one year, including, but not limited to, wallpapering and painting as improvements. Providers may not report such expenditures as prepaid expenses.

Laundry Expense. Providers must separately identify the expense associated with laundry services for which non-publicly aided residents are billed. Providers must identify such expense as non-related to Medicaid patient care.

Mortgage Acquisition Costs. Providers must classify mortgage acquisition costs as other assets. Providers may not add mortgage acquisition costs to fixed asset accounts.

Nursing Costs. The costs must be associated with direct resident care personnel and be required to meet federal and state laws.

Related Parties. Providers must disclose salary expense paid to a related party and must identify all goods and services purchased from a related party. If a provider purchases goods and services from a related party, it must disclose the related party's cost of the goods and services.

(g) Special Cost Reporting Requirements.

Facilities in Which Other Programs Are Operated. If a provider operates an adult day health program, an assisted living program, or provides outpatient services, the provider must exclude the expenses of such programs because they are not related to the provision of nursing facility care of Massachusetts publicly aided residents.

a. If the provider converts a portion of the facility to another program, the provider must identify the existing equipment no longer used in nursing facility operations and remove such equipment from the nursing facility records. Related depreciation expense for these fixed assets is no longer an allowable expense.

b. The provider must identify the total square footage of the existing building, the square footage associated with the program, and the equipment associated with the program.

c. The provider must allocate all shared costs, including shared capital costs, using a well-documented and generally accepted allocation method. The provider must directly assign to the program any additional capital expenditures associated with the program.

Hospital-based Nursing Facilities. A hospital-based nursing facility must file cost reports on a fiscal year basis consistent with the fiscal year used in the Massachusetts Hospital Cost Report.

a. The provider must identify the existing building and improvement costs associated with the nursing facility. The provider must allocate such costs on a square footage basis.

b. The provider must report major moveable equipment and fixed equipment in a manner consistent with the Hospital Cost Report. In addition, the provider must classify fixed equipment as either building improvements or equipment in accordance with the definitions contained in 101 CMR 206.02. The provider may elect to report major moveable and fixed equipment by one of two methods.

i. A provider may elect to specifically identify the major moveable and fixed equipment directly related to the care of publicly aided residents in the nursing facility. The provider must maintain complete documentation in a fixed asset ledger that clearly identifies each piece of equipment and its cost, date of purchase, and accumulated depreciation. The provider must submit this documentation to the Center with its first Notification of Change in Beds.

ii. If the provider elects not to identify specifically each item of major moveable and fixed equipment, EOHHS will allocate fixed equipment on a square footage basis.

c. The provider must report additional capital expenditures directly related to the establishment of the nursing facility within the hospital as additions. EOHHS will allocate capital expenditures that relate to the total plant on a square footage basis.

d. The provider must use direct costing whenever possible to obtain operating expenses associated with the nursing facility. The provider must allocate all costs shared by the hospital and the nursing facility using the statistics specified in the Hospital Cost Report instructions. The provider must disclose all analysis, allocations, and statistics used in preparing the Nursing Facility Cost Report.

(3) General Cost Principles. In order to report a cost as related to Medicaid patient care, a cost must satisfy the following criteria.

(a) The cost must be ordinary, necessary, and directly related to the care of publicly aided residents.

(b) The cost must adhere to the prudent buyer concept.

(c) Expenses otherwise allowable will not be included for purposes of determining rates under 101 CMR 206.00 where such expenses are paid to a related party unless the provider identifies any such related party and expenses attributable to it in the reports submitted under 101 CMR 206.00 and demonstrates that such expenses do not exceed the lower of the cost to the related party or the price of comparable services, facilities, or supplies that could be purchased elsewhere. The Center may request either the provider or the related party, or both, to submit information, books, and records relating to such expenses for the purpose of determining whether the expenses are allowable.

(d) Only the provider's contribution of generally available employee benefits will be deemed an allowable cost. Providers may vary generally available employee benefits by groups of employees at the option of the employer. To qualify as a generally available employee benefit, the provider must establish and maintain evidence of its nondiscriminatory nature. Generally available employee benefits include, but are not limited to, group health and life insurance, pension plans, seasonal bonuses, child care, and job related education and staff training. Bonuses related to profit, private occupancy, or directly or indirectly to rates of reimbursement will not be included for calculation of prospective rates. Benefits that are related to salaries will be limited to allowable salaries. Benefits, including pensions, related to non-administrative and non-nursing personnel must be included as part of operating costs. Benefits that are related to the director of nurses, including pensions and education, must be included as part of nursing costs. Providers may accrue expenses for employee benefits such as vacation, sick time, and holidays that employees have earned but have not yet taken, provided that these benefits are both stated in the written policy and are the actual practice of the provider and that such benefits are guaranteed to the employee even upon death or termination of employment. Such expenses may be recorded and claimed for reimbursement purposes only as of the date that a legal liability has been established.

(e) The cost must be for goods or services actually provided in the nursing facility.

(f) The cost must be reasonable.

(g) The cost must actually be paid by the provider. Costs not considered related to the care of Massachusetts publicly aided residents include, but are not limited to, costs discharged in bankruptcy; costs forgiven; costs converted to a promissory note; and accruals of self-insured costs based on actuarial estimates.

(h) A provider must report the following costs as non-allowable costs:

bad debts, refunds, charitable contributions, and courtesy allowances and contractual adjustments to the Commonwealth and other third parties;
federal and state income taxes, except the non-income related portion of the Massachusetts corporate excise tax;
expenses not directly related to the provision of resident care including, but not limited to, expenses related to other business activities and fund raising, gift shop expenses, research expenses, rental expense for space not required by the Department and expenditure of funds received under federal grants for compensation paid for training personnel and expenses related to grants of contracts for special projects;
compensation and fringe benefits of residents on a provider's payroll;
penalties and interest, incurred because of late payment of loans or other indebtedness, late filing of federal and state tax returns, or from late payment of municipal taxes;
any increase in compensation or fringe benefits granted as an unfair labor practice after a final adjudication by the court of last resort;
expenses for purchased service nursing services purchased from temporary nursing agencies not registered with the Department under 105 CMR 157.000: The Registration and Operation of Temporary Nursing Service Agencies or paid for at rates greater than the rates established by EOHHS pursuant to 101 CMR 345.00: Temporary Nursing Services ;
any expense or amortization of a capitalized cost that relates to costs or expenses incurred prior to the opening of the nursing facility;

all legal expenses, including those accounting expenses and filing fees associated with any appeal process;

prescribed legend drugs for individual patients;
recovery of expense items, that is, expenses that are reduced or eliminated by applicable income including, but not limited to, rental of quarters to employees and others, income from meals sold to persons other than residents, telephone income, vending machine income, and medical records income. Vending machine income will be recovered against other operating costs. Other recoverable income will be recovered against an account in the appropriate cost group category, such as administrative and general costs, other operating costs, nursing costs, and capital costs. The cost associated with laundry income that is generated from special services rendered to private patients must be identified and eliminated from the facility's claim for reimbursement. Special services are those services not rendered to all patients ( e.g ., dry cleaning, etc .). If the cost of special services cannot be determined, laundry income will be recovered against laundry expense;
costs of ancillary services required by a purchasing agency to be billed on a direct basis, such as prescribed drugs and direct therapy costs;
accrued expenses that remain unpaid more than 120 days after the close of the reporting year, excluding vacation and sick time accruals, will not be included in the prospective rates. When the Center receives satisfactory evidence of payment, EOHHS may reverse the adjustment and include that cost, if otherwise allowable, in the applicable prospective rates;
interest expense from related-party loans or on long-term debt that was not used to finance the purchase of nursing facility fixed asset additions; and
expenses paid for using funds from any low-interest or forgivable loan administered by EOHHS.

(4) Filing Deadlines.

(a) General. Except as provided in 101 CMR 206.08(4)(a)1. and 2., or in accordance with alternative deadlines established by EOHHS or the Center through administrative bulletin or other written issuance, providers must file required cost reports for the calendar year within 60 days of the deployment of the annual Nursing Facility Cost Report. If the 60^th day falls on a weekend or holiday, the reports are due by 5:00 P.M. on the following business day.

Hospital-based Nursing Facilities. Hospital-based nursing facilities must file cost reports no later than 90 days after the close of the hospital's fiscal year.

Appointment of a Resident Protector Receiver. If a receiver is appointed pursuant to M.G.L. c. 111, § 72N, the provider must file cost reports for the current reporting period or portion thereof, within 60 days of the receiver's appointment.

(b) Extension of Filing Date. The Center may grant a request for an extension of the filing due date for a maximum of 30 calendar days. In order to receive an extension, the provider must

submit the request itself, and not by agent or other representative;
demonstrate exceptional circumstances that prevent the provider from meeting the deadline; and
file the request with the Center no later than 30 calendar days before the due date.

(c) Administrative Bulletin. The Center may modify the filing deadlines by issuing an administrative bulletin 30 days prior to any proposed change.

(5) Incomplete Submissions. If the cost reports are incomplete, the Center will notify the provider in writing within 120 days of receipt. The Center will specify the additional information that the provider must submit to complete the cost reports. The provider must file the required information within 25 days of the date of notification or by April 1^st of the year the cost reports are filed, whichever is later. If the Center fails to notify the provider within the 120-day period, the cost reports will be considered complete and will be deemed to be filed on the date of receipt.

(6) Audits. The Center and the MassHealth agency may conduct desk audits or field audits to ensure accuracy and consistency in reporting. Providers must submit additional data and documentation relating to the cost report, the operations of the provider and any related party as requested during a desk or field audit even if the Center has accepted the provider's cost reports.

(7) Penalties. If a provider does not file the required cost reports by the due date, EOHHS may reduce the provider's rates for current services by 5% on the day following the date the submission is due and 5% for each month of noncompliance thereafter. The reduction accrues cumulatively such that the rate reduction equals 5% for the first month late, 10% for the second month late, and so on. The rate will be restored effective on the first of the month following the date the cost report is filed.

History

Amended by Mass Register Issue 1285, eff. 1/1/2015.

101 CMR, § 206.09 Special Provisions

(1) Rate Filings. EOHHS will file certified rates of payment for nursing facilities with the Secretary of the Commonwealth.

(2) Appeals. A provider may file an appeal at the Division of Administrative Law Appeals of any rate established pursuant to 101 CMR 206.00 within 30 calendar days after EOHHS files the rate with the Secretary of the Commonwealth. EOHHS may amend a rate or request additional information from the provider even if the provider has filed a pending appeal.

(3) Administrative Bulletins. EOHHS and the Center may issue administrative bulletins to clarify provisions of 101 CMR 206.00 or to specify data collection requirements. Such bulletins will be deemed to be incorporated in the provisions of 101 CMR 206.00. EOHHS and the Center will file the bulletins with the Secretary of the Commonwealth, distribute copies to providers, and make the bulletins accessible to the public at EOHHS's and the Center's offices during regular business hours.

(4) Severability. The provisions of 101 CMR 206.00 are severable. If any provision of 101 CMR 206.00 or the application of any provision of 101 CMR 206.00 is held invalid or unconstitutional, such provision will not be construed to affect the validity or constitutionality of any other provision of 101 CMR 206.00 or the application of any other provision.

History

Amended by Mass Register Issue 1285, eff. 1/1/2015.

101 CMR, § 206.10 Other Payment Provisions

(1) Temporary Resident Add-on.

(a) For dates of service beginning October 1, 2022, a nursing facility will be eligible for a member-specific temporary resident add-on if the resident meets all of the following criteria:

MassHealth is the resident's primary payer for nursing facility services at the time of admission;
the resident is medically eligible for nursing facility services under 130 CMR 456.409: Services Requirement for Medical Eligibility ;

the resident was transferred to the nursing facility for temporary residence purposes directly from their home; and

the resident was discharged from the nursing facility to their home within 30 calendar days of the admission date.

(b) Payment Amount. For individuals younger than 22 years old, the add-on is $250 per member per day. For individuals 22 years of age or older, the add-on is $130 per member per day.

(2) Ventilator Add-on. For dates of service beginning October 1, 2024, a nursing facility that provides ventilator services to ventilator-dependent MassHealth members will receive a member-specific ventilator add-on of $343 per member per day, provided all of the following criteria are met:

(a) MassHealth is the resident's primary payer for nursing facility services at the time of admission;

(b) The resident requires ventilator services at least daily;

(c) The facility is approved by EOHHS to provide specialized ventilator-dependent services, in accordance with processes established through administrative bulletin or other written issuance;

(d) The facility maintains a program for specialized ventilator services, in accordance with MassHealth requirements established through administrative bulletin or other written issuance; and

(e) The facility is not receiving the communication-limited resident ventilator add-on described in 101 CMR 206.10(3) or the tracheostomy add-on described in 101 CMR 206.10(6) for the resident.

(3) Communication-limited Resident Ventilator Add-on. For dates of service beginning October 1, 2024, a nursing facility that provides services to ventilator-dependent MassHealth members will receive a member-specific add-on of $457 per member per day, provided all of the following criteria are met:

(a) MassHealth is the resident's primary payer for nursing facility services at the time of admission;

(b) The resident requires ventilator services at least daily and is unable to communicate without the assistance of specialized communication technology that relies on eye movements, such as certain individuals with advanced amyotrophic lateral sclerosis (ALS);

(c) The facility is approved by EOHHS to provide specialized ventilator-dependent services, in accordance with processes established through administrative bulletin or other written issuance;

(d) The facility maintains a program for specialized ventilator services, in accordance with MassHealth requirements established through administrative bulletin or other written issuance; and

(e) The facility is not receiving the ventilator add-on described in 101 CMR 206.10(2) or the tracheostomy add-on described in 101 CMR 206.10(6) for the resident.

(4) COVID-19 Testing Supplemental Payment.

(a) Supplemental Payment Methodology. For the period of July 1, 2022, through April 30, 2023, EOHHS will pay nursing facilities a monthly supplemental payment to offset the cost of COVID-19 tests needed for staff surveillance testing requirements established by DPH, resident testing, and visitor testing. Each monthly supplemental payment shall be calculated as follows for each facility.

Determine the total staff who were up to date with their COVID-19 vaccination status and multiply by 4.
Determine the total staff who are not up to date with their COVID-19 vaccination status and multiply by 8.
Determine the total resident census and multiply by 5 to account for resident and visitor testing.
Add together the three products calculated in 101 CMR 206.10(4)(a)1. through
Multiply the sum calculated in 101 CMR 206.10(4)(a)4. by $12. This product will equal the facility's monthly COVID-19 testing supplemental payment.

(b) Definitions. For the purposes of 101 CMR 206.10(4), the following terms shall have the following meanings.

Calendar Quarter. Each of the four three-month periods in a given calendar year, running from January 1^st through March 31^st, April 1^st through June 30^th, July 1^st through September 30^th, and October 1^st through December 31^st.

Total Staff. The total quarterly average number of staff working at the facility as reported by the facility through the Centers for Disease Control and Prevention's National Healthcare Safety Network reporting tool (NHSN) for the most recent complete calendar quarter.

Total Resident Census. The total quarterly average number of residents in the facility as reported by the facility through NHSN for the most recent complete calendar quarter.

COVID-19 Vaccination Status. A determination of whether a person is up to date or not up to date in receiving their COVID-19 vaccines in accordance with DPH COVID-19 vaccination guidance for long term care facility staff, as reported by the facility through NHSN for the most recent complete calendar quarter.

(c) Disbursement of Supplemental Payments. The supplemental payments are paid on a monthly basis, and the payment amount shall be updated every three months, based on the previous, available calendar quarter data.

(d) Additional Guidance. EOHHS may, via administrative bulletin or other written issuance, establish a different data source for calculating the COVID-19 testing supplemental payments under 101 CMR 206.10(4), or establish additional rules governing such payments including, but not limited to, information on the relevant staff that must be tested, the frequency of testing, or additional reporting requirements.

(e) Correction of Material Error. EOHHS may adjust any testing supplemental payment upon EOHHS's determination that there was a material error in the calculation of the payment. EOHHS will not adjust any supplemental payment solely because a facility under-reported staff or resident numbers in its NHSN report.

(f) Audits and Enforcement. All information included in the NHSN reports is subject to verification and audit by EOHHS. Such verification or audit may include an in-person or desk audit, comparison of data to other data sources available to EOHHS, such as the federal Payroll Based Journal staffing level reporting tool, or other verification or audit mechanisms available to EOHHS. In the event that EOHHS determines a facility materially misstated or inaccurately reported information relevant to calculating the COVID-19 testing supplemental payment, EOHHS may pursue overpayment or sanction action under 130 CMR 450.000: Administrative and Billing Regulations .

(6) Tracheostomy Add-on. For dates of service beginning October 1, 2022, a nursing facility that provides tracheostomy services to tracheostomy-dependent MassHealth members will receive a member-specific tracheostomy add-on of $220 per member per day, provided all of the following criteria are met:

(a) MassHealth is the resident's primary payer for nursing facility services at the time of admission;

(b) the resident requires tracheostomy services; and

(c) the facility is not receiving the ventilator add-on described in 101 CMR 206.10(2) or the communication-limited resident ventilator add-on described in 101 CMR 206.10(3) for the resident.

(7) Medicaid Transitional Add-on. For dates of service beginning January 15, 2022, a nursing facility will be eligible for a transitional add-on of $200 per member per day for the first 60 days of the resident's nursing facility stay, not including any leaves of absence, if the resident meets all of the following criteria:

(a) MassHealth is the resident's primary payer for nursing facility services at the time of admission;

(b) The resident was transferred to the nursing facility directly from an acute or a non-acute inpatient hospital on or after January 15, 2022; and

(8) COVID-19 Monoclonal Antibody Treatment and COVID-19 Antiviral Treatment Claims.

(a) For dates of service beginning December 22, 2021, and notwithstanding any regulatory provision to the contrary, nursing facilities may submit separate claims to MassHealth on a fee-for-service basis for the administration of COVID-19 monoclonal antibody treatments and COVID-19 antiviral treatments to eligible MassHealth members and provided in a manner supported by medical evidence, provided in accordance with the emergency use authorization (EUA) issued by the federal Food and Drug Administration (FDA) or provided in accordance with full FDA approval, and provided in accordance with any guidance issued by DPH, the FDA, or CMS with respect to such treatments. Nursing facilities are required to ensure that any such monoclonal antibody treatments or antiviral treatments administered at the facility are administered by individuals whose education, credentials, and training qualify them to render such services.

(b) The costs of services described in 101 CMR 206.10(8)(a) are not included in the prospective payment system operating or nursing standard payment rates determined under 101 CMR 206.03 and 101 CMR 206.04. The costs of providing such services will be considered non-allowable costs under 101 CMR 206.08(3)(h)12.

(c) MassHealth payments for separate fee-for-service claims submitted by the nursing facility for the services described in 101 CMR 206.10(8)(a) must be paid at the rates established under 101 CMR 446.03(2) or 101 CMR 317.00, as applicable. Such fee-for-service claims payments must be considered payment in full for such services.

(d) EOHHS must establish, through administrative bulletin or other written issuance, the specific COVID-19 monoclonal antibody treatments or COVID-19 antiviral treatments that may be administered by the nursing facility, as well as the specific codes and billing instructions for such services.

(9) COVID-19 Vaccine Administration Claims.

(a) For dates of service beginning October 1, 2021, and notwithstanding any regulatory provision to the contrary, nursing facilities may submit separate claims to MassHealth on a fee-for-service basis for COVID-19 vaccine administration services, provided to eligible MassHealth members in accordance with an EUA issued by the FDA or full FDA approval, and in accordance with any guidance issued by the FDA or CMS with respect to such services. Nursing facilities are required to ensure that any such services administered by the facility are administered by individuals whose education, credentials, and training qualify them to render such services.

(b) The costs of services described in 101 CMR 206.10(9)(a) are not included in the prospective payment system operating or nursing standard payment rates determined under 101 CMR 206.03 and 101 CMR 206.04. The costs of providing such services will be considered non-allowable costs under 101 CMR 206.08(3)(h)12.

(c) MassHealth payments for separate fee-for-service claims submitted by the nursing facility for the services described in 101 CMR 206.10(9)(a) must be paid at the rates established under 101 CMR 446.03(2): Medicine . Such fee-for-service claims must be considered payment in full for such services.

(d) EOHHS must establish, through administrative bulletin or other written issuance, the specific codes and billing instructions for such services.

(10) Time-limited COVID-19 Monthly Staffing Supplemental Payment.

(a) General. A nursing facility will be eligible for supplemental payments to offset increased costs of providing care not accounted for in the nursing facility's prospective payment system rates during the COVID-19 pandemic. The supplemental payments will be made over six months, in the months of January, February, March, April, May, and June 2022. Supplemental payments will be distributed to nursing facilities based on their proportion of the total Medicaid Days reported by all nursing facility providers. The period used to determine each nursing facility's proportion of the total Medicaid Days is April 1, 2021, through September 30, 2021, as reported on each nursing facility's User Fee Assessment Forms for that period. These payments are to be used to pay for increased direct-care staffing costs incurred for dates of service beginning January 1, 2022, through June 30, 2022.

(b) Calculation of a Monthly Supplemental Payment. EOHHS will use the following methodology to calculate the time-limited COVID-19 monthly supplemental payments for each MassHealth nursing facility provider:

Divide the number of Massachusetts Medicaid Days as reported by each nursing facility provider on their Quarterly User Fee Assessment Form for the period of April 1, 2021, through September 30, 2021, by the total number of Massachusetts Medicaid Days, including Fee-For-Service and Managed Care bed days, across all nursing facility providers, as reported by all nursing facility providers on the Quarterly User Fee Assessment Form for the same period.
Multiply the quotient calculated in 101 CMR 206.10(10)(b)1. by $58,600,000.
Divide the product calculated in 101 CMR 206.10(10)(b)2. by six.
Each COVID-19 monthly supplemental payment shall equal the amount calculated in 101 CMR 206.10(10)(b)3. for each nursing facility.

(c) Correction of Material Error. EOHHS may adjust any supplemental payment upon EOHHS's determination that there was a material error in the calculation of the payment. EOHHS will not adjust any supplemental payment solely because a facility under-reported Massachusetts Medicaid days in its Quarterly User Fee Assessment Form.

(d) Permissible Uses of COVID-19 Staffing Supplemental Payments.

Facilities may use the COVID-19 supplemental payment only for the following direct-care staff expenses: increases in base wages or retention bonuses for directly employed staff, signing bonuses for new employees, premium pay, shift differentials, and expenses related to temporary nursing agency staff. The permissible expenses to be funded through these supplemental payments must be incurred by June 30,
For the purposes of the COVID-19 supplemental payment, direct-care staff shall include the following staff categories: registered nurses; licensed practical nurses; certified nurse aides; non-certified or resident care aides; director of nurses; in-house clerical staff regularly interacting with residents and caregivers ( e.g. , receptionists, unit clerks, business office staff working on-site); security staff; staff development coordinators; dietary staff; housekeeping/laundry staff; quality assurance professional staff; MMQ evaluation nurse/MDS coordinators; social service workers; behavioral health staff; plant operations/maintenance staff; interpreter service staff; restorative therapy staff; recreational therapy staff; physician services staff; and pharmacy consultant staff. Direct-care staff shall not include nursing facility administrators.

(e) Reporting Requirements.

Each facility will be required to report to EOHHS on the ways in which it expects to use, and ultimately uses, its received supplemental payments. The required reporting will be incorporated in the interim and final DCC-Q reports that facilities are required to submit by March 1, 2022, and July 30, 2022, respectively, in accordance with 101 CMR 206.12(3). Failure to complete the required supplemental payment reporting on the interim and final DCC-Q reports, failure to timely submit the interim or final DCC-Q reports, use of funds on anything other than permissible uses described herein, failure to incur permissible expenses to be funded through these supplemental payments by June 30, 2022, or failure to actually pay the supplemental payments for such incurred permissible expenses may result in partial or full recoupment of received supplemental payments as an overpayment under 130 CMR 450.237: Overpayments: Determination .
All information included in the reports regarding supplemental payments is subject to verification and audit by EOHHS. Failure to submit the required reporting or comply with audits or document requests with respect to the requirements herein may result in partial or full recoupment of the supplemental payments as overpayments under 130 CMR 450.237: Overpayments: Determination , or sanctions under 130 CMR 450.238: Sanctions: General .
EOHHS may, via administrative bulletin or other written issuance, provide further detail, or establish additional reporting requirements with respect to this supplemental payment.

(11) Workforce Supplemental Payment.

(a) Calculation of Supplemental Payment. Effective January 15, 2022, a nursing facility will be eligible for a Workforce Supplemental Payment, to support workforce retention and recruitment efforts during the COVID-19 pandemic, calculated for each nursing facility as follows:

Determine the total number of Massachusetts Medicaid days, including fee-for-service (FFS) days and managed care days, as reported by all nursing facilities in their Quarterly User Fee Assessment Forms for the period of April 1,2021, through September 30,
Divide the total amount of available funds, $25,000,000, by the total number of Massachusetts Medicaid days as determined in 101 CMR 206.10(11)(a)1.
For each nursing facility, multiply the quotient calculated in 101 CMR 206.10(11)(a)2. by the nursing facility's Massachusetts Medicaid days, including FFS days and managed care days, as reported in the nursing facility's Quarterly User Fee Assessment Forms for the period of April 1, 2021, through September 30, 2021.
The total Workforce Supplemental Payment will equal the total calculated in 101 CMR 206.10(11)(a)3. for each nursing facility.

(b) Correction of Material Error. EOHHS may adjust any Workforce Supplemental Payment upon EOHHS's determination that there was a material error in the calculation of the payment. EOHHS will not adjust any Workforce Supplemental Payment solely because a facility under-reported Massachusetts Medicaid days in its Quarterly User Fee Assessment Form.

Facilities shall use these Workforce Supplemental Payments to support direct-care staff recruitment and retention initiatives that may include but are not limited to increases in base wages and/or retention bonuses for directly employed staff, signing bonuses for new employees, premium pay, and shift differentials. The permissible expenses to be funded through these Workforce Supplemental Payments must be incurred by June 30, 2022.
For the purposes of the Workforce Supplemental Payment, direct-care staff shall include the following staff categories: registered nurses; licensed practical nurses; certified nurse aides; non-certified or resident care aides; director of nurses; in-house clerical staff regularly interacting with residents and caregivers ( e.g ., receptionists, unit clerks, business office staff working on-site); security staff; staff development coordinators; dietary staff; housekeeping/laundry staff; quality assurance professional staff; MMQ evaluation nurse/MDS coordinators; social service workers; behavioral health staff; plant operations/maintenance staff; interpreter service staff; restorative therapy staff; recreational therapy staff; physician services staff; and pharmacy consultant staff. Direct-care staff shall not include nursing facility administrators or temporary nursing agency staff.

(d) Reporting Requirements.

Each facility will be required to report to EOHHS on the ways in which it expects to use, and ultimately uses, its received Workforce Supplemental Payments. The required reporting will be incorporated in the interim and final DCC-Q reports that facilities are required to submit by March 1,2022, and July 30, 2022, respectively, in accordance with 101 CMR 206.12(3). Failure to complete the required Workforce Supplemental Payment reporting on the interim and final DCC-Q reports, failure to timely submit the interim or final DCC-Q reports, use of funds on anything other than permissible uses described herein, failure to incur permissible workforce expenses by June 30, 2022, or failure to actually pay the Workforce Supplemental Payment for such incurred permissible workforce expenses may result in partial or full recoupment of received Workforce Supplemental Payments as overpayments under 130 CMR 450.237: Overpayments: Determination .
All information included in the reports regarding Workforce Supplemental Payments is subject to verification and audit by EOHHS. Failure to submit the required or comply with audits or document requests with respect to the requirements herein may result in partial or full recoupment of the Workforce Supplemental Payments as overpayments under 130 CMR 450.237: Overpayments: Determination , or sanctions under 130 CMR 450.238: Sanctions: General .
EOHHS may, via administrative bulletin or other written issuance, establish additional reporting requirements with respect to this supplemental payment.

(13) Homelessness Rate Add-on.

(a) Eligibility Criteria. For dates of service beginning January 15, 2022, a nursing facility will be eligible for a member-based homelessness rate add-on of $200 per member per day for up to the first 180 days of the member's nursing facility stay, not including any leaves of absence, if the member meets all of the following criteria.

MassHealth is the member's primary payer for nursing facility services at the time of admission;
The member is clinically eligible for nursing facility services under 130 CMR 456.409: Services Requirement for Medical Eligibility ; and
The member has been approved for the member-based homelessness rate add-on by EOHHS because EOHHS has determined the member meets one or more of the following criteria:

a. The member has experienced homelessness for at least six months directly prior to admission as documented by a homeless provider agency and confirmed by EOHHS;

b. The member has been homeless directly prior to admission, as documented by a homeless provider agency and confirmed by EOHHS, and has a behavioral health condition;

c. The member is at risk of homelessness and has a behavioral health condition;

d. The member experienced a sudden or unexpected loss of primary residence (for example, due to fire, flooding, eviction, etc .) necessitating an emergency nursing facility admission; or

e. The member's living situation directly prior to admission required the involvement of Elder Protective Services.

(b) Non-applicability with Other Payments. A nursing facility may not receive this add-on for a member for whom the facility is receiving on the same dates of service a Medicaid transitional add-on under 101 CMR 206.10(7), a substance use disorder add-on or a substance use disorder induction period add-on under 101 CMR 206.10(14), a behavioral indicator add-on under 101 CMR 206.10(16), a bariatric add-on under 101 CMR 206.10(21), a per diem rate for severe mental or neurological disorders under 101 CMR 206.11, or a complicated high-cost care need add-on under 101 CMR 206.15.

For the purposes of the homelessness rate add-on, a member experiencing homelessness is any member who lacks a fixed, regular, and adequate nighttime residence and who has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car, park, abandoned building, bus or train station, airport, or camping group; or who is living in a supervised publicly- or privately-operated emergency shelter designated to provide temporary living arrangements, including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low-income individuals.
For the purposes of the homelessness rate add-on, a member at risk of homelessness is any member who does not have sufficient resources or support networks ( e.g ., family, friends, faith-based or other social networks) immediately available to prevent them from moving to an emergency shelter or another place not meant for human habitation.

(14) Substance Use Disorder (SUD) Add-on and SUD Induction Period Add-on.

(a) Eligibility Criteria.

For dates of service beginning October 1, 2024, a nursing facility that meets the criteria set forth in 101 CMR 206.10(14)(a)3. or 4., as applicable, will be eligible for a member specific Substance Use Disorder (SUD) add-on of $50 per member per day for each member residing in the facility, for whom MassHealth is the primary payer, who has a documented SUD diagnosis listed in 101 CMR 206.10(14)(b) and who receives at least one SUD service or treatment listed in 101 CMR 206.10(14)(c).
For dates of services beginning October 1, 2024, a nursing facility that meets the criteria set forth in 101 CMR 206.10(14)(a)(3) or (4), as applicable, will be eligible for a member specific SUD induction period add-on of $200 per member per day of induction period for each member residing in the facility, for whom MassHealth is the primary payer, who has a documented SUD diagnosis listed in 101 CMR 206.10(14)(b), and who requires transportation with direct care staff to an Opioid Treatment Program (OTP) clinic for the member's induction period.
The facility will be eligible to receive the add-ons under 101 CMR 206.10(14)(a)(1) and (2) only if it submits to EOHHS an attestation in a form and manner specified by EOHHS by the deadline specified by EOHHS confirming that the facility has processes in place to provide services to residents with SUD. This provision applies to all facilities unless they are a High-SUD nursing facility as described in 101 CMR 206.10(14)(a)(4).
A facility that meets the criteria for a High-SUD nursing facility, as determined by EOHHS, will be eligible to receive the add-ons under 101 CMR 206.10(14)(a)(1) and (2) only if:

i. The facility submits to EOHHS an attestation in a form and manner specified by EOHHS by the deadline specified by EOHHS confirming that the facility has processes in place to provide services to residents with SUD; and

ii. The facility submits to EOHHS:

(1) an attestation in a form and manner specified by EOHHS by the deadline specified by EOHHS, certifying that the facility has executed an appropriate agreement to share data and collaborate with at least one OTP. Such agreement must include agreed-upon policies and procedures as specified by EOHHS in administrative bulletin or other written issuance; and

(2) a copy of the executed agreement.

(b) ICD-10 Groups. For the purposes of the SUD add-on and the SUD induction period add-on, eligible ICD-10 diagnosis groups include F10 through F16 (mental and behavioral disorders due to psychoactive substance), F19 (other psychoactive substance related disorders), and T40 (poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics (hallucinogens)).

(c) SUD Services or Treatment. For the purposes of the SUD add-on and the SUD induction period add-on, eligible SUD services or treatment include opioid treatment services, medication for addiction treatment, and SUD-related counseling. EOHHS may establish further guidance regarding eligible SUD services and treatments through administrative bulletin or other written issuance.

(d) Denial of Payment and Overpayments. Facilities that fail to meet the requirements under 101 CMR 206.10(14)(a), (b), or (c) may be denied further SUD add-on payments and may be subject to overpayment action under 130 CMR 450.237: Overpayments: Determination . In addition, facilities that refuse to admit a resident with SUD solely because of their SUD diagnosis may be denied the SUD add-on for the rest of the rate year and may be subject to sanctions under 130 CMR 450.238: Sanctions: General .

(e) Additional Guidance. EOHHS may issue, via administrative bulletin or other written issuance, additional guidance regarding these add-ons, including but not limited to guidance on billing procedures and verification of medical records required to support the SUD diagnoses.

(15) Add-on for Home Dialysis in a Nursing Facility Setting.

(a) Dialysis Treatment for Members. Nursing facilities may have home dialysis services available on-site at the facility, after receiving approval from the Department of Public Health to operate an on-site home dialysis services program, in coordination with a licensed dialysis services provider.

(b) Add-on Rate of $85 per Member per Dialysis Treatment. Nursing facilities with an approved on-site home dialysis services program in accordance with 101 CMR 206.10(15)(a) may receive a rate add-on of $85 per member residing in the facility and receiving home dialysis services in the facility, for each instance of home dialysis services received in the nursing facility for which the following two conditions are concurrently met:

MassHealth is not the primary payer for the member's home dialysis services received in the nursing facility; and

MassHealth is the primary payer for the member's nursing facility services at the time of home dialysis services received in the nursing facility.

(c) Add-on Rate of $379 per Member per Dialysis Treatment. Nursing facilities with an approved on-site home dialysis services program in accordance with 101 CMR 206.10(15)(a) may receive a rate add-on of $379 per member residing in the facility and receiving home dialysis services in the facility, for each instance of home dialysis services received in the nursing facility for which the following two conditions are concurrently met:

MassHealth would be the primary payer for the dialysis services if they were received outside of the nursing facility; and
MassHealth is the primary payer for the member's nursing facility services at the time of home dialysis services received in the nursing facility.

(16) Behavioral Indicator Add-on.

(a) Eligibility Criteria. For dates of service beginning October 1, 2022, a nursing facility will be eligible for a member-specific behavioral indicator add-on of $50 per member per day for each member residing in the facility for whom MassHealth is the primary payer and who was coded as 2 or 3 on one or more of the following Minimum Data Set 3.0 (MDS 3.0) indicators: Behavioral Health (E0200A, E0200B, or E0200C), Rejection of Care (E0800), or Wandering (E0900). The add-on is meant to offset additional costs associated with certain members with behavioral conditions (for example, members with severe dementia).

(b) Additional Guidance. EOHHS may issue, via administrative bulletin or other written issuance, additional guidance regarding this add-on, including but not limited to billing procedures for the behavioral indicator add-on and verification of medical records required to support the MDS coding for the add-on.

(17) Add-on for Dialysis Services Provided at an Affiliated Inpatient Chronic Disease and Rehabilitation Hospital.

(a) Dialysis Treatment for Members. Nursing facility residents may receive dialysis services at an affiliated inpatient chronic disease and rehabilitation hospital that is licensed by DPH and located in the same building, in coordination with a licensed dialysis services provider, as long as the dialysis services are not licensed as outpatient services. If the dialysis services are licensed by DPH as services provided by an outpatient clinic in accordance with 105 CMR 145.000, the nursing facility may not receive the rate add-on under 101 CMR 206.10(17).

(b) Add-on Rate of $85 per Member per Dialysis Treatment. Nursing facilities may receive a rate add-on of $85 per member residing in the nursing facility and receiving dialysis services in a setting that meets the criteria specified in 101 CMR 206.10(17)(a) for each instance of dialysis services received in the affiliated facility for which the following two conditions are concurrently met:

MassHealth is not the primary payer for the member's dialysis services received in the affiliated facility; and
MassHealth is the primary payer for the member's nursing facility services at the time of dialysis services received in the affiliated facility.

(c) Add-on Rate of $379 per Member per Dialysis Treatment. Nursing facilities may receive a rate add-on of $379 per member residing in the nursing facility and receiving dialysis services in a setting that meets the criteria specified in 101 CMR 206.10(17)(a), for each instance of dialysis services received in the affiliated facility for which the following two conditions are concurrently met:

MassHealth would be the primary payer for the dialysis services if they were received outside of the nursing facility; and
MassHealth is the primary payer for the member's nursing facility services at the time of dialysis services received in the affiliated facility.

(18) Payments for Quality Improvements through COVID-19 Preparedness.

(a) General. A nursing facility will be eligible for a COVID-19 preparedness payment, as calculated in 101 CMR 206.10(18)(c), to be made upon verification of eligibility criteria described in 101 CMR 206.10(18)(b).

(b) Eligibility Criteria. A nursing facility will be eligible for a COVID-19 preparedness payment if the facility meets all of the criteria in 101 CMR 206.10(18)(b)1. through 5. MassHealth may provide further detail on such criteria, including on the specific infection control requirements, attestation forms and deadlines, any necessary reporting deadlines, specific requirements for COVID-19 therapeutic plans, and other information as MassHealth determines necessary pursuant to 101 CMR 206.10(18)(f).

The nursing facility

a. had an HPPD, as defined in 101 CMR 206.13(3), of 3.58 or higher for at least one calendar quarter from October 1, 2022, through December 31, 2024; or

b. achieved a minimum of 10% improvement in HPPD in at least one calendar quarter from January 1, 2023, through December 31, 2024, as compared to the calendar quarter ending December 31, 2022.

The nursing facility meets a minimum threshold of staff and residents who are up-to-date with COVID-19 vaccinations, with thresholds and deadlines established by MassHealth through administrative bulletin or other written issuance.
The nursing facility must attest to implementing core components of infection control requirements and outline a plan for ensuring compliance with these requirements and be in continuous substantial compliance with such requirements during the rate year.
A nursing facility must attest to having a plan in place to administer COVID-19 therapeutics, including monoclonal antibodies and antiviral therapies, to its residents as clinically appropriate.
The nursing facility must meet the 75% DCC-Q threshold established under 101 CMR 206.12(1).

(c) Payment Methodology. EOHHS will use the following methodology to calculate COVID-19 preparedness payments for each eligible nursing facility.

Determine the total number of Massachusetts Medicaid days, including fee-for-service (FFS) days and managed care days, as reported by eligible nursing facilities in their Quarterly User Fee Assessment Forms for the period of July 1, 2021, through June 30,
Determine which of the two thresholds of staff and residents who are up-to-date with COVID-19 vaccinations a nursing facility meets.
If the facility meets the higher of the two thresholds in 101 CMR 206.10(18)(c)2., multiply by 3 the number of Massachusetts Medicaid days, including fee-for-service (FFS) days and managed care days, as reported by an eligible nursing facility in its Quarterly User Fee Assessment Forms for the period of July 1, 2021, through June 30, 2022.
If the facility meets the lower of the two thresholds in 101 CMR 206.10(18)(c)2., keep the same the number of Massachusetts Medicaid days, including fee-for-service (FFS) days and managed care days, as reported by an eligible nursing facility in its Quarterly User Fee Assessment Forms for the period of July 1, 2021, through June 30, 2022.
Sum up Massachusetts Medicaid days in 101 CMR 206.10(18)(c)3. and 101 CMR 206.10(18)(c)4.
Divide the total amount of available funds, $16,550,000, by the total number of Massachusetts Medicaid days as determined in 101 CMR 206.10(18)(c)5.
For each eligible nursing facility meeting the higher of the two thresholds in 101 CMR 206.10(18)(c)2., multiply the quotient calculated in 101 CMR 206.10(18)(c)6. by the eligible nursing facility's Massachusetts Medicaid days, as calculated in 101 CMR 206.10(18)(c)3.
For each eligible nursing facility meeting the lower of the two thresholds in 101 CMR 206.10(18)(c)2., multiply the quotient calculated in 101 CMR 206.10(18)(c)6. by the eligible nursing facility's Massachusetts Medicaid days, as they appear in 101 CMR 206.10(18)(c)4.
If the product in 101 CMR 206.10(18)(c)7. is greater than $700,000, cap the total calculated for each eligible nursing facility at $700,000; otherwise keep the total as is.
If the product in 101 CMR 206.10(18)(c)8. is greater than $300,000, cap the total calculated for each eligible nursing facility at $300,000; otherwise keep the total as is.
Sum up the amounts calculated in 101 CMR 206.10(18)(c)9. and 101 CMR 206.10(18)(c)10.
Subtract the sum calculated in 101 CMR 206.10(18)(c)11. from $16,550,000.
Sum up Massachusetts Medicaid days for eligible nursing facilities in 101 CMR 206.10(18)(c)4. whose amounts calculated in 101 CMR 206.10(18)(c)10. are less than $300,000.
Divide the amount calculated in 101 CMR 206.10(18)(c)12. by the number calculated in 101 CMR 206.10(18)(c)13.
For each eligible nursing facility in 101 CMR 206.10(18)(c)4. whose amounts calculated in 101 CMR 206.10(18)(c)10. are less than $300,000, multiply the quotient calculated in 101 CMR 206.10(18)(c)14. by the eligible nursing facility's Massachusetts Medicaid days, as calculated in 101 CMR 206.10(18)(c)4.
For each eligible nursing facility in 101 CMR 206.10(18)(c)4. whose amounts calculated in 101 CMR 206.10(18)(c)10. are less than $300,000, sum up the amount in 101 CMR 206.10(18)(c)10. and the product calculated in 101 CMR 206.10(18)(c)15.
If the amount calculated in 101 CMR 206.10(18)(c)16. is greater than $300,000, cap the total calculated for each eligible nursing facility at $300,000; otherwise keep the total as is.
Sum up the amounts calculated in 101 CMR 206.10(18)(c)9. and 101 CMR 206.10(18)(c)10. for eligible facilities that reached the $300,000 cap, and in 101 CMR 206.10(18)(c)17.
Subtract the sum calculated in 101 CMR 206.10(18)(c)18. from $16,550,000.
Repeat the above steps for eligible facilities in 101 CMR 206.10(18)(c)4. whose amounts are less than $300,000 until the remaining funds are fully distributed.
The COVID-19 preparedness payments, for each eligible nursing facility, will equal the total calculated in 101 CMR 206.10(18)(c)9., 101 CMR 206.10(18)(c)10., 101 CMR 206.10(18)(c)17., or 101 CMR 206.10(18)(c)20., depending on whether an eligible facility was above or below the allowable cap.

(d) Overpayments. A nursing facility that fails to meet the criteria under 101 CMR 206.10(18)(b)1. and/or remain in compliance with all infection control requirements during the period of December 1, 2022, through June 30, 2023, under 101 CMR 206.10(18)(b)4. may be subject to overpayment action under 130 CMR 450.237: Overpayments: Determination .

(e) Correction of Material Error. EOHHS may adjust any supplemental payment upon EOHHS's determination that there was a material error in the calculation of the payment. EOHHS will not adjust any supplemental payment solely because a facility under-reported Massachusetts Medicaid days in its Quarterly User Fee Assessment Form.

(f) Additional Guidance. EOHHS may issue, via administrative bulletin or other written issuance, additional guidance regarding this add-on.

(21) Bariatric Add-on.

(a) For dates of service beginning on February 2, 2024, nursing facilities may receive a member-based rate add-on of $300 per member per day for each member residing in a facility for whom MassHealth is the primary payer and all of the following conditions are met:

prior to the member's admission, the facility must receive approval from MassHealth to bill the add-on based on the clinical profile of the member;
the member has a Body Mass Index (BMI) greater than 40 that can be supported by an ICD-10 code after admission;
the member is dependent, as defined by MDS, for at least one activity of daily living that requires a service listed in 130 CMR 456.409(B); and
the member requires a minimum of two staff members to assist with transfers, personal care and/or bed mobility.

(b) Non-applicability with Other Payments. A nursing facility may not receive this payment for a member for whom the facility is receiving on the same dates of service a homelessness rate add-on under 101 CMR 206.10(13), a severe mental and neurological disorder add-on under 101 CMR 206.11, or a complicated high-cost care need add-on under 101 CMR 206.15.

(22) Supplemental Payment for Qualified Nursing Facilities Located near North Adams.

(a) Beginning October 1, 2024, a nursing facility located within 17 miles of 71 Hospital Avenue in North Adams, Massachusetts will qualify for a supplemental payment to support additional allowable costs. Each qualified nursing facility will receive a proportional payment of the total amount available of $2,973,456.

(b) Qualified nursing facilities will receive a supplemental payment, which will be calculated and determined as follows.

Calculate the total of all qualified nursing facilities' Massachusetts Medicaid days, as reported on quarterly User Fee Assessment Forms for the period April 1, 2023, through March 31,
Determine each qualified nursing facility's proportion of Massachusetts Medicaid days as a total of all qualified nursing facility Massachusetts Medicaid days.
Multiply the proportion of each facility's Medicaid User Fee days by the total amount available of $2,973,456.

History

Adopted by Mass Register Issue 1427, eff. 10/2/2020.

101 CMR, § 206.11 Rates for Severe Mental and Neurological Disorder Services

(1) Qualifying Nursing Facility. For dates of service beginning January 15, 2022, qualifying nursing facilities will be able to receive a member-based per diem rate for residents with severe mental or neurological disorders who are receiving specialized rehabilitation services for such disorders. In order to qualify for this member-based per diem rate, a nursing facility must

(a) as of August 1, 2020, operate to provide nursing facility services, including the specialized rehabilitative services described in 101 CMR 206.11(1)(c), to residents with mental or neurological disorders, including residents with acquired brain injuries;

(b) demonstrate, in the form and manner requested by EOHHS, that the percentage of the facility's annual resident days for residents with mental or neurological disorders, including residents with acquired or traumatic brain injuries, is at least 50% of its total annual resident days;

an individualized therapeutic skill development plan for each member;

individual counseling;
group counseling (therapeutic and life skills groups), with group sessions offered multiple times each week to ensure access based on member needs and preferences;
sensory modulation and cognitive rehabilitation;

neuropsychological testing, evaluation, and intervention;

alcohol and substance use disorder counseling and prevention;
all mental health services as indicated by each resident's Pre-admission Screening and Resident Review (PASRR) Level II evaluation, or coordinate with additional providers and practitioners, who may separately bill or be paid under the appropriate provider regulations, for services designated as specialized services under the PASRR program and therefore are services that are not included in standard nursing facility services;
vocational programming; and
community reintegration.

(d) Maintain a program staff of specially trained professionals including, but not limited to, a neuropsychiatrist, a neuropsychologist, licensed mental health counselors, vocational specialists, life skills counselors, certified brain injury specialists, substance abuse counselors, and therapeutic technicians. All such staff must be trained in behavior modification and de-escalation techniques.

(2) Per Diem Rate for Approved Admitted Members. For dates of service beginning October 1, 2023, qualifying nursing facilities may receive a flat member-based per diem rate of $486 for members with a mental or neurological disorder that severely affects the member's behavior who are admitted on or after August 1, 2020, provided that the qualifying nursing facility receives approval from MassHealth prior to the member's admission that the member requires specialized rehabilitative services described in 101 CMR 206.11(1) and is therefore eligible for this enhanced rate. The specialized rehabilitative services program is designed to transition the member back to community-based care or less-restrictive placement, and such rate applies only during the time that the member has been approved by MassHealth for the enhanced rate. Qualifying nursing facilities receiving this per diem rate are not eligible for any other per diem rates or payments established under 101 CMR 206.00 with respect to such approved members, except as provided in 101 CMR 206.11(3) or, if applicable, 101 CMR 206.10. Qualifying facilities may also admit members without seeking approval from the MassHealth agency. In such circumstances, qualifying nursing facilities will receive the standard nursing facility rate established under 101 CMR 206.00 with respect to those members.

(3) High-cost Member Additional Rate. Qualifying nursing facilities may receive an additional member-based rate of $150 in addition to the per diem rate set by 101 CMR 206.11(2) for any member approved for admittance to the nursing facility for whom reasonable and allowable direct care costs associated with providing for such member's clinical care needs is more than 100% greater than the facility's average direct care costs per resident, provided that the facility

(a) certifies that the direct care costs associated with providing services to such member meets the requirements of 101 CMR 206.11(3);

(b) submits a summary of expected direct care costs associated with providing services to such member demonstrating that the requirements of 101 CMR 206.11(3) have been met; and

(c) receives approval from the MassHealth agency for the additional rate, to be applied prospectively from the date of approval, with respect to such member.

The MassHealth agency reserves the right to request additional documentation in support of the expected direct care costs prior to granting approval for this additional rate.

(4) Non-applicability with Other Payments. A nursing facility may not receive this payment for a member for whom the facility is receiving on the same dates of service a Medicaid transitional add-on under 101 CMR 206.10(7), a homelessness rate add-on under 101 CMR 206.10(13), a substance use disorder add-on or a substance use disorder induction period add-on under 101 CMR 206.10(14), a behavioral indicator add-on under 101 CMR 206.10(16), a bariatric add-on under 101 CMR 206.10(21), or a complicated high-cost care need add-on under 101 CMR 206.15.

History

Adopted by Mass Register Issue 1427, eff. 10/2/2020.

101 CMR, § 206.12 Direct Care Cost Quotient

(1) Beginning October 1, 2020, nursing facilities must have a Direct Care Cost Quotient (DCC-Q), as described in 101 CMR 206.12(2), of at least 75%. For the rate year beginning October 1, 2022, a nursing facility rate will be subject to a downward adjustment if the facility failed to be at or above the 75% DCC-Q threshold for the period of July 1, 2021, through June 30, 2022. For rate years beginning on or after October 1, 2023, a nursing facility rate will be subject to a downward adjustment if the facility fails to be at or above the 75% DCC-Q threshold in the previous full fiscal year.

(2) The DCC-Q will be calculated by dividing certain direct care workforce expenses, such as nursing, dietary, restorative therapy, or social worker staff expenses, by the facility's total revenue, excluding the revenue for non-nursing facility lines of business and subtracting the User Fee Assessments, certain federal and state payments, certain prescription drug expenses, and certain other ancillary costs related to services provided to Medicare residents, to be identified via administrative bulletin or other written issuance.

(a) A multiplier may be applied to one or more direct care workforce position types as an incentive. A multiplier must be calculated by multiplying the cost associated with a given direct care workforce position type in the numerator by 1.5 or more, but not to exceed 3.

(b) The workforce position types eligible for any multiplier described in 101 CMR 206.12(2) and the magnitude of such multiplier in calculating the DCC-Q may be established by EOHHS via administrative bulletin or other written issuance.

(3) All nursing facilities, including facilities in 101 CMR 206.12(5), will be required to submit an interim compliance report by March 1^st of each year and a final compliance report by July 31^stof each year. The interim report will be used to inform nursing facilities if they are on track to meet the 75% DCC-Q threshold set forth in 101 CMR 206.12(1). The final compliance report will be used for determining whether the facility met that threshold.

(4) The downward adjustment to the rate will be applied in the following rate year to facilities that failed to meet the 75% DCC-Q threshold. Such downward adjustment will be calculated as follows.

(a) For every 1% below the 75% DCC-Q threshold, a 0.5% downward adjustment will be applied to the facility's nursing and operating standard payments at each PDPM nursing case mix category.

(b) The maximum downward adjustment calculated in 101 CMR 206.12(3)(a) may be no more than 5% of the facility's nursing and operating standard payments at each PDPM nursing case mix. EOHHS may apply the maximum downward adjustment of 5% in the following rate year for facilities that fail to submit the final report by the due date established in 101 CMR 206.12(3).

(c) EOHHS will not adjust any downward adjustment under 101 CMR 206.12(4) solely because a facility under-reported certain direct care workforce expenses or over-reported its revenue in its final DCC-Q compliance report.

(5) Nursing facilities that had less than 5,000 Massachusetts Medicaid Days as reported on their Quarterly User Fee Assessment Forms for the period of April 1, 2023, through March 31, 2024, will be exempt from the downward adjustment set forth in 101 CMR 206.12(4).

(6) EOHHS may issue an administrative bulletin or other written issuance to clarify provisions of 101 CMR 206.12, and to provide further detail on the types of staffing and direct care expenditures that qualify towards the DCC-Q and the data reporting requirements.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 206.13 Average Staffing Hours Incentive

(1) As of October 5, 2020, each nursing facility is required to submit information on its staffing levels, including information demonstrating the facility's average hours per patient day (HPPD) to EOHHS, in the manner and format requested by EOHHS via administrative bulletin or other written issuance.

(2) As of January 1, 2021, a nursing facility that fails to meet an average of at least 3.58 (HPPD) in accordance with 101 CMR 206.13(1), is subject to a downward adjustment equal to 2% of the facility's standard rate for that calendar quarter. The dollar amount resulting from this adjustment will be considered an overpayment pursuant to 130 CMR 450.235: Overpayments .

(3) To determine a facility's average (HPPD) in each calendar quarter, EOHHS will divide the facility's total number of productive hours worked by nursing staff, including registered nurses, licensed practical nurses and nurses' aides, in the calendar quarter by the facility's total number of patient days in that calendar quarter.

(4) EOHHS may issue administrative bulletins or other written issuance to further clarify these provisions and to provide additional guidance regarding what qualifies as productive hours, what staff types are included in nursing staff, the reporting requirements, and the requirements for disputing the calculation described in 101 CMR 206.13(3).

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 206.14 Special Requirements Related to St. 2022, c. 268

Recognizing the constraints on nursing facility capacity and the intent of St. 2022, c. 268 to support economic growth and relief in the Commonwealth, nursing facilities are expected to use the incremental increases in funding resulting from the increased nursing and operating standard rates cost adjustment factor funded by St. 2022, c. 268 and implemented in 101 CMR 206.03(1)(a) and 101 CMR 206.06(7)(b), to support nursing facility workforce, direct care staffing, and capacity in order to increase capacity and the timeliness of admissions.

History

Adopted by Mass Register Issue 1429, eff. 10/5/2020.

101 CMR, § 206.15 Add-on for Members with Complicated High-cost Care Needs

(1) Members with Complicated High-cost Care Needs. Nursing facilities may receive a member-based rate add-on, in addition to the facility's standard per diem rate established under 101 CMR 206.00, for any member (for example, a resident requiring 1:1 staffing), for whom reasonable and allowable direct care costs associated with providing for such member's clinical care needs are significantly greater than the standard nursing facility rate (for example, because the member's care needs necessitates the purchase or rental of specialized equipment or hiring of additional staff). The facility may receive an add-on for such member, as calculated according to 101 CMR 206.15(2), provided that all of the following conditions are met:

(a) Prior to admission, the facility certifies that the direct care costs associated or expected to be associated with providing services to such member are necessary to provide the services recommended by the member's physician and care team, and documented in the member's care plan;

(b) The facility submitted a summary of expected direct care costs associated with providing services to such member demonstrating that the requirements of 101 CMR 206.15 have been met;

(c) The facility provides the MassHealth agency with any additional or clarifying documentation in support of the actual or expected direct care costs associated with the resident's care needs; and

(d) The facility receives approval from the MassHealth agency for the add-on.

(2) Complicated and High-cost Care Add-on Calculation. The add-on rate must be a daily rate equal to the total reasonable and allowable costs associated with the high-cost member as determined by EOHHS, above the standard nursing, capital, and operating costs considered and included in calculating the nursing facility's standard per diem rates established under 101 CMR 206.00, up to a maximum add-on of $600 per day. EOHHS must have sole discretion over what may be considered a reasonable and allowable cost for the purposes of calculating this add-on. The add-on for each resident must be effective on the later of the date the nursing facility receives MassHealth approval for the add-on or the date of the member's admission to the nursing facility. A nursing facility may not receive this add-on for a member for whom the facility is receiving on the same dates of service a Medicaid transitional add-on under 101 CMR 206.10(7), a homelessness rate add-on under 101 CMR 206.10(13), a substance use disorder add-on or a substance use disorder induction period add-on under 101 CMR 206.10(14), a behavioral indicator add-on under 101 CMR 206.10(16), a bariatric add-on under 101 CMR 206.10(21), or a per diem rate for severe mental or neurological disorders under 101 CMR 206.11.

(3) Periodic Recertification. A nursing facility that receives the add-on under 101 CMR 206.15 may be required periodically to recertify to MassHealth that all conditions established under 101 CMR 206.15(1)(a) continue to be met with respect to each member for whom it receives the add-on, and must submit updated direct care cost information for each member. If the facility fails to provide such certification and information, MassHealth may terminate the add-on received by the nursing facility for the member.

History

Adopted by Mass Register Issue 1454, eff. 10/1/2021.

101 CMR, § 206.16 Severability

The provisions of 101 CMR 206.00 are severable. If any provision of 101 CMR 206.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 206.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1532, eff. 10/1/2024 (EMERGENCY).

Rates For Community Health Centers Rates For Community Health Centers

101 CMR, § 304.01 General Provisions

(1) Scope and Purpose. 101 CMR 304.00 governs the payment rates to be used by governmental units and purchasers under M.G.L. c. 152 (the Workers' Compensation Act) for community health center services.

(2) Applicable Dates of Service. Rates in 101 CMR 304.00 apply for dates of service provided on or after January 1, 2023, unless otherwise indicated.

(3) Coverage. The rates of payment under 101 CMR 304.00 constitute full compensation for community health center services provided to publicly aided individuals as well as full compensation for necessary administration, professional supervision, and supporting services associated with patient care. Any client resources or third-party payments received on behalf of a publicly aided individual will reduce, by that amount, the amount of the purchasing governmental unit's obligation for services rendered to the publicly aided individual.

(4) Disclaimer of Authorization of Services. 101 CMR 304.00 is not authorization for or approval of the services for which rates are determined. The purchasing governmental unit or purchaser under M.G.L. c. 152 is responsible for the definition, authorization, and approval of services.

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and/or the Healthcare Common Procedure Coding System (HCPCS) . The publication of such updates and corrections will list:

(a) codes for which the code numbers change, with the corresponding cross references between new codes and the code being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same, but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 304.00 or to publish service code updates and corrections. In addition, EOHHS may issue administrative bulletins that specify the information and documentation necessary to implement 101 CMR 304.00.

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.02 Definitions

As used in 101 CMR 304.00, unless the context requires otherwise, terms have the meanings in 101 CMR 304.02.

340B Drug Pricing Program. A program established by Section 340B of Public Health Law 102-585, the Veterans Health Act of 1992.

Community Health Center (CHC). A facility licensed as a freestanding clinic by the Massachusetts Department of Public Health pursuant to M.G.L. c. 111, § 51 and, for the purposes of rates paid by MassHealth, meeting the definition and requirements established under 130 CMR 405.000: Community Health Center Services , that provides comprehensive ambulatory services and that is not financially or physically an integral part of a hospital.

Cost Report. The document used to report cost and other financial and statistical data in a format requested by and approved by the Center for Health Information and Analysis or EOHHS.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services. A program of health screening and other medical services for publicly aided individuals younger than 21 years old as required by federal law. Payment for such services is in accordance with 101 CMR 304.04.

Emergency Care. Medical care required immediately due to illness or injury with symptoms of sufficient severity that a prudent layperson would believe there is an immediate threat to life or high risk of permanent damage to the individual's health. Emergency conditions are those that require immediate medical treatment at the most accessible hospital equipped to provide emergency services. Emergency care does not include elective, primary, or urgent care.

Enhanced Global Delivery. The provision and supervision of case management, perinatal counseling (including, but not limited to, obstetrical-risk assessment and monitoring), in addition to pelvic or cesarean delivery, all routine prenatal visits, and one postpartum visit.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth of Massachusetts and any department, agency, board, commission, division, or political subdivision of the Commonwealth.

Group Behavioral Health Visit. A session conducted between two or more patients and an independently licensed mental or behavioral health clinician, a licensed mental or behavioral health clinician with supervision as required under such practitioners' licensure requirements, or an unlicensed clinician who completed a masters from an accredited educational institution and such degree allows eligibility for licensure as a behavioral health practitioner qualified to deliver outpatient behavioral health services, including clinical social work, mental health counseling, psychology, rehabilitative counseling or counseling education, and who is under appropriate supervision, and who must be actively moving toward licensure, within the community health center setting, conducted in-person or via a clinically appropriate telehealth modality in accordance with formal written guidance issued by MassHealth or EOHHS, for the purposes of examination, diagnosis or treatment for each patient in the session, and lasting a minimum of 30 minutes.

Group Medical Visit. A session conducted between two or more patients and a physician other than a psychiatrist; a physician assistant; a nurse practitioner; or a registered nurse, conducted in-person or via a clinically appropriate telehealth modality in accordance with formal written guidance issued by MassHealth or EOHHS, to introduce appropriate health care topics that could include, but are not limited to, preventive medicine approaches to personal health and safety and to present self-help and personal management information concerning family medicine, adult medicine, sex education, and chronic illness.

Individual Behavioral Health Visit. A meeting between a patient and an independently licensed mental or behavioral health clinician, a licensed mental or behavioral health clinician with supervision as required under such practitioners' licensure requirements, or an unlicensed clinician who completed a masters from an accredited educational institution and such degree allows eligibility for licensure as a behavioral health practitioner qualified to deliver outpatient behavioral health services, including clinical social work, mental health counseling, psychology, rehabilitative counseling or counseling education, and who is under appropriate supervision, and who must be actively moving toward licensure, within the community health center setting, conducted face-to-face or via a clinically appropriate telehealth modality in accordance with formal written guidance issued by MassHealth or EOHHS, for purposes of psychological assessment, diagnosis or treatment, and lasting a minimum of 16 minutes.

Individual Dental Visit. A meeting between a patient and a clinician licensed to provide dental services payable under 101 CMR 314.00: Dental Services within the community health center setting, conducted face-to-face or via a clinically appropriate telehealth modality in accordance with formal written guidance issued by MassHealth or EOHHS, for purposes of providing such dental services and for which the CHC dental add-on, as described under 101 CMR 304.04(2)(b)1., is applied.

Individual Medical Visit. A meeting between a patient and a physician other than a psychiatrist, a physician assistant, a nurse practitioner, or a registered nurse within the community health center setting, conducted face-to-face or via a clinically appropriate telehealth modality in accordance with formal written guidance issued by MassHealth or EOHHS, for purposes of examination, diagnosis, or treatment.

Individual Mental Health Visit. A meeting between a patient and either a psychiatrist or an advanced practice registered nurse (APRN) with a graduate degree and advanced training in psychiatric care (a psychiatric clinical nurse specialist or a psychiatric mental health nurse practitioner) within the community health center setting, conducted face-to-face or via a clinically appropriate telehealth modality in accordance with formal written guidance issued by MassHealth or EOHHS, for purposes of examination, diagnosis, or treatment.

Industrial Accident Patient. A person who receives medical services for which persons, corporations, or other entities are in whole or part liable under M.G.L. c. 152 (the Workers' Compensation Act).

MassHealth. The medical assistance and benefit programs administered by EOHHS pursuant to Title XIX of the Social Security Act (42 U.S.C. 1396), Title XXI of the Social Security Act (42 U.S.C. 1397), M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services to eligible members.

Nurse-midwife Medical Visit. A meeting between a patient and a nurse-midwife for prenatal and postpartum services, conducted at a community health center or via a clinically appropriate telehealth modality in accordance with formal written guidance issued by MassHealth or EOHHS. If a community health center chooses to be reimbursed by the enhanced global delivery rate set forth in 101 CMR 316.00: Rates for Surgery and Anesthesia , a nurse-midwife medical visit is not reimbursable.

Primary or Elective Care. Medical care required by individuals or families that is appropriate for the maintenance of health and the prevention of illness. This care includes, but is not limited to, physical examination, diagnosis and management of illness, ongoing health maintenance, accident prevention, and referral when necessary. This care does not require the specialized resources of a hospital emergency department.

Publicly Aided Individual. A person who receives health care and other services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Purchaser under M.G.L. c. 152. An insurance company, self-insurer, or worker's compensation agent of a department of the Commonwealth, county, city, or district that purchases medical services subject to M.G.L. c. 152, § 1.

Supporting Services. Services including, but not limited to, health education, health outreach, medical social work services, nutrition services (other than the WIC program), and translation services.

Urgent Care. Services required promptly to prevent impairment of health due to symptoms that a prudent layperson would believe require medical attention, but are not life threatening and do not pose a high risk of permanent damage to an individual's health. Urgent care does not include emergency care or primary or elective care.

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.03 General Rate Provisions and Maximum Allowable Fees

(1) Rate Determination. Rates of payment for authorized community health center services to which 101 CMR 304.00 applies are the lower of

(a) the community health center's usual charge to the general public (other than publicly aided individuals or industrial accident patients) for the same or similar services; or

(b) the schedule of allowable fees set forth in 101 CMR 304.04.

(2) Individual Consideration (I.C.). Non-listed procedures and services designated I.C. are individually considered items. The community health center's bill for such an item must be accompanied by a brief report of the procedure or service provided, including a pertinent history and diagnosis, a description of the service rendered, and the length of time spent with the patient. In making the determination of whether the service is appropriately classified as an individually considered item, the purchasing agency uses the following criteria:

(a) policies, procedures, and practices of other third-party purchasers of care, both governmental and private;

(b) the severity and complexity of the patient's disorder or disability;

(d) time, degree of skill, and cost, including equipment cost required to perform the procedure(s).

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.04 Rate Provisions

(1) Prospective Payment System (PPS) Methodology.

(a) Medical and Behavioral Health PPS Rate for Existing Community Health Centers. Each community health center that is a federally qualified health center (FQHC), enrolled with MassHealth as a community health center as of June 30, 2021, has an individual medical and behavioral health PPS rate established using the community health center's average total per-visit medical and behavioral health costs from calendar years 1999 and 2000, adjusted by reasonableness and inflated forward by the Medicare Economic Index (MEI). 1999 and 2000 per visit costs were adjusted for reasonableness by bounding PPS rates at the 50^th and 75^th percentile of 1999 and 2000 costs reported by community health centers that existed at the time and continue to be enrolled with MassHealth as community health centers as of June 30, 2021. The PPS rates for community health centers that were not so enrolled or did not have cost data in 1999 and 2000 were set at the mean PPS rate across all community health centers adjusted for reasonableness and carried forward by the MEI. Community health centers that experienced a change in scope of service, including a change in intensity, type, duration, or amount of service or service delivery that results in a material change in costs per visit will receive an adjustment to their PPS; provided that expenses associated with changes in scope of service may include, but are not limited to, capital expenses.

(b) Dental PPS Rate for Existing Community Health Centers. Each community health center that is a FQHC, existing and providing dental services as of June 30, 2021, has an individual dental PPS rate calculated based on its 1999 and 2000 per visit dental costs, and adjusted for reasonableness, the MEI, and changes in scope, in the same manner as the adjustments to the medical and behavioral health PPS rate described in 101 CMR 304.04(1)(a).

An entity that becomes a community health center that is also a FQHC on or after July 1, 2021, will receive as its initial PPS rate the mean PPS rate of all Massachusetts community health centers that are FQHCs as of the date of the entity's enrollment as a MassHealth community health center. The initial PPS rate will be effective through the end of the first full state fiscal year of operation as a MassHealth community health center. The community health center must provide EOHHS all relevant and requested cost data from the first year of operation as a community health center. EOHHS will then review the cost data to determine the community health center's per visit costs, adjusting for reasonableness and bounding the per visit costs at not more than the highest PPS in effect for MassHealth community health centers as of the first day of the entity's second full state fiscal year of enrollment as a community health center. The medical and behavioral health per visit costs, adjusted for reasonableness, will be the community health center's individualized medical and behavioral health PPS rate. The dental per visit costs, if applicable, adjusted for reasonableness, will be the community health center's individualized dental PPS rate. The individualized PPS rates will be effective for dates of service beginning on the first day of the second full state fiscal year of enrollment as a community health center, and will be adjusted thereafter in accordance with 101 CMR 304.04(1)(d).
A community health center that is newly providing dental services for the first time will be treated as a new community health center, in accordance with 101 CMR 304.04(1)(c)1., for the sole purpose of establishing a dental PPS rate.

(d) PPS Adjustments. PPS rate adjustments occurring on or after January 1, 2022, include:

Annual MEI adjustments in effect for dates of services beginning January 1^st of each year, as applied to the PPS rate in effect as of December 31^st of the previous year.
Changes in scope of service adjustments, as follows:

a. Community health centers that experienced a change in intensity, type, duration, or scope of service or service delivery that results in a material change in costs per visit may request adjustments to their PPS rates due to changes in scope of service, in a form and manner prescribed by EOHHS via administrative bulletin or other formal written issuance.

b. Change in scope of services may result in adjustments up to the higher of 10% above the requesting community health center's PPS rate in effect as of the date of the request or, if available, the 75^th percentile of costs reported through the most recent cost reports submitted after January 1, 2021, by all community health centers as of the date of the request; provided that if no cost reports have been submitted since January 1, 2021, a maximum adjustment of up to 10% above the requesting community health center's PPS rate in effect as of the date of the request will apply.

c. Changes in scope of service may result in a PPS rate adjustment if the incremental change in cost per visit attributable to the changes in scope of service amounts to at least a 3% change in cost per visit as compared to the community health center's PPS rate as of the date of the request. Request for scope changes may include cumulative changes for up to 18 months.

d. PPS rates effective January 1, 2022, incorporate changes in scope that were implemented on or before December 31, 2020.

e. Change in scope adjustments to PPS rates must be approved by EOHHS in order to become effective and EOHHS may request additional information as necessary to evaluate the request. If approved, the PPS rate adjustment will be effective as of the date of the implementation of the most recent change in scope of service included in the request, which shall be no sooner than six months prior to the date of request.

(e) PPS Rate Adjustment Notification. Individual community health center PPS rates will be updated, as adjusted in accordance with 101 CMR 304.04(1)(d), at least annually and notices will be provided to each individual community health center each time the community health center's PPS rate is adjusted.

(f) Authority to Issue Additional Guidance. EOHHS may provide by administrative bulletin or other written issuance further detail on the PPS rate calculation methodology, appeals or dispute procedures, changes in scope of service eligible for PPS rate adjustments, or the process by which changes in scope of service are reviewed, considered, and determined.

(2) Alternative Payment Methodology (APM). Through the APM, each community health center will be paid, in the aggregate as calculated on a quarterly basis, an amount at least equal to what the community health center would have received through the community health center's individual PPS rates for medical and behavioral health visits and for dental visits. The total APM is inclusive of the claims-based APM payments and the reconciliation wrap APM payments, as such payments are described in 101 CMR 304.04(2).

(a)

Medical and Behavioral Health Services Fee Schedule.

| Code | Allowable Fee | Description | | --- | --- | --- | | 99050 | $52.38 | Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed ( e.g ., holidays, Saturday or Sunday), in addition to basic service (Bill this code for urgent care provided Monday through Friday from 5:00 P.M. to 6:59 A.M., and Saturday from 7:00 A.M. to Monday 6:59 A.M.) (This code may be billed in addition to the individual medical visit.) | | 99381 | $222.00 | Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than one year) | | 99382 | $222.00 | Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures; early childhood (age one through four years) | | 99383 | $222.00 | Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures; late childhood (age five through 11 years) | | 99384 | $222.00 | Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures; adolescent (age 12 through 17 years) | | 99385 | $222.00 | Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures; age 18 through 39 years | | 99391 | $222.00 | Periodic comprehensive preventive medicine reevaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than one year) | | 99392 | $222.00 | Periodic comprehensive preventive medicine reevaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age one through four years) | | 99393 | $222.00 | Periodic comprehensive preventive medicine reevaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age five through 11 years) | | 99394 | $222.00 | Periodic comprehensive preventive medicine reevaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years) | | 99395 | $222.00 | Periodic comprehensive preventive medicine reevaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; age 18 through 39 years | | 99605 | $52.00 | Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, new patient (CDTM or MTM services, limit of two units per calendar year, telehealth permitted as appropriate) | | 99606 | $34.00 | Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; initial 15 minutes, established patient (CDTM or MTM services, limit of one unit per visit and six units per calendar year, telehealth permitted as appropriate) | | 99607 | $24.00 | Medication therapy management service(s) provided by a pharmacist, individual, face-to-face with patient, with assessment and intervention if provided; each additional 15 minutes (List separately in addition to code for primary service) (CDTM or MTM services, limit of three units per visit and 12 units per calendar year, telehealth permitted as appropriate) | | G0469 | $216.00 | Federally qualified health center (FQHC) visit, mental health, new patient (individual mental health visit, new patient) | | G0470 | $216.00 | Federally qualified health center (FQHC) visit, mental health, established patient (individual mental health visit, established patient) | | T1015 | $216.00 | Clinic visit/encounter, all-inclusive (individual medical visit excludes laboratory and radiology) | | T1015-HQ | $43.20 | Clinic visit/encounter, all-inclusive; group setting (group medical visit excludes laboratory and radiology) | | T1015-TH | $216.00 | Clinic visit/encounter, all-inclusive; obstetrical treatment/services, prenatal or postpartum (nurse-midwife medical visit excludes laboratory and radiology) | | T1040 | $140.00 | Medicaid certified community behavioral health clinic services, per diem (Clinic visit/behavioral health encounter, all-inclusive individual behavioral health visit) | | T1040-HQ | $28.00 | Medicaid certified community behavioral health clinic services, per diem (Clinic visit/behavioral health encounter, all-inclusive behavioral health visit; group setting) | | G0511 | $56.98 | Rural health clinic or federally qualified health center (RHC or FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM), per calendar month (Behavioral health integration; applies to all MassHealth community health centers) | | G0512 | $124.07 | Rural health clinic or federally qualified health center (RHC or FQHC) only, psychiatric collaborative care model (psychiatric COCM), 60 minutes or more of clinical staff time for psychiatric COCM services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month (applies to all MassHealth community health centers) |

EOHHS will calculate each community health center's total medical and behavioral health claims-based APM amounts paid in each quarter by summing the community health center's total amounts received for the services described in 101 CMR 304.04(2)(a)1., including claims paid through MassHealth fee-for-service and claims paid through MassHealth managed care, as those terms are defined in 130 CMR 501.001: Definition of Terms . This total quarterly medical and behavioral health claims-based APM amount is the amount used to determine the medical and behavioral health reconciliation wrap payment, calculated each quarter under 101 CMR 304.04(2)(c).

(b) Dental Services Claims-based APM Payments.

Community health centers may bill 101 CMR 314.00 for dental services rendered in accordance with that regulation. In addition, community health centers may bill the dental enhancement fee established under 101 CMR 314.00 for each separate individual dental visit provided by the community health center; provided that the dental enhancement fee established under 101 CMR 314.00 will be increased by an amount that, when added to such dental enhancement fee, totals $110 when billed to MassHealth by community health centers for MassHealth members (the "CHC dental add-on"); and provided further that the dental enhancement fee and the CHC dental add-on may be billed not more than once per member per day. Hospital-licensed health centers are not eligible for the CHC dental add-on.

EOHHS will calculate each community health center's total MassHealth dental claims-based APM amounts paid in each quarter by summing the community health center's quarterly MassHealth dental claims paid under 101 CMR 314.00, including dental MassHealth fee-for-service paid claims, claims paid through MassHealth managed care, as defined in 130 CMR 501.001, paid dental enhancement fees, and the quarterly CHC dental add-on paid claims. This total quarterly dental claims-based APM amount is the amount used to determine the dental reconciliation wrap payment, calculated each quarter under 101 CMR 304.04(2)(c).

(c) Reconciliation Wrap APM Payments. For each calendar quarter, MassHealth will provide required reconciliation wrap APM payments to community health centers that are Federally Qualified Health Center for the purposes of 42 U.S.C. § 1396a(bb) and that are not hospital licensed health centers.

A reconciliation wrap APM payment is required up to the medical and behavioral health PPS, if a community health center's total quarterly MassHealth medical and behavioral health claims-based APM payments described under 101 CMR 304.04(2)(a)2. are less than what the community health center would have received if it had been paid for such services on a per visit basis through its individual medical and behavioral health PPS rate. Such reconciliation wrap APM payment will equal the difference between the total MassHealth quarterly medical and behavioral health claims-based APM payments and what would have been paid for MassHealth medical and behavioral health visits through the medical and behavioral health PPS rate, in the aggregate, in the calendar quarter. For the purposes of calculating the medical and behavioral health reconciliation wrap APM payment, "visit" will include all individual medical visits, individual mental health visits, individual behavioral health visits, nurse-midwife medical visits, group medical visits, and group behavioral health visits; provided however, that group medical visits and group behavioral health visits will amount to 20% of a visit.
A reconciliation wrap APM payment is required for the dental PPS if a community health center's total MassHealth quarterly dental claims-based APM payments described under 101 CMR 304.04(2)(b)2., are less than what the community health center would have received if it had been paid for such services on a per visit basis through its individual dental PPS rate. Such reconciliation wrap APM payment will equal the difference between the total MassHealth quarterly dental claims-based APM payments and what would have been paid for MassHealth dental visits through the dental PPS rate, in the aggregate, in the calendar quarter. For the purposes of calculating the dental reconciliation wrap APM payment, "visit" will include all individual dental visits.
EOHHS will issue an administrative bulletin or other written issuance to clarify or provide further detail on this reconciliation wrap payment process including, but not limited to, clarifying the codes corresponding to counting the relevant medical and behavioral health visits and individual dental visits.

(3) Other Community Health Center Services. The rates of payment for other community health center services provided to publicly aided individuals and industrial accident patients are based on the applicable regulation and rates of payment for the specific care and services rendered as issued by EOHHS or the governmental unit or purchaser under M.G.L. c. 152 where the schedules of such governmental unit or purchaser under M.G.L. c. 152 have not been superseded by 101 CMR 304.00. Such care and services include, but are not limited to, those furnished by pharmacies, independent clinical laboratories, optometrists, opticians, podiatrists, and other individual practitioners and noninstitutional providers.

(4) 340B Transition Supplemental Payments. Subject to federal approval, eligible community health centers will receive monthly supplemental payments in accordance with 101 CMR 304.04(4).

(a) Eligibility for the Supplemental Payments.

Community health centers for which the calendar year 2016 gross margin earned on drugs purchased through the 340B Drug Pricing Program, as reported to the Center for Health Information and Analysis, is greater than the projected annual impact of the medical visit rate effective October 20, 2017, determined in accordance with 101 CMR 304.04(4)(c)3., will receive supplemental payments in accordance with 101 CMR 304.04(4).

Community health centers for which the calendar year 2016 gross margin earned on drugs purchased through the 340B Drug Pricing Program, as reported to the Center for Health Information and Analysis, is lower than or equal to the projected annual impact of the medical visit rate effective October 20, 2017, determined in accordance with 101 CMR 304.04(4)(c)3., will not receive supplemental payments in accordance with 101 CMR 304.04(4).

(b) Frequency and Duration of Supplemental Payments.

Supplemental payments will be made to eligible community health centers on a monthly basis.
Supplemental payments will be made for 75 months, beginning with October 2017.

(c) Calculation of Monthly Supplemental Payment Amounts for the First 12 Months of Payment. For each of the 12 months beginning with October 2017, a monthly supplemental payment will be made to eligible community health centers in an amount calculated in accordance with 101 CMR 304.04(4)(c). The amount of the monthly supplemental payment is calculated for each eligible community health center as follows:

Historical annual medical visit rate revenue is determined from claims data submitted by the community health center and MassHealth managed care organizations.
Projected annual medical visit rate revenue is calculated for the 12-month period beginning October 1, 2017, using the medical visit rate effective October 20, 2017, and medical visit claims and encounters, excluding behavioral health claims and encounters, including claims billed directly to the MassHealth Medicaid Management Information System (MMIS) by community health centers for state fiscal year 2015 and MassHealth managed care organization encounters for federal fiscal year 2016.

Projected annual impact of the medical visit rate effective October 20, 2017, is determined by subtracting historical annual medical visit rate revenue determined in accordance with 101 CMR 304.04(4)(c)1. from projected annual medical visit rate revenue determined in accordance with 101 CMR 304.04(4)(c)2.

Projected annual impact of the medical visit rate effective October 20, 2017, determined in accordance with 101 CMR 304.04(4)(c)3. is subtracted from calendar year 2016 gross margin earned on drugs purchased through the 340B Drug Pricing Program, as reported to the Center for Health Information and Analysis.
The projected annual medical visit rate revenue determined in accordance with 101 CMR 304.04(4)(c)2. is multiplied by 0.75.
The lower of the amount calculated in accordance with 101 CMR 304.04(4)(c)4. and the amount calculated in accordance with 101 CMR 304.04(4)(c)5. is divided by 12 to determine the community health center's monthly supplemental payment amount for the 12 months beginning with October

(d) Calculation of Monthly Supplemental Payment Amounts for Subsequent Months. For the 63 months beginning with October 2018, monthly supplemental payments will be made to eligible community health centers in an amount calculated in accordance with 101 CMR 304.04(4)(d). Monthly supplemental payment amounts are calculated for each eligible community health center in accordance with the following.

The community health center's average monthly supplemental payment amount for the 27 months beginning with October 2018 is equivalent to the community health center's monthly supplemental payment amount for the 12 months beginning with October 2017 calculated in accordance with 101 CMR 304.04(4)(c)6.

The community health center's average monthly supplemental payment amount for the 12 months beginning with January 2021 is the product of the community health center's monthly supplemental payment amount for the 12 months beginning with October 2017 calculated in accordance with 101 CMR 304.04(4)(c)6. and 0.75.
The community health center's average monthly supplemental payment amount for the 12 months beginning with January 2022 is the product of the community health center's monthly supplemental payment amount for the 12 months beginning with October 2017 calculated in accordance with 101 CMR 304.04(4)(c)6. and 0.50.
The community health center's average monthly supplemental payment amount for the 12 months beginning with January 2023 is the product of the community health center's monthly supplemental payment amount for the 12 months beginning with October 2017 calculated in accordance with 101 CMR 304.04(4)(c)6. and 0.25.

(e) Impact on Allowable Fees in Subsequent Periods. Subject to promulgation of further rate setting regulations as may be necessary to implement this provision, for each of the four 12-month periods beginning in or around January 2021, January 2022, January 2023, and January 2024, the allowable fees described in 101 CMR 304.04(2)(a) will be increased such that aggregate expenditures for such allowable fees in each period will increase over such expenditures from the previous 12-month period by 25% of the amount of aggregate expenditures for the 340B transition supplemental payments, as determined by EOHHS, in the 12-month period beginning October 2017 described in 101 CMR 304.04(4)(c), based on projected utilization, as determined by EOHHS.

(f) Authority to Issue Additional Guidance. EOHHS reserves the right to issue an administrative bulletin on these supplemental payment provisions including, but not limited to, an administrative bulletin to implement changes in the payment amounts and dates to account for any period during which 101 CMR 304.00 is in effect and MassHealth Managed Care Organizations (MCOs) continue to cover 340B drugs for MassHealth members.

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.05 Adjustment to Ensure Title XIX Access or Quality

A community health center may request an adjustment of rates if it can demonstrate that access to service delivery is threatened. In order to qualify, the community health center must obtain certification from EOHHS that, without an increase in rates, access to services to MassHealth members will be jeopardized or that the quality of service will fall below levels acceptable to EOHHS and required by Title XIX. If EOHHS makes such a certification, the community health center may submit an application for a rate adjustment. The community health center's application must include a copy of EOHHS certification, the number of clients in need of the particular service, the number of visits required, evidence of the direct relationship between services, and the cost of providing care and the minimal additional costs to adequately provide the services. EOHHS will review and act on a request for a change in rates within 60 days of the receipt of a completed application.

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.06 Program Innovation Provision

(1) Review of Program Innovation Applications. A community health center may apply for a prospective adjustment of its payment rates under 101 CMR 304.00 or establishment of a rate separate from its payment rates under 101 CMR 304.00 in order to implement a program innovation that advances a high priority policy initiative of the Commonwealth. EOHHS will review and act on such a request within 60 days after receipt of a program innovation application consisting of, but not limited to, a description of the purpose and scope of the program innovation, including number of personnel involved and proposed implementation process and timeline, and a detailed budget of expected additional costs and project volume associated with the program innovation.

(2) Criteria. An application pursuant to 101 CMR 304.06(1) may be submitted on the basis of implementing a program innovation that advances a current high priority policy initiative of a state agency.

(3) Implementation Schedule. EOHHS will not approve an application submitted pursuant to 101 CMR 304.06(1), unless the community health center demonstrates that it will implement the program innovation within three months of the effective date of the adjustment of its payment rates or the effective date of the separate rate. EOHHS reserves the right to lower the rate retroactive to the date on which the program innovation became effective if the program innovation is not implemented or if actual costs are lower than projected.

(4) Authority to Issue Additional Guidance. EOHHS reserves the right to issue an administrative bulletin on this program innovation provision including, but not limited to, an administrative bulletin to specify requirements related to applications, evaluation, use of funds, recordkeeping, and reporting.

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.07 Modifiers for Provider Preventable Conditions That Are National Coverage Determinations

The following are modifiers for use in reporting provider preventable conditions that are National Coverage Determinations. For more information on the use of these modifiers, see Appendix V of the MassHealth Community Health Center Manual.

| Modifier | Description | | --- | --- | | PA | Surgical or other invasive procedure on wrong body part | | PB | Surgical or other invasive procedure on wrong patient | | PC | Wrong surgery or other invasive procedure on patient |

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.08 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements ; provided, however, that the frequency of any required cost reports and the penalties, which will be no more severe than the penalties permitted under 101 CMR 304.08(2), will be determined and announced via administrative bulletin or other written issuance published by EOHHS.

(2) Penalty for Noncompliance. The purchasing governmental unit may impose a penalty in the amount up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 304.08(2).

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.09 Effect of Claims Submission for MassHealth Providers

Payment by MassHealth for community health center services pursuant to 101 CMR 304.00 constitutes an alternative payment methodology for federally qualified health center services as described by 42 U.S.C. § 1396a(bb)(6).

History

Amended by Mass Register Issue 1351, eff. 11/3/2017.

101 CMR, § 304.10 Severability

The provisions of 101 CMR 304.00 are severable, and if any provision of 101 CMR 304.00 or application of such provision to any community health center or any circumstances is held to be invalid or unconstitutional, such invalidity will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 304.00 or applications of such provisions to community health centers or circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1351, eff. 11/3/2017.

Rates for Behavioral Health Services Provided in Community Behavioral Health Centers Rates for Behavioral Health Services Provided in Community Behavioral Health Centers

101 CMR, § 305.01 General Provisions

(1) Scope and Purpose. 101 CMR 305.00 governs the rates to be used by all governmental units and worker's compensation insurers for outpatient behavioral health services and behavioral health emergency services provided by community behavioral health centers.

(2) Applicable Dates of Service. Rates contained in 101 CMR 305.00 apply for dates of service provided on or after January 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 305.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 305.00. Purchasing agencies and insurers are responsible for the definition, authorization, and approval of care and services extended to publicly aided clients.

(4) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list

(a) codes for which the code numbers change, with the corresponding cross references between existing and new codes and the codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 305.00.

History

Adopted by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 305.02 General Definitions

Meaning of Terms. In addition to the general definitions contained in 101 CMR 305.00, terms used in 101 CMR 305.00 will have the meaning ascribed in 101 CMR 305.02.

Adult Community Crisis Stabilization (Adult CCS). A community-based program that serves as a medically necessary, less-restrictive alternative to inpatient psychiatric hospitalization when clinically appropriate and provides short-term staff-secure, safe, and structured crisis stabilization and treatment services for individuals 18 years of age or older with mental health and substance use disorders. Stabilization and treatment also includes the capacity to provide induction onto and bridging for medication for the treatment of opioid use disorders (MOUD) and withdrawal management for opioid use disorders (OUD) as clinically indicated.

Adult Mobile Crisis Intervention (AMCI). A community-based behavioral health service available 24/7/365 and providing short-term mobile, on-site, face-to-face crisis assessment, intervention, and stabilization to individuals 21 years of age or older experiencing a behavioral health crisis. Services may be provided in community-based settings outside the CBHC, at the CBHC, or in emergency department sites of services to support stabilization for transition into the community, when necessary. Services may also be provided via telehealth. The purpose is to identify, assess, treat, and stabilize the situation and reduce the immediate risk of danger to the individual or others consistent with the individual's risk management/safety plan, if any.

Case Consultation. Intervention, including scheduled audio-only telephonic, audio-video, or in person meetings, for behavioral and medical management purposes on a member's behalf with agencies, employers, or institutions which may include the preparation of reports of the member's psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

Certified Peer Specialist (CPS). A person who has been trained by an agency approved by the Department of Mental Health (DMH) who is a self-identified person with lived experience of a mental health disorder and wellness who can effectively share their experiences and serve as a mentor, advocate, or facilitator for a member experiencing a mental health disorder.

Child and Adolescent Needs and Strengths (CANS). A tool that provides a standardized way to organize information gathered during behavioral health clinical assessments. A Massachusetts version of the tool has been developed and is intended to be used as a treatment decision support tool for behavioral health providers serving MassHealth members younger than 21 years old.

Community Behavioral Health Center (CBHC or Center). An entity that serves as a hub of coordinated and integrated behavioral health disorder treatment for individuals of all ages, including routine and urgent outpatient behavioral health services, mobile crisis services for adults and youth, and community crisis stabilization services for adults and youth.

Counselor. An individual who has earned a master's degree in counseling from a recognized educational program and who also meets conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

Couple Therapy. Psychotherapeutic services provided to a couple whose primary complaint is the disruption of their marriage, family, or relationship.

Diagnostic Evaluation Services. The examination and determination of a member's physical, psychological, social, economic, educational, and vocational assets and disabilities for the purpose of designing a treatment plan.

Eligible Provider. A community behavioral health center which meets the conditions of participation that have been or may be adopted by a governmental unit purchasing behavioral health services or by purchasers under M.G.L. c. 152.

Encounter Bundle. A flat rate per date of services for the provision of any of a set of designated services, regardless of the number of services provided to the individual on that date.

Enhanced Structured Outpatient Addiction Program (E-SOAP): American Society of Addiction Medicine (ASAM) Intensive Outpatient Services. A program that provides short-term, clinically intensive, structured day and/or evening substance use disorder (SUD) services. E-SOAP specifically serves specialty populations including: homeless individuals and people at risk of homelessness, pregnant individuals, and adolescents. E-SOAP services must meet requirements as set forth in 130 CMR 418.000: Substance Use Disorder Treatment Services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Family Consultation. A scheduled meeting with one or more of the parents, legal guardian, or foster parents of a child who is being treated by clinical staff at the center, when the parents, legal guardian, or foster parents are not members of the center.

Family Therapy. The psychotherapeutic treatment of more than one member of a family simultaneously in the same visit.

Governmental Unit. The Commonwealth of Massachusetts, or any of its departments, agencies, boards, commissions, or political subdivisions.

Group Therapy. The application of psychotherapeutic or counseling techniques to a group of persons, most of whom are not related by blood, marriage, or legal guardianship.

Individual Consideration (I.C.). Payment rates to eligible providers for services authorized in accordance with 101 CMR 305.03(2), but not listed herein, or authorized services performed in exceptional circumstances will be determined on an individual consideration basis by the governmental unit or purchaser under M.G.L. c. 152 upon receipt of a bill which describes the services rendered. The determination of rates of payment for authorized individual consideration procedures will be in accordance with the following criteria:

(a) time required to perform the service;

(b) degree of skill required for service rendered;

(d) policies, procedures, and practices of other third party purchasers of care; and

(e) such other standards and criteria as may be adopted from time to time by EOHHS pursuant to 101 CMR 305.03(4).

Individual Therapy. Psychotherapeutic services provided to an individual.

Intensive Outpatient Program (IOP). A mental health treatment service that provides timelimited, multi-disciplinary, multimodal structured treatment in an outpatient setting for individuals requiring a clinical intensity that exceeds outpatient treatment. Services include individual, group, and family therapy as well as case management services.

Medication Visit. A member visit specifically for prescription, review, and monitoring of psychotropic medication by a psychiatrist, psychiatric clinical nurse specialist, Advanced Practice Registered Nurse, or Physician Assistant or administration of prescribed intramuscular medication by a physician, nurse, or Physician Assistant.

Modifiers. Listed services may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of the appropriate two-digit number or letters.

Multiple-family Group Therapy. The treatment of more than one family unit, at the same time in the same visit, by one or more authorized staff member. There is more than one family member present per family unit and at least one of the family members per family unit must be an identified patient of the center.

Psychiatric Nurse. An individual who is currently registered by the Massachusetts Board of Registration in Nursing and who has earned a master's degree from an accredited graduate school of psychiatric nursing or who meets the conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

Psychiatric Clinical Nurse Specialist. A licensed registered nurse who is authorized by the Board of Registration in Nursing as practicing in an expanded role and who meets the requirements of 244 CMR 4.05(4): Psychiatric Nurse Mental Health Clinical Specialist (PNMHCS).

Psychiatric Social Worker. An individual who has earned a Master's degree from an accredited graduate school of social work or who meets the conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

Psychiatrist. An M.D. or Doctor of Osteopathic Medicine who is registered in Massachusetts and who is certified or eligible for certification by the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry who meets such conditions of participation as have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

Psychological Associate. A staff member trained in the field of clinical or counseling psychology or a closely related specialty who meets the conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152, and who

(a) has a minimum of a master's degree or the equivalent graduate study in clinical or counseling psychology or a closely related specialty from an accredited educational institution;

(b) is currently enrolled in or has completed a doctoral program in clinical or counseling psychology or a closely related specialty; and

(c) has had two years of full-time supervised clinical experience subsequent to obtaining a master's degree in a multidisciplinary mental-health setting. (One year of supervised clinical work in an organized graduate internship program may be substituted for each year of experience.)

Psychological Testing. The use of standardized test instruments to evaluate aspects of an individual's functioning, including aptitudes, educational achievements, cognitive processes, emotional conflicts, and type and degree of psychopathology, subject to the limitations of 101 CMR 329.00: Rates for Psychological and Independent Clinical Social Work Services.

Psychologist. An individual who by training and experience meets the requirements for licensing by the Massachusetts Board of Registration of Psychologists and is duly licensed to practice psychology in the Commonwealth or who meets the requirements of education and experience in psychology that have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c 152.

Psychotherapy for Crisis. An urgent assessment and history of a crisis state, a mental status exam, and a disposition. The treatment includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma.

Staff Member Authorized to Render Billable Mental Health Services. An individual who provides the services referred to in 101 CMR 305.00 under the auspices of an eligible provider and meets the qualifications of any of the following professions: psychiatrist, psychologist, psychological associate, social worker, psychiatric nurse, psychiatric clinical nurse specialist, counselor, or occupational therapist. This also includes staff members meeting the qualifications which have been or may be adopted by a governmental unit purchasing behavioral health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

Structured Outpatient Addiction Program (SOAP): ASAM Intensive Outpatient Services. A substance use disorder treatment service that provides short-term, multi-disciplinary, clinically intensive structured treatment to address the sub-acute needs of members with substance use disorders and/or co-occurring disorders. These services may be used as a transition service in the continuum of care toward lower intensity outpatient services or accessed directly. SOAP services must meet requirements as set forth in 130 CMR 418.000: Substance Use Disorder Treatment Services.

Telehealth. The use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to

(a) interactive audio-video technology;

(b) remote patient monitoring devices;

(d) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating, or monitoring of a patient's physical health, oral health, mental health, or substance use disorder condition.

Uniform Financial Statements and Independent Auditor's Report (UFR). The set of financial statements and schedules required of many human, social service, and health care providers who deliver services to publicly aided clients.

Youth Community Crisis Stabilization (YCCS). Staff-secure, safe, and structured crisis stabilization and treatment services in a community-based program that provides active treatment that includes restoration of functioning; strengthening the resources and capacities of the youth, family, and other natural supports; and ensuring a timely return to previous living environment to individuals 18 years of age or younger.

Youth Mobile Crisis Intervention (YMCI). A community-based behavioral health service available 24/7/365 providing short-term mobile, on-site, face-to-face crisis assessment, intervention, and stabilization to individuals younger than 21 years old experiencing a behavioral health crisis. Transition-aged youth older than 17 years of age and younger than 21 years old may be served by adult-trained clinicians with a certified peer specialist instead of a family partner based on an individual's clinical needs. Services may be provided in community-based settings outside the CBHC, at the CBHC, or in emergency department sites of services to support stabilization for transition into the community. Services may be provided via telehealth. The purpose is to identify, assess, treat, and stabilize the situation and reduce the immediate risk of danger to the youth or others consistent with the youth's risk management/safety plan, if any.

History

Adopted by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 305.03 Rate Provisions

(1) Rates as Full Compensation. The rates under 101 CMR 305.00 will constitute full compensation for behavioral health services provided by community behavioral health centers to publicly aided and industrial accident patients, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Except as otherwise provided in 101 CMR 305.03(4)(c), payment rates under 101 CMR 305.00 will be the lower of

(a) the eligible provider's usual charge to the general public; or

(b) the schedule of allowable rates for services provided by community behavioral health centers as set forth in 101 CMR 305.03(4)(a).

(3) Modifiers.

(a) -HB: Adult program, non-geriatric.

(b) -HA: Child/adolescent program.

(d) -U1: Medicaid level of care 1.

(e) -HN: A service rendered by a provider with a bachelor's degree.

(f) -HO: A service rendered by a provider with a master's degree.

(g) -ET: Emergency services.

(4) Fee Schedule.

(a) Encounter Bundle Rates. The services incorporated into the encounter bundled rate are specified in 101 CMR 305.03(4)(a)1.

Providers must bill one T1040 flat rate encounter bundle code for the provision of any of the set designated services, regardless of the number of services provided to the individual on that date.
The encounter bundle rates are as follows.

| Service Code | Modifier 1 | Service Description | Payment | | --- | --- | --- | --- | | T1040 | HB | Medicaid Certified Community Behavioral Health Clinic Services, per Diem (Adult Services) | $233.90 | | T1040 | HA | Medicaid Certified Community Behavioral Health Clinic Services, per Diem (Child/Adolescent Services) | $241.86 |

The designated services provided below must be billed in conjunction with the appropriate encounter bundle code set forth in 101 CMR 305.03(4)2. The designated service codes for all services provided on the same date must be billed under one encounter bundle code, regardless of the number of services provided to the individual on that date. The bundled encounter rates incorporate the following designated services codes.

| Service Code | Service description | | --- | --- | | 90791 | Psychiatric diagnostic evaluation | | 90791-HA | Psychiatric diagnostic evaluation performed with a CANS (Children and Adolescent Needs and Strengths) | | 90792 | Psychiatric Diagnostic Evaluation with Medical Services | | 90832 | Psychotherapy, 30 minutes with patient | | 90833 | Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure). (Use this add-on code with an appropriate evaluation and management service code when medication management is also provided.) | | 90834 | Psychotherapy, 45 minutes with patient | | 90836 | Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) (Use this add-on code with an appropriate evaluation and management service code when medication management is also provided.) | | 90837 | Psychotherapy, 60 minutes with patient | | 90838 | Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure). (Use this add-on code with an appropriate evaluation and management service code when medication management is also provided.) | | 90839 | Psychotherapy for crisis, first 60 minutes | | 90840 | Psychotherapy for crisis, each additional 30 minutes (List separately in addition to the code for primary procedure) (Add-on code). | | 90846 | Family psychotherapy (without the patient present), 50 minutes | | 90847 | Family psychotherapy with patient 50 minutes | | 90849 | Multiple-family group psychotherapy (per person session not to exceed ten clients) | | 90853 | Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients) | | 90882 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions (case consultation) | | 90887 | Interpretation or explanation of results of psychiatric, or other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient (per one-half hour) | | 96164 | Health behavior group intervention, 30 minutes | | 96165 | Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (add-on code). | | 96372 | Therapeutic prophylactic or diagnostic injection (specify substance use or drug); subcutaneous or intramuscular | | 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date or the encounter. | | 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 30-44 minutes of total time spent on the date of the encounter. | | 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 45-59 minutes of total time spent on the date of the encounter | | 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 60-74 minutes of total time spent on the date of the encounter. | | 99211 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. | | 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time spent on the date of the encounter. | | 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 20-29 minutes of total time spent on the date of the encounter. | | 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 30-39 minutes of total time spent on the date of the encounter. | | 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 40-54 minutes of total time spent on the date of the encounter. | | 99404 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure), 60 min | | 99412 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure) | | H0004 | Behavioral health counseling and therapy, per 15 minutes (individual counseling) (four units maximum) (per session) | | H0005 | Alcohol and/or drug services group counseling by a clinician (per 45-minute unit) (two units maximum) | | H0033 | Oral medication administration, direct observation (substance use disorder programs only) | | T1006 | Alcohol and/or substance abuse services; family/couple counseling (per 30 minutes, one unit maximum per day) |

(b) Crisis and Specialty Services. The MassHealth agency pays for crisis and specialty services separately from the bundled encounter rate. Crisis and specialty services may be billed on the same date of service as the encounter bundle, as clinically appropriate. Crisis intervention follow up services may not be billed on the same day as the crisis intervention per diem service. The MassHealth agency will only pay an AMCI provider a single per diem rate per member per day, regardless of the location of the encounter. For AMCI and YMCI services rendered in hospital emergency departments, the MassHealth agency will not pay AMCI or YMCI providers for AMCI or YMCI services once the hospital is authorized to bill the MassHealth agency directly for the provision of crisis intervention services, as determined by EOHHS. Rates are as follows.

Crisis Services.

| Service Code | Payment Rate | Service Description | | --- | --- | --- | | S9485 - ET | $632.05 | Crisis intervention mental health services, per diem . (Adult Community Crisis Stabilization per day rate) | | S9485 - HA, ET | $930.73 | Crisis intervention mental health services, per diem . (Youth Community Crisis Stabilization Per day rate) | | S9485 - HB | $632.08 | Crisis intervention mental health services, per diem . (Adult Mobile Crisis Intervention provided at hospital emergency department. Inclusive of initial evaluation and all follow-up intervention. Use Place of Service code 23.) | | S9485 - HE | $695.29 | Crisis intervention mental health services, per diem. (Adult Mobile Crisis Intervention provided at CBHC site. Inclusive of initial evaluation and first day crisis interventions.) | | S9485 - HA, HE | $695.29 | Crisis intervention mental health services, per diem . (Youth Mobile Crisis Intervention provided at CBHC site. Inclusive of initial evaluation and first day crisis interventions.) | | S9485 - U1 | $1,024.64 | Crisis intervention mental health services, per diem . (Adult Mobile Crisis Intervention provided at community-based sites of service outside of the CBHC site. Inclusive of initial evaluation and first day crisis interventions. Use Place of Service 15.) | | S9485 - HA, U1 | $1,075.87 | Crisis intervention mental health services, per diem . (Youth Mobile Crisis Intervention provided at community-based sites of service outside of the CBHC site. Inclusive of initial evaluation and first day crisis interventions Use Place of Service code 15.) | | H2011 - HN, HB | $30.57 | Crisis intervention service, per 15 minutes. (Adult Mobile Crisis Intervention provided at CBHC site by a Paraprofessional or Bachelor's level staff. Follow-up interventions provided up to the third day following initial evaluation.) | | H2011 - HN, HA | $33.94 | Crisis intervention service, per 15 minutes. (Youth Mobile Crisis Intervention provided at CBHC site by a Paraprofessional or Bachelor's level staff. Follow-up interventions provided up to the seventh day following initial evaluation.) | | H2011 - HO, HB | $39.70 | Crisis intervention service, per 15 minutes. (Adult Mobile Crisis Intervention provided at CBHC site by a Master's level Clinician. Follow-up interventions provided up to the third day following initial evaluation.) | | H2011 - HO, HA | $44.33 | Crisis intervention service, per 15 minutes. (Youth Mobile Crisis Intervention provided at CBHC site by a Master's level clinician. Follow-up interventions provided up to the seventh day following initial evaluation.) | | H2011 - HN, HB | $33.94 | Crisis intervention service, per 15 minutes. (Adult Mobile Crisis Intervention provided at a community-based site of service outside of the CBHC site by a Paraprofessional or Bachelor's level staff. Follow-up interventions provided up to the third day following initial evaluation. Use Place of Service code 15) | | H2011 - HN, HA | $33.94 | Crisis intervention service, per 15 minutes. (Youth Mobile Crisis Intervention at a community-based site of service outside of the CBHC site by a Paraprofessional or Bachelor's level staff. Follow-up interventions provided up to the seventh day following initial evaluation. Use Place of Service code 15) | | H2011 - HO, HB | $44.33 | Crisis intervention service, per 15 minutes. (Adult Mobile Crisis Intervention provided at a community-based site of service outside of the CBHC site by a Master's level clinician. Follow-up interventions provided up to the third day following initial evaluation. Use Place of Service code 15) | | H2011 - HO, HA | $44.33 | Crisis intervention service, per 15 minutes. (Youth Mobile Crisis Intervention provided at a community-based site of service outside of the CBHC site by a Master's level clinician. Follow-up interventions provided up to the seventh day following initial evaluation. Use Place of Service code 15) |

Specialty Services.

a. Required Services. A center must have the capacity to provide the following services. These required services are not included in the encounter bundled rate and will be paid at the rates set forth below or in the referenced regulations.

b. The rates for certified peer specialist services are as follows.

| Service Code | Payment Rate | Service Description | | --- | --- | --- | | H0046-HE | $16.92 | Mental health services, not otherwise specified (Certified Peer Specialist Services). |

c. For YMCI services at an Emergency Department site of service, refer to 101 CMR 352.00: Rates of Payment for Certain Children's Behavioral Health Services.

d. For community support programs, refer to 101 CMR 362.00: Rates for Community Support Program Services.

e. For recovery coaching services, refer to 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs.

f. For recovery support navigator services, refer to 101 CMR 444.00: Rates for Certain Substance Use Disorder Services.

(c) Optional Services. The following services are allowed but not required to be provided by the center. These optional services are not included in the encounter bundled rate. Providers are referred to the following regulations for applicable rates.

For psychological testing rates, refer to 101 CMR 329.00: Rates for Psychological and Independent Clinical Social Work Services.
For enhanced structured outpatient addiction program (E-SOAP) services, refer to 101 CMR 306.00: Rates for Mental Health Services Provided at Community Health Centers and Mental Health Centers.
For intensive outpatient program (IOP) services, refer to 101 CMR 306.00: Rates for Mental Health Services Provided at Community Health Centers and Mental Health Centers .
For structured outpatient addiction program (SOAP) services, refer to 101 CMR 306.00: Rates for Mental Health Services Provided at Community Health Centers and Mental Health Centers.

(5) Billing. Each center shall bill the governmental unit according to the appropriate fee schedule on a prescribed form. Each specific service must be separately enumerated on the bill.

History

Adopted by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 305.04 Reporting Requirements and Sanctions

(1) Required Reports.

(a) Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements.

(b) Additional Information. Eligible providers must file such additional information as EOHHS may from time to time reasonably require.

(2) Penalty for Noncompliance. The purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 305.04(2).

(3) Mergers, Acquisitions, or Other Transfers. A provider involved in a merger, buy out, acquisition, purchase, pooling of interest or other arrangement involving the transfer of business will be treated as a single provider for the purposes of 101 CMR 305.04. All compliance liabilities of the transferor shall be the responsibility of the transferee.

History

Adopted by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 305.05 Severability

The provisions of 101 CMR 305.00 are severable, and if any provision of 101 CMR 305.00 or application of such provision to any community behavioral health center or any circumstances shall be held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 305.00 or application of such provisions to community behavioral health centers or circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1485, eff. 1/1/2023.

Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers

101 CMR, § 306.01 General Provisions

(1) Scope and Purpose. 101 CMR 306.00 governs the rates to be used by all governmental units and worker's compensation insurers for outpatient mental health services provided by mental health centers and community health centers, including mental health services provided in nursing facilities. 101 CMR 306.00 does not govern rates for psychological testing services, which are governed by 101 CMR 329.00: Psychological Testing, Treatment and Related Services. In addition, 101 CMR 306.00 does not govern rates for other services, care and supplies provided by mental health center and community health centers to publicly aided and industrial accident patients including, but not limited to, psychiatric day treatment services, early intervention services, and medical services provided in community health centers.

(2) Applicable Dates of Service. Rates contained in 101 CMR 306.00 apply for dates of service provided on or after January 1, 2023, or as indicated in 101 CMR 306.03(5).

(3) Disclaimer of Authorization of Services. 101 CMR 306.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 306.00. Purchasing agencies and insurers are responsible for the definition, authorization, and approval of care and services extended to publicly aided clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 306.00.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 306.02 General Definitions

Meaning of Terms. In addition to the general definitions contained in 101 CMR 306.00, terms used in 101 CMR 306.00 shall have the meaning ascribed in 101 CMR 306.02.

Behavioral Health Urgent Care Provider. A center that meets the requirements set forth in 130 CMR 429.405(D).

Case Consultation. An intervention, including scheduled telephonic or in person meetings, for behavioral and medical management purposes on a member's behalf with agencies, employers or institutions which may include the preparation of reports of the member's psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

Certified Peer Specialist (CPS). A person who has been trained by an agency approved by the Department of Mental Health (DMH) who is a self-identified person with lived experience of a mental health disorder and wellness that can effectively share their experiences and serve as a mentor, advocate or facilitator for a member experiencing a mental health disorder.

Child and Adolescent Needs and Strengths (CANS). A tool that provides a standardized way to organize information gathered during a behavioral-health clinical assessments. A Massachusetts version of the tool has been developed and is intended to be used as a treatment decision support tool for behavioral-health providers serving MassHealth members younger than 21 years old.

Community Consultation and Education. Services provided by professional personnel to representatives of schools, courts, police, organizations, or agencies with the aim of problem solving and imparting knowledge in areas such as prevention, availability of resources and clinical procedures. Such consultation is distinct from case consultation in that it does not address the problems of a particular patient, but rather the community at large.

Community Health Center. A clinic which provides comprehensive ambulatory services and which is not financially or physically an integral part of a hospital.

Community Mental Health Center. A clinic which provides comprehensive ambulatory mental health services and which is not financially or physically an integral part of a hospital.

Couple Therapy. Psychotherapeutic services provided to a couple whose primary complaint is the disruption of their marriage, family, or relationship.

Counselor. An individual who has earned a master's degree in Counseling from a recognized educational program and who also meets conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

Eligible Provider. A mental health center or community health center which meets the conditions of participation that have been or may be adopted by a governmental unit purchasing mental health services or by purchasers under M.G.L. c. 152.

Emergency Services. Services providing immediate face-to-face mental health evaluation, diagnosis, hospital prescreening, treatment, and arrangements for further care and assistance as required, up to 24 hours per day, seven days per week, to individuals showing sudden, incapacitating emotional stress.

Enhanced Structured Outpatient Addiction Program (E-SOAP). American Society of Addiction Medicine (ASAM) Intensive Outpatient Services is a program that provides short-term, clinically intensive, structured day and/or evening substance use disorder services. E-SOAP specifically serves specialty populations including: homeless individuals and people at risk of homelessness, pregnant individuals, and adolescents. E-SOAP services must meet requirements as set forth in 130 CMR 418.000.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Family Consultation. A preplanned meeting with one or more of the parents, legal guardian, or foster parents of a child who is being treated by clinical staff at the center when the parents, legal guardian, or foster parents are not clients of the center.

Family Therapy. The treatment of more than one member of a family simultaneously in the same visit.

Governmental Unit. The Commonwealth of Massachusetts, or any of its departments, agencies, boards, commissions, or political subdivisions.

Group Therapy. The application of psychotherapeutic or counseling techniques to a group of persons, most of whom are not related by blood, marriage, or legal guardianship.

Individual Consideration. Payment rates to eligible providers for services authorized in accordance with 101 CMR 306.03(2), but not listed herein, or authorized services performed in exceptional circumstances shall be determined on an Individual Consideration basis by the governmental unit or purchaser under M.G.L. c. 152 upon receipt of a bill which describes the services rendered. The determination of rates of payment for authorized Individual Consideration procedures shall be in accordance with the following criteria:

(a) Time required to perform the service;

(b) Degree of skill required for service rendered;

(d) Policies, procedures, and practices of other third party purchasers of care; and

(e) Such other standards and criteria as may be adopted from time to time by EOHHS pursuant to 101 CMR 306.03(4).

Individual Therapy. Psychotherapeutic services provided to an individual.

Intensive Outpatient Program (IOP). A mental health treatment service that provides time-limited, multi-disciplinary, multimodal structured treatment in an outpatient setting for a complex or refractory clinical presentation. Service includes individual, group, and family therapy as well as case management services.

Medication Visit. A member visit specifically for prescription, review, and monitoring of medication by a psychiatrist, a psychiatric clinical nurse specialist, Advanced Practice Registered Nurse, or Physician Assistant, or administration of prescribed intramuscular medication by a physician or a nurse, or Physician Assistant.

Mental Health Center (Center). An entity that delivers a comprehensive group of diagnostic and psychotherapeutic treatment services to individuals seeking treatment for mental health disorders, which may include co-occurring substance use disorder, and their families by an interdisciplinary team under the medical direction of a psychiatrist.

Multiple Family Group Therapy. The treatment of more than one family unit at the same time in the same visit by one or more authorized staff members. There is more than one family member present per family unit and at least one of the family members per family unit must be an identified patient of the clinic program.

Occupational Therapist. An individual who is registered with the American Occupational Therapy Association and who also meets the conditions of participation which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

Preventive Behavioral Health Services. Short-term group intervention, recommended by a physician or other licensed practitioner, practicing within their scope of licensure, that cultivate coping skills and strategies for symptoms of depression, anxiety, and other social/emotional concerns, to prevent the development of behavioral health disorders for children and adolescents younger than 21 years old.

Psychiatric Clinical Nurse Specialist. A licensed registered nurse who is authorized by the board of Registration in Nursing as practicing in an expanded role and who meets the requirements of 244 CMR 4.05(4): Psychiatric Clinical Nurse Specialist.

Psychological Associate. A staff member trained in the field of clinical or counseling psychology or a closely related specialty who:

(a) has a minimum of a master's degree or the equivalent graduate study in clinical or counseling psychology or a closely related specialty from an accredited educational institution;

(b) is currently enrolled in or have completed a doctoral program in clinical or counseling psychology or a closely related specialty; and

(c) has had two years of full time supervised clinical experience subsequent to obtaining a master's degree in a multidisciplinary mental-health setting. (One year of supervised clinical work in an organized graduate internship program may be substituted for each year of experience.)

Psychologist. An individual who, by training and experience, meets the requirements for licensing by the Massachusetts Board of Registration of Psychologists and is duly licensed to practice psychology in the Commonwealth or who meets the requirements of education and experience in psychology that have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

Psychotherapy. The utilization of psychological and interpersonal theories and related practice methodologies to assess, interpret and modify conscious and unconscious processes of behavior.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in the whole or in part liable under a statutory program.

Reevaluation. A session between a client and one or more staff members who are authorized to render mental health services for the determination and examination by interview techniques of a patient's physical, psychological, social, economic, educational and vocational assets and disabilities for the purpose of reevaluating the diagnostic formulation, treatment plan and procedures in order to assess aspects of an individual's functioning.

Structured Outpatient Addiction Program (SOAP). ASAM Intensive Outpatient Services. A substance use disorder treatment service that provides short-term, multi-disciplinary, clinically intensive structured treatment to address the sub-acute needs of members with substance use disorder and/or co-occurring disorders. These services may be used as a transition service in the continuum of care toward lower intensity outpatient services, or accessed directly. SOAP services must meet requirements as set forth in 130 CMR 418.000: Substance Use Disorder Treatment Services.

Staff Member Authorized to Render Billable Mental Health Services. An individual who provides the services referred to in 101 CMR 306.00 under the auspices of an eligible provider and meets the qualifications of any of the following professions: psychiatrist, psychologist, psychological associate, social worker, psychiatric nurse, psychiatric clinical nurse specialist, counselor or occupational therapist. This also includes staff members meeting the qualifications which have been or may be adopted by a governmental unit purchasing mental health services from eligible providers or by purchasers of such services under M.G.L. c. 152.

State-operated Community Mental Health Center. A community mental health center operated by the Commonwealth, which is not financially or physically an integral part of a hospital.

Telehealth. The use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology including, but not limited to:

(a) interactive audio-video technology;

(b) remote patient monitoring devices;

(d) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient's physical health, oral health, mental health or substance use disorder condition.

Uniform Financial Statements and Independent Auditor's Report (UFR). The set of financial statements and schedules required of many human, social service and health care providers who deliver services to publicly-aided clients

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 306.03 Rate Provisions

(1) Rates as Full Compensation. The rates under 101 CMR 306.00 shall constitute full compensation for mental health services provided by community health centers and mental health centers to publicly aided and industrial accident patients, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Except as otherwise provided in 101 CMR 306.03(5)(c), payment rates under 101 CMR 306.00 shall be the lower of:

(a) the eligible provider's usual charge to the general public; or

(b) the schedule of allowable rates for services provided by mental health centers and community health centers as set forth in 101 CMR 306.03(5)(a).

(3) Child and Adolescent Needs and Strengths (CANS): Psychiatric Diagnostic Interview Examination for Children and Adolescents Younger than 21 Years Old. Eligible clinicians who complete the CANS for a MassHealth child or adolescent younger than 21 years old during a psychiatric diagnostic interview examination, must use procedure code 90791 accompanied by a modifier -HA to bill for the service.

(4) Modifiers.

(a) -25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health professional on the same day of the procedure or other service. Modifier '-25' applies to two E/M services provided on the same day.

(b) -59: Distinct Procedure Service. To identify a procedure distinct or independent from other services performed on the same day add the modifier '-59' to the end of the appropriate service code. Modifier '-59' is used to identify services/procedures that are not normally reported together, but are appropriate under certain circumstances. However, when another already established modifier is appropriate, it should be used rather than modifier '-59'.

(c) -SA Nurse Practitioner rendering service in collaboration with a physician. (Modifier '- SA' is to be applied to service codes billed by the mental health center which were performed by a psychiatric clinical nurse specialist.)

(d) -EP: Group psychotherapy modifier for preventive behavioral health session (only used with 90853)

(e) -GJ: Opt-out physician or practitioner emergency or urgent service. (Urgent Care services. To identify services provided by Mental Health Centers that are designated as Behavioral Health Urgent Care provider sites.)

(f) -AF: Specialty physician (This modifier is to be applied to service codes billed by the mental health center which were performed by a psychiatrist)

(g) -AH: Clinical psychologist (This modifier is to be applied to service codes billed by the mental health center which were performed by doctoral level clinician, including PhD, PsyD, EdD)

(i) -HO: Master's degree level (This modifier is to be applied to service codes billed by the mental health center which were performed by Master's level clinician, including Licensed Clinical Social Workers (LCSWs), Licensed Independent Clinical Social Workers (LICSWs), Licensed Alcohol and Drug Counselor I, Licensed Mental Health Counselor, Licensed Marriage and Family Therapist)

(j) -HL: Intern (This modifier is to be applied to service codes billed by the mental health center which were performed by intern level clinicians, including Post-Doctoral Fellows and Psychology Interns, Post-Master's Mental Health Counselors and Mental Health Counselor Interns, Post-Master's Marriage and Family Therapist, Licensed Alcohol and Drug Counselor IIs (LADC II), Certified Addiction Counselor / Certified Alcohol & Drug Abuse Counselor) (k) -HE: Mental health program (Certified Peer Specialist Services)

(5) Fee Schedule.

(a) Allowable fee for community health centers and mental health centers.

| Service Code | Payment Rate for service codes performed by a psychiatrist (Modifier -AF) | Payment Rate for service codes performed by a doctor level clinician (Modifier - AH) | Payment Rate for service codes performed by a Master level clinician (Modifier -HO) | Payment Rate for service codes performed by an intern (Modifier -HL) | Service Description | | --- | --- | --- | --- | --- | --- | | 90791 | $160.45 | 136.38 | 130.48 | 81.83 | Psychiatric diagnostic evaluation | | 90791-HA | $175.45 | 151.38 | 145.48 | 90.83 | Psychiatric diagnostic evaluation performed with a CANS (Children and Adolescent Needs and Strengths) | | 90832 | $69.60 | 59.16 | 52.20 | 35.50 | Psychotherapy, 30 minutes with patient | | 90833 | $63.83 | 54.26 | 47.87 | 32.56 | Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure.) | | 90834 | $95.46 | 95.46 | 95.46 | 57.28 | Psychotherapy, 45 minutes with patient | | 90836 | $82.90 | 82.90 | 82.90 | 49.74 | Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure.) | | 90837 | $135.04 | 125.69 | 125.69 | 75.41 | Psychotherapy, 60 minutes with patient | | 90839 | $171.13 | 171.13 | 171.13 | 102.68 | Psychotherapy for crisis, first 60 minutes | | 90840 | $85.57 | 85.57 | 85.57 | 51.34 | Psychotherapy for crisis, each additional 30 minutes (List separately in addition to the code for primary procedure) | | 90846 | $101.43 | 101.43 | 101.43 | 60.86 | Family psychotherapy (without the patient present), 50 minutes | | 90847 | $101.43 | 101.43 | 101.43 | 60.86 | Family psychotherapy (conjoint psychotherapy) (with patient present) 50 minutes | | 90849 | $32.16 | 27.69 | 27.69 | 16.61 | Multiple-family group psychotherapy (per person per session not to exceed 10 clients) | | 90853 | $30.31 | 30.31 | 30.31 | 18.19 | Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients) | | 90853-EP | $30.31 | 30.31 | 30.31 | 18.19 | Group psychotherapy (other than of a multiple-family group) (per person not to exceed 12 clients) (preventive behavioral health session) | | 90882 | $71.80 | 71.80 | 71.80 | 43.08 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions | | 90887 | $79.19 | 67.31 | 59.40 | 40.39 | Interpretation or explanation of results of psychiatric, or other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient | | 90840-GJ | $98.41 | 98.41 | 98.41 | 59.04 | Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service) | | 90846-GJ | $116.64 | 116.64 | 116.64 | 69.99 | Family psychotherapy (without the patient present), 50 minutes | | 90847-GJ | $116.64 | 116.64 | 116.64 | 69.99 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | | 90849-GJ | $36.98 | 31.84 | 31.84 | 19.10 | Multiple-family group psychotherapy (per person session not to exceed 10 clients) | | 90853-GJ | $34.86 | 34.86 | 34.86 | 20.92 | Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients) | | 90853-EP-GJ | $34.86 | 34.86 | 34.86 | 20.92 | Group psychotherapy (other than of a multiple-family group)(per person not to exceed 12 clients) (preventive behavioral health session) | | 90882-GJ | $82.57 | 82.57 | 82.57 | 49.54 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions | | 90887-GJ | $91.07 | 77.41 | 68.31 | 46.45 | Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient | | 90889-GJ | $49.66 | 49.66 | 49.66 | 29.80 | Preparation of report of patient's psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers |

| Service Code | Payment Rate | Service Description | | --- | --- | --- | | S9480-GJ | $65.11 | Intensive outpatient psychiatric services, per diem | | H0015-GJ | $71.59 | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Structured Outpatient Addiction Program) | | H0015-TF-GJ | $113.82 | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Enhanced Structured Outpatient Addiction Program) | | H0046-HE-GJ | $16.92 | Mental health services, not otherwise specified (Certified Peer Specialist) |

(b) Allowable fee for mental health service provided by a behavioral health urgent care provider:

| Service Code | Payment Rate for service codes performed by a psychiatrist (Modifier -AF) | Payment Rate for service codes performed by a doctoral level clinician (Modifier -AH) | Payment Rate for service codes performed by a Master level clinician (Modifier -HO) | Payment Rate for service codes performed by an intern (Modifier -HL) | Service Description | | --- | --- | --- | --- | --- | --- | | 90791-GJ | $184.52 | 156.84 | 150.05 | 94.10 | Psychiatric diagnostic evaluation | | 90791-HA-GJ | $201.77 | 174.09 | 167.30 | 104.45 | Psychiatric diagnostic evaluation performed with a CANS (Children and Adolescent Needs and Strengths) | | 90832-GJ | $80.04 | 68.03 | 60.03 | 40.83 | Psychotherapy, 30 minutes with patient | | 90833-GJ | $73.40 | 62.40 | 55.05 | 37.44 | Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | | 90834-GJ | $109.78 | 109.78 | 109.78 | 65.87 | Psychotherapy, 45 minutes with patient | | 90836-GJ | $95.34 | 95.34 | 95.34 | 57.20 | Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | | 90837-GJ | $155.30 | 144.54 | 144.54 | 86.72 | Psychotherapy, 60 minutes with patient | | 90839-GJ | $196.80 | 196.80 | 196.80 | 118.08 | Psychotherapy for crisis; first 60 minutes | | 90840-GJ | $98.41 | 98.41 | 98.41 | 59.04 | Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service) | | 90846-GJ | $116.64 | 116.64 | 116.64 | 69.99 | Family psychotherapy (without the patient present), 50 minutes | | 90847-GJ | $116.64 | 116.64 | 116.64 | 69.99 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | | 90849-GJ | $36.98 | 31.84 | 31.84 | 19.10 | Multiple-family group psychotherapy (per person session not to exceed 10 clients) | | 90853-GJ | $34.86 | 34.86 | 34.86 | 20.92 | Group psychotherapy (other than multiple-family group) (per person per session not to exceed 12 clients) | | 90853-EP-GJ | $34.86 | 34.86 | 34.86 | 20.92 | Group psychotherapy (other than of a multiple-family group)(per person not to exceed 12 clients) (preventive behavioral health session) | | 90882-GJ | $82.57 | 82.57 | 82.57 | 49.54 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions | | 90887-GJ | $91.07 | 77.41 | 68.31 | 46.45 | Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient | | 90889-GJ | $49.66 | 49.66 | 49.66 | 29.80 | Preparation of report of patient's psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers |

(d) Rates for Medication Visit. Services for Medication Visit shall be billed using the appropriate E/M code: 99201-99205, 99211-99215, 99304-99310, 99324-99328, 99334-99337, 99341-99345, and 99347-99350. Definitions, payment rules, and rates for these services are contained in 101 CMR 317.00: Medicine .

(e) The allowable fee for payment for covered E/M services provided by a practitioner other than a psychiatrist is 85% of the fees described in 101 CMR 306.03(5)(e).

(f) Rates for state-operated community mental health centers. A state-operated community mental health center will be paid at rates based on that center's reasonable cost of providing covered services to eligible MassHealth members.

The methodology set forth below governs rates for non-ESP services provided by a state-operated community mental health center between June 1, 2008, and June 30, 2009.

a. Initial Payments. Initial payments will be made at the rates in effect on the date of service.

b. Preliminary Reconciliation. There will be a preliminary reconciliation for each state-operated community mental health center based on the difference between the initial payments and payments based on rates calculated using the center's preliminary projected FY2009 reasonable costs. In order to determine the preliminary projected FY2009 reasonable costs, EOHHS will review costs reported in the FY2008 UFR by each state-operated community mental health center, and apply a cost adjustment factor based on the Massachusetts Consumer Price Index.

c. Final Reconciliation. There will be a final reconciliation for each state-operated community mental health center based on the difference between total payments pursuant to the preliminary reconciliation and payments based rates calculated using the center's reported reasonable costs for the rate period. In order to determine the reported reasonable costs, EOHHS will review costs reported in the FY2009 UFR by each state-operated community mental health center.

Rates Effective July 1, 2009. Payments for services provided effective July 1, 2009, will be determined as follows:

a. Initial Payments. Initial payments will be based on rates calculated by applying a cost adjustment factor to the reasonable costs reported by each center in its most recently submitted UFR.

b. Final Reconciliation. For each fiscal year beginning July 1, 2009, there will be a final reconciliation for each state-operated community mental health center based on the difference between the initial payments and payments based on rates calculated using the center's final reasonable costs for that fiscal year. In order to determine the final reasonable costs, EOHHS will review the costs reported in each center's UFR submitted for that fiscal year.

(6) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list:

(a) codes for which the code numbers only changed, with the corresponding cross-walk;

(b) codes for which the code remains the same but the description has changed; and

(c) deleted codes for which there is no cross-walk. In addition, for entirely new codes which require new pricing, EOHHS will list these codes and apply Individual Consideration in reimbursing these new codes until rates are established.

(7) Billing. Each clinic shall bill the governmental unit according to the appropriate fee schedule on a prescribed form. Each specific service must be separately enumerated on the bill.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 306.04 Reporting Requirements and Sanctions

(1) Required Reports.

(a) Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements.

(b) Additional Information. Eligible providers must file such additional information as EOHHS may from time to time reasonably require.

(3) Mergers, Acquisitions, Other Transfers. A provider involved in a merger, buy out, acquisition, purchase, pooling of interest or other arrangement involving the transfer of business will be treated as a single provider for the purposes of 101 CMR 306.04. All compliance liabilities of the transferor shall be the responsibility of the transferee.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 306.05 Severability

The provisions of 101 CMR 306.00 are severable, and if any provision of 101 CMR 306.00 or application of such provision to any mental health center or community health center or any circumstances shall be held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 306.00 or application of such provisions to mental health centers or community health centers or circumstances other than those held invalid.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

Rates for Psychiatric Day Treatment Center Services Rates for Psychiatric Day Treatment Center Services

101 CMR, § 307.01 General Provisions

(1) Scope and Purpose. 101 CMR 307.00 establishes payment rates for psychiatric day treatment center services rendered by eligible providers to publicly aided individuals. The rates set forth in 101 CMR 307.00 also apply to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act).

(2) Applicable Dates of Service. Rates contained in 101 CMR 307.00 apply for dates of service provided on or after March 1, 2024.

(3) Coverage. The payment rates in 101 CMR 307.00 constitute full compensation for psychiatric day treatment center services provided to publicly aided and workers' compensation individuals including, but not limited to, administrative or supervisory duties and costs in connection with service provision.

(4) Disclaimer of Authorization of Services. 101 CMR 307.00 is not authorization for or approval of the substantive services, or lengths of time, for which rates are paid pursuant to 101 CMR 307.00. Governmental units or workers' compensation insurers that purchase services from eligible providers are responsible for the definition, authorization, and approval of care and services extended to covered individuals and the length of time for which the approval is applicable.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy upon and understanding of substantive provisions of 101 CMR 307.00.

History

Adopted by Mass Register Issue 1383, eff. 1/25/2019.

101 CMR, § 307.02 Definitions

As used in 101 CMR 307.00, terms have the meanings in 101 CMR 307.02.

Eligible Provider. A psychiatric day treatment center that meets the conditions of participation that have been or may be adopted by a governmental unit purchasing psychiatric day treatment center services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any department, agency, board, commission, division, or political subdivision of the Commonwealth.

Preadmission Evaluation Visit. A comprehensive evaluation of at least one hour by a professional to determine the need for psychiatric day treatment program services and to design a treatment plan.

Psychiatric Day Treatment Center. A clinic that provides a psychiatric day treatment program and is freestanding; that is, not financially or physically an integral part of a hospital.

Psychiatric Day Treatment Program. A planned combination of diagnostic, treatment, and rehabilitative services provided to mentally or emotionally disturbed persons who need more active or inclusive treatment than is typically available through a weekly visit to a mental health center or hospital outpatient department, but who do not need full-time hospitalization or institutionalization. Such a program utilizes multiple, intensive, and focused activities in a supportive environment to enable such persons to acquire more realistic and appropriate behavior patterns, attitudes, and skills for eventual independent functioning in the community.

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program.

Visit. A face-to-face encounter between a client and one or more staff members of a psychiatric day treatment center.

History

Adopted by Mass Register Issue 1383, eff. 1/25/2019.

101 CMR, § 307.03 Rates of Payment

The rates of payment for psychiatric day treatment center services are listed in 101 CMR 307.03.

| Code | Rate | Service | | --- | --- | --- | | H2012 | $28.77 | Behavioral health day treatment, per hour | | H2012-U1 | $80.13 | Behavioral health day treatment, per hour (Preadmission evaluation visit) | | 90887 | See 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health and Mental Health Centers for the rate . | See 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health and Mental Health Centers for the rate. |

History

Adopted by Mass Register Issue 1383, eff. 1/25/2019.

101 CMR, § 307.04 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

(2) Penalty for Noncompliance. A purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty for noncompliance under 101 CMR 307.04(2).

History

Adopted by Mass Register Issue 1383, eff. 1/25/2019.

101 CMR, § 307.05 Severability

The provisions of 101 CMR 307.00 are severable. If any provision of 101 CMR 307.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 307.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1383, eff. 1/25/2019.

Rates for Certain Services for the Personal Care Attendant Program Rates for Certain Services for the Personal Care Attendant Program

101 CMR, § 309.01 General Provisions

(1) Scope and Purpose. 101 CMR 309.00 governs the rates of payment to be used by all governmental units for the personal care attendant (PCA) program. 101 CMR 309.00 also governs payments for PCA services provided to individuals covered by M.G.L. c. 152 (the Worker's Compensation Act). Rates for transitional living program services are approved under 114.5 CMR 4.00: Rates for Certain Social, Rehabilitation and Health Care Services.

(2) Applicable Dates of Service. Rates contained in 101 CMR 309.00 apply for dates of service described in 101 CMR 309.03.

(3) Coverage. The payment rates established by 101 CMR 309.00 apply to certain services for the PCA program provided by eligible PCA providers and personal care management (PCM) agencies to enable publicly aided persons with permanent or chronic disabilities to live independently in the community. The payment rates established by 101 CMR 309.00 are full compensation for services rendered and for certain related administrative or supervisory duties rendered in the provision of services.

(4) Disclaimer of Authorization of Services. 101 CMR 309.00 is not authorization for or approval of the services for which rates are established by 101 CMR 309.00. Governmental units that purchase PCA services are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals.

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections by administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS) maintained by the Centers for Medicare & Medicaid Services (CMS). The publication of such updates and corrections will list

(a) codes for which only the code numbers change, with the corresponding cross-references between existing and new codes;

(b) deleted codes for which there are no corresponding new codes; and

(c) codes for entirely new services that require pricing. These codes will be paid on an individual consideration basis until rates are established.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify the substantive provisions of 101 CMR 309.00 and to notify interested parties of payment updates pursuant to 101 CMR 309.01(5).

History

Adopted by Mass Register Issue 1307, eff. 2/26/2016.

101 CMR, § 309.02 Definitions

As used in 101 CMR 309.00, unless the context requires otherwise, terms have the meanings in 101 CMR 309.02.

Activities of Daily Living (ADLs). Those specific activities described in 130 CMR 422.410(A): Activities of Daily Living (ADLs). Such activities are performed by a PCA to physically assist a member with mobility, taking medications, bathing or grooming, dressing, passive range of motion exercises, eating, and toileting.

Activity Form. The timesheet designated by the MassHealth agency to be used by the member for recording all PCA activity time for each pay period. The member or the member's surrogate submits completed activity forms to the fiscal intermediary.

Activity Time. The actual amount of time spent by a PCA physically assisting the member with ADLs and instrumental activities of daily living (IADLs). Activity time is reported on the activity form.

Consumer. A MassHealth member who is receiving PCA services. The consumer is the employer of the PCA.

Employer Expense Component. The portion of the PCA rate designated as reimbursement to members for their mandated employer's share of Social Security, federal and state taxes, unemployment insurance taxes, Medicare, and worker's compensation premiums.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Evaluation. An initial determination by the PCM agency of the scope and type of PCA services to be provided to a member who meets the qualifications of 130 CMR 422.403: Eligible Members . The evaluation is conducted by a registered nurse or licensed practical nurse and an occupational therapist in accordance with 130 CMR 422.422(C): Evaluation to Initiate PCA Services or 130 CMR 422.438(B): Evaluation .

Fiscal Intermediary. An entity contracting with MassHealth to perform employer-required tasks and related administrative tasks including, but not limited to, tasks described in 130 CMR 422.419(B): The Fiscal Intermediary .

Functional Skills Training. Training provided by a PCM agency in accordance with 130 CMR 422.421(B): Functional Skills Training to assist members who have obtained prior authorization (PA) for PCA services and their surrogates or administrative proxies, if necessary, in developing the skills and resources to maximize the member's management of the PCA program including, but not limited to, personal health care, PCA services, activities of daily living, and activities related to the fiscal intermediary.

Governmental Unit. The Commonwealth of Massachusetts and any department, division, agency, board, commission, or political subdivision of the Commonwealth.

Individual Consideration. The method to determine payment for services for service codes for which no rate has been established. The governmental unit or purchaser analyzes the eligible provider's report of services rendered and charges submitted under the appropriate unlisted services or procedures category. The purchaser determines an appropriate payment for individual consideration procedures in accordance with the following standards and criteria:

(a) time required to perform the procedure;

(b) degree of skill required in care rendered;

(d) policies, procedures, and practices of other third-party purchasers of care, governmental and private; and

(e) applicable relative value studies.

Instrumental Activities of Daily Living (IADLs). Those specific activities described in 130 CMR 422.410(B): Instrumental Activities of Daily Living (IADLs) that are instrumental to the care of the member's health and are performed by a PCA, such as meal preparation and cleanup, laundry, shopping, housekeeping, maintenance of medical equipment, transportation to medical providers, and completion of paperwork required for the member to receive PCA services.

Intake and Orientation. Functions performed by a PCM agency for a member who is seeking PCA services, but for whom the MassHealth agency has not yet granted PA for PCA services. These functions include, but are not limited to, instruction and orientation in the rules, policies, and procedures of the PCA program; instruction in the member's rights and responsibilities when using PCA services; instruction in the role of the PCM agency and the fiscal intermediary, including the use of activity forms; and instruction in the skills and tasks necessary to manage PCA services.

MassHealth. The medical assistance program administered by the Executive Office of Health and Human Services pursuant to M.G.L. c. 118E and in accordance with Titles XIX and XXI of the federal Social Security Act and a § 1115 Demonstration Waiver.

MassHealth Program Regulations. Regulations governing the PCA program are contained in 130 CMR 422.000: Personal Care Attendant Services and 130 CMR 450.000: Administrative and Billing Regulations .

PCA Services. Physical assistance with ADLs and IADLs provided to a member by a PCA in accordance with the member's authorized evaluation or reevaluation, service agreement, and 130 CMR 422.410: Activities of Daily Living and Instrumental Activities of Daily Living .

PCA Wage Component. The portion of the PCA rate that is designated as the PCA's gross hourly wage.

Personal Care Attendant (PCA). A person who meets the requirements of 130 CMR 422.404(A)(1): Personal Care Attendants and who is hired by the member or surrogate to provide PCA services. In addition, for the sole purpose of M.G.L. c. 118E, §§ 70 through 75, a PCA is a person who is hired by the member or surrogate to provide PCA services through a senior care organization (SCO) contracting with the MassHealth agency pursuant to M.G.L. c. 118E, § 9D, or a person who is hired by the member or surrogate to provide PCA services through an integrated care organization (ICO) contracting with the MassHealth agency pursuant to M.G.L. c. 118E, § 9F. Unless explicitly stated in 130 CMR 422.000: Personal Care Attendant Services , in the SCO's MassHealth contract, or in the ICO's MassHealth contract, no other provisions of 130 CMR 422.000 apply to any SCO, ICO, or PCA hired by any eligible MassHealth member through a SCO or ICO.

Personal Care Management (PCM) Agency. A public or private agency or entity under contract with MassHealth to provide PCM functions to eligible members in accordance with 130 CMR 422.000: Personal Care Attendant Services and the PCM functions contract.

Personal Care Management (PCM) Functions. Administrative functions provided by a PCM agency to a member in accordance with a contract with EOHHS including, but not limited to, those services identified in the PCM contract and 130 CMR 422.419(A): The PCM Agency .

Prior Authorization (PA). An approval, modification, deferral, or denial for PCA services to the consumer by the MassHealth agency in accordance with 130 CMR 422.416: PCA Program: Prior Authorization for PCA Services and 130 CMR 422.418: PCA Program: Special Payments .

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program of public assistance. This includes a consumer.

Reevaluation. A determination of the scope and type of PCA services to be provided to a member who has requested a continuation of PCA services because the current authorization is expiring. The reevaluation is conducted in accordance with 130 CMR 422.422(D): Reevaluation .

Service Agreement. A written plan of services, consistent with the requirements of 130 CMR 422.423: PCA Program: Service Agreement and the PCM functions contract, that is developed jointly by the PCM agency; the member; and the member's surrogate, if any. The service agreement describes the responsibilities of the PCA, the member, the surrogate, the fiscal intermediary, and the PCM agency. If the member does not require a surrogate, the service agreement must state that the member is solely responsible for the management tasks, including hiring, firing, scheduling, training, supervising, and otherwise directing the PCA. The service agreement must also describe the type and frequency of functional skills training that the member and the surrogate, if appropriate, require from the PCM agency to manage the PCA program successfully.

Uniform Financial Statement and Independent Auditor's Report (UFR). An annual fiscal filing requirement of revenue and expense activity for programs funded fully or in part by contracts with the Commonwealth. The Operational Services Division issues instructions for UFR preparation and compliance under 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services.

History

Adopted by Mass Register Issue 1307, eff. 2/26/2016.

101 CMR, § 309.03 General Rate Provisions

(1) Services or Functions Included in the Rate. The approved rate includes payment for care and services or functions listed in 101 CMR 309.03(4) that are part of the PCA program under 130 CMR 422.401 through 130 CMR 422.423 subject only to the terms of the purchase agreement between the eligible provider and the purchasing governmental unit.

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by the purchasing governmental unit for services rendered, accept the approved program rate as full payment and discharge of all obligations for services rendered. Any third-party payments received on behalf of a publicly aided consumer will reduce, by that amount, the amount of the purchasing governmental unit's obligation for services rendered to the consumer.

(3) Payment Limitation. Except as provided in 101 CMR 309.03(2), no purchasing governmental unit may pay less than, or more than, the approved program rate.

(4) Rates of Payment for PCM Functions Effective July 1, 2023.

| Code | Modifier | Rate | Unit | Description | | --- | --- | --- | --- | --- | | 99456 | $265.41 | Per Session | Work related or medical disability examination by other than the treating physician that includes: completion of a medical history commensurate with the patient's condition; performance of an examination commensurate with the patient's condition; formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; development of future medical treatment plan; and completion of necessary documentation/certificates and report (initial evaluation of a member to determine the need, and extent of the need, for PCA services) (per evaluation). | | | 99456 | TS | $152.54 | Per Session | Work related or medical disability examination by other than the treating physician that includes: completion of a medical history commensurate with the patient's condition; performance of an examination commensurate with the patient's condition; formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; development of future medical treatment plan; and completion of necessary documentation/certificates and report (code with modifier for reevaluations). | | T1023 | $120.92 | Per Session | Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project, or treatment protocol, per encounter (per session charge for intake and orientation services provided to a member who does not yet have PA for PCA services) (maximum three sessions). | | | T2022 | $58.99 | Per Member per Month | Case management per month. (Current PA for PCA services required for each member.) Use this code to bill administrative (per member per month). Bill code on the first of month. During a transfer, both PCM agencies may bill for the month the transfer took place (one-month limit). | | | T2022 | U1 | $0 | Per Session | Case management per month. (Current PA for PCA services required for each member.) Use to bill for required quarterly comprehensive (in person) functional skills training (FST) visits during the first year of approved PCA services. (Bill on the date FST was delivered.) (Bill code once in each calendar year quarter only.) Cannot be billed on the same date as T2022 U2, U3, U4, U5, or another unit of T2022 U1 was billed. | | T2022 | U2 | $0 | Per Session | Case management per month. (Current PA for PCA services required for each member.) Use to bill for required annual comprehensive (in person) FST (limit one per year). (Bill on date FST was delivered.) Cannot be billed on the same date as T2022 U3, U4, U5, or another unit of T2022 U2 was billed. | | T2022 | U5 | $0 | Per Session | Case management per month. (Current PA for PCA services required for each member.) Use to bill for FST (in person) within ten days of identifying a new surrogate. (Bill on date FST was delivered.) Cannot be billed on same date as T2022 U1, U2, U3, U4, or another unit of T2022 U5 was billed. May bill only once during a calendar year, regardless of multiple surrogate changes. This code does not apply to administrative proxy changes. | | T2022 | U3 | $0 | Per Session | Case management per month. (Current PA for PCA services required for each member.) Use to bill for issue-focused (in person) FST. (Bill on date FST was delivered.) Cannot be billed on same date as T2022 U1, U2, U5, or another unit of T2022 U3 was billed. | | T2022 | U4 | $0 | Per Session | Case management per month. (Current PA for PCA services required for each member.) Use to bill for issue-focused (telephone contact with FST delivery) FST. (Bill on date FST was delivered.) Cannot be billed on same date as T2022 U1 U2 or U5 was billed |

(5) PCA Rates. The rates for PCA services consist of the employer expense component and the PCA wage component.

(a) Rates. The rates of payment for PCA services are established in accordance with the provisions of any collective bargaining agreement under M.G.L. c. 150E and as authorized by the MassHealth program regulations at 130 CMR 422.413: Payment for PCA Services.

(b) PCA Wage Component. Beginning on the effective date of a collective bargaining agreement, the PCA wage component is based on amounts established by the collective bargaining agreement.

(c) Employer Expense Component. The employer expense component is the sum of the employer mandated contribution for each statutorily required tax and benefit. Each mandated contribution amount is calculated by multiplying the PCA wage component by the percentage required by statute, regulation, or other official document. EOHHS issues specific rates in an administrative bulletin that lists rates in time increments that conform to the definitions of the procedure codes authorized for payment by the MassHealth agency. The employer expense component for mandated employer expenses is subject to audit and may be adjusted in accordance with provisions of the fiscal intermediary contract with the purchasing agency.

History

Adopted by Mass Register Issue 1307, eff. 2/26/2016.

101 CMR, § 309.04 Filing and Reporting Requirements

(1) Cost Reporting Requirements. All providers must comply with the requirements of 957 CMR 6.00: Cost Reporting Requirements.

History

Adopted by Mass Register Issue 1307, eff. 2/26/2016.

101 CMR, § 309.05 Severability

The provisions of 101 CMR 309.00 are severable. If any provision of 101 CMR 309.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 309.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1307, eff. 2/26/2016.

Rates for Adult Day Health Services Rates for Adult Day Health Services

101 CMR, § 310.01 General Provisions

(1) Scope and Purpose. 101 CMR 310.00 governs the payment rates for adult day health services provided to publicly aided individuals. The payment rates in 101 CMR 310.00 also apply to individuals covered by the Workers' Compensation Act, M.G.L. c. 152.

(2) Applicable Dates of Service. Rates contained in 101 CMR 310.00 apply for dates of service provided on or after July 1, 2025.

(3) Coverage. The payment rates in 101 CMR 310.00 are full compensation for adult day health services as well as for any related administrative or supervisory duties rendered in connection with the provision of adult day health services.

(4) Disclaimer of Authorization of Services. 101 CMR 310.00 is neither authorization for nor approval of the substantive services for which rates are determined pursuant to 101 CMR 310.00. Governmental units or workers' compensation insurers that purchase care are responsible for the definition, authorization, and approval of care and services to covered individuals.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 310.00.

History

Amended by Mass Register Issue 1348, eff. 9/22/2017.

101 CMR, § 310.02 General Definitions

As used in 101 CMR 310.00, terms have the meanings set forth in 101 CMR 310.02.

Adult. Any person 18 years of age or older.

Adult Day Health Services. Programs approved by the MassHealth agency under 130 CMR 404.000: Adult Day Health Services and that provide for adult recipients an alternative to 24-hour long-term institutional care through an organized program of health care and supervision, restorative services, and socialization.

Basic Level of Care. The level of care for publicly aided clients receiving adult day health services as defined in 130 CMR 404.402: Basic Payment Level.

Center. The Center for Health Information and Analysis (CHIA) established under M.G.L. c. 12C.

Complex Level of Care. The level of care for publicly aided clients receiving adult day health services as defined in 130 CMR 404.402: Complex Payment Level.

Day Setting. Any single physical facility that is open at least Monday through Friday for eight hours per day that has been reviewed and approved by the MassHealth agency and other proper authorities for the operation of the adult day health services program.

Eligible Provider. Any person, partnership, corporation, or other entity that is authorized in the Commonwealth of Massachusetts to engage in the business of furnishing adult day health services to the public and who also meets such conditions of participation as may be adopted by a governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth; any department, agency, board, or commission of the Commonwealth; and any political subdivision of the Commonwealth.

Non-wheelchair Transportation. Transportation services provided by a motor vehicle for members who are ambulatory and can be transported in a van while seated on a bench or singleseat passenger chair.

Partial Per Diem. Adult day health services provided for a period equal to or less than three hours per day.

Per Diem. Adult day health services provided for a period greater than three hours per day. MassHealth will not pay for services that exceed six hours per day.

Publicly Aided Individual. A person whose medical and other services a governmental unit is in whole or part liable for under a statutory program.

Re-engagement Services. Services provided to ensure successful re-engagement of members who have not received site-based services during the period of March 24, 2020, through June 30, 2023. This is a one-time only claim per MassHealth member ID on or after the 45^th day of service with sustainable re-engagement in site-based services.

Restorative Services. Indirect services including, but not limited to, case conferences or those of an in-service educational therapist, speech pathologist, or other qualified restorative therapist.

Transportation. Method by which a member is brought from their home to the adult day health provider or from the adult day health provider to the member's home. Transportation service includes assisting the member while they enter and exit the vehicle, as appropriate. A member's home may include a temporary housing environment such as a shelter or transitional housing.

Wheelchair Transportation. Transportation service provided to a member who requires a wheelchair.

History

Amended by Mass Register Issue 1348, eff. 9/22/2017.

101 CMR, § 310.03 Rate Provisions

(1) Rate as Full Payment. Each eligible provider must, as a condition of receipt of payment from one or more purchasing governmental units for services rendered, accept the approved rates as full payment and discharge of all obligations for the services rendered, subject only to appellate rights as set forth in M.G.L. 118E. There will be no duplication or supplementation of payment from sources other than those expressly recognized or anticipated in the computation of the rate. Any client resources or third-party payments received on behalf of a publicly assisted client must reduce, by that amount, the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(2) Covered Services. The payment rates in 101 CMR 310.00 apply to adult day health services provided by eligible providers in a day setting, where:

(a) a patient's medical condition indicates a need for nursing care, supervision or a need for therapeutic services that alone or in combination would require institutional placement; or

(b) a patient's psycho-social condition is such that without program intervention the patient's medical condition would continue to deteriorate or is such that institutional placement is imminent.

(3) Exclusions. The payment rates in 101 CMR 310.00 do not apply to the following circumstances and services:

(a) specialized day programs primarily for the developmentally disabled, blind, deaf, or acutely mentally ill;

(b) adult day health programs operating out of state;

(c) physician services paid on a fee for fee-service basis under 101 CMR 316.00: Rates for Surgery and Anesthesia Services and 101 CMR 317.00: Rates for Medicine Services;

(d) restorative therapy services paid on a fee-for-service basis under 101 CMR 339.00: Rates for Restorative Services ; and

(e) services and costs paid under other regulations promulgated by EOHHS.

(4) Payment Rates. For dates of service on and after July 1, 2025, the base rate for adult day health services is the lower of the established charge or the rate listed below in 101 CMR 310.03(4).

| Code | Per Diem Base Rate | Description | | --- | --- | --- | | S5102 | $99.49 | Basic Level of Care | | S5102 TG | $136.72 | Complex Level of Care |

| Code | Partial Per Diem Rate | Description | | --- | --- | --- | | S5101 | $49.75 | Basic Level of Care | | S5101 TG | $68.36 | Complex Level of Care |

| Code | Rate | Description | | --- | --- | --- | | S5105 | $2000.00 | Admission Services (one-time only on or after the 45^th day of service) | | S5105 KZ | $2000.00 | Re-engagement Services (one-time only on or after the 45^th day of service) | | T2003 | $28.56 | Non-wheelchair (ambulatory) transportation (one-way trip) | | T2003 U6 | $34.98 | Wheelchair transportation (one-way trip) |

History

Amended by Mass Register Issue 1348, eff. 9/22/2017.

101 CMR, § 310.04 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Amended by Mass Register Issue 1348, eff. 9/22/2017.

101 CMR, § 310.05 Severability

The provisions of 101 CMR 310.00 are severable. If any provision of 101 CMR 310.00 or application of any provisions to an applicable person, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 310.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1348, eff. 9/22/2017.

Rates for Family Planning Services Rates for Family Planning Services

101 CMR, § 312.01 General Provisions

(1) Scope and Purpose. 101 CMR 312.00 governs the rates of payment used by all governmental units to pay eligible providers which provide family planning services to publicly aided individuals.

(2) Applicable Dates of Service. Rates in 101 CMR 312.00 apply for dates of service provided on or after May 1, 2025, unless otherwise indicated.

(3) Coverage. 101 CMR 312.00 and the rates of payment in 101 CMR 312.00 apply to family planning services rendered by eligible providers at a family planning agency setting. The rates of payment under 101 CMR 312.00 are full compensation for all services rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 312.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 312.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of the care and services extended to publicly-aided individuals.

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology(CPT) and/or the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list:

(a) codes for which the code numbers change, with the corresponding cross-references between new codes and the codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same, but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (IC) payment for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, to clarify its policy on and understanding of substantive provisions of 101 CMR 312.00, and as otherwise specified in 101 CMR 312.00.

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

101 CMR, § 312.02 General Definitions

As used in 101 CMR 312.00, unless the context clearly otherwise requires, the following terms have the meanings in 101 CMR 312.02.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Comprehensive Family Planning Agency. A public or private agency that demonstrates the capability of providing family planning medical services, family planning counseling services, follow-up health care, outreach and community education.

Eligible Provider. A comprehensive family planning agency which meets such conditions of participation as may be required by a governmental unit purchasing such services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Established Patient. A patient who has received professional services from the provider within the past three years.

Governmental Unit. The Commonwealth, any department, agency, board or commission of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration (IC). For specified drugs, injectables/vaccines, and medical and related supplies that are listed in 101 CMR 312.03(4) with IC, payment will be at cost, subject to any documentation requirements of the governmental unit.

New Patient. A patient who has not received any professional services from the provider within the past three years.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

Separate Procedure. Some of the listed procedures are commonly performed as an integral part of a total service and, as such, do not warrant a separate identification or payment. When, however, such a procedure is performed independently of, and is not immediately related to other services, it may be listed separately in the procedure description. Thus, when a procedure that is ordinarily a component of a larger procedure is performed alone for a specific purpose, it may be considered to be a separate procedure.

There are certain procedures designated as "(SP)" which are in addition to those procedures designated "separate procedure" by the AMA-CPT coding structure. These "(SP)" procedures were designated "Independent Procedures" (IP) in the former six-digit coding structure.

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

101 CMR, § 312.03 General Rate Provisions

(1) Reimbursement as Full Payment. Each eligible provider must, as a condition of payment made by the purchasing governmental unit for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Any third-party payments or sliding fees received on behalf of a publicly aided individual reduces, by that amount, the purchasing governmental unit's payment for services rendered to the publicly aided individual.

(2) Rates. Subject to the conditions listed herein, rates of payment for authorized family planning services for which 101 CMR 312.00 applies are the lowest of:

(a) the eligible provider's usual fee to the general public;

(b) the eligible provider's actual charge submitted; and

(3) Modifiers.

(a) 24 - Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period.

(b) 25 - Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service.

(d) LT - Left side (used to identify procedures performed on the left side of the body).

(e) RT - Right side (used to identify procedures performed on the right side of the body).

(f) Modifiers for Provider Preventable Conditions. Below are modifiers for reporting "provider preventable conditions" that are National Coverage Determinations, in accordance with 42 CFR 447.26.

| Modifier Name | Description | | --- | --- | | -PA | Surgical or other invasive procedure on wrong body part | | -PB | Surgical or other invasive procedure on wrong patient | | -PC | Wrong surgery or other invasive procedure on patient |

(4) Schedule of Allowable Fees.

| Code | Allowable Fee | Description | | --- | --- | --- | | 90651 | IC | Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use. | | New Patient | | | | 99202 | $95.14 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | 99203 | $144.55 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | 99204 | $210.21 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | 99205 | $265.12 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | Established Patient | | | | 99211 | $37.74 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | 99212 | $68.06 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | 99213 | $104.23 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | 99214 | $150.82 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | 99215 | $201.78 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. (In addition, visit includes counseling, anticipatory guidance, risk factor reduction, interventions, and the ordering of appropriate laboratory and diagnostic procedures.) | | Preventive Medicine Services | | | | 99384 | $110.46 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years) | | 99385 | $110.46 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years | | 99386 | $123.75 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years | | 99394 | $95.86 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years) | | 99395 | $96.34 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years | | 99396 | $102.56 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years | | 99402 | $71.15 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individual (separate procedure); approximately 30 minutes. | | Allowable Medical and Related Supplies | | | | S4993 | $11.33 | Contraceptives pills for birth control | | All Other Medical and Related Supplies | | | | S4989 | IC | Contraceptive intrauterine device (e.g., Progestacert IUD), including implants and supplies. | | A4261 | IC | Cervical cap for contraceptive use | | A4266 | $9.77 | Diaphragm for contraceptive use (includes applicator and contraceptive cream or jelly) | | A4267 | $0.19 | Contraceptive supply, condom, male, each | | A4268 | $2.14 | Contraceptive supply, condom, female, each | | A4269 | $4.10 | Contraceptive supply, spermicide (e.g., foam, gel), each (per tube or package) (includes contraceptive sponges) | | J1050 | IC | Injection, medroxyprogesterone acetate, 1 mg | | J3490- FP | IC | Unclassified Drugs (service provided as part of a Medicaid family planning program) (may be used by other governmental purchasers of family planning services) | | J7296 | IC | Levonorgestrel-releasing intrauterine contraceptive system (Kyleena), 19.5 mg | | J7297 | IC | Levonorgestrel-releasing intrauterine contraceptive system (Liletta), 52 mg | | J7298 | IC | Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg | | J7300 | IC | Intrauterine copper contraceptive | | J7301 | IC | Levonorgestrel-releasing intrauterine contraceptive system (Skyla), 13.5 mg | | J7303 | IC | Contraceptive supply, hormone containing vaginal ring, each | | J7304 | IC | Contraceptive supply, hormone containing patch, each | | J7307 | IC | Etonogestrel (contraceptive) implant system, including implant and supplies | | Medical and Surgical Procedures | | | | 11976 | $158.16 | Removal, implantable contraceptive capsules. | | 11981 | $261.55 | Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable) |

(5) Other Family Planning Services. The rates of payment for other family planning services not listed in 101 CMR 312.03(4) that are authorized by the purchasing governmental unit, will be based on the applicable EOHHS regulations such as 101 CMR 313.00: Rates for Freestanding Clinics Providing Abortion and Sterilization Services ; 101 CMR 316.00: Rates for Surgery and Anesthesia Services ; 101 CMR 317.00: Ratesfor Medicine Services ; 101 CMR 318.00: Rates for Radiology Services ; and 101 CMR 320.00: Rates for Clinical Laboratory Services .

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

101 CMR, § 312.04 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

101 CMR, § 312.05 Severability

The provisions of 101 CMR 312.00 are severable. If any provision of 101 CMR 312.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 312.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

Rates For Freestanding Clinics Providing Abortion And Sterilization Services Rates For Freestanding Clinics Providing Abortion And Sterilization Services

101 CMR, § 313.01 General Provisions

(1) Scope and Purpose. 101 CMR 313.00 governs the rates of payment used by governmental units to pay eligible providers for abortion and sterilization services provided to publicly aided individuals.

(2) Applicable Dates of Service. Rates contained in 101 CMR 313.00 apply for dates of service provided on or after May 1, 2025, unless otherwise indicated.

(3) Coverage. 101 CMR 313.00 and the rates of payment contained in 101 CMR 313.00 apply to abortion and sterilization services rendered by eligible providers in an ambulatory clinic setting. The rates of payment under 101 CMR 313.00 are full compensation for all services rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 313.00 is neither authorization for nor approval of the substantive services for which rates are determined pursuant to 101 CMR 313.00. Governmental units that purchase services from eligible providers are responsible for the definition, authorization, coverage policies, and approval of the care and services extended to publicly aided individuals.

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and/or the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list:

(a) codes for which the code numbers change, with the corresponding cross reference between new codes and the codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same, but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (IC) reimbursement for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, to clarify its policy on and understanding of substantive provisions of 101 CMR 313.00, and as otherwise specified in 101 CMR 313.00.

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

101 CMR, § 313.02 General Definitions

As used in 101 CMR 313.00, unless the context clearly otherwise requires, the following terms have the meanings in 101 CMR 313.02.

Ambulatory Abortion or Sterilization Clinic. A state-licensed freestanding ambulatory clinic that provides abortion or sterilization services and which is in compliance with applicable clinic licensure rules and regulations.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Eligible Provider. State-licensed freestanding ambulatory abortion or sterilization clinics providing abortion and/or sterilization services which meet such conditions of participation as may be required by a governmental unit purchasing such services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Established Patient. A patient who has received professional services from the provider within the past three years.

Governmental Unit. The Commonwealth, any department, agency, board or commission of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration (IC). For specified drugs and injectables listed in 101 CMR 313.03(5) with IC, payment will be at cost, subject to any documentation requirements of the governmental unit.

Modifier. Listed services and procedures may be modified under certain circumstances. When applicable, the modifying circumstances must be identified by the addition of the appropriate two-letter or numeric designation.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

101 CMR, § 313.03 General Rate Provisions

(1) Rate Determination. Rates of payment for eligible providers of abortion and sterilization services are the lowest of

(a) the eligible provider's usual fee to the general public;

(b) the eligible provider's actual charge submitted; and

(2) Abortion Services. The rates for an induced abortion, physician and clinic services include preoperative evaluation and counseling, laboratory services, surgery, anesthesia, and postoperative care due to complications. The post-abortion visit rate constitutes full compensation for routine follow-up care for abortion patients who return for such care.

(3) Sterilization Services. The rates of payment for sterilization services represent full compensation for these services, which include preoperative evaluation and counseling, laboratory services, surgery, anesthesia, and postoperative care.

(4) Modifiers.

(a) Modifier -51 Pertains to Multiple Procedures. This modifier must be used to report multiple procedures performed at the same session. The service code for the major procedure or service must be reported without a modifier. The secondary, additional or lesser procedure(s) must be identified by adding the modifier -51 to the end of the service code for the secondary procedure(s). The addition of the modifier -51 to the second and subsequent procedure codes allows 50% of the allowable fee contained in 101 CMR 313.03(5) to be paid to the eligible provider.

(b) Modifier -TF - Intermediate Level of Care. Use with procedure codes 59840, 59841, or S2260, if applicable, in accordance with the fee schedules set forth in 101 CMR 313.03(5).

(c) Modifier -TG - Complex/High Tech Level of Care. Use with procedure codes 59840, 59841, or S2260, if applicable, in accordance with the fee schedules set forth in 101 CMR 313.03(5).

(d) Modifiers for Provider Preventable Conditions. Below are modifiers for reporting "provider preventable conditions" that are National Coverage Determinations, in accordance with 42 CFR 447.26.

(5) Maximum Allowable Rates.

| Code | Modifer | Allowable Fee | Description | | --- | --- | --- | --- | | 55250 | | $555.69 | Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) | | 58600 | | $862.13 | Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral | | 58670 | | $804.01 | Laparoscopy, surgical, with fulguration of oviducts (with or without transection) | | 58671 | | $847.03 | Laparoscopy, surgical; with occlusion of oviducts by device ( e.g ., band, clip or Falope ring) | | 59820 | | $448.31 | Treatment of missed abortion, completed surgically first trimester (includes physician's charges and clinic services) | | 59840 | | $409.46 | Induced abortion, by dilation and curettage (includes physician's charges and clinic services with either I.V. sedation or general anesthesia) | | 59840 | -TF | $556.67 | Induced abortion, by dilation and curettage (includes physician's charges and clinic services with either I.V. sedation or general anesthesia) | | 59840 | -TG | $785.14 | Induced abortion, by dilation and curettage (includes physician's charges and clinic services with either I.V. sedation or general anesthesia) | | 59841 | | $636.33 | Induced abortion, by dilation and evacuation (includes physician's charges and clinic services) | | 59841 | -TF | $1,204.11 | Induced abortion, by dilation and evacuation (includes physician's charges and clinic services) | | 59841 | -TG | $1,285.55 | Induced abortion, by dilation and evacuation (includes physician's charges and clinic services) | | J2790 | | IC | Injection, Rho D immune globulin, human, full dose, 300 mcg (1500 IU) (when required only, reimbursed at the actual wholesale cost of the serum. A copy of the purchase invoice must be submitted with the claim form) | | S0190 | | IC | Mifepristone, oral, 200mg | | S0191 | | IC | Misoprostol, oral, 200mcg | | S0199 | | $501.57 | Medically induced abortion by oral ingestion of medication including all associated services and supplies ( e.g ., patient counseling, office visits confirmation of pregnancy by HCG, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs | | S2260 | | $776.09 | Induced abortion, 17 to 24 weeks (includes physician's charges and clinic services) | | S2260 | -TF | $1,055.48 | Induced abortion, 17 to 24 weeks (includes physician's charges and clinic services) | | S2260 | -TG | $1,490.08 | Induced abortion, 17 to 24 weeks (includes physician's charges and clinic services) |

(6) Services and Payments Covered under Other Regulations. The rates of payment for other abortion and sterilization services not listed in 101 CMR 313.03(5) that are authorized by the purchasing governmental unit will be based on the applicable EOHHS regulations, such as 101 CMR 312.00: Rates for Family Planning Services ; 101 CMR 316.00: Rates for Surgery and Anesthesia Services ; for 101 CMR 317.00: Rates for Medicine Services ; and 101 CMR 318.00: Rates for Radiology Services .

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

101 CMR, § 313.04 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

(2) Penalty for Noncompliance. A purchasing governmental unit may impose a penalty in the amount up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 313.04(2).

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

101 CMR, § 313.05 Severability

The provisions of 101 CMR 313.00 are severable. If any provision of 101 CMR 313.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 313.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted, Mass Register Issue 1261, eff. 5/23/2014.

Rates for Dental Services Rates for Dental Services

101 CMR, § 314.01 General Provisions

(1) Scope. 101 CMR 314.00 governs the rates of payments used by all governmental units in making payments to eligible dental providers for dental services rendered to publicly aided individuals.

(2) Applicable Dates of Service. Rates contained in 101 CMR 314.00 apply for dates of service provided on or after June 1, 2024.

(3) Coverage. The rates of payment contained in 101 CMR 314.00 or determined in accordance with the provisions of 101 CMR 314.00, are full compensation for dental services rendered to publicly aided individuals as well as for any related administrative or supervisory duties in connection with the provision of services, without regard to where these services are rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 314.00 is neither authorization for nor approval of the substantive services for which rates are determined pursuant to 101 CMR 314.00. Governmental units that purchase services from eligible providers are responsible for the definition, authorization, and approval of services extended to publicly aided patients.

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Dental Association's Current Dental Terminology (CDT). The publication of such updates and corrections will list

(a) codes for which the code numbers change, with the corresponding cross-reference between new codes and codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same, but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS may list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 314.00 and to issue coding updates and corrections in accordance with 101 CMR 314.01(5).

History

Adopted by Mass Register Issue 1342, eff. 6/30/2017.

101 CMR, § 314.02 Definitions

As used in 101 CMR 314.00, unless the context requires otherwise, terms have the meanings ascribed in 101 CMR 314.02.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Early Periodic Screening, Diagnostic and Treatment (EPSDT)-eligible MassHealth Members. Publicly aided individuals who are eligible to receive EPSDT services under 130 CMR 420.000: Dental Services and 130 CMR 450.000: Administrative and Billing Regulations .

Eligible Dental Provider.

(a) A provider of dental services who meets the conditions of participation of a governmental unit purchasing such services. Eligible dental providers may include the following:

dentists registered by the Massachusetts Board of Registration in Dentistry in accordance with the provisions of M.G.L. c. 112;
authorized governmental, nonprofit, or charitably incorporated dental clinics not involved with teaching dental students;
authorized dental clinics that wholly or partially derive support from Title V funds under the Social Security Act;

teaching dental clinics operated by dental education institutions; and

public health dental hygienists who are certified by the Massachusetts Board of Registration in Dentistry and who provide services in public health settings that include schools, long-term nursing facilities, medical facilities, and shelters.

(b) MassHealth providers of dental services must satisfy the provider eligibility requirements set forth in 130 CMR 420.000: Dental Services and 130 CMR 450.000: Administrative and Billing Regulations .

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Publicly Aided Individual. A person who receives medical or dental care and services for which a governmental unit is liable, in whole or in part, under a statutory program of public assistance.

History

Adopted by Mass Register Issue 1342, eff. 6/30/2017.

101 CMR, § 314.03 Rate Provisions

(1) Rate Determination. Subject to 101 CMR 314.03(2) and (3), rates of payment for authorized dental services to which 101 CMR 314.00 applies will be the lower of

(a) the eligible dentist provider's usual and customary fee to patients other than publicly aided individuals; or

(b) the allowable fee listed in 101 CMR 314.04, 314.05, or 314.06, as applicable.

(2) Rates Determination for EPSDT-eligible MassHealth Members. Rates of payment for authorized dental services to which 101 CMR 314.05 applies provided by eligible dental providers to EPSDT-eligible MassHealth members will be the allowable fee (EPSDT-eligible members) listed in 101 CMR 314.05.

(3) Individual Consideration (I.C.).

(a) Unlisted procedures and dental procedures designated I.C. are individually considered items. Determination of appropriate payment for procedures designated I.C. will be in accordance with the following standards and criteria:

time required to perform the procedure;
degree of skill required in the procedure performed;
severity and/or complexity of the patient's dental disease or condition; and
policies, procedures and practices of other third-party purchasers of dental services, both governmental and private.

(b) If an eligible provider believe that any such procedure merits a higher fee than recommended, the provider may submit the prescribed claim form with supporting documentation. Such claims will be individually processed.

(4) Reimbursement as Full Payment. Each eligible dental provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rates as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly aided individual.

(5) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(6) Prior Authorization. A number of procedures require authorization from the appropriate purchasing agency before providing the service and before payment will be made. Eligible dental providers should refer to the appropriate purchasing agency manual before providing services.

History

Adopted by Mass Register Issue 1342, eff. 6/30/2017.

101 CMR, § 314.04 Allowable Fees: Anesthesia Services (Hospital)

Reimbursement for anesthesia services is set forth in 101 CMR 316.00: Rates for Surgery and Anesthesia Services .

History

Adopted by Mass Register Issue 1342, eff. 6/30/2017.

101 CMR, § 314.05 Allowable Fees: Non-hospital Services

| Code | Allowed Fee | Allowed Fee (EPSDT-eligible members) | Description | | --- | --- | --- | --- | | | | | I. Diagnostic | | D0120 | $24 | $31 | Periodic oral evaluation - established patient | | D0140 | $43 | $49 | Limited oral evaluation - problem focused | | D0145 | I.C. | $27 | Oral evaluation for a patient under three years old and counseling with primary caregiver | | D0150 | $41 | $62 | Comprehensive oral evaluation - new or established patient | | D0160 | $64 | $77 | Detailed and extensive oral evaluation - problem focused, by report | | D0170 | $39 | $45 | Re-evaluation - limited, problem focused (established patient; not postoperative visit) | | D0171 | I.C. | I.C. | Re-evaluation - post-operative office visit | | D0180 | $37 | $58 | Comprehensive periodontal evaluation - new or established patient | | D0190 | $20 | $29 | Screening of patient | | D0191 | $20 | $29 | Assessment of patient | | D0210 | $76 | $94 | Intraoral - complete series of radiographic images | | D0220 | $15 | $21 | Intraoral - periapical, first radiographic image | | D0230 | $13 | $17 | Intraoral - periapical, each additional radiographic image | | D0240 | $21 | $26 | Intraoral - occlusal radiographic image | | D0250 | $23 | $28 | Extra oral 2D projection radiographic image created using a stationary radiation source, and detector | | D0251 | I.C. | I.C. | Extra-oral posterior dental radiographic image | | D0270 | $14 | $17 | Bitewing - single radiographic image | | D0272 | $25 | $32 | Bitewings - two radiographic images | | D0273 | $27 | $35 | Bitewings - three radiographic images | | D0274 | $36 | $46 | Bitewings - four radiographic images | | D0277 | $47 | $55 | Vertical bitewings - 7 to 8 radiographic images | | D0310 | $45 | $48 | Sialography | | D0320 | $230 | $321 | Temporomandibular joint arthrogram, including injection | | D0321 | $96 | $114 | Other temporomandibular joint radiographic image, by report | | D0322 | I.C. | I.C. | Tomographic survey | | D0330 | $69 | $94 | Panoramic radiographic image | | D0340 | $74 | $85 | 2D cephalometric radiographic image acquisition, measurement and analysis | | D0350 | $39 | $47 | 2D oral/facial photographic image obtained intra-orally or extra-orally | | D0364 | I.C. | I.C. | Cone beam CT capture and interpretation with limited field of view - less than one whole jaw | | D0365 | I.C. | I.C. | Cone beam CT capture and interpretation with field of view of one full dental arch - mandible | | D0366 | I.C. | I.C. | Cone beam CT capture and interpretation with field of view of one full dental arch - maxilla, with or without cranium | | D0367 | I.C. | I.C. | Cone beam CT capture and interpretation with field of view of both jaws, with or without cranium | | D0368 | I.C. | I.C. | Cone beam CT capture and interpretation for TMJ series including two or more exposures | | D0369 | I.C. | I.C. | Maxillofacial MRI capture and interpretation | | D0370 | I.C. | I.C. | Maxillofacial ultrasound capture and interpretation | | D0371 | I.C. | I.C. | Sialoendoscopy capture and interpretation | | D0372 | I.C. | I.C. | Intraoral tomosynthesis - comprehensive series of radiographic images | | D0373 | I.C. | I.C. | Intraoral tomosynthesis - bitewing radiographic image | | D0374 | I.C. | I.C. | Intraoral tomosynthesis - periapical radiographic image | | D0380 | I.C. | I.C. | Cone beam CT image capture with limited field of view -less than one whole jaw | | D0381 | I.C. | I.C. | Cone beam CT image capture with field of view of one full dental arch - mandible | | D0382 | I.C. | I.C. | Cone beam CT image capture with field of view of one full dental arch - maxilla, with or without cranium | | D0383 | I.C. | I.C. | Cone beam CT image capture with field of view of both jaws, with or without cranium | | D0384 | I.C. | I.C. | Cone beam CT image capture for TMJ series including two or more exposures | | D0385 | I.C. | I.C. | Maxillofacial MRI image capture | | D0386 | I.C. | I.C. | Maxillofacial ultrasound image capture | | D0387 | I.C. | I.C. | Intraoral tomosynthesis - comprehensive series of radiographic image - image capture only | | D0388 | I.C. | I.C. | Intraoral tomosynthesis - bitewing radiographic image -image capture only | | D0389 | I.C. | I.C. | Intraoral tomosynthesis - periapical radiographic image -image capture only | | D0391 | I.C. | I.C. | Interpretation of diagnostic image by a practitioner not associated with capture of the image, including report | | D0393 | I.C. | I.C. | Virtual treatment simulation using 3D image volume or surface scan | | D0394 | I.C. | I.C. | Digital subtraction of two or more images or image volumes of the same modality | | D0395 | I.C. | I.C. | Fusion of two or more 3D image volumes of one or more modalities | | D0411 | I.C. | I.C. | HbA1c in-office of service testing | | D0412 | I.C. | I.C. | Blood glucose level test- in-office using a glucose meter | | D0414 | I.C. | I.C. | Laboratory processing of microbial specimen to include culture and sensitivity studies, preparation and transmission of written report | | D0415 | I.C. | I.C. | Collection of microorganisms for culture and sensitivity | | D0416 | I.C. | I.C. | Viral culture | | D0417 | I.C. | I.C. | Collection and preparation of saliva sample for laboratory diagnostic testing | | D0418 | I.C. | I.C. | Analysis of saliva sample | | D0419 | I.C. | I.C. | Assessment of salivary flow by measurement | | D0422 | I.C. | I.C. | Collection and preparation of genetic sample material for laboratory analysis and report | | D0423 | I.C. | I.C. | Genetic test for susceptibility to diseases - specimen analysis | | D0425 | I.C. | I.C. | Caries susceptibility tests | | D0431 | I.C. | I.C. | Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and malignant lesions, not to include cytology or biopsy procedures | | D0460 | $31 | $37 | Pulp vitality tests | | D0470 | $62 | $72 | Diagnostic casts | | D0472 | $72 | $87 | Accession of tissue, gross examination, preparation, and transmission of written report | | D0473 | I.C. | I.C. | Accession of tissue, gross and microscopic examination, preparation and transmission of written report | | D0474 | I.C. | I.C. | Accession of tissue, gross and microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of written report | | D0475 | I.C. | I.C. | Decalcification procedure | | D0476 | I.C. | I.C. | Special stains for microorganisms | | D0477 | I.C. | I.C. | Special stains, not for microorganisms | | D0478 | I.C. | I.C. | Immunohistochemical stains | | D0479 | I.C. | I.C. | Tissue in-situ hybridization, including interpretation | | D0480 | $54 | $65 | Accession of exfoliative cytologic smears, microscopic examination, preparation and transmission of written report | | D0481 | I.C. | I.C. | Electron microscopy | | D0482 | I.C. | I.C. | Direct immunofluorescence | | D0483 | I.C. | I.C. | Indirect immunofluorescence | | D0484 | I.C. | I.C. | Consultation on slides prepared elsewhere | | D0485 | I.C. | I.C. | Consultation, including preparation of slides from biopsy material supplied by referring source | | D0486 | I.C. | I.C. | Accession of brush biopsy sample, microscopic examination, preparation and transmission of written report | | D0502 | I.C. | I.C. | Other oral pathology procedures, by report | | D0600 | I.C. | I.C. | Non-ionizing diagnostic procedure capable of quantifying, monitoring, and recording changes in structure of enamel, dentin, and cementum | | D0601 | I.C. | I.C. | caries risk assessment and documentation, with a finding of low risk | | D0602 | I.C. | I.C. | caries risk assessment and documentation, with a finding of moderate risk | | D0603 | I.C. | I.C. | caries risk assessment and documentation, with a finding of high risk | | D0604 | I.C. | I.C. | Antigen testing for a public health related pathogen, including coronavirus | | D0605 | I.C. | I.C. | Antibody testing for a public health related pathogen, including coronavirus | | D0701 | I.C. | I.C. | Panoramic radiographic image- image capture only | | D0702 | I.C. | I.C. | 2-D Cephalometric radiographic image- image capture only | | D0703 | I.C. | I.C. | 2-D oral/facial photographic image obtained intra-orally or extra-orally image capture only | | D0705 | I.C. | I.C. | Extra-oral posterior dental radiographic image- image capture only | | D0706 | I.C. | I.C. | Intraoral- occlusal radiographic image- image capture only | | D0707 | I.C. | I.C. | Intraoral- periapical radiographic image- image capture | | D0708 | I.C. | I.C. | Intraoral- bitewing radiographic image- image capture only | | D0709 | I.C. | I.C. | Intraoral- comprehensive series of radiographic images-image capture only | | D0801 | I.C. | I.C. | 3D dental surface scan - direct | | D0802 | I.C. | I.C. | 3D dental surface scan - indirect | | D0803 | I.C. | I.C. | 3D facial surface scan - direct | | D0804 | I.C. | I.C. | 3D facial surface scan - indirect | | D0999 | I.C. | I.C. | Unspecified diagnostic procedure, by report | | II. Preventive | | | | | D1110 | $60 | $75 | Prophylaxis - adult | | D1120 | $39 | $55 | Prophylaxis - child | | D1206 | $26 | $28 | Topical application of fluoride varnish | | D1208 | $29 | $31 | Topical application of fluoride - excluding varnish | | D1310 | I.C. | I.C. | Nutritional counseling for the control of dental disease | | D1320 | I.C. | I.C. | Tobacco counseling for the control and prevention of oral disease | | D1321 | I.C. | I.C. | Counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance use | | D1330 | $15 | $21 | Oral hygiene instructions | | D1351 | $30 | $44 | Sealant - per tooth | | D1352 | I.C. | I.C. | Preventive resin restoration in a moderate to high caries risk patient- permanent tooth | | D1353 | I.C. | I.C. | Sealant repair - per tooth | | D1354 | $15 | $15 | Application of caries arresting medicament - per tooth | | D1355 | I.C. | I.C. | Caries preventive medicament application- per tooth | | D1510 | $191 | $229 | Space maintainer - fixed, unilateral - per quadrant | | D1516 | $306 | $345 | Space maintainer- fixed- bilateral, maxillary | | D1517 | $306 | $345 | Space maintainer- fixed- bilateral, mandibular | | D1520 | $230 | $244 | Space maintainer - removable-unilateral- per quadrant | | D1526 | $345 | $368 | Space maintainer- removable- bilateral, maxillary | | D1527 | $345 | $368 | Space maintainer- removable- bilateral, mandibular | | D1551 | I.C. | I.C. | Re-cement or re-bond bilateral space maintainer- maxillary | | D1552 | I.C. | I.C. | Re-cement or re-bond bilateral space maintainer- mandibular | | D1553 | I.C. | I.C. | Re-cement or re-bond unilateral space maintainer- per quadrant | | D1556 | I.C. | I.C. | Removal of fixed unilateral space maintainer- per quadrant | | D1557 | I.C. | I.C. | Removal of fixed bilateral space maintainer- maxillary | | D1558 | I.C. | I.C. | Removal of fixed bilateral space maintainer- mandibular | | D1575 | I.C. | I.C. | Distal shoe space maintainer - fixed, unilateral- per quadrant | | D1781 | I.C. | I.C. | Vaccine administration - human papillomavirus - Dose 1 | | D1782 | I.C. | I.C. | Vaccine administration - human papillomavirus - Dose 2 | | D1783 | I.C. | I.C. | Vaccine administration - human papillomavirus - Dose 3 | | D1999 | I.C. | I.C. | Unspecified preventive procedure, by report | | III. Restorative | | | | | D2140 | $62 | $77 | Amalgam-one surface, primary or permanent | | D2150 | $77 | $95 | Amalgam-two surfaces, primary or permanent | | D2160 | $92 | $110 | Amalgam-three surfaces, primary or permanent | | D2161 | $116 | $137 | Amalgam-four or more surfaces, primary or permanent | | D2330 | $72 | $98 | Resin-based composite - one surface, anterior | | D2331 | $92 | $118 | Resin-based composite - two surfaces, anterior | | D2332 | $116 | $147 | Resin-based composite - three surfaces, anterior | | D2335 | $146 | $188 | Resin -based composite - four or more surfaces or involving incisal angle (anterior) | | D2390 | $106 | $133 | Resin-based composite crown, anterior | | D2391 | $62 | $99 | Resin-based composite - one surface, posterior | | D2392 | $77 | $123 | Resin-based composite - two surfaces, posterior | | D2393 | $92 | $133 | Resin-based composite - three surfaces, posterior | | D2394 | $116 | $182 | Resin-based composite - four or more surfaces, posterior | | D2410 | I.C. | I.C. | Gold foil - one surface | | D2420 | I.C. | I.C. | Gold foil - two surfaces | | D2430 | I.C. | I.C. | Gold foil - three surfaces | | D2510 | I.C. | I.C. | Inlay - metallic - one surface | | D2520 | I.C. | I.C. | Inlay - metallic - two surfaces | | D2530 | $307 | $367 | Inlay - metallic - three or more surfaces | | D2542 | $499 | $596 | Onlay - metallic - two surfaces | | D2543 | $690 | $788 | Onlay - metallic - three surfaces | | D2544 | $715 | $800 | Onlay - metallic - four or more surfaces | | D2610 | I.C. | I.C. | Inlay - porcelain/ceramic - one surface | | D2620 | $422 | $504 | Inlay - porcelain/ceramic - two surfaces | | D2630 | $640 | $744 | Inlay - porcelain/ceramic - three or more surfaces | | D2642 | $675 | $722 | Onlay - porcelain/ceramic - two surfaces | | D2643 | $651 | $768 | Onlay - porcelain/ceramic - three surfaces | | D2644 | $660 | $788 | Onlay - porcelain/ceramic - four or more surfaces | | D2650 | I.C. | I.C. | Inlay - resin-based composite - one surface | | D2651 | I.C. | I.C. | Inlay - resin-based composite - two surfaces | | D2652 | I.C. | I.C. | Inlay - resin-based composite - three or more surfaces | | D2662 | $613 | $656 | Onlay - resin-based composite - two surfaces | | D2663 | $612 | $727 | Onlay - resin-based composite - three surfaces | | D2664 | $612 | $731 | Onlay - resin-based composite - four or more surfaces | | D2710 | $230 | $244 | Crown - resin-based composite (indirect) | | D2712 | I.C. | I.C. | Crown - 3/4 resin-based composite (indirect) | | D2720 | $633 | $757 | Crown - resin with high noble metal | | D2721 | $460 | $550 | Crown - resin with predominantly base metal | | D2722 | $521 | $558 | Crown - resin with noble metal | | D2740 | $729 | $853 | Crown - porcelain/ceramic | | D2750 | $686 | $800 | Crown - porcelain fused to high noble metal | | D2751 | $613 | $727 | Crown - porcelain fused to predominantly base metal | | D2752 | $633 | $735 | Crown - porcelain fused to noble metal | | D2753 | I.C. | I.C. | Crown- porcelain fused to titanium and titanium alloys | | D2780 | $705 | $841 | Crown - % cast high noble metal | | D2781 | I.C. | I.C. | Crown - % cast predominately base metal | | D2782 | I.C. | I.C. | Crown - % cast noble metal | | D2783 | $682 | $812 | Crown - % porcelain/ceramic | | D2790 | $690 | $808 | Crown - full cast high noble metal | | D2791 | $538 | $641 | Crown - full cast predominantly base metal | | D2792 | $651 | $748 | Crown - full cast noble metal | | D2794 | I.C. | I.C. | Crown - titanium and titanium alloys | | D2799 | $191 | $228 | Interim crown - further treatment or completion of diagnosis necessary prior to final impression | | D2910 | $57 | $69 | Re-cement or re-bond inlay, onlay or partial coverage restoration | | D2915 | I.C. | I.C. | Re-cement or re-bond indirectly fabricated or prefabricated post and core | | D2920 | $57 | $68 | Re-cement or re-bond crown | | D2921 | I.C. | I.C. | Reattachment of tooth fragment, incisal edge or cusp | | D2928 | I.C. | I.C. | Prefabricated porcelain/ceramic crown- permanent tooth | | D2929 | I.C. | I.C. | Prefabricated porcelain/ceramic crown - primary tooth | | D2930 | $153 | $205 | Prefabricated stainless steel crown - primary tooth | | D2931 | $171 | $199 | Prefabricated stainless steel crown - permanent tooth | | D2932 | $211 | $224 | Prefabricated resin crown | | D2933 | $153 | $184 | Prefabricated stainless steel crown with resin window | | D2934 | $153 | $184 | Prefabricated esthetic coated stainless steel crown - primary tooth | | D2940 | $61 | $72 | Protective restoration | | D2941 | I.C. | I.C. | Interim therapeutic restoration- primary dentition | | D2949 | I.C. | I.C. | Restorative foundation for an indirect restoration | | D2950 | $164 | $197 | Core buildup, including any pins when required | | D2951 | $27 | $31 | Pin retention - per tooth, in addition to restoration | | D2952 | $233 | $276 | Post and core in addition to crown, indirectly fabricated | | D2953 | I.C. | I.C. | Each additional indirectly fabricated post - same tooth | | D2954 | $191 | $229 | Prefabricated post and core in addition to crown | | D2955 | I.C. | I.C. | Post removal | | D2957 | I.C. | I.C. | Each additional prefabricated post - same tooth | | D2960 | $307 | $420 | Labial veneer (resin laminate) - direct | | D2961 | $422 | $504 | Labial veneer (resin laminate) - indirect | | D2962 | $574 | $688 | Labial veneer (porcelain laminate) - laboratory | | D2971 | I.C. | I.C. | Additional procedures to customize a crown to fit under an existing partial denture framework | | D2975 | I.C. | I.C. | Coping | | D2980 | $115 | $137 | Crown repair necessitated by restorative material failure | | D2981 | I.C. | I.C. | Inlay repair necessitated by restorative material failure | | D2982 | I.C. | I.C. | Onlay repair necessitated by restorative material failure | | D2983 | I.C. | I.C. | Veneer repair necessitated by restorative material failure | | D2999 | I.C. | I.C. | Unspecified restorative procedure, by report | | IV. Endodontics | | | | | D3110 | $34 | $40 | Pulp cap - direct (excluding final restoration) | | D3120 | $34 | $40 | Pulp cap - indirect (excluding final restoration) | | D3220 | $88 | $106 | Therapeutic pulpotomy (excluding final restoration) -removal of pulp coronal to the dentinocemental junction and application of medicament | | D3221 | $115 | $123 | Pulpal debridement, primary and permanent teeth | | D3222 | I.C. | I.C. | Partial pulpotomy for apexogenesis- permanent tooth with incomplete root development | | D3230 | I.C. | I.C. | Pulpal therapy (resorbable filling) - anterior, primary tooth (excluding final restoration) | | D3240 | I.C. | I.C. | Pulpal therapy (resorbable filling) - posterior, primary tooth (excluding final restoration) | | D3310 | $544 | $544 | Endodontic therapy, anterior (excluding final restoration) | | D3320 | $639 | $639 | Endodontic therapy, premolar tooth (excluding final restoration) | | D3330 | $829 | $829 | Endodontic therapy, molar tooth (excluding final restoration) | | D3331 | I.C. | I.C. | Treatment of root canal obstruction; nonsurgical access | | D3332 | $191 | $205 | Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth | | D3333 | $230 | $274 | Internal root repair of perforation defects | | D3346 | $456 | $545 | Retreatment of previous root canal therapy - anterior | | D3347 | $538 | $641 | Retreatment of previous root canal therapy - premolar | | D3348 | $613 | $789 | Retreatment of previous root canal therapy - molar | | D3351 | $122 | $146 | Apexification/recalcification - initial visit (apical closure/calcific repair of perforations, root resorption, etc.) | | D3352 | I.C. | I.C. | Apexification/recalcification - interim medication replacement | | D3353 | I.C. | I.C. | Apexification/recalcification - final visit (includes completed root canal therapy - apical closure/calcific repair of perforations, root resorption, etc.) | | D3355 | I.C. | I.C. | Pulpal regeneration - intial visit | | D3356 | I.C. | I.C. | Pulpal regeneration - interim medication replacement | | D3357 | I.C. | I.C. | Pulpal regeneration - completion of treatment | | D3410 | $407 | $471 | Apicoectomy - anterior | | D3421 | $460 | $550 | Apicoectomy - premolar (first root) | | D3425 | $598 | $639 | Apicoectomy - molar (first root) | | D3426 | $230 | $264 | Apicoectomy (each additional root) | | D3428 | I.C. | I.C. | Bone graft in conjunction with periradicular surgery - per tooth, single site | | D3429 | I.C. | I.C. | Bone graft in conjunction with periradicular surgery - each additional contiguous tooth in the same surgical site | | D3430 | $77 | $91 | Retrograde filling - per root | | D3431 | I.C. | I.C. | Biological materials to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery | | D3432 | I.C. | I.C. | Guided tissue regeneration, resorbable barrier, per site, in conjunction with periradicular surgery | | D3450 | $288 | $343 | Root amputation - per root | | D3460 | $462 | $744 | Endodontic endosseous implant | | D3470 | I.C. | I.C. | Intentional re-implantation (including necessary splinting) | | D3471 | I.C. | I.C. | Surgical repair of root resorption- anterior | | D3472 | I.C. | I.C. | Surgical repair of root resorption- premolar | | D3473 | I.C. | I.C. | Surgical repair of root resorption- molar | | D3501 | I.C. | I.C. | Surgical repair of root surface without apicoectomy or repair or repair of root resorption- anterior | | D3502 | I.C. | I.C. | Surgical repair of root surface without apicectomy or repair of root resorption- premolar | | D3503 | I.C. | I.C. | Surgical repair of root surface without apicectomy or repair of root resorption- molar | | D3910 | I.C. | I.C. | Surgical procedure for isolation of tooth with rubber dam | | D3911 | I.C. | I.C. | Intraorifice barrier | | D3920 | $211 | $243 | Hemisection (including any root removal), not including root canal therapy | | D3921 | I.C. | I.C. | Decoronation or submergence of an erupted tooth | | D3950 | $69 | $111 | Canal preparation and fitting of preformed dowel or post | | D3999 | I.C. | I.C. | Unspecified endodontic procedure, by report | | V. Periodontics | | | | | D4210 | $307 | $343 | Gingivectomy or gingivoplasty - Four or more contiguous teeth or bounded teeth spaces per quadrant | | D4211 | $111 | $133 | Gingivectomy or gingivoplasty - one to three contiguous teeth or bounded teeth spaces per quadrant | | D4212 | I.C. | I.C. | Gingivectomy or gingivoplasty to allow access for restorative procedure, per tooth | | D4230 | I.C. | I.C. | Anatomical crown exposure - Four or more contiguous teeth or bounded tooth spaces per quadrant | | D4231 | I.C. | I.C. | Anatomical crown exposure - one to three teeth or bounded tooth spaces per quadrant | | D4240 | $449 | $606 | Gingival flap procedure, including root planing - four or more contiguous teeth or tooth bounded spaces per quadrant | | D4241 | I.C. | I.C. | Gingival flap procedure, including root planing - one to three contiguous teeth or tooth bounded spaces per quadrant | | D4245 | I.C. | I.C. | Apically positioned flap | | D4249 | $460 | $550 | Clinical crown lengthening - hard tissue | | D4260 | $795 | $1,101 | Osseous surgery (including elevation of a full thickness flap and closure) - four or more contiguous teeth or bounded teeth spaces per quadrant | | D4261 | $708 | $759 | Osseous surgery (including elevation of a full thickness flap and closure) - one to three contiguous teeth or tooth bounded spaces per quadrant | | D4263 | $253 | $351 | Bone replacement graft - retained natural tooth - first site in quadrant | | D4264 | $188 | $202 | Bone replacement graft - retained natural tooth - each additional site in quadrant | | D4265 | I.C. | I.C. | Biologic materials to aid in soft and osseous tissue regeneration, per site | | D4266 | $307 | $359 | Guided tissue regeneration, natural teeth - resorbable barrier, per site | | D4267 | $307 | $328 | Guided tissue regeneration, natural teeth - non-resorbable barrier, per site | | D4268 | I.C. | I.C. | Surgical revision procedure, per tooth | | D4270 | $604 | $800 | Pedicle soft tissue graft procedure | | D4273 | $651 | $779 | Autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft | | D4274 | $326 | $384 | Mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures in the same anatomical area) | | D4275 | I.C. | I.C. | Non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant, or edentulous tooth position in graft | | D4276 | I.C. | I.C. | Combined connective tissue and pedicle graft, per tooth | | D4277 | I.C. | I.C. | Free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant, or edentulous tooth position in graft | | D4278 | I.C. | I.C. | Free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant, or edentulous tooth position in same graft site | | D4283 | I.C. | I.C. | Autogenous connective tissue graft procedure (including donor and recipient surgical sites) - each additional contiguous tooth, implant or edentulous tooth position in same graft site | | D4285 | I.C. | I.C. | Non-autogenous connective tissue graft procedure (including recipient surgical site and donor material) | | D4286 | I.C. | I.C. | Removal of non-resorbable barrier | | D4322 | I.C. | I.C. | Splint - intra-coronal; natural teeth or prosthetic crowns | | D4323 | I.C. | I.C. | Splint - extra-coronal; natural teeth or prosthetic crowns | | D4341 | $134 | $160 | Periodontal scaling and root planing - four or more teeth per quadrant | | D4342 | $90 | $107 | Periodontal scaling and root planing - one to three teeth, per quadrant | | D4346 | $60 | $75 | Scaling in presence of generalized moderate or severe gingival inflammation - full mouth, after oral evaluation | | D4355 | $77 | $93 | Full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit | | D4381 | $88 | $121 | Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth | | D4910 | $80 | $111 | Periodontal maintenance | | D4920 | $67 | $76 | Unscheduled dressing change (by someone other than treating dentist) | | D4921 | I.C. | I.C. | Gingival irrigation with a medicinal agent - per quadrant | | D4999 | I.C. | I.C. | Unspecified periodontal procedure, by report | | VI. Prosthodontics (Removable) | | | | | D5110 | $730 | $858 | Complete denture - maxillary | | D5120 | $730 | $852 | Complete denture - mandibular | | D5130 | $767 | $935 | Immediate denture - maxillary | | D5140 | $766 | $934 | Immediate denture - mandibular | | D5211 | $556 | $650 | Maxillary partial denture - resin base (including retentive/clasping materials, rests and teeth) | | D5212 | $595 | $691 | Mandibular partial denture - resin base (including retentive/clasping materials, rests and teeth) | | D5213 | $1,097 | $974 | Maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) | | D5214 | $1,134 | $986 | Mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) | | D5221 | I.C. | I.C. | Immediate maxillary partial denture - resin base (including retentive/clasping materials, rests and teeth) | | D5222 | I.C. | I.C. | Immediate mandibular partial denture - resin base (including retentive/clasping materials, rests and teeth) | | D5223 | I.C. | I.C. | Immediate maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) | | D5224 | I.C. | I.C. | Immediate mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth) | | D5225 | I.C. | $974 | Maxillary partial denture - flexible base (including any clasps, rests and teeth) | | D5226 | I.C. | $986 | Mandibular partial denture - flexible base (including any clasps, rests and teeth) | | D5227 | I.C. | I.C. | Immediate maxillary partial denture - flexible base (including any clasps, rests and teeth) | | D5228 | I.C. | I.C. | Immediate mandibular partial denture - flexible base (including any clasps, rests and teeth) | | D5282 | I.C. | I.C. | Removable unilateral partial denture- one piece cast metal (including retentive/clasping materials, rests and teeth), maxillary | | D5283 | I.C. | I.C. | Removable unilateral partial denture- one piece cast metal (including retentive/clasping materials, rests and teeth), mandibular | | D5284 | I.C. | I.C. | Removable unilateral partial denture- one piece flexible base (including retentive/clasping materials, rests and teeth) -per quadrant | | D5286 | I.C. | I.C. | Removable unilateral partial denture- one piece resin (including clasps and teeth) - per quadrant | | D5410 | $42 | $49 | Adjust complete denture - maxillary | | D5411 | $42 | $49 | Adjust complete denture - mandibular | | D5421 | $53 | $56 | Adjust partial denture - maxillary | | D5422 | $39 | $45 | Adjust partial denture - mandibular | | D5511 | $85 | $109 | Repair broken complete denture base, mandibular | | D5512 | $85 | $109 | Repair broken complete denture base, maxillary | | D5520 | $77 | $89 | Replace missing or broken teeth - complete denture (each tooth) | | D5611 | $77 | $93 | Repair broken resin partial denture base, mandibular | | D5612 | $77 | $93 | Repair broken resin partial denture base, maxillary | | D5621 | $104 | $121 | Repair broken cast partial denture base, mandibular | | D5622 | $104 | $121 | Repair broken cast partial denture base, maxillary | | D5630 | $99 | $107 | Repair or replace broken retentive/clasping materials - per tooth | | D5640 | $77 | $91 | Replace broken teeth - per tooth | | D5650 | $92 | $110 | Add tooth to existing partial denture | | D5660 | $98 | $125 | Add clasp to existing partial denture per tooth | | D5670 | I.C. | I.C. | Replace all teeth and acrylic on cast metal framework (maxillary) | | D5671 | I.C. | I.C. | Replace all teeth and acrylic on cast metal framework (mandibular) | | D5710 | $253 | $301 | Rebase complete maxillary denture | | D5711 | $201 | $257 | Rebase complete mandibular denture | | D5720 | $230 | $274 | Rebase maxillary partial denture | | D5721 | $284 | $323 | Rebase mandibular partial denture | | D5725 | I.C. | I.C. | Rebase hybrid prosthesis | | D5765 | I.C. | I.C. | Soft liner for complete or partial removable denture - indirect | | D5730 | $158 | $188 | Reline complete maxillary denture (direct) | | D5731 | $173 | $184 | Reline lower complete mandibular denture (direct) | | D5740 | $142 | $169 | Reline maxillary partial denture (direct) | | D5741 | $134 | $160 | Reline mandibular partial denture (direct) | | D5750 | $214 | $255 | Reline complete maxillary denture (indirect) | | D5751 | $215 | $256 | Reline complete mandibular denture (indirect) | | D5760 | $211 | $252 | Reline maxillary partial denture (indirect) | | D5761 | $211 | $252 | Reline mandibular partial denture (indirect) | | D5810 | $145 | $193 | Interim complete denture (maxillary) | | D5811 | $145 | $193 | Interim complete denture (mandibular) | | D5820 | $268 | $321 | Interim partial denture (including retentive/clasping materials, rests and teeth), maxillary | | D5821 | $295 | $316 | Interim partial denture (including retentive/clasping materials, rests and teeth), mandibular | | D5850 | $72 | $86 | Tissue conditioning, maxillary | | D5851 | $65 | $77 | Tissue conditioning, mandibular | | D5862 | $230 | $254 | Precision attachment, by report | | D5863 | I.C. | I.C. | Overdenture- complete maxillary | | D5864 | I.C. | I.C. | Overdenture- partial maxillary | | D5865 | I.C. | I.C. | Overdenture- complete mandibular | | D5866 | I.C. | I.C. | Overdenture- partial mandibular | | D5867 | I.C. | I.C. | Replacement of replaceable part of semi-precision or precision attachment, per attachment | | D5875 | I.C. | I.C. | Modification of removable prosthesis following implant surgery | | D5876 | I.C. | I.C. | Add metal substructure to acrylic full denture (per arch) | | D5899 | I.C. | I.C. | Unspecified removable prosthodontic procedure, by report | | D5911 | I.C. | I.C. | Facial moulage (sectional) | | D5912 | I.C. | I.C. | Facial moulage (complete) | | D5913 | I.C. | I.C. | Nasal prosthesis | | D5914 | I.C. | I.C. | Auricular prosthesis | | D5915 | I.C. | I.C. | Orbital prosthesis | | D5916 | I.C. | I.C. | Ocular prosthesis | | D5919 | I.C. | I.C. | Facial prosthesis | | D5922 | I.C. | I.C. | Nasal septal prosthesis | | D5923 | I.C. | I.C. | Ocular prosthesis, interim | | D5924 | I.C. | I.C. | Cranial prosthesis | | D5925 | I.C. | I.C. | Facial augmentation implant prosthesis | | D5926 | I.C. | I.C. | Nasal prosthesis, replacement | | D5927 | I.C. | I.C. | Auricular prosthesis, replacement | | D5928 | I.C. | I.C. | Orbital prosthesis, replacement | | D5929 | I.C. | I.C. | Facial prosthesis, replacement | | D5931 | I.C. | I.C. | Obturator prosthesis, surgical | | D5932 | I.C. | I.C. | Obturator prosthesis, definitive | | D5933 | I.C. | I.C. | Obturator prosthesis, modification | | D5934 | I.C. | I.C. | Mandibular resection prosthesis with guide flange | | D5935 | I.C. | I.C. | Mandibular resection prosthesis without guide flange | | D5936 | I.C. | I.C. | Obturator prosthesis, interim | | D5937 | I.C. | I.C. | Trismus appliance (not for TM treatment) | | D5951 | I.C. | I.C. | Feeding aid | | D5952 | I.C. | I.C. | Speech aid prosthesis, pediatric | | D5953 | I.C. | I.C. | Speech aid prosthesis, adult | | D5954 | I.C. | I.C. | Palatal augmentation prosthesis | | D5955 | I.C. | I.C. | Palatal lift prosthesis, definitive | | D5958 | I.C. | I.C. | Palatal lift prosthesis, interim | | D5959 | I.C. | I.C. | Palatal lift prosthesis, modification | | D5960 | I.C. | I.C. | Speech aid prosthesis, modification | | D5982 | I.C. | I.C. | Surgical stent | | D5983 | I.C. | I.C. | Radiation carrier | | D5984 | I.C. | I.C. | Radiation shield | | D5985 | I.C. | I.C. | Radiation cone locator | | D5986 | I.C. | I.C. | Fluoride gel carrier | | D5987 | I.C. | I.C. | Commissure splint | | D5988 | I.C. | I.C. | Surgical splint | | D5991 | I.C. | I.C. | Vesiculobullous disease medicament carrier | | D5992 | I.C. | I.C. | Adjust maxillofacial prosthetic appliance, by report | | D5993 | I.C. | I.C. | Maintenance and cleaning of a maxillofacial prosthesis (extra or intra-oral) other than required adjustments, by report | | D5995 | I.C. | I.C. | Periodontal medicament carrier with peripheral seal -laboratory processed- maxillary | | D5996 | I.C. | I.C. | Periodontal medicament carrier with peripheral seal -laboratory processed- mandibular | | D5999 | I.C. | I.C. | Unspecified maxillofacial prosthesis, by report | | VII. Implant Services | | | | | D6010 | $1,151 | $1,374 | Surgical placement of implant body: endosteal implant | | D6011 | I.C. | I.C. | Surgical access to an implant body (second stage implant surgery) | | D6012 | I.C. | I.C. | Surgical placement of interim implant body for transitional prosthesis: endosteal implant | | D6013 | I.C. | I.C. | Surgical placement of mini implant | | D6040 | $1,534 | $1,632 | Surgical placement: eposteal implant | | D6050 | $134 | $162 | Surgical placement: transosteal implant | | D6051 | I.C. | I.C. | Interim implant abutment placement | | D6055 | $230 | $274 | Connecting bar - implant supported or abutment supported | | D6056 | $278 | $331 | Prefabricated abutment - includes modification and placement | | D6057 | $402 | $480 | Custom fabricated abutment - includes placement | | D6058 | $920 | $982 | Abutment supported porcelain/ceramic crown | | D6059 | $756 | $894 | Abutment supported porcelain fused to metal crown (high noble metal) | | D6060 | $729 | $778 | Abutment supported porcelain fused to metal crown (predominantly base metal) | | D6061 | $758 | $812 | Abutment supported porcelain fused to metal crown (noble metal) | | D6062 | $767 | $894 | Abutment supported cast metal crown (high noble metal) | | D6063 | I.C. | I.C. | Abutment supported cast metal crown (predominantly base metal) | | D6064 | $920 | $1,091 | Abutment supported cast metal crown (noble metal) | | D6065 | $920 | $1,015 | Implant supported porcelain/ceramic crown | | D6066 | $878 | $1,049 | Implant supported crown- porcelain fused to high noble alloys | | D6067 | $996 | $1,067 | Implant supported crown - high noble alloys | | D6068 | I.C. | I.C. | Abutment supported retainer for porcelain/ceramic FPD | | D6069 | I.C. | I.C. | Abutment supported retainer for porcelain fused to metal FPD (high noble metal) | | D6070 | I.C. | I.C. | Abutment supported retainer for porcelain fused to metal FPD (predominantly base metal) | | D6071 | I.C. | I.C. | Abutment supported retainer for porcelain fused to metal FPD (noble metal) | | D6072 | I.C. | I.C. | Abutment supported retainer for cast metal FPD (high noble metal) | | D6073 | I.C. | I.C. | Abutment supported retainer for cast metal FPD (predominantly base metal) | | D6074 | I.C. | I.C. | Abutment supported retainer for cast metal FPD (noble metal) | | D6075 | I.C. | I.C. | Implant supported retainer for ceramic FPD | | D6076 | I.C. | I.C. | Implant supported retainer for FPD - porcelain fused to high noble alloys | | D6077 | I.C. | I.C. | Implant supported retainer for metal FPD - high noble alloys | | D6080 | $96 | $115 | Implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments | | D6081 | I.C. | I.C. | Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of implant surfaces, without flap entry and closure. | | D6082 | I.C. | I.C. | Implant supported crown- porcelain fused to predominantly base alloys | | D6083 | I.C. | I.C. | Implant supported crown- porcelain fused to noble alloys | | D6084 | I.C. | I.C. | Implant supported crown- porcelain fused to titanium or titanium alloys | | D6085 | I.C. | I.C. | Interim implant crown | | D6086 | I.C. | I.C. | Implant supported crown- predominantly base alloys | | D6087 | I.C. | I.C. | Implant supported crown- noble alloys | | D6088 | I.C. | I.C. | Implant supported crown- titanium and titanium alloys | | D6090 | I.C. | I.C. | Repair implant supported prosthesis, by report | | D6091 | I.C. | I.C. | Replacement of replaceable part of semi-precision or precision attachment of implant/abutment supported prosthesis, per attachment | | D6092 | I.C. | I.C. | Re-cement or re-bond implant/abutment supported crown | | D6093 | I.C. | I.C. | Re-cement or re-bond implant/abutment supported fixed partial denture | | D6094 | I.C. | I.C. | Abutment supported crown - titanium and titanium alloys | | D6095 | I.C. | I.C. | Repair implant abutment, by report | | D6096 | I.C. | I.C. | Remove broken implant retaining screw | | D6097 | I.C. | I.C. | Abutment supported crown - porcelain fused to titanium or titanium alloys | | D6098 | I.C. | I.C. | Implant supported retainer- porcelain fused to predominantly base alloys | | D6099 | I.C. | I.C. | Implant supported retainer for FPD- porcelain fused to noble alloys | | D6100 | I.C. | I.C. | Surgical removal of implant body | | D6101 | I.C. | I.C. | Debridement of a peri-implant defect or defects surrounding a single implant, and surface cleaning of exposed implant surfaces, including flap entry and closure | | D6102 | I.C. | I.C. | Debridement and osseous contouring of a peri-implant defect or defects surrounding a single implant and includes surface cleaning of the exposed implant surfaces, including flap entry and closure | | D6103 | I.C. | I.C. | Bone graft for repair of peri-implant defect - does not include flap entry and closure | | D6104 | I.C. | I.C. | Bone graft at time of implant placement | | D6105 | I.C. | I.C. | Removal of implant body not requiring bone removal or flap elevation | | D6106 | I.C. | I.C. | Guided tissue regeneration - resorbable barrier, per implant | | D6107 | I.C. | I.C. | Guided tissue regeneration - non-resorbable barrier, per implant | | D6110 | I.C. | I.C. | Implant/abutment supported removable denture for edentulous arch - maxillary | | D6111 | I.C. | I.C. | Implant/abutment supported removable denture for edentulous arch - mandibular | | D6112 | I.C. | I.C. | Implant/abutment supported removable denture for partially edentulous arch - maxillary | | D6113 | I.C. | I.C. | Implant/abutment supported removable denture for partially edentulous arch - mandibular | | D6114 | I.C. | I.C. | Implant/abutment supported fixed denture for edentulous arch - maxillary | | D6115 | I.C. | I.C. | Implant/abutment supported fixed denture for edentulous arch - mandibular | | D6116 | I.C. | I.C. | Implant/abutment supported fixed denture for partially edentulous arch - maxillary | | D6117 | I.C. | I.C. | Implant/abutment supported fixed denture for partially edentulous arch- mandibular | | D6118 | I.C. | I.C. | Implant/abutment supported interim fixed denture for edentulous arch - mandibular | | D6119 | I.C. | I.C. | Implant/abutment supported interim fixed denture for edentulous arch - maxillary | | D6120 | I.C. | I.C. | Implant supported retainer- porcelain fused to titanium and titanium alloys | | D6121 | I.C. | I.C. | Implant supported retainer for metal FPD- predominantly base alloys | | D6122 | I.C. | I.C. | Implant supported retainer for metal FPD- noble alloys | | D6123 | I.C. | I.C. | Implant supported retainer for metal FPD- titanium and titanium alloys | | D6190 | I.C. | I.C. | Radiographic/surgical implant index, by report | | D6191 | I.C. | I.C. | Semi-precision abutment- placement | | D6192 | I.C. | I.C. | Semi-precision attachment - placement | | D6194 | I.C. | I.C. | Abutment supported retainer crown for FPD - titanium and titanium alloys | | D6195 | I.C. | I.C. | Abutment supported retainer- porcelain fused to titanium and titanium alloys | | D6197 | I.C. | I.C. | Replacement of restorative material used to close an access opening of a screw-retained implant supported prosthesis, per implant | | D6198 | I.C. | I.C. | Remove interim implant component | | D6199 | I.C. | I.C. | Unspecified implant procedure, by report | | D6205 | I.C. | I.C. | Pontic - indirect resin based composite | | D6210 | $651 | $748 | Pontic - cast high noble metal | | D6211 | $584 | $667 | Pontic - cast predominantly base metal | | D6212 | $632 | $676 | Pontic - cast noble metal | | D6214 | I.C. | I.C. | Pontic - titanium and titanium alloys | | D6240 | $671 | $792 | Pontic - porcelain fused to high noble metal | | D6241 | $606 | $691 | Pontic - porcelain fused to predominantly base metal | | D6242 | $613 | $731 | Pontic - porcelain fused to noble metal | | D6243 | I.C. | I.C. | Pontic - porcelain fused to titanium and titanium alloys | | D6245 | I.C. | I.C. | Pontic - porcelain/ceramic | | D6250 | $703 | $807 | Pontic - resin with high noble metal | | D6251 | $517 | $575 | Pontic - resin with predominantly base metal | | D6252 | $555 | $691 | Pontic - resin with noble metal | | D6253 | I.C. | I.C. | Interim pontic - further treatment or completion of diagnosis necessary prior to final impression | | D6545 | $268 | $320 | Retainer - cast metal for resin bonded fixed prosthesis | | D6548 | I.C. | I.C. | Retainer - porcelain/ceramic for resin bonded fixed prosthesis | | D6549 | I.C. | I.C. | Resin retainer - for resin bonded fixed prosthesis | | D6600 | I.C. | I.C. | Retainer inlay - porcelain/ceramic, two surfaces | | D6601 | I.C. | I.C. | Retainer inlay - porcelain/ceramic, three or more surfaces | | D6602 | I.C. | I.C. | Retainer inlay - cast high noble metal, two surfaces | | D6603 | I.C. | I.C. | Retainer inlay - cast high noble metal, three or more surfaces | | D6604 | I.C. | I.C. | Retainer inlay - cast predominantly base metal, two surfaces | | D6605 | I.C. | I.C. | Retainer inlay - cast predominantly base metal, three or more surfaces | | D6606 | I.C. | I.C. | Retainer inlay - cast noble metal, two surfaces | | D6607 | I.C. | I.C. | Retainer inlay - cast noble metal, three or more surfaces | | D6608 | I.C. | I.C. | Retainer onlay - porcelain/ceramic, two surfaces | | D6609 | I.C. | I.C. | Retainer onlay - porcelain/ceramic, three or more surfaces | | D6610 | I.C. | I.C. | Retainer onlay - cast high noble metal, two surfaces | | D6611 | I.C. | I.C. | Retainer onlay - cast high noble metal, three or more surfaces | | D6612 | I.C. | I.C. | Retainer onlay - cast predominantly base metal, two surfaces | | D6613 | I.C. | I.C. | Retainer onlay - cast predominantly base metal, three or more surfaces | | D6614 | I.C. | I.C. | Retainer onlay - cast noble metal, two surfaces | | D6615 | I.C. | I.C. | Retainer onlay - cast noble metal, three or more surfaces | | D6624 | I.C. | I.C. | Retainer inlay - titanium | | D6634 | I.C. | I.C. | Retainer onlay - titanium | | D6710 | I.C. | I.C. | Retainer crown - indirect resin based composite | | D6720 | $527 | $671 | Retainer crown - resin with high noble metal | | D6721 | $536 | $610 | Retainer crown - resin with predominantly base metal | | D6722 | $207 | $246 | Retainer crown - resin with noble metal | | D6740 | I.C. | I.C. | Retainer crown - porcelain/ceramic | | D6750 | $678 | $779 | Retainer crown - porcelain fused to high noble metal | | D6751 | $610 | $691 | Retainer crown - porcelain fused to predominantly base metal | | D6752 | $613 | $731 | Retainer crown - porcelain fused to noble metal | | D6753 | I.C. | I.C. | Retainer crown - 3/4 porcelain fused to titanium and titanium alloys | | D6780 | $517 | $617 | Retainer crown - 3/4 cast high noble metal | | D6781 | I.C. | I.C. | Retainer crown - 3/4 cast predominately base metal | | D6782 | I.C. | I.C. | Retainer crown - 3/4 cast noble metal | | D6783 | I.C. | I.C. | Retainer crown - 3/4 porcelain/ceramic | | D6784 | I.C. | I.C. | Retainer crown - 3/4 titanium and titanium alloys | | D6790 | $703 | $897 | Retainer crown - full cast high noble metal | | D6791 | $556 | $661 | Retainer crown - full cast predominantly base metal | | D6792 | $589 | $701 | Retainer crown - full cast noble metal | | D6793 | I.C. | I.C. | Interim retainer crown - further treatment or completion of diagnosis necessary prior to final impression | | D6794 | I.C. | I.C. | Crown - titanium and titanium alloys | | D6920 | I.C. | I.C. | Connector bar | | D6930 | $72 | $87 | Recement bridge | | D6940 | $153 | $204 | Stress breaker | | D6950 | $166 | $220 | Precision attachment | | D6980 | $134 | $155 | Fixed partial denture repair necessitated by restorative material failure | | D6985 | I.C. | I.C. | Pediatric partial denture, fixed | | D6999 | I.C. | I.C. | Unspecified fixed prosthodontic procedure, by report | | X. Exodontic | | | | | D7111 | $75 | $80 | Extraction, coronal remnants - primary tooth | | D7140 | $77 | $107 | Extraction, erupted tooth or exposed root (elevation and/or forceps removal) | | D7210 | $149 | $179 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated | | D7220 | $191 | $223 | Removal of impacted tooth - soft tissue | | D7230 | $249 | $286 | Removal of impacted tooth - partially bony | | D7240 | $295 | $378 | Removal of impacted tooth - completely bony | | D7241 | $326 | $427 | Removal of impacted tooth - completely bony, with unusual surgical complications | | D7250 | $144 | $173 | Surgical removal of residual tooth roots (cutting procedure) | | D7251 | I.C. | I.C. | Coronectomy - intentional partial tooth removal, impacted teeth only | | D7260 | $339 | $398 | Oroantral fistula closure | | D7261 | I.C. | I.C. | Primary closure of a sinus perforation | | D7270 | $106 | $145 | Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth | | D7272 | $161 | $218 | Tooth transplantation (includes reimplantation from one site to another and splinting and/or stabilization) | | D7280 | $380 | $452 | Exposure of an unerupted tooth | | D7282 | I.C. | I.C. | Mobilization of erupted or malpositioned tooth to aid eruption | | D7283 | $73 | $84 | Placement of device to facilitate eruption of impacted tooth | | D7285 | $122 | $146 | Incisional biopsy of oral tissue - hard (bone, tooth) | | D7286 | $164 | $197 | Incisional biopsy of oral tissue - soft | | D7287 | I.C. | I.C. | Exfoliative cytological sample collection | | D7288 | I.C. | I.C. | Brush biopsy - transepithelial sample collection | | D7290 | $79 | $109 | Surgical repositioning of teeth | | D7291 | $137 | $165 | Transseptal fiberotomy/supra crestal fiberotomy, by report | | D7292 | I.C. | I.C. | Placement of temporary anchorage device (screw retained plate) requiring flap | | D7293 | I.C. | I.C. | Placement of temporary anchorage device requiring flap | | D7294 | I.C. | I.C. | Placement of temporary anchorage device without flap | | D7295 | I.C. | I.C. | Harvest of bone for use in autogenous grafting procedure | | D7296 | I.C. | I.C. | Corticotomy - one to three teeth or tooth spaces, per quadrant | | D7297 | I.C. | I.C. | Corticotomy - four or more teeth or tooth spaces, per quadrant | | D7298 | I.C. | I.C. | Removal of temporary anchorage device (screw retained plate), requiring flap | | D7299 | I.C. | I.C. | Removal of temporary anchorage device, requiring flap | | D7300 | I.C. | I.C. | Removal of temporary anchorage device without flap | | D7310 | $142 | $163 | Alveoloplasty in conjunction with extractions-four or more teeth or tooth spaces, per quadrant | | D7311 | $128 | $146 | Alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant | | D7320 | $187 | $202 | Alveoloplasty not in conjunction with extractions - four or more teeth or tooth spaces, per quadrant | | D7321 | $149 | $162 | Alveoloplasty not in conjunction with extractions - one to three teeth or tooth spaces, per quadrant | | D7340 | $747 | $796 | Vestibuloplasty - ridge extension (second epithelialization) | | D7350 | $943 | $1,236 | Vestibuloplasty - ridge extension (including soft tissue grafts, muscle reattachments, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) | | D7410 | $115 | $124 | Excision of benign lesion up to 1.25 cm | | D7411 | $208 | $254 | Excision of benign lesion greater than 1.25 cm | | D7412 | I.C. | I.C. | Excision of benign lesion, complicated | | D7413 | I.C. | I.C. | Excision of malignant lesion up to 1.25 cm | | D7414 | I.C. | I.C. | Excision of malignant lesion greater than 1.25 cm | | D7415 | I.C. | I.C. | Excision of malignant lesion, complicated | | D7440 | $188 | $256 | Excision of malignant tumor - lesion diameter up to 1.25 cm | | D7441 | $249 | $339 | Excision of malignant tumor - lesion diameter greater than 1.25 cm | | D7450 | $248 | $252 | Removal of benign odontogenic cyst or tumor - lesion diameter up to 1.25 cm | | D7451 | $288 | $343 | Removal of benign odontogenic cyst or tumor - lesion diameter greater than 1.25 cm | | D7460 | $121 | $142 | Removal of benign nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm | | D7461 | $143 | $194 | Removal of benign nonodontogenic cyst or tumor - lesion diameter greater than 1.25 cm | | D7465 | I.C. | I.C. | Destruction of lesion(s) by physical or chemical method, by report | | D7471 | $143 | $194 | Removal of lateral exostosis (maxilla or mandible) | | D7472 | I.C. | I.C. | Removal of torus palatinus | | D7473 | I.C. | I.C. | Removal of torus mandibularis | | D7485 | I.C. | I.C. | Surgical reduction of osseous tuberosity | | D7490 | I.C. | I.C. | Radical resection of maxilla or mandible | | D7509 | I.C. | I.C. | Marsupialization of odontogenic cyst | | D7510 | $96 | $115 | Incision and drainage of abscess - intraoral soft tissue | | D7511 | I.C. | I.C. | Incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of multiple fascial spaces) | | D7520 | $80 | $86 | Incision and drainage of abscess - extraoral soft tissue | | D7521 | I.C. | I.C. | Incision and drainage of abscess - extraoral soft tissue - complicated (includes drainage of multiple fascial spaces) | | D7530 | $210 | $224 | Removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue | | D7540 | $464 | $544 | Removal of reaction-producing foreign bodies, musculoskeletal system | | D7550 | I.C. | I.C. | Partial ostectomy/sequestrectomy for removal of nonvital bone | | D7560 | $267 | $364 | Maxillary sinusotomy for removal of tooth fragment or foreign body | | D7610 | $1,250 | $1,704 | Maxilla - open reduction (teeth immobilized, if present) | | D7620 | $419 | $569 | Maxilla - closed reduction (teeth immobilized, if present) | | D7630 | $1,045 | $1,425 | Mandible - open reduction (teeth immobilized, if present) | | D7640 | $624 | $850 | Mandible - closed reduction (teeth immobilized, if present) | | D7650 | $833 | $1,135 | Malar and/or zygomatic arch - open reduction | | D7660 | $207 | $282 | Malar and/or zygomatic arch - closed reduction | | D7670 | $296 | $387 | Alveolus - closed reduction, may include stabilization of teeth | | D7671 | I.C. | I.C. | Alveolus - open reduction, may include stabilization of teeth | | D7680 | I.C. | I.C. | Facial bones - complicated reduction with fixation and multiple surgical approaches | | D7710 | $1,250 | $1,704 | Maxilla - open reduction | | D7720 | I.C. | I.C. | Maxilla - closed reduction | | D7730 | $1,045 | $1,425 | Mandible - open reduction | | D7740 | $624 | $846 | Mandible - closed reduction | | D7750 | $833 | $1,135 | Malar and/or zygomatic arch - open reduction | | D7760 | $207 | $282 | Malar and/or zygomatic arch - closed reduction | | D7770 | $312 | $380 | Alveolus - open reduction stabilization of teeth | | D7771 | I.C. | I.C. | Alveolus, closed reduction stabilization of teeth | | D7780 | $115 | $137 | Facial bones - complicated reduction with fixation and multiple surgical approaches | | D7810 | $521 | $711 | Open reduction of dislocation | | D7820 | $80 | $109 | Closed reduction of dislocation | | D7830 | I.C. | I.C. | Manipulation under anesthesia | | D7840 | $833 | $1,135 | Condylectomy | | D7850 | I.C. | I.C. | Surgical discectomy; with/without implant | | D7852 | I.C. | I.C. | Disc repair | | D7854 | I.C. | I.C. | Synovectomy | | D7856 | I.C. | I.C. | Myotomy | | D7858 | I.C. | I.C. | Joint reconstruction | | D7860 | I.C. | I.C. | Arthrotomy | | D7865 | I.C. | I.C. | Arthroplasty | | D7870 | $106 | $145 | Arthrocentesis | | D7871 | I.C. | I.C. | Nonarthroscopic lysis and lavage | | D7872 | I.C. | I.C. | Arthroscopy - diagnosis, with or without biopsy | | D7873 | I.C. | I.C. | Arthroscopy: lavage and lysis of adhesions | | D7874 | I.C. | I.C. | Arthroscopy: disc repositioning and stabilization | | D7875 | I.C. | I.C. | Arthroscopy: synovectomy | | D7876 | I.C. | I.C. | Arthroscopy: discectomy | | D7877 | I.C. | I.C. | Arthroscopy: debridement | | D7880 | $345 | $367 | Occlusal orthotic device, by report | | D7881 | I.C. | I.C. | Occlusal orthotic device adjustment | | D7899 | I.C. | I.C. | Unspecified TMD therapy, by report | | D7910 | $31 | $42 | Suture of recent small wounds up to 5 cm | | D7911 | $106 | $129 | Complicated suture - up to 5 cm | | D7912 | $106 | $145 | Complicated suture - greater than 5 cm | | D7920 | I.C. | I.C. | Skin graft (identify defect covered, location and type of graft) | | D7921 | I.C. | I.C. | Collection and application of autologous blood concentrate product | | D7922 | I.C. | I.C. | Placement of intra-socket biological dressing to aid in hemostasis or clot stabilization, per site | | D7940 | I.C. | I.C. | Osteoplasty - for orthognathic deformities | | D7941 | I.C. | I.C. | Osteotomy - mandibular rami | | D7943 | $2,501 | $3,409 | Osteotomy - mandibular rami with bone graft; includes obtaining the graft | | D7944 | $1,015 | $1,384 | Osteotomy-segmented or subapical | | D7945 | $2,084 | $2,843 | Osteotomy - body of mandible | | D7946 | I.C. | I.C. | LeFort I (maxilla - total) | | D7947 | I.C. | I.C. | LeFort I (maxilla - segmented) | | D7948 | I.C. | I.C. | LeFort II or LeFort III (osteoplasty of facial bones for midface hypoplasia or retrusion) - without bone graft | | D7949 | I.C. | I.C. | LeFort II or LeFort III - with bone graft | | D7950 | $833 | $1,135 | Osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla-autogenous or nonautogenous, by report | | D7951 | I.C. | I.C. | Sinus augmentation with bone or bone substitutes | | D7952 | I.C. | I.C. | Sinus augmentation via a vertical approach | | D7953 | I.C. | I.C. | Bone replacement graft for ridge preservation - per site | | D7955 | I.C. | I.C. | Repair of maxillofacial soft and/or hard tissue defect | | D7956 | I.C. | I.C. | Guided tissue regeneration, edentulous area - resorbable barrier, per site | | D7957 | I.C. | I.C. | Guided tissue regeneration, edentulous area -non-resorbable barrier, per site | | D7961 | $107 | $353 | Buccal/labial frenectomy (frenulectomy) | | D7962 | $107 | $353 | Lingual frenectomy (frenulectomy) | | D7963 | $416 | $480 | Frenuloplasty | | D7970 | $246 | $334 | Excision of hyperplastic tissue - per arch | | D7971 | $79 | $109 | Excision of pericoronal gingival | | D7972 | I.C. | I.C. | Surgical reduction of fibrous tuberosity | | D7979 | I.C. | I.C. | Non-surgical sialolithotomy | | D7980 | $106 | $145 | Surgical sialolithotomy | | D7981 | $649 | $850 | Excision of salivary gland, by report | | D7982 | $282 | $387 | Sialodochoplasty | | D7983 | $517 | $705 | Closure of salivary fistula | | D7990 | I.C. | I.C. | Emergency tracheotomy | | D7991 | I.C. | I.C. | Coronoidectomy | | D7993 | I.C. | I.C. | Surgical placement of craniofacial implant - extra oral | | D7994 | I.C. | I.C. | Surgical placement: zygomatic implant | | D7995 | I.C. | I.C. | Synthetic graft - mandible or facial bones, by report | | D7996 | I.C. | I.C. | Implant - mandible for augmentation purposes (excluding alveolar ridge), by report | | D7997 | I.C. | I.C. | Appliance removal (not by dentist who placed appliance), includes removal of archbar | | D7998 | I.C. | I.C. | Intraoral placement of a fixation device not in conjunction with a fracture | | D7999 | I.C. | I.C. | Unspecified oral surgery procedure, by report | | XI. Orthodontic | | | | | D8010 | I.C. | $250 | Limited orthodontic treatment of the primary dentition | | D8020 | I.C. | $250 | Limited orthodontic treatment of the transitional dentition | | D8030 | I.C. | $250 | Limited orthodontic treatment of the adolescent dentition | | D8040 | I.C. | $250 | Limited orthodontic treatment of the adult dentition | | D8070 | I.C. | I.C. | Comprehensive orthodontic treatment of the transitional dentition | | D8080 | $1,227 | $1,302 | Comprehensive orthodontic treatment of the adolescent dentition | | D8090 | I.C. | I.C. | Comprehensive orthodontic treatment of the adult dentition | | D8210 | $85 | $95 | Removable appliance therapy | | D8220 | I.C. | I.C. | Fixed appliance therapy | | D8660 | $24 | $31 | Pre-orthodontic treatment examination to monitor growth and development | | D8670 | $215 | $288 | Periodic orthodontic treatment visit (as part of contract) | | D8680 | $85 | $102 | Orthodontic retention (removal of appliances, construction and placement of retainer(s)) | | D8681 | I.C. | I.C. | Removable orthodontic retainer adjustment | | D8690 | $122 | $136 | Orthodontic treatment (alternative billing to a contract fee) | | D8695 | I.C. | I.C. | Removal of fixed orthodontic appliances for reasons other than completion of treatment | | D8696 | I.C. | I.C. | Repair of orthodontic appliance- maxillary | | D8697 | I.C. | I.C. | Repair of orthodontic appliance- mandibular | | D8698 | I.C. | I.C. | Re-cement or re-bond fixed retainer- maxillary | | D8699 | I.C. | I.C. | Re-cement or re-bond fixed retainer- mandibular | | D8701 | I.C. | I.C. | Repair of fixed retainer, includes reattachment- maxillary | | D8702 | I.C. | I.C. | Repair of fixed retainer, includes reattachment- mandibular | | D8703 | $85 | $95 | Replacement of lost or broken retainer- maxillary | | D8704 | $85 | $95 | Replacement of lost or broken retainer- mandibular | | D8999 | I.C. | I.C. | Unspecified orthodontic procedure, by report | | XII. Adjunctive General Services | | | | | D9110 | $36 | $75 | Palliative treatment of dental pain - per visit | | D9120 | I.C. | I.C. | Fixed partial denture sectioning | | D9130 | I.C. | I.C. | Temporomandibular joint dysfunction- non-invasive physical therapies | | D9210 | $11 | $15 | Local anesthesia not in conjunction with operative or surgical procedures | | D9211 | I.C. | I.C. | Regional block anesthesia | | D9212 | I.C. | I.C. | Trigeminal division block anesthesia | | D9215 | I.C. | I.C. | Local anesthesia in conjunction with operative or surgical procedures | | D9219 | I.C. | I.C. | Evaluation for moderate sedation, deep sedation or general anesthesia | | D9222 | $90 | $109 | Deep sedation/general anesthesia - first 15 minutes | | D9223 | $90 | $109 | Deep sedation/general anesthesia - each additional 15-minute increment | | D9230 | $15 | $22 | Analgesia, anxiolysis, inhalation of nitrous oxide | | D9239 | $78 | $101 | Intravenous moderate (conscious) sedation analgesia - first 15 minutes | | D9243 | $78 | $101 | Intravenous moderate (conscious) sedation analgesia - each additional 15-minute increment | | D9248 | $45 | $45 | Nonintravenous conscious sedation | | D9310 | $54 | $63 | Consultation-diagnostic service provided by dentist or physician other than requesting dentist or physician | | D9311 | I.C. | I.C. | Consultation with medical health care professional | | D9410 | $39 | $36 | House/extended care facility call, once per facility per day | | D9420 | $34 | $48 | Hospital or ambulatory surgical center call | | D9430 | $18 | $26 | Office visit for observation (during regularly scheduled hours) - no other services performed | | D9440 | $23 | $30 | Office visit - after regularly scheduled hours | | D9450 | $31 | $31 | Case presentation, subsequent to detailed and extensive treatment planing | | D9610 | $29 | $40 | Therapeutic parenteral drug, single administration | | D9612 | I.C. | I.C. | Therapeutic parenteral drugs, two or more administrations, different medications | | D9613 | I.C. | I.C. | Infiltration of sustained release therapeutic drug, per quadrant | | D9630 | $8 | $10 | Drugs or medicaments dispensed in the office for home use | | D9910 | $21 | $22 | Application of desensitizing medicament | | D9911 | I.C. | I.C. | Application of desensitizing resin for cervical and/or root surface, per tooth | | D9912 | I.C. | I.C. | Pre-visit patient screening | | D9920 | $86 | $86 | Behavior management, by report | | D9930 | $30 | $66 | Treatment of complications (postsurgical) - unusual circumstances, by report | | D9932 | I.C. | I.C. | Cleaning and inspection of removable complete denture, maxillary | | D9933 | I.C. | I.C. | Cleaning and inspection of removable complete denture, mandibular | | D9934 | I.C. | I.C. | Cleaning and inspection of removable partial denture, maxillary | | D9935 | I.C. | I.C. | Cleaning and inspection of removable partial denture, mandibular | | D9941 | $61 | $85 | Fabrication of athletic mouthguard | | D9942 | I.C. | I.C. | Repair and/or reline of occlusal guard | | D9943 | I.C. | I.C. | Occlusal guard adjustment | | D9944 | I.C. | $308 | Occlusal guard- hard appliance, full arch | | D9945 | I.C. | $308 | Occlusal guard- soft appliance, partial arch | | D9946 | I.C. | $308 | Occlusal guard- hard appliance, partial arch | | D9947 | I.C. | I.C. | Custom sleep apnea appliance fabrication and placement | | D9948 | I.C. | I.C. | Adjustment of custom sleep apnea appliance | | D9949 | I.C. | I.C. | Repair of custom sleep apnea appliance | | D9950 | $32 | $45 | Occlusion analysis - mounted case | | D9951 | $32 | $45 | Occlusal adjustment - limited | | D9952 | $149 | $179 | Occlusal adjustment - complete | | D9953 | I.C. | I.C. | Reline custom sleep apnea appliance (indirect) | | D9961 | I.C. | I.C. | Duplicate/copy patient's records | | D9970 | I.C. | I.C. | Enamel microabrasion | | D9971 | I.C. | I.C. | Odontoplasty - per tooth | | D9972 | I.C. | I.C. | External bleaching - per arch - performed in office | | D9973 | I.C. | I.C. | External bleaching - per tooth | | D9974 | I.C. | I.C. | Internal bleaching - per tooth | | D9975 | I.C. | I.C. | External bleaching for home application per arch; includes materials and fabrication of custom trays | | D9985 | I.C. | I.C. | Sales tax | | D9986 | I.C. | I.C. | Missed appointment | | D9987 | I.C. | I.C. | Cancelled appointment | | D9990 | I.C. | I.C. | Certified translation or sign-language services- per visit | | D9991 | I.C. | I.C. | Dental case management - addressing appointment compliance barriers | | D9992 | I.C. | I.C. | Dental case management - care coordination | | D9993 | I.C. | I.C. | Dental case management - motivational interviewing | | D9994 | I.C. | I.C. | Dental case management - patient education to improve oral health literacy | | D9995 | I.C. | I.C. | Teledentistry - synchronuous; real-time encounter | | D9996 | I.C. | I.C. | Teledentistry - asynchronous; information stored and forwarded to dentist for subsequent review | | D9997 | I.C. | I.C. | Dental case management- patients with special health care needs | | D9999 | I.C. | D0120 I.C. | Unspecified adjunctive procedure, by report |

History

Adopted by Mass Register Issue 1342, eff. 6/30/2017.

101 CMR, § 314.06 Allowable Fees: Hospital Services

Maximum allowable fees for professional services rendered in a hospital setting are governed under 101 CMR 316.00: Rates for Surgery and Anesthesia Services , 101 CMR 318.00: Rates for Radiology Services , and 101 CMR 317.00: Rates for Medicine Services .

History

Adopted by Mass Register Issue 1342, eff. 6/30/2017.

101 CMR, § 314.07 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1342, eff. 6/30/2017.

101 CMR, § 314.08 Severability

The provisions of 101 CMR 314.00 are severable. If any provision of 101 CMR 314.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 314.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1342, eff. 6/30/2017.

Rates for Vision Care Services and Ophthalmic Materials Rates for Vision Care Services and Ophthalmic Materials

101 CMR, § 315.01 General Provisions

(1) Scope. 101 CMR 315.00 governs the rates of payment used by governmental units and purchasers under M.G.L. c. 152, § 1 et seq . (the Workers' Compensation Act) for vision-care services and ophthalmic materials provided to publicly aided and industrial accident patients.

(2) Applicable Dates of Service. Rates contained in 101 CMR 315.00 are effective for dates of service on or after February 14, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 315.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 315.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care and services provided to publicly aided clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify provisions of 101 CMR 315.00, or to issue coding updates and corrections under 101 CMR 315.01(5).

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list:

(a) codes for which the code numbers change, with the corresponding cross references between the new codes and the codes being replaced. Rates for such updated codes are set at the rate of the code that is being replaced;

(b) codes for which the code numbers remain the same but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (IC) payment for these codes until appropriate rates can be developed.

History

Amended by Mass Register Issue 1407, eff. 1/1/2020.

101 CMR, § 315.02 General Definitions

The terms used in 101 CMR 315.00 shall have the meanings ascribed in 101 CMR 315.02 and in the CPT Coding Handbook. The descriptions and five-digit procedure codes included in 101 CMR 315.00 are obtained from the American Medical Association's Current Procedural Terminology (CPT) , copyright 2024, or the 2024 Healthcare Common Procedure Coding System Level II (HCPCS) unless otherwise specified. Both sources provide a listing of descriptive terms and alpha-numeric identifying codes and modifiers for reporting medical services and procedures performed by health-care providers.

Consultation - a type of service provided by a physician or ophthalmologist or optometrist whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or ophthalmologist or optometrist or other appropriate source. A physician consultant may initiate diagnostic and/or therapeutic services. The request for a consultation from the attending physician or ophthalmologist or optometrist or other appropriate source and the need for consultation must be documented in the patient's medical record. The consultant's opinion and any services that were ordered or performed must also be documented in the patient's medical record and communicated to the requesting physician or other appropriate source. Any specifically identifiable procedure ( i.e ., identified with a specific CPT code) performed on or subsequent to the date of the initial consultation should be reported separately. If a consultant subsequently assumes responsibility for management of a portion or all of the patient's condition(s), the consultation codes should not be used.

Eligible Provider (Provider) - ophthalmologists, optometrists, and dispensing opticians who are registered by an appropriate board of registration in accordance with the provision of M.G.L. c. 112; are not under contractual arrangement with a hospital or affiliated teaching institution for professional services; and who also meet such conditions of participation as may be required by a governmental unit purchasing vision-care services and ophthalmic materials or by purchasers under M.G.L. c. 152.

EOHHS - the Executive Office of Health and Human Services established under M.G.L. c. 6A.

Established Patient - a patient who has received professional services from the physician or ophthalmologist or optometrist within the past three years.

Governmental Unit - the Commonwealth, any department, agency, board, or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Individual Consideration (IC) - for service codes for which no rate is listed, the purchaser determines the payment amount on an individual consideration basis upon receipt of a bill that describes the services rendered. The purchaser shall determine the appropriate payment in accordance with the following criteria:

(a) time required to perform the procedure;

(b) degree of skill required for the procedure rendered;

(d) cost of goods supplied in rendering the service, including catalogue prices of major supplies; and

(e) policies, procedures, and practices of other third-party purchasers of care, governmental and private.

Low Vision - any pathological, traumatic, or congenital condition of the eye or brain that results in reduced visual acuity or reduction of visual field, and that is not amenable to medical, surgical, or ordinary optical correction.

Low-vision Aids - includes, but is not limited to, microscopic and telescopic lenses to correct low vision.

Low-vision Evaluation - a series of evaluative vision tests to measure the degree of low vision and the corrective lenses or aids required.

Modifiers - listed services may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of the appropriate two-digit number or letters placed after the usual procedure number from which it is separated by a hyphen.

New Patient - a patient who has not received any professional services from the physician or ophthalmologist or optometrist within the past three years.

Ocular Prosthetic Services - the dispensing and adjustment of false eyes.

Publicly Aided Individual - a person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

Vision-care Services and Ophthalmic Materials - professional care of the eye for the purpose of diagnosing and correcting refractive errors and includes the measurement, specification, formulation, construction, and dispensing of eyeglasses and related eye-care appliances.

History

Amended by Mass Register Issue 1407, eff. 1/1/2020.

101 CMR, § 315.03 General Rate Provisions

(1) Rate Determination. The rates for authorized vision-care services and ophthalmic materials under 101 CMR 315.00 are the lower of

(a) the provider's usual fee to patients other than publicly aided or industrial accident patients; or

(b) the schedule of allowable fees set forth in 101 CMR 315.04.

(2) Reimbursement as Full Payment. The rates established by 101 CMR 315.00 are full compensation for vision services provided to publicly aided and industrial-accident patients as well as for any related administrative or supervisory duties in connection with the provision of vision-care services without regard to where the services are provided.

(3) Bulk Purchase Contract. If the provider is required by the purchasing governmental unit to order material from designated suppliers under a bulk purchase contract, the provider shall bill the purchasing agency only for the relevant dispensing fee.

History

Amended by Mass Register Issue 1407, eff. 1/1/2020.

101 CMR, § 315.04 Allowable Fees for Vision-care Services

(1) Modifiers. The following modifiers are used to adjust payments under the circumstances noted in 101 CMR 315.04(1)(a) and (b).

(a) -52 Reduced Services. Modifier -52 is used to describe circumstances in which services provided were reduced in comparison to the full description of the service. When a provider does not complete a procedure in its entirety, such as a provider electing to partially reduce or eliminate a service, the procedure must be billed by appending modifier -52 to the service code. The rate for services billed with modifier -52 is 86% of the rate listed in 101 CMR 315.04(2). For example, modifier -52 would be used for a procedure that includes administration of eyedrops when an optometrist who is not certified to distribute eyedrops, performs the procedure.

(b) Provider Preventable Conditions. The following modifiers are used to report provider preventable conditions in accordance with 42 CFR. 447.26 and result in nonpayment for services.

| Modifier | Description | | --- | --- | | PA | Surgical or other invasive procedure performed on the wrong body part | | PB | Surgical or other invasive procedure performed on the wrong patient | | PC | Wrong surgical or other invasive procedure performed on a patient |

(2) Services and Payments Covered Under Other Regulations. Payments for some services performed by ophthalmologists are governed by other EOHHS regulations, including 101 CMR 316.00: Rates for Surgery and Anesthesia Services ; and 101 CMR 317.00: Rates for Medicine Services . The following codes are included in 101 CMR 316.00: 65210, 65222, 67820, 67938, 68761,68801, and 68840. The following codes are included in 101 CMR 317.00: 92132, 92133, 92134, 92201, 92202, 92227, 92228, 92250, 92273, 92274, 99174, and 99177.

| Procedure Code | Rate | Description | | --- | --- | --- | | 76512 | $103.11 | Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) | | 76513 | $103.11 | Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy, unilateral or bilateral | | 76514 | $9.56 | Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness) | | 92002 | $57.88 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient | | 92004 | $74.91 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits | | 92012 | $48.47 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient | | 92014 | $55.08 | Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits | | 92015 | $13.78 | Determination of refractive state | | 92020 | $22.07 | Gonioscopy (separate procedure) | | 92065 | $30.13 | Orthoptic training; performed by a physician or other qualified health care professional | | 92081 | $23.29 | Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent) | | 92082 | $61.33 | Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33) | | 92083 | $90.11 | Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2) | | 92100 | $33.06 | Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (eg, diurnal curve or medical treatment of acute elevation of intraocular pressure) | | 92225 | $51.03 | Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial | | 92226 | $46.27 | Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent | | 92229 | IC | Imaging of retina for detection or monitoring of disease; point-of-care autonomous analysis and report, unilateral or bilateral | | 92230 | $78.79 | Fluorescein angioscopy with interpretation and report | | 92260 | $27.92 | Ophthalmodynamometry | | 92275 | $97.85 | Electroretinography with interpretation and report | | 92285 | $41.27 | External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, slit lamp photography, goniophotography, stereophotography) | | 92310 | IC | Prescription of optical and physical characteristics of and fitting of contact lens, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia | | 92326 | $52.38 | Replacement of contact lens | | 92340 | $33.06 | Fitting of spectacles, except for aphakia; monofocal | | 92340 RB | $10.17 | Fitting of spectacles, except for aphakia; monofocal (replacement and repair) (per lens) | | 92341 | $40.80 | Fitting of spectacles, except for aphakia; bifocal | | 92341 RB | $15.22 | Fitting of spectacles, except for aphakia; bifocal (replacement and repair) (per lens) | | 92342 | $40.80 | Fitting of spectacles, except for aphakia; multifocal, other than bifocal | | 92342 RB | $15.22 | Fitting of spectacles, except for aphakia; multifocal, other than bifocal (replacement and repair) (per lens) | | 92370 | $12.07 | Repair and refitting spectacles; except for aphakia | | 92499 | IC | Unlisted ophthalmological service or procedure | | 92541 | $47.25 | Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording | | 92542 | $41.49 | Positional nystagmus test, minimum of 4 positions, with recording | | 92544 | $32.12 | Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording | | 99173 | $24.28 | Screening test of visual acuity, quantitative, bilateral | | 99202 | $53.99 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | | 99203 | $80.50 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | | 99204 | $114.12 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | | 99205 | $144.59 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | | 99211 | $17.48 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional | | 99212 | $32.19 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. | | 99213 | $44.49 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | | 99214 | $69.65 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | | 99215 | $101.38 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | | 99242 | $61.23 | Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | | 99243 | $79.04 | Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | | 99244 | $110.19 | Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | | 99245 | $149.03 | Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. | | 99252 | $63.52 | Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. | | 99253 | $94.24 | Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | | 99254 | $135.78 | Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | | 99304 | $51.28 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. | | 99305 | $68.53 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. | | 99306 | $87.41 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded. | | 99307 | $28.26 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. | | 99308 | $44.28 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | | 99309 | $60.98 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | | 99310 | $60.98 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | | 99341 | $47.20 | Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | | 99342 | $69.24 | Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | | 99344 | IC | Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | | 99347 | $36.83 | Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | | 99348 | $57.91 | Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | | 99349 | $88.90 | Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | | T2002 | $9.99 | Nonemergency transportation; per diem |

FRAMES

| Procedure Code | Rate | Description | | --- | --- | --- | | V2020 | $60.30 | Frames, purchases | | V2025 | IC | Deluxe frame |

SINGLE VISION, GLASS OR PLASTIC

If procedure code 92395 is reported, recode with specific lens type below.

| Procedure Code | Rate | Description | | --- | --- | --- | | V2100 | $33.33 | Sphere, single vision, plano to plus or minus 4.00, per lens | | V2101 | $35.14 | Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens | | V2102 | $49.42 | Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens | | V2103 | $28.97 | Spherocylinder, single vision, plano to plus or minus 4.00c sphere, 0.12 to 2.00d cylinder, per lens | | V2104 | $32.05 | Spherocylinder, single vision, plano to plus or minus 4.00c sphere, 2.12 to 4.00d cylinder, per lens | | V2105 | $34.91 | Spherocylinder, single vision, plano to plus or minus 4.00c sphere, 4.25 to 6.00d cylinder, per lens | | V2106 | $41.61 | Spherocylinder, single vision, plano to plus or minus 4.00c sphere, over 6.00d cylinder, per lens | | V2107 | $36.82 | Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, 0.12 to 2.00d cylinder, per lens | | V2108 | $38.13 | Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens | | V2109 | $42.23 | Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens | | V2110 | $42.45 | Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens | | V2111 | $43.42 | Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 0.25 to 2.25d cylinder, per lens | | V2112 | $47.40 | Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens | | V2113 | $54.77 | Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens | | V2114 | $57.85 | Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens | | V2115 | $62.98 | Lenticular (myodisc), per lens, single vision | | V2118 | $83.22 | Aniseikonic lens, single vision | | V2121 | $71.95 | Lenticular lens, per lens, single | | V2199 | IC | Not otherwise classified, single vision lens |

BIFOCAL, GLASS OR PLASTIC

| V2200 | $47.07 | Sphere, bifocal, plano to plus or minus 4.00d, per lens | | --- | --- | --- | | V2201 | $50.32 | Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens | | V2202 | $57.39 | Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens | | V2203 | $46.75 | Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 0.12 to 2.00d cylinder, per lens | | V2204 | $49.35 | Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens | | V2205 | $52.48 | Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens | | V2206 | $54.74 | Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens | | V2207 | $53.06 | Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 0.12 to 2.00d cylinder, per lens | | V2208 | $54.09 | Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens | | V2209 | $61.26 | Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens | | V2210 | $61.33 | Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens | | V2211 | $68.76 | Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 0.25 to 2.25d cylinder, per lens | | V2212 | $74.81 | Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens | | V2213 | $72.09 | Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens | | V2214 | $71.27 | Spherocylinder, bifocal, sphere over plus or minus 12.00d, per lens | | V2215 | $72.35 | Lenticular (myodisc), per lens, bifocal | | V2218 | $114.79 | Aniseikonic, per lens, bifocal | | V2219 | $37.90 | Bifocal seg width over 28mm | | V2220 | $30.73 | Bifocal add over 3.25d | | V2221 | $89.62 | Lenticular lens, per lens, bifocal | | V2299 | IC | Specialty bifocal (by report) |

TRIFOCAL, GLASS OR PLASTIC

| Procedure Code | Rate | Description | | --- | --- | --- | | V2300 | $61.57 | Sphere, trifocal, plano to plus or minus 4.00d, per lens | | V2301 | $83.69 | Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d per lens | | V2302 | $93.07 | Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00, per lens | | V2303 | $62.06 | Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 0.12 to 2.00d cylinder, per lens | | V2304 | $63.68 | Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 2.25 to 4.00d cylinder, per lens | | V2305 | $79.35 | Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00 cylinder, per lens | | V2306 | $76.81 | Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens | | V2307 | $83.62 | Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 0.12 to 2.00d cylinder, per lens | | V2308 | $86.13 | Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens | | V2309 | $98.37 | Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens | | V2310 | $83.27 | Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens | | V2311 | $95.63 | Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 0.25 to 2.25d cylinder, per lens | | V2312 | $101.68 | Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens | | V2313 | $110.82 | Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens | | V2314 | $91.50 | Spherocylinder, trifocal, sphere over plus or minus 12.00d, per lens | | V2315 | $135.42 | Lenticular, (myodisc), per lens, trifocal | | V2318 | $166.50 | Aniseikonic lens, trifocal | | V2319 | $45.29 | Trifocal seg width over 28 mm | | V2320 | $44.58 | Trifocal add over 3.25d | | V2321 | $132.23 | Lenticular lens, per lens, trifocal | | V2399 | IC | Specialty trifocal (by report) |

VARIABLE ASPHERICITY

| Procedure Code | Rate | Description | | --- | --- | --- | | V2410 | $76.31 | Variable asphericity lens, single vision, full field, glass or plastic, per lens | | V2430 | $93.80 | Variable asphericity lens, bifocal, full field, glass or plastic, per lens | | V2499 | IC | Variable sphericity lens, other type |

CONTACT LENSES

If procedure code 92396 is reported, recode with specific lens type listed below (per lens).

| Procedure Code | Rate | Description | | --- | --- | --- | | V2500 | $72.55 | Contact lens, PMMA, spherical, per lens | | V2501 | $140.53 | Contact lens, PMMA, toric or prism ballast, per lens | | V2502 | $170.42 | Contact lens PMMA, bifocal, per lens | | V2503 | $159.44 | Contact lens, PMMA, color vision deficiency, per lens | | V2510 | $107.81 | Contact lens, gas permeable, spherical, per lens | | V2511 | $180.96 | Contact lens, gas permeable, toric, prism ballast, per lens | | V2512 | $189.61 | Contact lens, gas permeable, bifocal, per lens | | V2513 | $153.63 | Contact lens, gas permeable, extended wear, per lens | | V2520 | $50.77 | Contact lens, hydrophilic, spherical, per lens | | V2521 | $77.98 | Contact lens, hydrophilic, toric, or prism ballast, per lens | | V2522 | $95.74 | Contact lens, hydrophilic, bifocal, per lens | | V2523 | $80.46 | Contact lens, hydrophilic, extended wear, per lens | | V2530 | IC | Contact lens, scleral, gas impermeable, per lens (for contact lens modification, see 92325) | | V2531 | IC | Contact lens, scleral, gas permeable, per lens (for contact lens modification, see 92325) | | V2599 | IC | Contact lens, other type |

LOW-VISION AIDS

If procedure code 92392 is reported, recode with specific systems listed below.

| Procedure Code | Rate | Description | | --- | --- | --- | | V2600 | IC | Handheld low vision aids and other nonspectacle mounted aids | | V2610 | IC | Single lens spectacle mounted low vision aids | | V2615 | IC | Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system |

PROSTHETIC EYE

| Procedure Code | Rate | Description | | --- | --- | --- | | V2623 | IC | Prosthetic eye, plastic, custom | | V2624 | IC | Polishing/resurfacing of ocular prosthesis | | V2625 | IC | Enlargement of ocular prosthesis | | V2626 | IC | Reduction of ocular prosthesis | | V2627 | IC | Scleral cover shell | | V2628 | IC | Fabrication and fitting of ocular conformer | | V2629 | IC | Prosthetic eye, other type |

INTRAOCULAR LENSES

| Procedure Code | Rate | Description | | --- | --- | --- | | V2630 | IC | Anterior chamber intraocular lens | | V2631 | IC | Iris supported intraocular lens | | V2632 | IC | Posterior chamber intraocular lens |

MISCELLANEOUS

| Procedure Code | Rate | Description | | --- | --- | --- | | V2700 | $39.08 | Balance lens, per lens | | V2710 | $54.56 | Slab off prism, glass or plastic, per lens | | V2715 | $9.88 | Prism, per lens | | V2718 | $31.43 | Press-on lens, Fresnel prism, per lens | | V2730 | $18.40 | Special base curve, glass or plastic, per lens | | V2744 | $13.96 | Tint, photochromatic, per lens | | V2745 | $8.67 | Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens | | V2750 | $16.24 | Antireflective coating, per lens | | V2755 | $18.84 | U-V lens, per lens | | V2760 | $14.35 | Scratch resistant coating, per lens | | V2770 | $22.15 | Occluder lens, per lens | | V2780 | $11.68 | Oversize lens, per lens | | V2781 | IC | Progressive lens, per lens | | V2785 | IC | Processing, preserving and transporting corneal tissue | | V2788 | IC | Presbyopia correcting function of intraocular lens | | V2799 | IC | Vision item or service, miscellaneous |

History

Amended by Mass Register Issue 1407, eff. 1/1/2020.

101 CMR, § 315.05 Severability

The provisions of 101 CMR 315.00 are severable. If any provision of 101 CMR 315.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 315.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1407, eff. 1/1/2020.

Rates for surgery and anesthesia services Rates for surgery and anesthesia services

101 CMR, § 316.01 General Provisions

(1) Scope and Purpose.

(a) 101 CMR 316.00 governs the payment rates used by all governmental units for surgery and anesthesia services provided to publicly aided patients. Rates for services provided to individuals covered by the Workers' Compensation Act, M.G.L. c. 152, are not set forth in 101 CMR 316.00, but are at 114.3 CMR 40.00: Rates for Services under M.G.L. c. 152, Worker's Compensation Act .

(b) The following laboratory services have a professional and technical component: 83020, 84165, 84166, 84181, 84182, 85390, 85576, 86255, 86256, 86320, 86325, 86327, 86334, 86335, 87164, 87207, 88371, 88372 and 89060. Payment rates for the professional component are contained herein. Payment rates for the technical component for these codes are contained in 101 CMR 320.00: Rates for Clinical Laboratory Services .

(2) Applicable Dates of Service. Rates contained in 101 CMR 316.00 apply for dates of service on or after January 1, 2025, except as otherwise noted.

(3) Coverage.

(a) Payment rates in 101 CMR 316.00 are used to pay for surgical and anesthesia services rendered to patients in a private medical office, freestanding ambulatory surgical center, licensed clinic, hospital or other inpatient or outpatient facility or department, or other appropriate setting by an individual eligible provider, when an eligible provider bills for the medical services rendered and no other payment method applies.

(b) The rates of payment under 101 CMR 316.00 are full compensation for patient care rendered to publicly aided patients as well as for any related administrative or supervisory duties in connection with patient care. The rates of payment also reimburse all overhead expenses associated with the service provided, without regard to where the care is rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 316.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 316.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided patients.

(a) The publication of such updates and corrections will list

codes for which the code numbers change, with the corresponding cross references between the new codes and the codes being replaced. Rates for such updated codes are set at the rate of the code that is being replaced;
deleted codes for which there are no corresponding new codes; and

codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) reimbursement for these codes until appropriate rates can be developed.

(b) For entirely new codes that require new pricing and have Medicare assigned relative value units (RVUs) (or, for applicable services, Medicare rates), EOHHS may list these codes and price them according to the rate methodology used in setting physician rates. When Medicare RVUs (or, for applicable services, Medicare rates) are not available, EOHHS may apply individual consideration in reimbursing for these new codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue Administrative Bulletins to add, delete, or otherwise update codes or modifiers, and to clarify its policy on and understanding of substantive provisions of 101 CMR 316.00. EOHHS may also issue Administrative Bulletins to clarify to which duly licensed or certified health care professionals or students the rate methods in 101 CMR 316.00 apply.

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 316.02 General Definitions

Meaning of Terms. The five-digit procedure codes and two-digit modifiers included in 101 CMR 316.00, and their corresponding descriptions, utilize the Healthcare Common Procedure Code System (HCPCS) for Level I and Level II coding. Level I CPT-4 codes are obtained from the Physicians' 2023 Current Procedural Terminology (CPT), copyright 2022 by the American Medical Association (AMA), unless otherwise specified. Level II codes are obtained from the 2023 HCPCS, maintained jointly by the Centers for Medicare & Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and the Health Insurance Association of America. HCPCS is a listing of descriptive terms and identifying codes and modifiers for reporting medical services and procedures performed by physicians and other health care professionals, as well as associated nonphysician services. No fee schedules, basic unit value, relative value guides, conversion factors, or scales are included in any part of the Physicians' Current Procedure Terminology . For code descriptions, see the anesthesia and surgery service code spreadsheets on the EOHHS rates website at: www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services.

In addition, terms used in 101 CMR 316.00 have the meanings set forth in 101 CMR 316.02.

Accountable Care Organization (ACO). An entity that enters into a population-based payment model contract with EOHHS as an accountable care organization, wherein the entity is held financially accountable for the cost and quality of care for an attributed or enrolled member population. ACOs include Accountable Care Partnership Plans, Primary Care ACOs, and MCO-administered ACOs.

Eligible Provider. The rates established in 101 CMR 316.00 apply in accordance with 101 CMR 316.01 to the following types of providers who meet conditions of participation of the governmental unit purchasing such services, and to the extent specified by such governmental unit. Eligible providers must provide such services in accordance with generally accepted professional standards and in accordance with state licensing requirements and certification by national credentialing bodies as required by law.

(a) A licensed physician (other than an intern, resident, fellow, or house officer), licensed podiatrist, and licensed dentist.

(b) A provider of radiation oncology services. Radiation oncology services may be rendered by eligible providers such as, but not limited to, independent radiation oncology centers. These eligible providers must be physically and financially independent of a hospital or a physician's office.

(c) A clinic licensed by the Massachusetts Department of Public Health in accordance with 105 CMR 140.000: Licensure of Clinics to provide surgical diagnostic services.

(d) A freestanding birth center facility that is not operating under a hospital's license, and is licensed as a birth center by the Massachusetts Department of Public Health pursuant to 105 CMR 142.000: Operation and Maintenance of Birth Centers .

(e) An advanced practice registered nurse who is authorized by the Board of Registration in Nursing to practice as a certified nurse practitioner, certified nurse midwife, clinical nurse specialist, psychiatric clinical nurse specialist, or a certified registered nurse anesthetist (CRNA).

(f) A licensed physician assistant who is authorized by the Board of Registration for Physician Assistants to practice as a physician assistant.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Facility Setting Fee. Payments for services provided by an individual eligible provider in a hospital (including, without limitation, a hospital inpatient department, outpatient department, emergency department, and hospital licensed health center), or skilled nursing facility or freestanding ambulatory surgical center (ASC), will be made according to a facility setting fee when an applicable facility setting fee has been established for that procedure.

Global Delivery. Includes direct provision and supervision of case management, maternal education (including, but not limited to, nutrition, pregnancy and childbirth, and reproductive health), and obstetrical risk assessment and monitoring, in addition to pelvic or Cesarean-section delivery, all routine prenatal visits, and one postpartum visit.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration (I.C.). Surgical procedures that are authorized but not listed in 101 CMR 316.00, surgical procedures performed in unusual circumstances, and services designated I.C. are individually considered items. The governmental unit or purchaser analyzes the eligible provider's report of services rendered and charges submitted under the appropriate unlisted services or procedures category. The governmental unit or purchaser determines appropriate payment for procedures designated I.C. in accordance with the following standards and criteria:

(a) the amount of time required to perform the service;

(b) the degree of skill required to perform the service;

(d) any applicable relative-value studies;

(e) any complications or other circumstances that may be deemed relevant;

(f) the policies, procedures and practices of other third party insurers;

(g) the payment rate for prescribed drugs as set forth in 101 CMR 331.00: Prescribed Drugs ; and

(h) a copy of the current invoice from the supplier.

Primary Care Clinician (PCC) Plan. A managed care option administered by the MassHealth agency through which enrolled members receive primary care and certain other medical services.

Publicly Aided Individual (or Publicly Aided Patient). A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Separate Procedure. Some of the listed procedures are commonly carried out as an integral part of a total service, and as such do not warrant a separate identification. When, however, such a procedure is performed independently of, and is not immediately related to, other services, it may be listed as a separate procedure in the procedure description. Thus, when a procedure that is ordinarily a component of a larger procedure is performed alone for a specific purpose, it may be considered to be a separate procedure.

Surgical Team Fee. Reimbursement for highly complex surgical procedures requiring the expertise of several physicians (usually of different specialties) and other highly skilled, specially-trained personnel. More than one surgeon may be performing parts of the procedure simultaneously. The unit fee is payable to the director of the surgical team and includes all assistant surgeon fees; there are no separate payments for assisting surgical services. The director of the surgical team is expected to distribute the unit fee to the members of the surgical team.

Unlisted Procedure or Service. A service or procedure that may be provided that is not listed in 101 CMR 316.05. When reporting such a service, the appropriate "Unlisted Procedure" code may be used to indicate the service.

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 316.03 General Rate Provisions

(1) Rate Determination. Rates of payment for services for which 101 CMR 316.00 applies are the lowest of

(a) the eligible provider's usual fee to patients other than publicly aided patients;

(b) the eligible provider's actual charge submitted; or

(c) the allowable fees in accordance with 101 CMR 316.04 (for anesthesia services), or the schedule of allowable fees set forth in 101 CMR 316.05 (for surgical services), as applicable, and taking into account appropriate modifiers and any other applicable rate provision(s) in accordance with 101 CMR 316.03.

(2) Supplemental Payment.

(a) Eligibility. An eligible provider who is a physician, certified nurse practitioner, physician assistant, or CRNA is eligible for a supplemental payment for services to publicly aided individuals eligible under Titles XIX and XXI of the Social Security Act if the following conditions are met:

the eligible provider is employed by a nonprofit group practice that was established in accordance with St. 1997, c. 163 and is affiliated with a Commonwealth-owned medical school;
such nonprofit group practice must have been established on or before January 1, 2000, in order to support the purposes of a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school; and
the services are provided at a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school.

(b) Payment Method. This supplemental payment may not exceed the difference between

payments to the eligible provider made pursuant to the rates applicable under 101 CMR 316.03(1), 101 CMR 317.03(1): Rate Determination and 101 CMR 318.03(1): Rate Determination ; and
the federal upper payment limit established by the Centers for Medicare & Medicaid Services.

(3) Rate Variations Based on Practice Site. Payments for certain services provided by individual eligible providers that can be routinely furnished in physicians' offices are reduced when such services are furnished in facility settings. 101 CMR 316.05 establishes facility setting fees applied to services rendered in a facility when a practice site differential is warranted.

(4) Allowable Fee for Certain Eligible Providers. Payment for services provided by eligible providers who are certified nurse practitioners, clinical nurse specialists, psychiatric clinical nurse specialists, and physician assistants as specified in 101 CMR 316.02, is 85% of the fees contained in 101 CMR 316.05.

(5) Global Surgical Package. The payment for a surgical procedure includes a standard package of preoperative, intraoperative, and postoperative services. Reimbursement for these procedures includes payment for services related to the surgery when furnished by the eligible provider who performs the surgery. The services included in the global surgical package may be furnished in any setting, e.g ., in hospitals, ASCs, physicians' offices. Included in the global fee is preoperative period of one day for major surgery and the postoperative period of 90 days for major surgery, as determined by the Centers for Medicare & Medicaid Services (CMS). The postoperative period for minor surgery is either zero or ten days depending on the procedure, as determined by CMS. Visits to a patient in an intensive care or critical care unit are also included if made by the surgeon.

(6) Obstetrical Services. Obstetrical fees contained in 101 CMR 316.05 are intended to include only the procedure or procedures performed and care to the publicly aided patient while hospitalized with the exception of global delivery (59400, 59510, 59610, 59618). Outpatient antepartum and postpartum obstetrical care may be billed under the appropriate medical procedure code in accordance with 101 CMR 317.00: Rates for Medicine Services . Medical problems complicating labor and delivery management or medical complications of pregnancy may require additional resources or services and should be identified by utilizing the appropriate procedure codes in 101 CMR 317.00: Rates for Medicine Services in addition to the procedure codes for maternity care listed in 101 CMR 316.05.

(7) Casts and Appliances. All maximum allowable fees include the initial application of a cast, traction device, or similar appliance.

(8) CPT Category III Codes. All surgery related CPT category III codes are included as a part of 101 CMR 316.00 and have an assigned fee of I.C.

(9) PCC Plan Enhanced Fee. Primary Care Clinicians (PCCs) receive an enhanced rate for certain types of primary and preventive care visits provided to their PCC Plan members enrolled with the PCC on the date of service. The enhanced fee specified in 101 CMR 353.03(A) is added to the rate for the procedure code billed. The MassHealth agency pays PCCs an enhanced fee for delivering primary care services in accordance with the terms of the PCC provider contract.

(10) Primary Care ACO-participating PCPs Enhanced Fee. Primary Care ACO-participating Primary Care Providers (participating PCPs) receive an enhanced rate for certain types of primary and preventive care visits provided to Primary Care ACO members enrolled with the participating PCP on the date of service. The enhanced fee specified in 101 CMR 353.03(B) is added to the rate for the procedure code billed. The MassHealth agency pays participating PCPs an enhanced fee for delivering primary care services in accordance with the terms of the participating PCP contract.

(11) Multiple Endoscopy Procedures. When multiple endoscopy procedures are performed through the same endoscope, payment is made for the endoscopy with the highest rate plus the difference between the next highest rate and the base endoscopy. When two related endoscopies and an unrelated endoscopy are performed, the special endoscopic payment rules apply to the related endoscopies. Unrelated endoscopic procedures are treated as a separate surgery and reimbursed using the payment rules for multiple surgery claims.

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 316.04 Maximum Allowable Fees - Anesthesia Services

(1) Anesthesia Services. Anesthesia services may include, but are not limited to, general, regional, supplementation of local anesthesia, or other supportive services in order to afford the patient the anesthesia care deemed optimal by the anesthesiologist or CRNA during any procedure. These services include the usual preoperative and postoperative visits, the anesthesia care during the procedure, the administration of fluids, and/or blood incident to the anesthesia or surgery, and the usual monitoring procedures. Unusual forms of monitoring ( e.g ., intra arterial, central venous, and Swan Ganz) are not included.

(2) Rate Determination. The administration of anesthesia is reported by the use of the anesthesia five digit procedure code (00100-01999) listed in 101 CMR 316.05(4)(a) and modifiers applicable to anesthesia services listed in 101 CMR 316.04(7). Payment for anesthesia services is determined by a system of base anesthesia units and time anesthesia units. The total anesthesia reimbursement (the "Total Anesthesia Fee") is the sum of the number of base anesthesia units multiplied by the base anesthesia unit fee, plus the number of time anesthesia units multiplied by the time anesthesia unit fee. Anesthesia time units are measured in minutes and one time anesthesia unit equals one minute. Payable anesthesia time starts when the anesthesiologist or CRNA begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist or CRNA is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision.

(3) Maximum Unit Fee. The maximum allowable fee for anesthesia services under 101 CMR 316.00 is $19.90 per base anesthesia unit and $1.33 per one minute time anesthesia unit.

(4) Multiple Surgery Procedures. When anesthesia is administered for multiple surgery procedures, only the base anesthesia units for the procedure with the largest number of units is used for the base anesthesia unit portion of the Total Anesthesia Fee calculation.

(5) Personally Performed Anesthesia Services. Personally performed anesthesia services are anesthesia procedures that are personally performed alone by either an anesthesiologist or a CRNA. For a CRNA, personally performed anesthesia services are those that a CRNA performs alone without medical direction of an anesthesiologist. Payment for personally performed anesthesia services of an anesthesiologist, or for personally performed anesthesia services of a CRNA for which the governmental unit provides separate payment, may be claimed by appending the appropriate anesthesia modifier to the anesthesia procedure code. Payment for personally performed anesthesia services by an anesthesiologist, or by a CRNA, is 100% of the Total Anesthesia Fee; provided that, if a CRNA is employed by the facility in which the personally performed anesthesia service is provided, governmental units may specify other payment rules for the CRNA's services including, without limitation, specifying that there is no separate payment for the CRNA's services.

(6) Medical Direction of CRNA Anesthesia Services. Payment for an anesthesiologist's medical direction of a CRNA, or for the services of a CRNA performed with medical direction of an anesthesiologist for which the governmental unit provides separate payment, may be claimed by appending the appropriate anesthesia modifier to the anesthesia procedure code. If an anesthesiologist provides medical direction of a CRNA, payment for the anesthesiologist's services is 50% of the Total Anesthesia Fee. Payment for the CRNA's services performed with medical direction of an anesthesiologist is 50% of the Total Anesthesia Fee; provided that, if a CRNA is employed by the facility in which the anesthesia service is performed, governmental units may specify other payment rules for the CRNA's services including, without limitation, specifying that there is no separate payment for the CRNA's services.

(7) Modifiers. For modifiers and related descriptions applicable to anesthesia services (AA, QK, QY, QX, and QZ), see 101 CMR 316.05(3).

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 316.05 Maximum Allowable Fees - Surgical Services

(1) Surgical and Obstetrical Services. Except as provided elsewhere in this 101 CMR 316.05(1), the allowable fees for surgical and obstetrical services are the fees listed in 101 CMR 316.05(4)(b), subject to 101 CMR 316.03 and appropriate modifiers, as applicable. (Anesthesia procedure codes (00100-01999) and corresponding base anesthesia units for purposes of 101 CMR 316.04 are listed in 101 CMR 316.05(4)(a)). Certain codes in 101 CMR 316.05(4)(b) are identified with an asterisk (*). The allowable fees for these codes are as set forth in 101 CMR 316.05(4)(b), except when any of those codes are billed as part of a facial feminization surgery to treat gender dysphoria, in which case the allowable fees are those set forth in 101 CMR 316.05(4)(c). (Anesthesia procedure codes (00100-01999) and corresponding base anesthesia units for purposes of 101 CMR 316.04 are listed in 101 CMR 316.05(4)(a)).

(2) Unless otherwise specified, guidelines, notes, and definitions provided in the 2023 CPT Coding Handbook are applicable to the use of the procedure codes and modifiers listed below, as well as their corresponding descriptions. For code descriptions, see the anesthesia and surgery service code spreadsheets at: www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services.

(3) Modifiers.

(a) 26: Professional Component. The component of a service or procedure representing the physician's or other qualified health care professional's work interpreting or performing the service or procedure. (When the physician or other qualified health care professional component is reported separately, the addition of modifier 26 to the procedure code will allow payment of the professional component allowable fee (PC Fee) contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable.)

(b) 50: Bilateral Procedure. Payment for bilateral procedures performed at the same operative session must be identified by the appropriate service code and modifier 50. Only one claim line is billed for both procedures. (The addition of modifier 50 to the bilateral code will allow payment of 150% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible provider for performance of both bilateral procedures.)

(c) 51: Multiple Procedures. This modifier must be used to report multiple procedures performed at the same session. The service code for the major procedure or service must be reported without a modifier. The secondary, additional, or lesser procedure(s) must be identified by adding modifier 51 to the end of the service code for the secondary procedure(s). (The addition of modifier 51 to the second and subsequent procedure codes allows payment of 50% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible provider.)

Note: This modifier should not be used with designated "add-on" codes or with codes in which the narrative begins with "each additional."

(d) 52: Reduced Services. Under certain circumstances, a service or procedure is partially reduced or eliminated at the physician's or other qualified health care professional's election. Under these circumstances, the service provided can be identified by its usual procedure number and addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.

(e) 54: Surgical Care Only. When one eligible physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the appropriate procedure code. (This allows payment of 85% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the physician or other qualified health care professional performing the surgery.)

(f) 55: Postoperative Management Only. When one eligible physician or other qualified health care professional performs the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the appropriate procedure code. (This allows payment of 15% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the physician or other qualified health care professional.)

(g) 58: Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional during the Postoperative Period. It may be necessary to indicate the performance of a procedure or service during the postoperative period was:

planned or anticipated (staged);
more extensive than original procedure; or
for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure. Note: for treatment of a problem that requires a return to the operating/procedure room ( e.g ., unanticipated clinical condition), see modifier 78.

(h) 59: Distinct Procedural Service. To identify a procedure distinct or independent from other services performed on the same day add modifier 59 to the end of the appropriate service code. Modifier 59 is used to identify services/procedures that are not normally reported together, but are appropriate under certain circumstances, for example, different site or organ system. However, when another already established modifier is appropriate, it should be used rather than modifier 59.

(i) 62: Two Surgeons. When two eligible surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report their distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the procedure once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate codes(s) may also be reported with modifier 62 added.) (The addition of modifier 62 to the procedure code allows payment of 57.5% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to each surgeon. No separate payment will be made for assisting surgical services in these cases; it is included in the total surgical fee listed.)

(j) 66: Surgical Team. This modifier must be used to identify highly complex procedures (requiring the concomitant services of several eligible physicians, often of different specialties, plus other highly skilled, specially trained personnel, and various types of complex equipment) carried out under the "surgical team" concept. The unit fee is payable to the director of the surgical team and includes all assistant surgeon fees; there are no separate payments for assisting surgical services. The director of the surgical team is expected to distribute the unit fee to the eligible members of the surgical team.

(k) 76: Repeat Procedure by Same Physician or Other Qualified Health Care Professional. The physician or other qualified health care professional may need to indicate that a procedure or service was repeated subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure/service or the separate five-digit modifier code 09976 may be used.

(l) 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. The physician or other qualified health care professional may need to indicate that a basic procedure or service performed by another physician or other qualified health care professional had to be repeated. This situation may be reported by adding modifier 77 to the repeated procedure/service or the separate five-digit modifier code 09977 may be used.

(m) 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional following Initial Procedure for a Related Procedure during the Postoperative Period. The physician or other qualified health care professional may need to indicate that another procedure was performed during that postoperative period of the initial procedure. When this subsequent procedure is related to the first, and requires the use of the operating room, it may be reported by adding modifier 78 to the related procedure, or by using the separate five-digit modifier 09978. (For repeat procedures on the same day, see modifier 76.)

(n) 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional during the Postoperative Period. The physician or other qualified health care professional may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using modifier 79 or by using the separate five-digit modifier 09979. (For repeat procedures on the same day, see modifier 76.)

(o) 80: Assistant Surgeon. Surgical assistant services may be identified by adding modifier 80 to the usual procedure code. (This allows payment of 15% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible assistant surgeon.)

(p) 82: Assistant Surgeon (when qualified resident surgeon not available). Surgical assistant services may be identified by adding modifier 82 to the usual procedure code when a qualified resident surgeon is not available. (This allows payment of 15% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, to the eligible assistant surgeon.)

(q) AA: Anesthesia Services Performed Personally by an Anesthesiologist. This allows payment of 100% of the Total Anesthesia Fee for the anesthesiologist's services.

(r) AS: Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistance at Surgery. This allows payment of 15% of the allowable fee contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable, for services of the eligible physician assistant, certified nurse practitioner, or clinical nurse specialist assisting in surgery.

(s) E1: Upper left, eyelid.

(t) E2: Lower left, eyelid.

(u) E3: Upper right, eyelid.

(v) E4: Lower right, eyelid.

(w) F1: Left hand, second digit.

(x) F2: Left hand, third digit.

(y) F3: Left hand, fourth digit.

(z) F4: Left hand, fifth digit.

(aa) F5: Right hand, thumb.

(bb) F6: Right hand, second digit.

(cc) F7: Right hand, third digit.

(dd) F8: Right hand, fourth digit.

(ee) F9: Right hand, fifth digit.

(ff) FA: Left hand, thumb.

(gg) LC: Left circumflex coronary artery.

(hh) LD: Left anterior descending coronary artery.

(ii) LT: Left side: Used to identify procedures performed on the left side of the body.

(jj) PA: Surgical or Other Invasive Procedure Performed on the Wrong Body Part. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services.

(kk) PB: Surgical or Other Invasive Procedure Performed on the Wrong Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services.

(ll) PC: Wrong Surgical or Other Invasive Procedure Performed on a Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services.

(mm) QK: Medical Direction by a Physician of Two, Three, or Four Concurrent Anesthesia Procedures. Used to indicate physician medical direction of multiple CRNAs. This allows payment of 50% of the Total Anesthesia Fee for the physician's services.

(nn) QY: Medical Direction of One CRNA by a Physician. Used to indicate physician medical direction of one CRNA. This allows payment of 50% of the Total Anesthesia Fee for the physician's services.

(oo) QX: CRNA Anesthesia Services with Medical Direction by a Physician. Used to indicate CRNA anesthesia services with medical direction by a physician. This allows payment of 50% of the Total Anesthesia Fee for the CRNA's services. Not for use if CRNA is employed by the facility in which the anesthesia services were performed.

(pp) QZ: CRNA Anesthesia Services without Medical Direction by a Physician. This allows payment of 100% of the Total Anesthesia Fee for the CRNA's services. Not for use if CRNA is employed by the facility in which the anesthesia services were performed.

(qq) RC: Right Coronary Artery.

(rr) RT: Right Side: Used to identify procedures performed on the right side of the body.

(ss) SA: Nurse Practitioner Rendering Service in Collaboration with a Physician. This modifier is to be applied to service codes billed by a physician that were performed by a certified nurse practitioner employed by the physician (the physician employer must be practicing as an individual and not practicing as a professional corporation or as a member of a group practice. A certified nurse practitioner billing under his or her own individual provider number, or a group practice, should not use this modifier.

(tt) T1: Left foot, second digit.

(uu) T2: Left foot, third digit.

(vv) T3: Left foot, fourth digit.

(ww) T4: Left foot, fifth digit.

(xx) T5: Right foot, great toe.

(yy) T6: Right foot, second digit.

(zz) T7: Right foot, third digit.

(aaa) T8: Right foot, fourth digit.

(bbb) T9: Right foot, fifth digit.

(ccc) TA: Left foot, great toe.

(ddd) TC: Technical Component. The component of a service or procedure representing the cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits, and other overhead expenses of the service or procedures, excluding the physician's professional component. (When the technical component is reported separately, the addition of modifier TC to the procedure code will allow payment of the technical component allowable fee (TC Fee) contained in 101 CMR 316.05(4)(b), adjusted by 101 CMR 316.03 as applicable.)

(eee) E: Separate Encounter. A service that is distinct because it occurred during a separate encounter.

(fff) XS: Separate Structure. A service that is distinct because it was performed on a separate organ/structure.

(ggg) XP: Separate Practitioner. A service that is distinct because it was performed by a different practitioner.

(hhh) XU: Unusual Non-overlapping Service. The use of a service that is distinct because it does not overlap usual components of the main service.

(4) Procedure Codes; Fee Schedules.

(a) Anesthesia Services - List of Procedure Codes and Base Anesthesia Units.

| AnestHesia Table | | | | --- | --- | --- | | Code | Units | Description ( see anesthesia service code spreadsheet at: www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia-services) | | 00100 | 5 | | | 00102 | 6 | | | 00103 | 5 | | | 00104 | 4 | | | 00120 | 5 | | | 00124 | 4 | | | 00126 | 4 | | | 00140 | 5 | | | 00142 | 4 | | | 00144 | 6 | | | 00145 | 6 | | | 00147 | 4 | | | 00148 | 4 | | | 00160 | 5 | | | 00162 | 7 | | | 00164 | 4 | | | 00170 | 5 | | | 00172 | 6 | | | 00174 | 6 | | | 00176 | 7 | | | 00190 | 5 | | | 00192 | 7 | | | 00210 | 11 | | | 00211 | 10 | | | 00212 | 5 | | | 00214 | 9 | | | 00215 | 9 | | | 00216 | 15 | | | 00218 | 13 | | | 00220 | 10 | | | 00222 | 6 | | | 00300 | 5 | | | 00320 | 6 | | | 00322 | 3 | | | 00326 | 7 | | | 00350 | 10 | | | 00352 | 5 | | | 00400 | 3 | | | 00402 | 5 | | | 00404 | 5 | | | 00406 | 13 | | | 00410 | 4 | | | 00450 | 5 | | | 00452 | 6 | | | 00454 | 3 | | | 00470 | 6 | | | 00472 | 10 | | | 00474 | 13 | | | 00500 | 15 | | | 00520 | 6 | | | 00522 | 4 | | | 00524 | 4 | | | 00528 | 8 | | | 00529 | 11 | | | 00530 | 4 | | | 00532 | 4 | | | 00534 | 7 | | | 00537 | 7 | | | 00539 | 18 | | | 00540 | 12 | | | 00541 | 15 | | | 00542 | 15 | | | 00546 | 15 | | | 00548 | 17 | | | 00550 | 10 | | | 00560 | 15 | | | 00561 | 25 | | | 00562 | 20 | | | 00563 | 25 | | | 00566 | 25 | | | 00567 | 18 | | | 00580 | 20 | | | 00600 | 10 | | | 00604 | 13 | | | 00620 | 10 | | | 00622 | 13 | | | 00625 | 13 | | | 00626 | 15 | | | 00630 | 8 | | | 00632 | 7 | | | 00634 | 10 | | | 00635 | 4 | | | 00640 | 3 | | | 00670 | 13 | | | 00700 | 4 | | | 00702 | 4 | | | 00730 | 5 | | | 00731 | 5 | | | 00732 | 5 | | | 00750 | 4 | | | 00752 | 6 | | | 00754 | 7 | | | 00756 | 7 | | | 00770 | 15 | | | 00790 | 7 | | | 00792 | 13 | | | 00794 | 8 | | | 00796 | 30 | | | 00797 | 11 | | | 00800 | 4 | | | 00802 | 5 | | | 00811 | 5 | | | 00812 | 5 | | | 00813 | 5 | | | 00820 | 5 | | | 00830 | 4 | | | 00832 | 6 | | | 00834 | 5 | | | 00836 | 6 | | | 00840 | 6 | | | 00842 | 4 | | | 00844 | 7 | | | 00846 | 8 | | | 00848 | 8 | | | 00851 | 6 | | | 00860 | 6 | | | 00862 | 7 | | | 00864 | 8 | | | 00865 | 7 | | | 00866 | 10 | | | 00868 | 10 | | | 00870 | 5 | | | 00872 | 7 | | | 00873 | 5 | | | 00880 | 15 | | | 00882 | 10 | | | 00902 | 5 | | | 00904 | 7 | | | 00906 | 4 | | | 00908 | 6 | | | 00910 | 3 | | | 00912 | 5 | | | 00914 | 5 | | | 00916 | 5 | | | 00918 | 5 | | | 00920 | 3 | | | 00921 | 3 | | | 00922 | 6 | | | 00924 | 4 | | | 00926 | 4 | | | 00928 | 6 | | | 00930 | 4 | | | 00932 | 4 | | | 00934 | 6 | | | 00936 | 8 | | | 00938 | 4 | | | 00940 | 3 | | | 00942 | 4 | | | 00944 | 6 | | | 00948 | 4 | | | 00950 | 5 | | | 00952 | 4 | | | 01112 | 5 | | | 01120 | 6 | | | 01130 | 3 | | | 01140 | 15 | | | 01150 | 10 | | | 01160 | 4 | | | 01170 | 8 | | | 01173 | 12 | | | 01200 | 4 | | | 01202 | 4 | | | 01210 | 6 | | | 01212 | 10 | | | 01214 | 8 | | | 01215 | 10 | | | 01220 | 4 | | | 01230 | 6 | | | 01232 | 5 | | | 01234 | 8 | | | 01250 | 4 | | | 01260 | 3 | | | 01270 | 8 | | | 01272 | 4 | | | 01274 | 6 | | | 01320 | 4 | | | 01340 | 4 | | | 01360 | 5 | | | 01380 | 3 | | | 01382 | 3 | | | 01390 | 3 | | | 01392 | 4 | | | 01400 | 4 | | | 01402 | 7 | | | 01404 | 5 | | | 01420 | 3 | | | 01430 | 3 | | | 01432 | 6 | | | 01440 | 8 | | | 01442 | 8 | | | 01444 | 8 | | | 01462 | 3 | | | 01464 | 3 | | | 01470 | 3 | | | 01472 | 5 | | | 01474 | 5 | | | 01480 | 3 | | | 01482 | 4 | | | 01484 | 4 | | | 01486 | 7 | | | 01490 | 3 | | | 01500 | 8 | | | 01502 | 6 | | | 01520 | 3 | | | 01522 | 5 | | | 01610 | 5 | | | 01620 | 4 | | | 01622 | 4 | | | 01630 | 5 | | | 01634 | 9 | | | 01636 | 15 | | | 01638 | 10 | | | 01650 | 6 | | | 01652 | 10 | | | 01654 | 8 | | | 01656 | 10 | | | 01670 | 4 | | | 01680 | 3 | | | 01710 | 3 | | | 01712 | 5 | | | 01714 | 5 | | | 01716 | 5 | | | 01730 | 3 | | | 01732 | 3 | | | 01740 | 4 | | | 01742 | 5 | | | 01744 | 5 | | | 01756 | 6 | | | 01758 | 5 | | | 01760 | 7 | | | 01770 | 6 | | | 01772 | 6 | | | 01780 | 3 | | | 01782 | 4 | | | 01810 | 3 | | | 01820 | 3 | | | 01829 | 3 | | | 01830 | 3 | | | 01832 | 6 | | | 01840 | 6 | | | 01842 | 6 | | | 01844 | 6 | | | 01850 | 3 | | | 01852 | 4 | | | 01860 | 3 | | | 01916 | 5 | | | 01920 | 7 | | | 01922 | 7 | | | 01924 | 5 | | | 01925 | 7 | | | 01926 | 8 | | | 01930 | 5 | | | 01931 | 7 | | | 01932 | 6 | | | 01933 | 7 | | | 01937 | 5 | | | 01938 | 5 | | | 01939 | 5 | | | 01940 | 5 | | | 01941 | 5 | | | 01942 | 5 | | | 01951 | 3 | | | 01952 | 5 | | | 01953 | 1 | | | 01958 | 5 | | | 01960 | 5 | | | 01961 | 7 | | | 01962 | 8 | | | 01963 | 8 | | | 01964 | 4 | | | 01965 | 4 | | | 01966 | 4 | | | 01967 | 5 | | | 01968 | 2 | | | 01969 | 5 | | | 01990 | 7 | | | 01991 | 3 | | | 01992 | 5 | | | 01995 | 5 | | | 01996 | 3 | | | 01999 | 0 | |

(b) Surgical Services - Fee Schedule.

NFAC - "Nonfacility". These amounts apply when service is performed in a non-facility setting.

FAC - "Facility". These amounts, also known as the Facility Setting Fee, apply when service is performed in a facility setting.

Global Fee. These amounts apply when no site of service differential rate is specified.

| Code | NFAC | FAC | Global | PC | TC | Description ( see surgery services code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery-and-anesthesia) | | --- | --- | --- | --- | --- | --- | --- | | 0404T | - | - | I.C. | - | - | | | 10004 | $38.13 | $31.16 | - | - | - | | | 10005 | $104.50 | $53.88 | - | - | - | | | 10006 | $44.97 | $36.66 | - | - | - | | | 10007 | $232.93 | $64.72 | - | - | - | | | 10008 | $111.57 | $37.65 | - | - | - | | | 10009 | $343.38 | $79.55 | - | - | - | | | 10010 | $186.69 | $51.70 | - | - | - | | | 10011 | - | - | I.C. | - | - | | | 10012 | - | - | I.C. | - | - | | | 10021 | $78.37 | $40.34 | - | - | - | | | 10030 | $514.00 | $98.31 | - | - | - | | | 10035 | $292.97 | $61.83 | - | - | - | | | 10036 | $245.12 | $31.11 | - | - | - | | | 10040 | $90.70 | $38.48 | - | - | - | | | 10060 | $97.09 | $80.48 | - | - | - | | | 10061 | $162.94 | $138.84 | - | - | - | | | 10080 | $198.93 | $79.47 | - | - | - | | | 10081 | $268.48 | $127.86 | - | - | - | | | 10120 | $117.64 | $80.14 | - | - | - | | | 10121 | $203.52 | $137.63 | - | - | - | | | 10140 | $130.80 | $89.02 | - | - | - | | | 10160 | $100.43 | $73.11 | - | - | - | | | 10180 | $203.11 | $134.27 | - | - | - | | | 11000 | $44.69 | $19.78 | - | - | - | | | 11001 | $21.00 | $10.82 | - | - | - | | | 11004 | - | - | $411.28 | - | - | | | 11005 | - | - | $557.85 | - | - | | | 11006 | - | - | $505.96 | - | - | | | 11008 | - | - | $196.76 | - | - | | | 11010 | $349.60 | $205.77 | - | - | - | | | 11011 | $382.07 | $217.62 | - | - | - | | | 11012 | $498.93 | $306.09 | - | - | - | | | 11042 | $100.25 | $44.27 | - | - | - | | | 11043 | $176.69 | $112.94 | - | - | - | | | 11044 | $234.18 | $164.81 | - | - | - | | | 11045 | $30.18 | $18.39 | - | - | - | | | 11046 | $54.46 | $39.73 | - | - | - | | | 11047 | $89.91 | $70.35 | - | - | - | | | 11055 | $56.51 | $11.51 | - | - | - | | | 11056 | $64.74 | $15.99 | - | - | - | | | 11057 | $70.28 | $20.73 | - | - | - | | | 11102 | $79.70 | $28.01 | - | - | - | | | 11103 | $39.30 | $16.00 | - | - | - | | | 11104 | $98.66 | $34.64 | - | - | - | | | 11105 | $46.23 | $18.91 | - | - | - | | | 11106 | $122.21 | $41.59 | - | - | - | | | 11107 | $55.87 | $22.66 | - | - | - | | | 11200 | $70.82 | $58.50 | - | - | - | | | 11201 | $13.79 | $12.19 | - | - | - | | | 11300 | $79.84 | $25.20 | - | - | - | | | 11301 | $95.55 | $37.96 | - | - | - | | | 11302 | $107.46 | $44.25 | - | - | - | | | 11303 | $118.85 | $52.42 | - | - | - | | | 11305 | $82.86 | $27.42 | - | - | - | | | 11306 | $96.21 | $36.22 | - | - | - | | | 11307 | $108.65 | $46.24 | - | - | - | | | 11308 | $113.95 | $51.27 | - | - | - | | | 11310 | $91.49 | $33.91 | - | - | - | | | 11311 | $107.01 | $46.47 | - | - | - | | | 11312 | $122.01 | $55.58 | - | - | - | | | 11313 | $140.82 | $70.65 | - | - | - | | | 11400 | $100.23 | $64.34 | - | - | - | | | 11401 | $121.72 | $80.74 | - | - | - | | | 11402 | $133.58 | $87.78 | - | - | - | | | 11403 | $153.03 | $113.12 | - | - | - | | | 11404 | $173.30 | $124.28 | - | - | - | | | 11406 | $243.28 | $185.42 | - | - | - | | | 11420 | $99.47 | $62.51 | - | - | - | | | 11421 | $124.23 | $82.98 | - | - | - | | | 11422 | $139.01 | $103.12 | - | - | - | | | 11423 | $157.88 | $118.24 | - | - | - | | | 11424 | $181.28 | $134.41 | - | - | - | | | 11426 | $251.34 | $201.52 | - | - | - | | | 11440 | $112.28 | $81.74 | - | - | - | | | 11441 | $135.27 | $101.52 | - | - | - | | | 11442 | $149.98 | $111.68 | - | - | - | | | 11443 | $175.98 | $135.27 | - | - | - | | | 11444 | $217.07 | $169.67 | - | - | - | | | 11446 | $291.49 | $236.59 | - | - | - | | | 11450 | $336.30 | $197.82 | - | - | - | | | 11451 | $409.29 | $249.93 | - | - | - | | | 11462 | $325.90 | $187.96 | - | - | - | | | 11463 | $415.32 | $251.67 | - | - | - | | | 11470 | $355.66 | $217.18 | - | - | - | | | 11471 | $419.15 | $263.27 | - | - | - | | | 11600 | $153.85 | $92.25 | - | - | - | | | 11601 | $177.28 | $111.66 | - | - | - | | | 11602 | $189.68 | $121.38 | - | - | - | | | 11603 | $215.32 | $144.88 | - | - | - | | | 11604 | $239.49 | $159.13 | - | - | - | | | 11606 | $341.72 | $234.32 | - | - | - | | | 11620 | $154.64 | $92.76 | - | - | - | | | 11621 | $178.26 | $112.37 | - | - | - | | | 11622 | $195.65 | $127.08 | - | - | - | | | 11623 | $227.97 | $156.73 | - | - | - | | | 11624 | $259.00 | $177.31 | - | - | - | | | 11626 | $310.80 | $216.26 | - | - | - | | | 11640 | $158.18 | $95.51 | - | - | - | | | 11641 | $183.88 | $116.92 | - | - | - | | | 11642 | $206.95 | $136.24 | - | - | - | | | 11643 | $241.99 | $169.67 | - | - | - | | | 11644 | $297.71 | $209.86 | - | - | - | | | 11646 | $384.33 | $288.98 | - | - | - | | | 11719 | $10.79 | $5.43 | - | - | - | | | 11720 | $25.24 | $10.51 | - | - | - | | | 11721 | $33.84 | $17.24 | - | - | - | | | 11730 | $89.31 | $39.49 | - | - | - | | | 11732 | $25.64 | $12.51 | - | - | - | | | 11740 | $44.68 | $24.32 | - | - | - | | | 11750 | $123.31 | $75.64 | - | - | - | | | 11755 | $94.74 | $44.39 | - | - | - | | | 11760 | $145.22 | $83.08 | - | - | - | | | 11762 | $222.01 | $139.79 | - | - | - | | | 11765 | $129.10 | $69.90 | - | - | - | | | 11770 | $277.00 | $138.53 | - | - | - | | | 11771 | $483.91 | $337.67 | - | - | - | | | 11772 | $595.42 | $437.67 | - | - | - | | | 11900 | $44.20 | $22.23 | - | - | - | | | 11901 | $53.60 | $33.78 | - | - | - | | | 11920 | $149.08 | $81.31 | - | - | - | | | 11921 | $172.91 | $97.64 | - | - | - | | | 11922 | $47.21 | $21.50 | - | - | - | | | 11950 | $62.53 | $38.70 | - | - | - | | | 11951 | $82.55 | $53.89 | - | - | - | | | 11952 | $110.05 | $75.50 | - | - | - | | | 11954 | $121.20 | $82.63 | - | - | - | | | 11960 | - | - | $773.63 | - | - | | | 11970 | - | - | $424.45 | - | - | | | 11971 | - | - | $418.04 | - | - | | | 11976 | $110.18 | $67.86 | - | - | - | | | 11980 | $71.85 | $40.78 | - | - | - | | | 11981 | $76.64 | $45.84 | - | - | - | | | 11982 | $85.48 | $54.15 | - | - | - | | | 11983 | $107.40 | $75.79 | - | - | - | | | 12001 | $72.71 | $32.80 | - | - | - | | | 12002 | $87.49 | $42.76 | - | - | - | | | 12004 | $101.19 | $52.98 | - | - | - | | | 12005 | $135.18 | $68.22 | - | - | - | | | 12006 | $156.64 | $84.05 | - | - | - | | | 12007 | $175.68 | $104.70 | - | - | - | | | 12011 | $86.71 | $40.11 | - | - | - | | | 12013 | $90.31 | $42.10 | - | - | - | | | 12014 | $109.52 | $53.81 | - | - | - | | | 12015 | $131.61 | $67.86 | - | - | - | | | 12016 | $167.15 | $92.15 | - | - | - | | | 12017 | - | - | $110.61 | - | - | | | 12018 | - | - | $124.81 | - | - | | | 12020 | $232.80 | $141.47 | - | - | - | | | 12021 | $136.11 | $106.38 | - | - | - | | | 12031 | $205.83 | $114.50 | - | - | - | | | 12032 | $236.77 | $143.30 | - | - | - | | | 12034 | $259.63 | $153.84 | - | - | - | | | 12035 | $301.25 | $179.91 | - | - | - | | | 12036 | $332.49 | $209.02 | - | - | - | | | 12037 | $371.35 | $242.52 | - | - | - | | | 12041 | $206.34 | $108.84 | - | - | - | | | 12042 | $240.84 | $146.83 | - | - | - | | | 12044 | $296.89 | $159.76 | - | - | - | | | 12045 | $321.09 | $206.19 | - | - | - | | | 12046 | $385.34 | $236.95 | - | - | - | | | 12047 | $421.26 | $262.70 | - | - | - | | | 12051 | $221.34 | $127.60 | - | - | - | | | 12052 | $245.47 | $149.85 | - | - | - | | | 12053 | $283.48 | $161.34 | - | - | - | | | 12054 | $298.71 | $163.45 | - | - | - | | | 12055 | $393.61 | $223.53 | - | - | - | | | 12056 | $449.01 | $288.57 | - | - | - | | | 12057 | $470.35 | $313.67 | - | - | - | | | 13100 | $265.39 | $149.95 | - | - | - | | | 13101 | $309.24 | $185.76 | - | - | - | | | 13102 | $89.60 | $52.64 | - | - | - | | | 13120 | $276.45 | $174.40 | - | - | - | | | 13121 | $330.11 | $191.91 | - | - | - | | | 13122 | $97.51 | $60.82 | - | - | - | | | 13131 | $301.01 | $180.21 | - | - | - | | | 13132 | $364.54 | $225.53 | - | - | - | | | 13133 | $127.85 | $91.96 | - | - | - | | | 13151 | $327.31 | $207.32 | - | - | - | | | 13152 | $382.93 | $249.54 | - | - | - | | | 13153 | $141.00 | $100.56 | - | - | - | | | 13160 | - | - | $594.51 | - | - | | | 14000 | $488.38 | $380.18 | - | - | - | | | 14001 | $619.53 | $490.43 | - | - | - | | | 14020 | $540.27 | $427.78 | - | - | - | | | 14021 | $662.93 | $533.02 | - | - | - | | | 14040 | $581.29 | $469.33 | - | - | - | | | 14041 | $704.64 | $572.33 | - | - | - | | | 14060 | $586.40 | $500.69 | - | - | - | | | 14061 | $760.25 | $614.82 | - | - | - | | | 14350 | - | - | $505.42 | - | - | | | 15002 | $264.41 | $161.29 | - | - | - | | | 15003 | $52.65 | $32.83 | - | - | - | | | 15004 | $301.17 | $191.63 | - | - | - | | | 15005 | $87.16 | $65.19 | - | - | - | | | 15040 | $204.75 | $91.45 | - | - | - | | | 15050 | $457.83 | $350.69 | - | - | - | | | 15100 | $662.59 | $536.97 | - | - | - | | | 15101 | $143.32 | $81.72 | - | - | - | | | 15110 | $629.58 | $531.29 | - | - | - | | | 15111 | $82.95 | $74.12 | - | - | - | | | 15115 | $605.13 | $512.73 | - | - | - | | | 15116 | $113.99 | $101.40 | - | - | - | | | 15120 | $644.03 | $516.27 | - | - | - | | | 15121 | $160.62 | $99.02 | - | - | - | | | 15130 | $553.99 | $451.41 | - | - | - | | | 15131 | $72.39 | $65.96 | - | - | - | | | 15135 | $669.12 | $570.29 | - | - | - | | | 15136 | $71.32 | $65.96 | - | - | - | | | 15150 | $529.66 | $474.75 | - | - | - | | | 15151 | $86.48 | $78.98 | - | - | - | | | 15152 | $110.51 | $103.01 | - | - | - | | | 15155 | $603.52 | $548.08 | - | - | - | | | 15156 | $115.94 | $108.18 | - | - | - | | | 15157 | $129.43 | $118.18 | - | - | - | | | 15200 | $640.84 | $504.78 | - | - | - | | | 15201 | $108.56 | $56.07 | - | - | - | | | 15220 | $590.56 | $459.59 | - | - | - | | | 15221 | $100.36 | $50.54 | - | - | - | | | 15240 | $710.75 | $600.13 | - | - | - | | | 15241 | $132.76 | $77.32 | - | - | - | | | 15260 | $763.37 | $636.68 | - | - | - | | | 15261 | $157.76 | $100.44 | - | - | - | | | 15271 | $118.26 | $61.21 | - | - | - | | | 15272 | $18.25 | $12.09 | - | - | - | | | 15273 | $237.16 | $142.88 | - | - | - | | | 15274 | $63.36 | $32.56 | - | - | - | | | 15275 | $121.46 | $68.16 | - | - | - | | | 15276 | $24.36 | $18.20 | - | - | - | | | 15277 | $262.86 | $164.03 | - | - | - | | | 15278 | $73.01 | $40.60 | - | - | - | | | 15570 | $693.07 | $547.90 | - | - | - | | | 15572 | $672.28 | $553.89 | - | - | - | | | 15574 | $668.15 | $551.64 | - | - | - | | | 15576 | $597.06 | $487.78 | - | - | - | | | 15600 | $265.59 | $162.74 | - | - | - | | | 15610 | $288.05 | $187.34 | - | - | - | | | 15620 | $347.68 | $249.12 | - | - | - | | | 15630 | $358.38 | $261.69 | - | - | - | | | 15650 | $418.77 | $306.54 | - | - | - | | | 15730 | $1,103.72 | $687.23 | - | - | - | | | 15731 | $853.48 | $749.83 | - | - | - | | | 15733 | - | - | $770.44 | - | - | | | 15734 | - | - | $1,113.55 | - | - | | | 15736 | - | - | $911.34 | - | - | | | 15738 | - | - | $946.21 | - | - | | | 15740 | $771.47 | $632.46 | - | - | - | | | 15750 | - | - | $693.94 | - | - | | | 15756 | - | - | $1,700.44 | - | - | | | 15757 | - | - | $1,690.41 | - | - | | | 15758 | - | - | $1,685.04 | - | - | | | 15760 | $647.47 | $527.21 | - | - | - | | | 15769 | - | - | $361.50 | - | - | | | 15770 | - | - | $508.52 | - | - | | | 15771 | $463.43 | $383.08 | - | - | - | | | 15772 | $144.20 | $109.11 | - | - | - | | | 15773 | $455.45 | $377.78 | - | - | - | | | 15774 | $141.19 | $106.11 | - | - | - | | | 15775 | $289.22 | $189.32 | - | - | - | | | 15776 | $389.89 | $258.38 | - | - | - | | | 15777 | - | - | $157.53 | - | - | | | 15778 | - | - | $279.60 | - | - | | | 15780 | $652.26 | $501.73 | - | - | - | | | 15781 | $416.72 | $326.46 | - | - | - | | | 15782 | $375.98 | $280.89 | - | - | - | | | 15783 | $347.12 | $269.18 | - | - | - | | | 15786 | $178.53 | $100.86 | - | - | - | | | 15787 | $23.21 | $12.23 | - | - | - | | | 15788 | $306.87 | $165.72 | - | - | - | | | 15789 | $411.17 | $311.27 | - | - | - | | | 15792 | $262.87 | $161.36 | - | - | - | | | 15793 | $366.83 | $270.67 | - | - | - | | | 15819 | - | - | $603.61 | - | - | | | 15820 | $444.15 | $391.92 | - | - | - | | | 15821 | $475.03 | $417.44 | - | - | - | | | 15822 | $356.07 | $304.38 | - | - | - | | | 15823 | $476.45 | $418.59 | - | - | - | | | 15824 | - | - | I.C. | - | - | | | 15825 | - | - | I.C. | - | - | | | 15826 | - | - | I.C. | - | - | | | 15828 | - | - | I.C. | - | - | | | 15829 | - | - | I.C. | - | - | | | 15830 | - | - | $876.41 | - | - | | | 15832 | - | - | $693.25 | - | - | | | 15833 | - | - | $661.45 | - | - | | | 15834 | - | - | $673.08 | - | - | | | 15835 | - | - | $700.37 | - | - | | | 15836 | - | - | $601.89 | - | - | | | 15837 | $663.54 | $541.14 | - | - | - | | | 15838 | - | - | $492.32 | - | - | | | 15839 | $679.82 | $556.08 | - | - | - | | | 15840 | - | - | $761.00 | - | - | | | 15841 | - | - | $1,331.28 | - | - | | | 15842 | - | - | $2,010.01 | - | - | | | 15845 | - | - | $799.81 | - | - | | | 15847 | - | - | I.C. | - | - | | | 15851 | $41.92 | $48.35 | - | - | - | | | 15852 | - | - | $33.56 | - | - | | | 15853 | - | - | $9.04 | - | - | | | 15854 | - | - | $12.72 | - | - | | | 15860 | - | - | $77.71 | - | - | | | 15876 | - | - | I.C. | - | - | | | 15877 | - | - | I.C. | - | - | | | 15878 | - | - | I.C. | - | - | | | 15879 | - | - | I.C. | - | - | | | 15920 | - | - | $483.96 | - | - | | | 15922 | - | - | $604.03 | - | - | | | 15931 | - | - | $527.63 | - | - | | | 15933 | - | - | $655.00 | - | - | | | 15934 | - | - | $710.52 | - | - | | | 15935 | - | - | $871.42 | - | - | | | 15936 | - | - | $674.49 | - | - | | | 15937 | - | - | $782.35 | - | - | | | 15940 | - | - | $531.30 | - | - | | | 15941 | - | - | $707.05 | - | - | | | 15944 | - | - | $706.60 | - | - | | | 15945 | - | - | $770.06 | - | - | | | 15946 | - | - | $1,208.09 | - | - | | | 15950 | - | - | $483.53 | - | - | | | 15951 | - | - | $681.34 | - | - | | | 15952 | - | - | $692.30 | - | - | | | 15953 | - | - | $762.37 | - | - | | | 15956 | - | - | $872.20 | - | - | | | 15958 | - | - | $885.89 | - | - | | | 15999 | - | - | I.C. | - | - | | | 16000 | $59.95 | $33.43 | - | - | - | | | 16020 | $66.12 | $41.75 | - | - | - | | | 16025 | $119.51 | $82.02 | - | - | - | | | 16030 | $150.26 | $97.23 | - | - | - | | | 16035 | - | - | $142.01 | - | - | | | 16036 | - | - | $60.07 | - | - | | | 17000 | $52.03 | $41.85 | - | - | - | | | 17003 | $5.26 | $1.52 | - | - | - | | | 17004 | $131.49 | $74.71 | - | - | - | | | 17106 | $264.00 | $208.56 | - | - | - | | | 17107 | $342.35 | $270.57 | - | - | - | | | 17108 | $482.61 | $394.76 | - | - | - | | | 17110 | $89.25 | $51.48 | - | - | - | | | 17111 | $103.69 | $62.71 | - | - | - | | | 17250 | $68.75 | $28.04 | - | - | - | | | 17260 | $77.47 | $53.36 | - | - | - | | | 17261 | $115.30 | $65.22 | - | - | - | | | 17262 | $138.59 | $82.88 | - | - | - | | | 17263 | $149.56 | $91.44 | - | - | - | | | 17264 | $160.13 | $97.45 | - | - | - | | | 17266 | $182.17 | $114.67 | - | - | - | | | 17270 | $116.22 | $71.76 | - | - | - | | | 17271 | $129.22 | $79.14 | - | - | - | | | 17272 | $146.12 | $90.68 | - | - | - | | | 17273 | $161.61 | $102.42 | - | - | - | | | 17274 | $188.69 | $125.21 | - | - | - | | | 17276 | $218.35 | $150.59 | - | - | - | | | 17280 | $108.87 | $64.95 | - | - | - | | | 17281 | $139.27 | $88.65 | - | - | - | | | 17282 | $158.96 | $102.18 | - | - | - | | | 17283 | $186.97 | $126.97 | - | - | - | | | 17284 | $212.11 | $148.09 | - | - | - | | | 17286 | $269.95 | $199.51 | - | - | - | | | 17311 | $525.58 | $262.83 | - | - | - | | | 17312 | $320.55 | $140.03 | - | - | - | | | 17313 | $494.32 | $235.58 | - | - | - | | | 17314 | $307.51 | $129.40 | - | - | - | | | 17315 | $60.53 | $37.23 | - | - | - | | | 17340 | $39.60 | $36.92 | - | - | - | | | 17360 | $95.13 | $69.68 | - | - | - | | | 17380 | - | - | I.C. | - | - | | | 17999 | - | - | I.C. | - | - | | | 19000 | $79.28 | $31.07 | - | - | - | | | 19001 | $19.65 | $15.10 | - | - | - | | | 19020 | $364.68 | $237.45 | - | - | - | | | 19030 | $128.18 | $55.86 | - | - | - | | | 19081 | $396.71 | $119.23 | - | - | - | | | 19082 | $310.23 | $60.07 | - | - | - | | | 19083 | $397.35 | $112.10 | - | - | - | | | 19084 | $305.98 | $56.62 | - | - | - | | | 19085 | $613.86 | $130.68 | - | - | - | | | 19086 | $480.25 | $65.64 | - | - | - | | | 19100 | $116.64 | $49.95 | - | - | - | | | 19101 | $253.31 | $167.06 | - | - | - | | | 19105 | $1,864.23 | $152.20 | - | - | - | | | 19110 | $375.51 | $265.96 | - | - | - | | | 19112 | $356.81 | $244.32 | - | - | - | | | 19120 | $394.70 | $312.47 | - | - | - | | | 19125 | $434.02 | $344.83 | - | - | - | | | 19126 | - | - | $115.59 | - | - | | | 19281 | $188.63 | $72.12 | - | - | - | | | 19282 | $135.23 | $36.39 | - | - | - | | | 19283 | $204.03 | $72.52 | - | - | - | | | 19284 | $151.77 | $36.33 | - | - | - | | | 19285 | $295.65 | $61.83 | - | - | - | | | 19286 | $244.31 | $31.11 | - | - | - | | | 19287 | $511.18 | $91.74 | - | - | - | | | 19288 | $397.80 | $46.13 | - | - | - | | | 19294 | - | - | $118.51 | - | - | | | 19296 | $2,991.91 | $153.07 | - | - | - | | | 19297 | - | - | $68.19 | - | - | | | 19298 | $690.36 | $236.10 | - | - | - | | | 19300 | $449.69 | $328.63 | - | - | - | | | 19301 | - | - | $489.91 | - | - | | | 19302 | - | - | $672.18 | - | - | | | 19303 | - | - | $708.74 | - | - | | | 19305 | - | - | $854.68 | - | - | | | 19306 | - | - | $907.22 | - | - | | | 19307 | - | - | $875.35 | - | - | | | 19316 | - | - | $595.55 | - | - | | | 19318 | - | - | $819.01 | - | - | | | 19325 | - | - | $465.17 | - | - | | | 19328 | - | - | $418.67 | - | - | | | 19330 | - | - | $487.30 | - | - | | | 19340 | - | - | $571.92 | - | - | | | 19342 | - | - | $573.87 | - | - | | | 19350 | $636.04 | $508.28 | - | - | - | | | 19355 | $578.21 | $465.45 | - | - | - | | | 19357 | - | - | $877.07 | - | - | | | 19361 | - | - | $1,163.94 | - | - | | | 19364 | - | - | $2,022.76 | - | - | | | 19367 | - | - | $1,321.44 | - | - | | | 19368 | - | - | $1,614.61 | - | - | | | 19369 | - | - | $1,501.02 | - | - | | | 19370 | - | - | $506.46 | - | - | | | 19371 | - | - | $536.66 | - | - | | | 19380 | - | - | $608.43 | - | - | | | 19396 | $213.40 | $105.99 | - | - | - | | | 19499 | - | - | I.C. | - | - | | | 20100 | - | - | $440.23 | - | - | | | 20101 | $457.20 | $155.07 | - | - | - | | | 20102 | $475.42 | $187.76 | - | - | - | | | 20103 | $435.05 | $256.94 | - | - | - | | | 20150 | - | - | $750.83 | - | - | | | 20200 | $170.10 | $69.93 | - | - | - | | | 20205 | $235.52 | $113.65 | - | - | - | | | 20206 | $177.57 | $42.31 | - | - | - | | | 20220 | $184.95 | $64.42 | - | - | - | | | 20225 | $303.63 | $94.72 | - | - | - | | | 20240 | - | - | $102.92 | - | - | | | 20245 | - | - | $253.21 | - | - | | | 20250 | - | - | $291.26 | - | - | | | 20251 | - | - | $315.40 | - | - | | | 20500 | $95.54 | $67.15 | - | - | - | | | 20501 | $113.75 | $26.70 | - | - | - | | | 20520 | $168.16 | $111.65 | - | - | - | | | 20525 | $362.69 | $185.38 | - | - | - | | | 20526 | $62.50 | $42.15 | - | - | - | | | 20527 | $66.85 | $48.91 | - | - | - | | | 20550 | $43.93 | $28.67 | - | - | - | | | 20551 | $43.93 | $28.67 | - | - | - | | | 20552 | $40.26 | $27.40 | - | - | - | | | 20553 | $46.61 | $31.34 | - | - | - | | | 20555 | - | - | $249.58 | - | - | | | 20560 | $19.82 | $10.98 | - | - | - | | | 20561 | $28.76 | $16.44 | - | - | - | | | 20600 | $40.26 | $26.06 | - | - | - | | | 20604 | $63.16 | $33.70 | - | - | - | | | 20605 | $41.95 | $27.22 | - | - | - | | | 20606 | $68.40 | $38.13 | - | - | - | | | 20610 | $49.06 | $33.26 | - | - | - | | | 20611 | $76.40 | $43.99 | - | - | - | | | 20612 | $49.14 | $30.39 | - | - | - | | | 20615 | $196.16 | $121.70 | - | - | - | | | 20650 | $174.51 | $123.62 | - | - | - | | | 20660 | - | - | $175.42 | - | - | | | 20661 | - | - | $394.57 | - | - | | | 20662 | - | - | $397.68 | - | - | | | 20663 | - | - | $367.09 | - | - | | | 20664 | - | - | $668.09 | - | - | | | 20665 | $90.41 | $74.07 | - | - | - | | | 20670 | $282.25 | $110.03 | - | - | - | | | 20680 | $463.35 | $315.77 | - | - | - | | | 20690 | - | - | $447.63 | - | - | | | 20692 | - | - | $844.18 | - | - | | | 20693 | - | - | $335.77 | - | - | | | 20694 | $332.58 | $260.00 | - | - | - | | | 20696 | - | - | $877.69 | - | - | | | 20697 | - | - | $1,470.17 | - | - | | | 20700 | - | - | $61.94 | - | - | | | 20701 | - | - | $47.33 | - | - | | | 20702 | - | - | $104.22 | - | - | | | 20703 | - | - | $75.17 | - | - | | | 20704 | - | - | $107.47 | - | - | | | 20705 | - | - | $91.24 | - | - | | | 20802 | - | - | $2,032.83 | - | - | | | 20805 | - | - | $2,411.41 | - | - | | | 20808 | - | - | $2,904.06 | - | - | | | 20816 | - | - | $1,522.23 | - | - | | | 20822 | - | - | $1,318.96 | - | - | | | 20824 | - | - | $1,525.18 | - | - | | | 20827 | - | - | $1,354.08 | - | - | | | 20838 | - | - | $2,065.38 | - | - | | | 20900 | $304.35 | $134.27 | - | - | - | | | 20902 | - | - | $203.46 | - | - | | | 20910 | - | - | $364.03 | - | - | | | 20920 | - | - | $304.18 | - | - | | | 20922 | $463.29 | $370.08 | - | - | - | | | 20924 | - | - | $383.00 | - | - | | | 20930 | - | - | I.C. | - | - | | | 20931 | - | - | $80.02 | - | - | | | 20932 | - | - | $551.64 | - | - | | | 20933 | - | - | $506.58 | - | - | | | 20934 | - | - | $551.40 | - | - | | | 20936 | - | - | I.C. | - | - | | | 20937 | - | - | $121.40 | - | - | | | 20938 | - | - | $132.51 | - | - | | | 20939 | - | - | $51.00 | - | - | | | 20950 | $208.01 | $65.51 | - | - | - | | | 20955 | - | - | $1,830.87 | - | - | | | 20956 | - | - | $1,955.02 | - | - | | | 20957 | - | - | $2,037.14 | - | - | | | 20962 | - | - | $1,986.30 | - | - | | | 20969 | - | - | $2,018.14 | - | - | | | 20970 | - | - | $2,107.30 | - | - | | | 20972 | - | - | $2,101.10 | - | - | | | 20973 | - | - | $2,218.18 | - | - | | | 20974 | $63.84 | $38.13 | - | - | - | | | 20975 | - | - | $129.42 | - | - | | | 20979 | $43.16 | $23.61 | - | - | - | | | 20982 | $2,817.90 | $266.73 | - | - | - | | | 20983 | $4,120.43 | $248.27 | - | - | - | | | 20985 | - | - | $105.96 | - | - | | | 20999 | - | - | I.C. | - | - | | | 21010 | - | - | $561.35 | - | - | | | 21011 | $290.98 | $198.84 | - | - | - | | | 21012 | - | - | $256.85 | - | - | | | 21013 | $413.85 | $304.83 | - | - | - | | | 21014 | - | - | $394.88 | - | - | | | 21015 | - | - | $526.77 | - | - | | | 21016 | - | - | $754.03 | - | - | | | 21025 | $602.58 | $497.32 | - | - | - | | | 21026 | $410.96 | $324.72 | - | - | - | | | 21029 | $590.73 | $471.27 | - | - | - | | | 21030 | $354.07 | $273.98 | - | - | - | | | 21031 | $297.85 | $207.86 | - | - | - | | | 21032 | $287.58 | $197.86 | - | - | - | | | 21034 | $985.64 | $845.82 | - | - | - | | | 21040 | $359.02 | $276.26 | - | - | - | | | 21044 | - | - | $650.05 | - | - | | | 21045 | - | - | $902.06 | - | - | | | 21046 | - | - | $748.49 | - | - | | | 21047 | - | - | $909.36 | - | - | | | 21048 | - | - | $752.15 | - | - | | | 21049 | - | - | $859.86 | - | - | | | 21050 | - | - | $657.32 | - | - | | | 21060 | - | - | $595.03 | - | - | | | 21070 | - | - | $463.45 | - | - | | | 21073 | $291.14 | $182.94 | - | - | - | | | 21076 | $648.18 | $522.29 | - | - | - | | | 21077 | $1,586.71 | $1,283.52 | - | - | - | | | 21079 | $1,088.10 | $863.12 | - | - | - | | | 21080 | $1,253.50 | $981.11 | - | - | - | | | 21081 | $1,156.56 | $898.36 | - | - | - | | | 21082 | $1,068.73 | $821.78 | - | - | - | | | 21083 | $1,022.33 | $762.80 | - | - | - | | | 21084 | $1,165.32 | $881.94 | - | - | - | | | 21085 | $512.79 | $357.97 | - | - | - | | | 21086 | $1,180.87 | $946.51 | - | - | - | | | 21087 | $1,180.87 | $946.51 | - | - | - | | | 21088 | - | - | I.C. | - | - | | | 21089 | - | - | I.C. | - | - | | | 21100 | $484.05 | $269.51 | - | - | - | | | 21110 | $677.60 | $558.95 | - | - | - | | | 21116 | $172.23 | $33.22 | - | - | - | | | 21121 | $484.04 | $400.74 | - | - | - | | | 21122 | - | - | $571.48 | - | - | | | 21125 | $2,082.91 | $500.24 | - | - | - | | | 21127 | $3,196.55 | $573.59 | - | - | - | | | 21138 | - | - | $688.26 | - | - | | | 21141 | - | - | $1,007.10 | - | - | | | 21142 | - | - | $1,032.91 | - | - | | | 21143 | - | - | $1,063.61 | - | - | | | 21145 | - | - | $1,166.82 | - | - | | | 21146 | - | - | $1,218.58 | - | - | | | 21147 | - | - | $1,282.17 | - | - | | | 21150 | - | - | $1,232.75 | - | - | | | 21151 | - | - | $1,355.04 | - | - | | | 21154 | - | - | $1,457.80 | - | - | | | 21155 | - | - | $1,614.77 | - | - | | | 21159 | - | - | $1,930.99 | - | - | | | 21160 | - | - | $2,092.83 | - | - | | | 21172 | - | - | $1,569.37 | - | - | | | 21175 | - | - | $1,649.48 | - | - | | | 21179 | - | - | $1,136.80 | - | - | | | 21180 | - | - | $1,268.42 | - | - | | | 21181 | - | - | $559.14 | - | - | | | 21182 | - | - | $1,575.55 | - | - | | | 21183 | - | - | $1,712.89 | - | - | | | 21184 | - | - | $1,840.91 | - | - | | | 21188 | - | - | $1,194.89 | - | - | | | 21193 | - | - | $927.62 | - | - | | | 21194 | - | - | $1,073.01 | - | - | | | 21195 | - | - | $1,015.54 | - | - | | | 21196 | - | - | $1,083.54 | - | - | | | 21198 | - | - | $769.29 | - | - | | | 21199 | - | - | $762.02 | - | - | | | 21206 | - | - | $729.43 | - | - | | | 21215 | $3,266.67 | $590.68 | - | - | - | | | 21230 | - | - | $563.06 | - | - | | | 21235 | $567.22 | $432.76 | - | - | - | | | 21240 | - | - | $793.07 | - | - | | | 21242 | - | - | $765.82 | - | - | | | 21243 | - | - | $1,266.37 | - | - | | | 21244 | - | - | $765.21 | - | - | | | 21245 | $946.86 | $719.73 | - | - | - | | | 21246 | - | - | $640.51 | - | - | | | 21247 | - | - | $1,189.40 | - | - | | | 21248 | $747.00 | $593.26 | - | - | - | | | 21249 | $1,007.75 | $826.96 | - | - | - | | | 21255 | - | - | $1,014.95 | - | - | | | 21256 | - | - | $930.67 | - | - | | | 21260 | - | - | $1,035.11 | - | - | | | 21261 | - | - | $1,822.86 | - | - | | | 21263 | - | - | $1,688.27 | - | - | | | 21267 | - | - | $1,211.65 | - | - | | | 21268 | - | - | $1,514.93 | - | - | | | 21270 | $778.56 | $562.68 | - | - | - | | | 21275 | - | - | $635.79 | - | - | | | 21280 | - | - | $447.03 | - | - | | | 21282 | - | - | $305.58 | - | - | | | 21295 | - | - | $152.36 | - | - | | | 21299 | - | - | I.C. | - | - | | | 21315 | $118.77 | $44.85 | - | - | - | | | 21320 | $170.48 | $70.58 | - | - | - | | | 21325 | - | - | $346.09 | - | - | | | 21330 | - | - | $413.14 | - | - | | | 21335 | - | - | $546.75 | - | - | | | 21336 | - | - | $491.09 | - | - | | | 21337 | $326.76 | $231.14 | - | - | - | | | 21338 | - | - | $519.99 | - | - | | | 21339 | - | - | $585.12 | - | - | | | 21340 | - | - | $568.10 | - | - | | | 21343 | - | - | $829.39 | - | - | | | 21344 | - | - | $1,050.26 | - | - | | | 21345 | $618.11 | $485.53 | - | - | - | | | 21346 | - | - | $789.49 | - | - | | | 21347 | - | - | $793.32 | - | - | | | 21348 | - | - | $821.39 | - | - | | | 21355 | $347.74 | $250.78 | - | - | - | | | 21356 | $422.58 | $307.67 | - | - | - | | | 21360 | - | - | $399.19 | - | - | | | 21365 | - | - | $812.54 | - | - | | | 21366 | - | - | $956.82 | - | - | | | 21385 | - | - | $555.56 | - | - | | | 21386 | - | - | $521.81 | - | - | | | 21387 | - | - | $579.42 | - | - | | | 21390 | - | - | $607.54 | - | - | | | 21395 | - | - | $756.81 | - | - | | | 21400 | $168.08 | $130.04 | - | - | - | | | 21401 | $398.46 | $251.95 | - | - | - | | | 21406 | - | - | $443.23 | - | - | | | 21407 | - | - | $489.59 | - | - | | | 21408 | - | - | $679.50 | - | - | | | 21421 | $499.56 | $419.20 | - | - | - | | | 21422 | - | - | $476.86 | - | - | | | 21423 | - | - | $602.68 | - | - | | | 21431 | - | - | $533.65 | - | - | | | 21432 | - | - | $544.77 | - | - | | | 21433 | - | - | $1,294.23 | - | - | | | 21435 | - | - | $1,055.69 | - | - | | | 21436 | - | - | $1,522.24 | - | - | | | 21440 | $544.27 | $435.00 | - | - | - | | | 21445 | $614.37 | $493.04 | - | - | - | | | 21450 | $465.85 | $376.39 | - | - | - | | | 21451 | $602.86 | $500.27 | - | - | - | | | 21452 | $594.62 | $366.96 | - | - | - | | | 21453 | $861.22 | $729.71 | - | - | - | | | 21454 | - | - | $368.10 | - | - | | | 21461 | $1,448.32 | $822.11 | - | - | - | | | 21462 | $1,564.32 | $905.70 | - | - | - | | | 21465 | - | - | $597.00 | - | - | | | 21470 | - | - | $871.72 | - | - | | | 21480 | $112.42 | $22.69 | - | - | - | | | 21485 | $768.74 | $624.91 | - | - | - | | | 21490 | - | - | $587.95 | - | - | | | 21497 | $557.38 | $460.96 | - | - | - | | | 21499 | - | - | I.C. | - | - | | | 21501 | $379.47 | $255.73 | - | - | - | | | 21502 | - | - | $377.46 | - | - | | | 21510 | - | - | $338.74 | - | - | | | 21550 | $208.45 | $118.19 | - | - | - | | | 21552 | - | - | $335.00 | - | - | | | 21554 | - | - | $546.08 | - | - | | | 21555 | $336.40 | $233.01 | - | - | - | | | 21556 | - | - | $400.07 | - | - | | | 21557 | - | - | $710.78 | - | - | | | 21558 | - | - | $994.84 | - | - | | | 21600 | - | - | $427.16 | - | - | | | 21601 | - | - | $842.43 | - | - | | | 21602 | - | - | $1,142.95 | - | - | | | 21603 | - | - | $1,241.76 | - | - | | | 21610 | - | - | $842.82 | - | - | | | 21615 | - | - | $454.89 | - | - | | | 21616 | - | - | $516.04 | - | - | | | 21620 | - | - | $376.35 | - | - | | | 21627 | - | - | $409.79 | - | - | | | 21630 | - | - | $985.01 | - | - | | | 21632 | - | - | $887.57 | - | - | | | 21685 | - | - | $739.83 | - | - | | | 21700 | - | - | $257.87 | - | - | | | 21705 | - | - | $382.93 | - | - | | | 21720 | - | - | $402.72 | - | - | | | 21725 | - | - | $412.07 | - | - | | | 21740 | - | - | $744.89 | - | - | | | 21742 | - | - | I.C. | - | - | | | 21743 | - | - | I.C. | - | - | | | 21750 | - | - | $493.87 | - | - | | | 21811 | - | - | $428.86 | - | - | | | 21812 | - | - | $520.22 | - | - | | | 21813 | - | - | $709.76 | - | - | | | 21820 | $117.98 | $116.10 | - | - | - | | | 21825 | - | - | $411.20 | - | - | | | 21899 | - | - | I.C. | - | - | | | 21920 | $199.88 | $117.12 | - | - | - | | | 21925 | $381.24 | $286.96 | - | - | - | | | 21930 | $387.48 | $274.99 | - | - | - | | | 21931 | - | - | $351.23 | - | - | | | 21932 | - | - | $497.41 | - | - | | | 21933 | - | - | $550.35 | - | - | | | 21935 | - | - | $757.05 | - | - | | | 21936 | - | - | $1,043.90 | - | - | | | 22010 | - | - | $725.14 | - | - | | | 22015 | - | - | $713.77 | - | - | | | 22100 | - | - | $649.21 | - | - | | | 22101 | - | - | $654.12 | - | - | | | 22102 | - | - | $584.84 | - | - | | | 22103 | - | - | $98.28 | - | - | | | 22110 | - | - | $793.70 | - | - | | | 22112 | - | - | $849.54 | - | - | | | 22114 | - | - | $849.54 | - | - | | | 22116 | - | - | $102.06 | - | - | | | 22206 | - | - | $1,801.87 | - | - | | | 22207 | - | - | $1,768.20 | - | - | | | 22208 | - | - | $425.51 | - | - | | | 22210 | - | - | $1,326.15 | - | - | | | 22212 | - | - | $1,128.42 | - | - | | | 22214 | - | - | $1,128.49 | - | - | | | 22216 | - | - | $263.11 | - | - | | | 22220 | - | - | $1,205.24 | - | - | | | 22222 | - | - | $1,308.00 | - | - | | | 22224 | - | - | $1,180.30 | - | - | | | 22226 | - | - | $260.58 | - | - | | | 22310 | $239.01 | $227.76 | - | - | - | | | 22315 | $676.39 | $583.71 | - | - | - | | | 22318 | - | - | $1,223.13 | - | - | | | 22319 | - | - | $1,354.32 | - | - | | | 22325 | - | - | $1,100.00 | - | - | | | 22326 | - | - | $1,123.29 | - | - | | | 22327 | - | - | $1,145.16 | - | - | | | 22328 | - | - | $204.68 | - | - | | | 22505 | - | - | $97.38 | - | - | | | 22510 | $1,445.01 | $317.67 | - | - | - | | | 22511 | $1,439.43 | $298.43 | - | - | - | | | 22512 | $577.11 | $149.90 | - | - | - | | | 22513 | $4,624.03 | $375.02 | - | - | - | | | 22514 | $4,603.86 | $350.03 | - | - | - | | | 22515 | $2,376.71 | $158.46 | - | - | - | | | 22526 | $1,588.31 | $242.68 | - | - | - | | | 22527 | $1,312.52 | $111.26 | - | - | - | | | 22532 | - | - | $1,330.37 | - | - | | | 22533 | - | - | $1,229.23 | - | - | | | 22534 | - | - | $261.26 | - | - | | | 22548 | - | - | $1,452.25 | - | - | | | 22551 | - | - | $1,256.73 | - | - | | | 22552 | - | - | $286.97 | - | - | | | 22554 | - | - | $937.98 | - | - | | | 22556 | - | - | $1,237.68 | - | - | | | 22558 | - | - | $1,128.45 | - | - | | | 22585 | - | - | $235.77 | - | - | | | 22586 | - | - | $1,501.26 | - | - | | | 22590 | - | - | $1,180.37 | - | - | | | 22595 | - | - | $1,127.08 | - | - | | | 22600 | - | - | $971.29 | - | - | | | 22610 | - | - | $955.74 | - | - | | | 22612 | - | - | $1,173.89 | - | - | | | 22614 | - | - | $283.32 | - | - | | | 22630 | - | - | $1,153.85 | - | - | | | 22632 | - | - | $232.02 | - | - | | | 22633 | - | - | $1,336.15 | - | - | | | 22634 | - | - | $350.93 | - | - | | | 22800 | - | - | $1,018.34 | - | - | | | 22802 | - | - | $1,565.34 | - | - | | | 22804 | - | - | $1,795.82 | - | - | | | 22808 | - | - | $1,348.07 | - | - | | | 22810 | - | - | $1,488.66 | - | - | | | 22812 | - | - | $1,632.34 | - | - | | | 22818 | - | - | $1,590.04 | - | - | | | 22819 | - | - | $1,831.70 | - | - | | | 22830 | - | - | $615.15 | - | - | | | 22836 | - | - | $1,276.23 | - | - | | | 22837 | - | - | $1,404.98 | - | - | | | 22838 | - | - | $1,423.46 | - | - | | | 22840 | - | - | $549.50 | - | - | | | 22841 | - | - | I.C. | - | - | | | 22842 | - | - | $553.15 | - | - | | | 22843 | - | - | $592.08 | - | - | | | 22844 | - | - | $715.82 | - | - | | | 22845 | - | - | $526.46 | - | - | | | 22846 | - | - | $547.75 | - | - | | | 22847 | - | - | $584.28 | - | - | | | 22848 | - | - | $261.06 | - | - | | | 22849 | - | - | $968.53 | - | - | | | 22850 | - | - | $551.31 | - | - | | | 22852 | - | - | $531.14 | - | - | | | 22853 | - | - | $187.03 | - | - | | | 22854 | - | - | $242.90 | - | - | | | 22855 | - | - | $824.29 | - | - | | | 22856 | - | - | $1,201.07 | - | - | | | 22857 | - | - | $1,312.84 | - | - | | | 22858 | - | - | $367.34 | - | - | | | 22859 | - | - | $241.43 | - | - | | | 22860 | - | - | I.C. | - | - | | | 22861 | - | - | $1,703.20 | - | - | | | 22862 | - | - | $1,706.85 | - | - | | | 22864 | - | - | $1,522.91 | - | - | | | 22865 | - | - | $1,666.59 | - | - | | | 22867 | - | - | $800.56 | - | - | | | 22868 | - | - | $176.56 | - | - | | | 22869 | - | - | $323.46 | - | - | | | 22870 | - | - | $86.60 | - | - | | | 22899 | - | - | I.C. | - | - | | | 22900 | - | - | $422.95 | - | - | | | 22901 | - | - | $495.73 | - | - | | | 22902 | $363.77 | $251.55 | - | - | - | | | 22903 | - | - | $329.53 | - | - | | | 22904 | - | - | $776.69 | - | - | | | 22905 | - | - | $978.75 | - | - | | | 22999 | - | - | I.C. | - | - | | | 23000 | $428.42 | $272.26 | - | - | - | | | 23020 | - | - | $523.82 | - | - | | | 23030 | $343.02 | $192.23 | - | - | - | | | 23031 | $340.38 | $168.97 | - | - | - | | | 23035 | - | - | $517.65 | - | - | | | 23040 | - | - | $544.41 | - | - | | | 23044 | - | - | $432.03 | - | - | | | 23065 | $173.46 | $120.16 | - | - | - | | | 23066 | $440.94 | $279.97 | - | - | - | | | 23071 | - | - | $315.66 | - | - | | | 23073 | - | - | $522.35 | - | - | | | 23075 | $401.10 | $249.23 | - | - | - | | | 23076 | - | - | $410.55 | - | - | | | 23077 | - | - | $835.69 | - | - | | | 23078 | - | - | $1,061.68 | - | - | | | 23100 | - | - | $388.65 | - | - | | | 23101 | - | - | $350.33 | - | - | | | 23105 | - | - | $486.35 | - | - | | | 23106 | - | - | $385.67 | - | - | | | 23107 | - | - | $502.93 | - | - | | | 23120 | - | - | $449.17 | - | - | | | 23125 | - | - | $538.64 | - | - | | | 23130 | - | - | $472.66 | - | - | | | 23140 | - | - | $424.35 | - | - | | | 23145 | - | - | $528.48 | - | - | | | 23146 | - | - | $475.56 | - | - | | | 23150 | - | - | $507.39 | - | - | | | 23155 | - | - | $604.57 | - | - | | | 23156 | - | - | $516.16 | - | - | | | 23170 | - | - | $431.31 | - | - | | | 23172 | - | - | $435.96 | - | - | | | 23174 | - | - | $580.81 | - | - | | | 23180 | - | - | $499.83 | - | - | | | 23182 | - | - | $512.43 | - | - | | | 23184 | - | - | $562.48 | - | - | | | 23190 | - | - | $439.14 | - | - | | | 23195 | - | - | $562.49 | - | - | | | 23200 | - | - | $1,121.21 | - | - | | | 23210 | - | - | $1,312.19 | - | - | | | 23220 | - | - | $1,436.28 | - | - | | | 23330 | $236.58 | $127.84 | - | - | - | | | 23333 | - | - | $361.33 | - | - | | | 23334 | - | - | $793.04 | - | - | | | 23335 | - | - | $946.49 | - | - | | | 23350 | $129.87 | $36.66 | - | - | - | | | 23395 | - | - | $961.02 | - | - | | | 23397 | - | - | $853.25 | - | - | | | 23400 | - | - | $732.25 | - | - | | | 23405 | - | - | $467.82 | - | - | | | 23406 | - | - | $564.09 | - | - | | | 23410 | - | - | $619.82 | - | - | | | 23412 | - | - | $643.28 | - | - | | | 23415 | - | - | $530.82 | - | - | | | 23420 | - | - | $734.96 | - | - | | | 23430 | - | - | $564.07 | - | - | | | 23440 | - | - | $571.14 | - | - | | | 23450 | - | - | $710.68 | - | - | | | 23455 | - | - | $741.73 | - | - | | | 23460 | - | - | $818.12 | - | - | | | 23462 | - | - | $799.87 | - | - | | | 23465 | - | - | $838.57 | - | - | | | 23466 | - | - | $843.82 | - | - | | | 23470 | - | - | $895.70 | - | - | | | 23472 | - | - | $1,076.84 | - | - | | | 23473 | - | - | $1,197.28 | - | - | | | 23474 | - | - | $1,291.45 | - | - | | | 23480 | - | - | $619.20 | - | - | | | 23485 | - | - | $716.49 | - | - | | | 23490 | - | - | $649.10 | - | - | | | 23491 | - | - | $763.64 | - | - | | | 23500 | $176.74 | $180.76 | - | - | - | | | 23505 | $281.53 | $260.10 | - | - | - | | | 23515 | - | - | $547.30 | - | - | | | 23520 | $190.48 | $188.34 | - | - | - | | | 23525 | $312.42 | $284.56 | - | - | - | | | 23530 | - | - | $439.85 | - | - | | | 23532 | - | - | $477.69 | - | - | | | 23540 | $189.38 | $186.97 | - | - | - | | | 23545 | $283.99 | $253.19 | - | - | - | | | 23550 | - | - | $436.60 | - | - | | | 23552 | - | - | $492.54 | - | - | | | 23570 | $185.23 | $191.39 | - | - | - | | | 23575 | $321.78 | $295.80 | - | - | - | | | 23585 | - | - | $733.84 | - | - | | | 23600 | $264.23 | $249.77 | - | - | - | | | 23605 | $367.46 | $331.57 | - | - | - | | | 23615 | - | - | $666.93 | - | - | | | 23616 | - | - | $924.51 | - | - | | | 23620 | $214.92 | $205.55 | - | - | - | | | 23625 | $304.53 | $277.22 | - | - | - | | | 23630 | - | - | $591.86 | - | - | | | 23650 | $260.46 | $233.67 | - | - | - | | | 23655 | - | - | $315.73 | - | - | | | 23660 | - | - | $447.81 | - | - | | | 23665 | $339.60 | $310.40 | - | - | - | | | 23670 | - | - | $657.07 | - | - | | | 23675 | $428.14 | $385.28 | - | - | - | | | 23680 | - | - | $700.51 | - | - | | | 23700 | - | - | $148.99 | - | - | | | 23800 | - | - | $771.77 | - | - | | | 23802 | - | - | $962.22 | - | - | | | 23900 | - | - | $1,033.62 | - | - | | | 23920 | - | - | $842.02 | - | - | | | 23921 | - | - | $361.31 | - | - | | | 23929 | - | - | I.C. | - | - | | | 23930 | $280.19 | $162.34 | - | - | - | | | 23931 | $239.27 | $123.56 | - | - | - | | | 23935 | - | - | $393.60 | - | - | | | 24000 | - | - | $366.30 | - | - | | | 24006 | - | - | $540.49 | - | - | | | 24065 | $201.44 | $123.24 | - | - | - | | | 24066 | $484.70 | $320.51 | - | - | - | | | 24071 | - | - | $304.96 | - | - | | | 24073 | - | - | $519.47 | - | - | | | 24075 | $415.96 | $250.97 | - | - | - | | | 24076 | - | - | $414.70 | - | - | | | 24077 | - | - | $769.45 | - | - | | | 24079 | - | - | $982.20 | - | - | | | 24100 | - | - | $322.91 | - | - | | | 24101 | - | - | $387.09 | - | - | | | 24102 | - | - | $469.13 | - | - | | | 24105 | - | - | $279.83 | - | - | | | 24110 | - | - | $451.27 | - | - | | | 24115 | - | - | $558.88 | - | - | | | 24116 | - | - | $648.34 | - | - | | | 24120 | - | - | $407.78 | - | - | | | 24125 | - | - | $474.82 | - | - | | | 24126 | - | - | $495.27 | - | - | | | 24130 | - | - | $393.57 | - | - | | | 24134 | - | - | $566.55 | - | - | | | 24136 | - | - | $481.58 | - | - | | | 24138 | - | - | $526.21 | - | - | | | 24140 | - | - | $534.29 | - | - | | | 24145 | - | - | $453.22 | - | - | | | 24147 | - | - | $481.61 | - | - | | | 24149 | - | - | $891.41 | - | - | | | 24150 | - | - | $1,149.34 | - | - | | | 24152 | - | - | $1,002.37 | - | - | | | 24155 | - | - | $642.37 | - | - | | | 24160 | - | - | $939.92 | - | - | | | 24164 | - | - | $548.58 | - | - | | | 24200 | $168.10 | $105.96 | - | - | - | | | 24201 | $426.95 | $279.64 | - | - | - | | | 24220 | $150.58 | $48.80 | - | - | - | | | 24300 | - | - | $341.38 | - | - | | | 24301 | - | - | $570.07 | - | - | | | 24305 | - | - | $442.22 | - | - | | | 24310 | - | - | $364.20 | - | - | | | 24320 | - | - | $590.11 | - | - | | | 24330 | - | - | $544.78 | - | - | | | 24331 | - | - | $593.59 | - | - | | | 24332 | - | - | $469.93 | - | - | | | 24340 | - | - | $457.43 | - | - | | | 24341 | - | - | $570.40 | - | - | | | 24342 | - | - | $585.77 | - | - | | | 24343 | - | - | $545.32 | - | - | | | 24344 | - | - | $824.32 | - | - | | | 24345 | - | - | $542.03 | - | - | | | 24346 | - | - | $833.20 | - | - | | | 24357 | - | - | $321.22 | - | - | | | 24358 | - | - | $405.47 | - | - | | | 24359 | - | - | $504.22 | - | - | | | 24360 | - | - | $681.00 | - | - | | | 24361 | - | - | $757.72 | - | - | | | 24362 | - | - | $796.78 | - | - | | | 24363 | - | - | $1,080.56 | - | - | | | 24365 | - | - | $487.23 | - | - | | | 24366 | - | - | $516.33 | - | - | | | 24370 | - | - | $1,146.74 | - | - | | | 24371 | - | - | $1,314.15 | - | - | | | 24400 | - | - | $626.52 | - | - | | | 24410 | - | - | $795.26 | - | - | | | 24420 | - | - | $808.91 | - | - | | | 24430 | - | - | $793.14 | - | - | | | 24435 | - | - | $813.63 | - | - | | | 24470 | - | - | $511.29 | - | - | | | 24495 | - | - | $719.67 | - | - | | | 24498 | - | - | $653.51 | - | - | | | 24500 | $286.32 | $263.01 | - | - | - | | | 24505 | $393.68 | $350.83 | - | - | - | | | 24515 | - | - | $666.14 | - | - | | | 24516 | - | - | $647.90 | - | - | | | 24530 | $302.68 | $276.16 | - | - | - | | | 24535 | $481.23 | $439.45 | - | - | - | | | 24538 | - | - | $604.02 | - | - | | | 24545 | - | - | $698.57 | - | - | | | 24546 | - | - | $779.40 | - | - | | | 24560 | $264.55 | $232.94 | - | - | - | | | 24565 | $422.57 | $383.73 | - | - | - | | | 24566 | - | - | $550.49 | - | - | | | 24575 | - | - | $556.83 | - | - | | | 24576 | $279.03 | $247.42 | - | - | - | | | 24577 | $433.89 | $393.18 | - | - | - | | | 24579 | - | - | $632.16 | - | - | | | 24582 | - | - | $623.59 | - | - | | | 24586 | - | - | $815.88 | - | - | | | 24587 | - | - | $816.85 | - | - | | | 24600 | $295.14 | $265.41 | - | - | - | | | 24605 | - | - | $369.40 | - | - | | | 24615 | - | - | $541.55 | - | - | | | 24620 | - | - | $451.64 | - | - | | | 24635 | - | - | $515.55 | - | - | | | 24640 | $80.28 | $60.46 | - | - | - | | | 24650 | $209.99 | $194.72 | - | - | - | | | 24655 | $351.47 | $315.05 | - | - | - | | | 24665 | - | - | $502.11 | - | - | | | 24666 | - | - | $556.48 | - | - | | | 24670 | $232.07 | $211.45 | - | - | - | | | 24675 | $360.51 | $324.62 | - | - | - | | | 24685 | - | - | $498.93 | - | - | | | 24800 | - | - | $630.75 | - | - | | | 24802 | - | - | $754.04 | - | - | | | 24900 | - | - | $557.27 | - | - | | | 24920 | - | - | $555.04 | - | - | | | 24925 | - | - | $435.18 | - | - | | | 24930 | - | - | $584.22 | - | - | | | 24931 | - | - | $699.57 | - | - | | | 24935 | - | - | $924.27 | - | - | | | 24940 | - | - | I.C. | - | - | | | 24999 | - | - | I.C. | - | - | | | 25000 | - | - | $269.39 | - | - | | | 25001 | - | - | $268.90 | - | - | | | 25020 | - | - | $581.83 | - | - | | | 25023 | - | - | $1,006.28 | - | - | | | 25024 | - | - | $585.53 | - | - | | | 25025 | - | - | $919.14 | - | - | | | 25028 | - | - | $542.87 | - | - | | | 25031 | - | - | $284.41 | - | - | | | 25035 | - | - | $447.71 | - | - | | | 25040 | - | - | $426.23 | - | - | | | 25065 | $199.58 | $120.03 | - | - | - | | | 25066 | - | - | $283.25 | - | - | | | 25071 | - | - | $319.88 | - | - | | | 25073 | - | - | $407.66 | - | - | | | 25075 | $406.30 | $241.31 | - | - | - | | | 25076 | - | - | $396.32 | - | - | | | 25077 | - | - | $664.78 | - | - | | | 25078 | - | - | $868.60 | - | - | | | 25085 | - | - | $344.30 | - | - | | | 25100 | - | - | $270.57 | - | - | | | 25101 | - | - | $312.16 | - | - | | | 25105 | - | - | $375.15 | - | - | | | 25107 | - | - | $473.38 | - | - | | | 25109 | - | - | $410.59 | - | - | | | 25110 | - | - | $268.45 | - | - | | | 25111 | - | - | $252.29 | - | - | | | 25112 | - | - | $301.21 | - | - | | | 25115 | - | - | $575.91 | - | - | | | 25116 | - | - | $462.85 | - | - | | | 25118 | - | - | $295.83 | - | - | | | 25119 | - | - | $385.68 | - | - | | | 25120 | - | - | $385.49 | - | - | | | 25125 | - | - | $455.02 | - | - | | | 25126 | - | - | $458.00 | - | - | | | 25130 | - | - | $348.07 | - | - | | | 25135 | - | - | $429.00 | - | - | | | 25136 | - | - | $382.43 | - | - | | | 25145 | - | - | $399.52 | - | - | | | 25150 | - | - | $433.74 | - | - | | | 25151 | - | - | $446.64 | - | - | | | 25170 | - | - | $1,093.31 | - | - | | | 25210 | - | - | $379.21 | - | - | | | 25215 | - | - | $473.23 | - | - | | | 25230 | - | - | $333.20 | - | - | | | 25240 | - | - | $330.93 | - | - | | | 25246 | $154.81 | $53.30 | - | - | - | | | 25248 | - | - | $318.07 | - | - | | | 25250 | - | - | $408.43 | - | - | | | 25251 | - | - | $545.78 | - | - | | | 25259 | - | - | $338.09 | - | - | | | 25260 | - | - | $486.44 | - | - | | | 25263 | - | - | $484.83 | - | - | | | 25265 | - | - | $570.46 | - | - | | | 25270 | - | - | $379.83 | - | - | | | 25272 | - | - | $428.10 | - | - | | | 25274 | - | - | $507.47 | - | - | | | 25275 | - | - | $512.30 | - | - | | | 25280 | - | - | $432.71 | - | - | | | 25290 | - | - | $335.21 | - | - | | | 25295 | - | - | $404.33 | - | - | | | 25300 | - | - | $526.21 | - | - | | | 25301 | - | - | $490.60 | - | - | | | 25310 | - | - | $475.04 | - | - | | | 25312 | - | - | $545.26 | - | - | | | 25315 | - | - | $582.49 | - | - | | | 25316 | - | - | $691.04 | - | - | | | 25320 | - | - | $752.01 | - | - | | | 25332 | - | - | $640.05 | - | - | | | 25335 | - | - | $711.73 | - | - | | | 25337 | - | - | $675.16 | - | - | | | 25350 | - | - | $514.01 | - | - | | | 25355 | - | - | $579.16 | - | - | | | 25360 | - | - | $499.75 | - | - | | | 25365 | - | - | $691.82 | - | - | | | 25370 | - | - | $763.86 | - | - | | | 25375 | - | - | $718.46 | - | - | | | 25390 | - | - | $583.00 | - | - | | | 25391 | - | - | $749.31 | - | - | | | 25392 | - | - | $762.14 | - | - | | | 25393 | - | - | $846.21 | - | - | | | 25394 | - | - | $593.28 | - | - | | | 25400 | - | - | $607.63 | - | - | | | 25405 | - | - | $779.78 | - | - | | | 25415 | - | - | $728.86 | - | - | | | 25420 | - | - | $873.49 | - | - | | | 25425 | - | - | $725.63 | - | - | | | 25426 | - | - | $841.51 | - | - | | | 25430 | - | - | $556.28 | - | - | | | 25431 | - | - | $596.20 | - | - | | | 25440 | - | - | $582.45 | - | - | | | 25441 | - | - | $707.35 | - | - | | | 25442 | - | - | $613.83 | - | - | | | 25443 | - | - | $595.46 | - | - | | | 25444 | - | - | $626.86 | - | - | | | 25445 | - | - | $547.73 | - | - | | | 25446 | - | - | $879.74 | - | - | | | 25447 | - | - | $632.33 | - | - | | | 25449 | - | - | $777.73 | - | - | | | 25450 | - | - | $471.32 | - | - | | | 25455 | - | - | $555.48 | - | - | | | 25490 | - | - | $545.79 | - | - | | | 25491 | - | - | $560.09 | - | - | | | 25492 | - | - | $684.23 | - | - | | | 25500 | $225.86 | $203.36 | - | - | - | | | 25505 | $397.03 | $358.19 | - | - | - | | | 25515 | - | - | $510.66 | - | - | | | 25520 | $448.69 | $421.10 | - | - | - | | | 25525 | - | - | $601.22 | - | - | | | 25526 | - | - | $722.87 | - | - | | | 25530 | $210.49 | $192.54 | - | - | - | | | 25535 | $387.06 | $355.45 | - | - | - | | | 25545 | - | - | $478.30 | - | - | | | 25560 | $230.63 | $204.65 | - | - | - | | | 25565 | $406.27 | $360.74 | - | - | - | | | 25574 | - | - | $515.61 | - | - | | | 25575 | - | - | $684.90 | - | - | | | 25600 | $269.83 | $257.51 | - | - | - | | | 25605 | $420.41 | $395.77 | - | - | - | | | 25606 | - | - | $511.66 | - | - | | | 25607 | - | - | $564.61 | - | - | | | 25608 | - | - | $628.87 | - | - | | | 25609 | - | - | $796.37 | - | - | | | 25622 | $244.43 | $224.88 | - | - | - | | | 25624 | $385.88 | $347.84 | - | - | - | | | 25628 | - | - | $547.42 | - | - | | | 25630 | $241.93 | $223.99 | - | - | - | | | 25635 | $365.69 | $330.07 | - | - | - | | | 25645 | - | - | $436.91 | - | - | | | 25650 | $261.69 | $241.60 | - | - | - | | | 25651 | - | - | $377.89 | - | - | | | 25652 | - | - | $476.35 | - | - | | | 25660 | - | - | $349.23 | - | - | | | 25670 | - | - | $463.83 | - | - | | | 25671 | - | - | $408.68 | - | - | | | 25675 | $357.61 | $320.38 | - | - | - | | | 25676 | - | - | $481.38 | - | - | | | 25680 | - | - | $409.94 | - | - | | | 25685 | - | - | $557.34 | - | - | | | 25690 | - | - | $380.59 | - | - | | | 25695 | - | - | $482.80 | - | - | | | 25800 | - | - | $556.00 | - | - | | | 25805 | - | - | $641.06 | - | - | | | 25810 | - | - | $656.97 | - | - | | | 25820 | - | - | $500.03 | - | - | | | 25825 | - | - | $608.24 | - | - | | | 25830 | - | - | $782.66 | - | - | | | 25900 | - | - | $544.00 | - | - | | | 25905 | - | - | $532.12 | - | - | | | 25907 | - | - | $468.31 | - | - | | | 25909 | - | - | $520.52 | - | - | | | 25915 | - | - | $871.90 | - | - | | | 25920 | - | - | $558.60 | - | - | | | 25922 | - | - | $496.65 | - | - | | | 25924 | - | - | $545.78 | - | - | | | 25927 | - | - | $668.61 | - | - | | | 25929 | - | - | $456.68 | - | - | | | 25931 | - | - | $620.35 | - | - | | | 25999 | - | - | I.C. | - | - | | | 26010 | $273.87 | $108.34 | - | - | - | | | 26011 | $382.84 | $142.05 | - | - | - | | | 26020 | - | - | $426.89 | - | - | | | 26025 | - | - | $322.49 | - | - | | | 26030 | - | - | $376.23 | - | - | | | 26034 | - | - | $423.56 | - | - | | | 26035 | - | - | $653.34 | - | - | | | 26037 | - | - | $427.54 | - | - | | | 26040 | - | - | $245.89 | - | - | | | 26045 | - | - | $363.63 | - | - | | | 26055 | $468.88 | $226.22 | - | - | - | | | 26060 | - | - | $198.03 | - | - | | | 26070 | - | - | $249.77 | - | - | | | 26075 | - | - | $262.26 | - | - | | | 26080 | - | - | $308.77 | - | - | | | 26100 | - | - | $263.14 | - | - | | | 26105 | - | - | $265.05 | - | - | | | 26110 | - | - | $252.75 | - | - | | | 26111 | - | - | $317.02 | - | - | | | 26113 | - | - | $417.45 | - | - | | | 26115 | $432.16 | $255.38 | - | - | - | | | 26116 | - | - | $401.68 | - | - | | | 26117 | - | - | $561.95 | - | - | | | 26118 | - | - | $794.56 | - | - | | | 26121 | - | - | $458.77 | - | - | | | 26123 | - | - | $638.70 | - | - | | | 26125 | - | - | $197.45 | - | - | | | 26130 | - | - | $361.41 | - | - | | | 26135 | - | - | $424.61 | - | - | | | 26140 | - | - | $390.08 | - | - | | | 26145 | - | - | $396.09 | - | - | | | 26160 | $487.63 | $244.70 | - | - | - | | | 26170 | - | - | $315.25 | - | - | | | 26180 | - | - | $347.25 | - | - | | | 26185 | - | - | $428.76 | - | - | | | 26200 | - | - | $347.02 | - | - | | | 26205 | - | - | $461.58 | - | - | | | 26210 | - | - | $345.98 | - | - | | | 26215 | - | - | $434.18 | - | - | | | 26230 | - | - | $383.28 | - | - | | | 26235 | - | - | $377.52 | - | - | | | 26236 | - | - | $338.89 | - | - | | | 26250 | - | - | $799.99 | - | - | | | 26260 | - | - | $601.27 | - | - | | | 26262 | - | - | $479.56 | - | - | | | 26320 | - | - | $270.19 | - | - | | | 26340 | - | - | $279.63 | - | - | | | 26341 | $91.77 | $59.89 | - | - | - | | | 26350 | - | - | $586.98 | - | - | | | 26352 | - | - | $651.36 | - | - | | | 26356 | - | - | $610.82 | - | - | | | 26357 | - | - | $681.12 | - | - | | | 26358 | - | - | $748.25 | - | - | | | 26370 | - | - | $613.83 | - | - | | | 26372 | - | - | $712.18 | - | - | | | 26373 | - | - | $686.99 | - | - | | | 26390 | - | - | $679.67 | - | - | | | 26392 | - | - | $775.56 | - | - | | | 26410 | - | - | $474.74 | - | - | | | 26412 | - | - | $562.18 | - | - | | | 26415 | - | - | $662.25 | - | - | | | 26416 | - | - | $714.32 | - | - | | | 26418 | - | - | $494.39 | - | - | | | 26420 | - | - | $581.20 | - | - | | | 26426 | - | - | $386.98 | - | - | | | 26428 | - | - | $622.84 | - | - | | | 26432 | - | - | $430.62 | - | - | | | 26433 | - | - | $451.67 | - | - | | | 26434 | - | - | $545.13 | - | - | | | 26437 | - | - | $523.40 | - | - | | | 26440 | - | - | $513.68 | - | - | | | 26442 | - | - | $770.68 | - | - | | | 26445 | - | - | $480.50 | - | - | | | 26449 | - | - | $535.80 | - | - | | | 26450 | - | - | $366.79 | - | - | | | 26455 | - | - | $364.72 | - | - | | | 26460 | - | - | $354.83 | - | - | | | 26471 | - | - | $518.13 | - | - | | | 26474 | - | - | $512.77 | - | - | | | 26476 | - | - | $506.40 | - | - | | | 26477 | - | - | $492.48 | - | - | | | 26478 | - | - | $520.77 | - | - | | | 26479 | - | - | $530.08 | - | - | | | 26480 | - | - | $616.25 | - | - | | | 26483 | - | - | $678.88 | - | - | | | 26485 | - | - | $653.12 | - | - | | | 26489 | - | - | $748.85 | - | - | | | 26490 | - | - | $651.73 | - | - | | | 26492 | - | - | $718.63 | - | - | | | 26494 | - | - | $654.20 | - | - | | | 26496 | - | - | $702.03 | - | - | | | 26497 | - | - | $701.27 | - | - | | | 26498 | - | - | $903.82 | - | - | | | 26499 | - | - | $676.32 | - | - | | | 26500 | - | - | $519.27 | - | - | | | 26502 | - | - | $589.44 | - | - | | | 26508 | - | - | $530.47 | - | - | | | 26510 | - | - | $505.16 | - | - | | | 26516 | - | - | $580.19 | - | - | | | 26517 | - | - | $672.38 | - | - | | | 26518 | - | - | $680.51 | - | - | | | 26520 | - | - | $538.27 | - | - | | | 26525 | - | - | $540.48 | - | - | | | 26530 | - | - | $413.81 | - | - | | | 26531 | - | - | $483.23 | - | - | | | 26535 | - | - | $337.33 | - | - | | | 26536 | - | - | $588.24 | - | - | | | 26540 | - | - | $547.64 | - | - | | | 26541 | - | - | $647.11 | - | - | | | 26542 | - | - | $563.90 | - | - | | | 26545 | - | - | $572.57 | - | - | | | 26546 | - | - | $804.87 | - | - | | | 26548 | - | - | $622.56 | - | - | | | 26550 | - | - | $1,254.71 | - | - | | | 26551 | - | - | $2,463.46 | - | - | | | 26553 | - | - | $2,447.17 | - | - | | | 26554 | - | - | $2,843.56 | - | - | | | 26555 | - | - | $1,060.14 | - | - | | | 26556 | - | - | $2,546.15 | - | - | | | 26560 | - | - | $499.58 | - | - | | | 26561 | - | - | $757.89 | - | - | | | 26562 | - | - | $1,052.23 | - | - | | | 26565 | - | - | $557.63 | - | - | | | 26567 | - | - | $562.00 | - | - | | | 26568 | - | - | $723.90 | - | - | | | 26580 | - | - | $1,172.07 | - | - | | | 26587 | - | - | $787.37 | - | - | | | 26590 | - | - | $1,089.33 | - | - | | | 26591 | - | - | $386.69 | - | - | | | 26593 | - | - | $507.07 | - | - | | | 26596 | - | - | $631.46 | - | - | | | 26600 | $239.52 | $227.46 | - | - | - | | | 26605 | $261.75 | $234.70 | - | - | - | | | 26607 | - | - | $395.01 | - | - | | | 26608 | - | - | $372.96 | - | - | | | 26615 | - | - | $441.62 | - | - | | | 26641 | $329.64 | $298.57 | - | - | - | | | 26645 | $339.25 | $307.37 | - | - | - | | | 26650 | - | - | $374.23 | - | - | | | 26665 | - | - | $480.60 | - | - | | | 26670 | $273.49 | $242.69 | - | - | - | | | 26675 | $362.10 | $328.62 | - | - | - | | | 26676 | - | - | $395.56 | - | - | | | 26685 | - | - | $441.69 | - | - | | | 26686 | - | - | $474.88 | - | - | | | 26700 | $266.79 | $244.30 | - | - | - | | | 26705 | $344.13 | $309.58 | - | - | - | | | 26706 | - | - | $345.94 | - | - | | | 26715 | - | - | $440.44 | - | - | | | 26720 | $159.97 | $149.79 | - | - | - | | | 26725 | $269.75 | $238.41 | - | - | - | | | 26727 | - | - | $367.70 | - | - | | | 26735 | - | - | $455.94 | - | - | | | 26740 | $185.04 | $174.86 | - | - | - | | | 26742 | $294.15 | $262.27 | - | - | - | | | 26746 | - | - | $565.40 | - | - | | | 26750 | $149.10 | $150.44 | - | - | - | | | 26755 | $252.85 | $215.09 | - | - | - | | | 26756 | - | - | $330.82 | - | - | | | 26765 | - | - | $388.31 | - | - | | | 26770 | $226.25 | $204.83 | - | - | - | | | 26775 | $311.77 | $278.29 | - | - | - | | | 26776 | - | - | $349.35 | - | - | | | 26785 | - | - | $421.82 | - | - | | | 26820 | - | - | $645.12 | - | - | | | 26841 | - | - | $603.15 | - | - | | | 26842 | - | - | $647.03 | - | - | | | 26843 | - | - | $609.24 | - | - | | | 26844 | - | - | $667.79 | - | - | | | 26850 | - | - | $573.77 | - | - | | | 26852 | - | - | $647.48 | - | - | | | 26860 | - | - | $483.19 | - | - | | | 26861 | - | - | $74.25 | - | - | | | 26862 | - | - | $597.38 | - | - | | | 26863 | - | - | $167.29 | - | - | | | 26910 | - | - | $593.35 | - | - | | | 26951 | - | - | $549.67 | - | - | | | 26952 | - | - | $535.13 | - | - | | | 26989 | - | - | I.C. | - | - | | | 26990 | - | - | $521.19 | - | - | | | 26991 | $548.97 | $400.58 | - | - | - | | | 26992 | - | - | $762.01 | - | - | | | 27000 | - | - | $299.58 | - | - | | | 27001 | - | - | $411.72 | - | - | | | 27003 | - | - | $456.70 | - | - | | | 27005 | - | - | $541.13 | - | - | | | 27006 | - | - | $539.54 | - | - | | | 27025 | - | - | $694.35 | - | - | | | 27027 | - | - | $670.22 | - | - | | | 27030 | - | - | $702.96 | - | - | | | 27033 | - | - | $729.49 | - | - | | | 27035 | - | - | $851.42 | - | - | | | 27036 | - | - | $765.35 | - | - | | | 27040 | $263.83 | $149.46 | - | - | - | | | 27041 | - | - | $535.32 | - | - | | | 27043 | - | - | $351.23 | - | - | | | 27045 | - | - | $549.76 | - | - | | | 27047 | $380.65 | $271.91 | - | - | - | | | 27048 | - | - | $459.09 | - | - | | | 27049 | - | - | $989.66 | - | - | | | 27050 | - | - | $312.09 | - | - | | | 27052 | - | - | $441.47 | - | - | | | 27054 | - | - | $523.56 | - | - | | | 27057 | - | - | $755.28 | - | - | | | 27059 | - | - | $1,337.41 | - | - | | | 27060 | - | - | $356.68 | - | - | | | 27062 | - | - | $347.92 | - | - | | | 27065 | - | - | $403.58 | - | - | | | 27066 | - | - | $620.52 | - | - | | | 27067 | - | - | $779.03 | - | - | | | 27070 | - | - | $672.54 | - | - | | | 27071 | - | - | $741.31 | - | - | | | 27075 | - | - | $1,541.76 | - | - | | | 27076 | - | - | $1,859.97 | - | - | | | 27077 | - | - | $2,072.03 | - | - | | | 27078 | - | - | $1,520.36 | - | - | | | 27080 | - | - | $386.36 | - | - | | | 27086 | $244.77 | $128.80 | - | - | - | | | 27087 | - | - | $462.41 | - | - | | | 27090 | - | - | $627.36 | - | - | | | 27091 | - | - | $1,184.90 | - | - | | | 27093 | $185.22 | $50.23 | - | - | - | | | 27095 | $247.90 | $60.14 | - | - | - | | | 27096 | $126.08 | $61.27 | - | - | - | | | 27097 | - | - | $518.73 | - | - | | | 27098 | - | - | $528.26 | - | - | | | 27100 | - | - | $628.48 | - | - | | | 27105 | - | - | $657.62 | - | - | | | 27110 | - | - | $730.81 | - | - | | | 27111 | - | - | $681.29 | - | - | | | 27120 | - | - | $970.54 | - | - | | | 27122 | - | - | $826.34 | - | - | | | 27125 | - | - | $846.69 | - | - | | | 27130 | - | - | $956.40 | - | - | | | 27132 | - | - | $1,241.66 | - | - | | | 27134 | - | - | $1,409.33 | - | - | | | 27137 | - | - | $1,087.89 | - | - | | | 27138 | - | - | $1,129.56 | - | - | | | 27140 | - | - | $674.52 | - | - | | | 27146 | - | - | $946.99 | - | - | | | 27147 | - | - | $1,089.35 | - | - | | | 27151 | - | - | $1,176.53 | - | - | | | 27156 | - | - | $1,266.05 | - | - | | | 27158 | - | - | $1,043.06 | - | - | | | 27161 | - | - | $912.89 | - | - | | | 27165 | - | - | $1,027.73 | - | - | | | 27170 | - | - | $874.50 | - | - | | | 27175 | - | - | $503.35 | - | - | | | 27176 | - | - | $695.28 | - | - | | | 27177 | - | - | $837.18 | - | - | | | 27178 | - | - | $695.28 | - | - | | | 27179 | - | - | $736.17 | - | - | | | 27181 | - | - | $839.86 | - | - | | | 27185 | - | - | $544.78 | - | - | | | 27187 | - | - | $748.83 | - | - | | | 27197 | - | - | $102.12 | - | - | | | 27198 | - | - | $236.28 | - | - | | | 27200 | $146.28 | $147.62 | - | - | - | | | 27202 | - | - | $399.54 | - | - | | | 27215 | - | - | $451.96 | - | - | | | 27216 | - | - | $666.97 | - | - | | | 27217 | - | - | $627.48 | - | - | | | 27218 | - | - | $858.32 | - | - | | | 27220 | $319.70 | $314.61 | - | - | - | | | 27222 | - | - | $741.20 | - | - | | | 27226 | - | - | $790.51 | - | - | | | 27227 | - | - | $1,225.97 | - | - | | | 27228 | - | - | $1,392.51 | - | - | | | 27230 | $375.50 | $367.73 | - | - | - | | | 27232 | - | - | $541.25 | - | - | | | 27235 | - | - | $681.24 | - | - | | | 27236 | - | - | $891.99 | - | - | | | 27238 | - | - | $359.37 | - | - | | | 27240 | - | - | $718.93 | - | - | | | 27244 | - | - | $917.31 | - | - | | | 27245 | - | - | $916.45 | - | - | | | 27246 | $301.10 | $297.62 | - | - | - | | | 27248 | - | - | $560.30 | - | - | | | 27250 | - | - | $129.75 | - | - | | | 27252 | - | - | $566.68 | - | - | | | 27253 | - | - | $706.21 | - | - | | | 27254 | - | - | $949.83 | - | - | | | 27256 | $237.96 | $177.42 | - | - | - | | | 27257 | - | - | $270.10 | - | - | | | 27258 | - | - | $833.16 | - | - | | | 27259 | - | - | $1,149.53 | - | - | | | 27265 | - | - | $320.10 | - | - | | | 27266 | - | - | $444.85 | - | - | | | 27267 | - | - | $338.52 | - | - | | | 27268 | - | - | $415.51 | - | - | | | 27269 | - | - | $924.30 | - | - | | | 27275 | - | - | $140.06 | - | - | | | 27278 | $9,727.25 | $351.37 | - | - | - | | | 27279 | - | - | $608.25 | - | - | | | 27280 | - | - | $1,009.39 | - | - | | | 27282 | - | - | $649.89 | - | - | | | 27284 | - | - | $1,189.22 | - | - | | | 27286 | - | - | $1,221.37 | - | - | | | 27290 | - | - | $1,209.82 | - | - | | | 27295 | - | - | $935.03 | - | - | | | 27299 | - | - | I.C. | - | - | | | 27301 | $519.22 | $384.76 | - | - | - | | | 27303 | - | - | $483.26 | - | - | | | 27305 | - | - | $369.96 | - | - | | | 27306 | - | - | $256.56 | - | - | | | 27307 | - | - | $311.63 | - | - | | | 27310 | - | - | $555.15 | - | - | | | 27323 | $213.03 | $132.68 | - | - | - | | | 27324 | - | - | $313.12 | - | - | | | 27325 | - | - | $431.60 | - | - | | | 27326 | - | - | $400.55 | - | - | | | 27327 | $391.03 | $239.44 | - | - | - | | | 27328 | - | - | $469.27 | - | - | | | 27329 | - | - | $775.20 | - | - | | | 27330 | - | - | $324.62 | - | - | | | 27331 | - | - | $365.30 | - | - | | | 27332 | - | - | $491.62 | - | - | | | 27333 | - | - | $450.07 | - | - | | | 27334 | - | - | $522.07 | - | - | | | 27335 | - | - | $579.38 | - | - | | | 27337 | - | - | $315.12 | - | - | | | 27339 | - | - | $563.35 | - | - | | | 27340 | - | - | $289.09 | - | - | | | 27345 | - | - | $372.10 | - | - | | | 27347 | - | - | $403.57 | - | - | | | 27350 | - | - | $498.19 | - | - | | | 27355 | - | - | $463.29 | - | - | | | 27356 | - | - | $561.09 | - | - | | | 27357 | - | - | $620.08 | - | - | | | 27358 | - | - | $200.69 | - | - | | | 27360 | - | - | $688.02 | - | - | | | 27364 | - | - | $1,159.23 | - | - | | | 27365 | - | - | $1,519.62 | - | - | | | 27369 | $147.81 | $29.69 | - | - | - | | | 27372 | $457.31 | $304.64 | - | - | - | | | 27380 | - | - | $478.76 | - | - | | | 27381 | - | - | $624.16 | - | - | | | 27385 | - | - | $467.52 | - | - | | | 27386 | - | - | $651.03 | - | - | | | 27390 | - | - | $345.54 | - | - | | | 27391 | - | - | $442.85 | - | - | | | 27392 | - | - | $541.34 | - | - | | | 27393 | - | - | $383.40 | - | - | | | 27394 | - | - | $497.08 | - | - | | | 27395 | - | - | $666.26 | - | - | | | 27396 | - | - | $470.91 | - | - | | | 27397 | - | - | $690.39 | - | - | | | 27400 | - | - | $528.51 | - | - | | | 27403 | - | - | $490.05 | - | - | | | 27405 | - | - | $513.42 | - | - | | | 27407 | - | - | $603.46 | - | - | | | 27409 | - | - | $728.34 | - | - | | | 27412 | - | - | $1,228.12 | - | - | | | 27415 | - | - | $1,027.19 | - | - | | | 27416 | - | - | $736.53 | - | - | | | 27418 | - | - | $626.84 | - | - | | | 27420 | - | - | $565.19 | - | - | | | 27422 | - | - | $562.03 | - | - | | | 27424 | - | - | $567.44 | - | - | | | 27425 | - | - | $349.49 | - | - | | | 27427 | - | - | $538.23 | - | - | | | 27428 | - | - | $841.25 | - | - | | | 27429 | - | - | $947.85 | - | - | | | 27430 | - | - | $562.27 | - | - | | | 27435 | - | - | $614.37 | - | - | | | 27437 | - | - | $502.05 | - | - | | | 27438 | - | - | $633.79 | - | - | | | 27440 | - | - | $602.90 | - | - | | | 27441 | - | - | $622.15 | - | - | | | 27442 | - | - | $656.72 | - | - | | | 27443 | - | - | $616.29 | - | - | | | 27445 | - | - | $936.82 | - | - | | | 27446 | - | - | $856.94 | - | - | | | 27447 | - | - | $955.40 | - | - | | | 27448 | - | - | $624.89 | - | - | | | 27450 | - | - | $763.15 | - | - | | | 27454 | - | - | $966.97 | - | - | | | 27455 | - | - | $725.06 | - | - | | | 27457 | - | - | $720.70 | - | - | | | 27465 | - | - | $932.34 | - | - | | | 27466 | - | - | $887.46 | - | - | | | 27468 | - | - | $1,001.34 | - | - | | | 27470 | - | - | $884.84 | - | - | | | 27472 | - | - | $945.79 | - | - | | | 27475 | - | - | $503.79 | - | - | | | 27477 | - | - | $555.29 | - | - | | | 27479 | - | - | $690.98 | - | - | | | 27485 | - | - | $510.15 | - | - | | | 27486 | - | - | $1,046.62 | - | - | | | 27487 | - | - | $1,301.31 | - | - | | | 27488 | - | - | $898.23 | - | - | | | 27495 | - | - | $846.66 | - | - | | | 27496 | - | - | $419.92 | - | - | | | 27497 | - | - | $441.28 | - | - | | | 27498 | - | - | $499.93 | - | - | | | 27499 | - | - | $533.16 | - | - | | | 27500 | $403.62 | $368.54 | - | - | - | | | 27501 | $387.88 | $380.91 | - | - | - | | | 27502 | - | - | $567.66 | - | - | | | 27503 | - | - | $605.43 | - | - | | | 27506 | - | - | $1,000.82 | - | - | | | 27507 | - | - | $723.54 | - | - | | | 27508 | $405.80 | $383.30 | - | - | - | | | 27509 | - | - | $518.68 | - | - | | | 27510 | - | - | $515.30 | - | - | | | 27511 | - | - | $743.44 | - | - | | | 27513 | - | - | $918.85 | - | - | | | 27514 | - | - | $721.12 | - | - | | | 27516 | $403.19 | $375.60 | - | - | - | | | 27517 | - | - | $525.44 | - | - | | | 27519 | - | - | $666.53 | - | - | | | 27520 | $257.65 | $237.29 | - | - | - | | | 27524 | - | - | $570.23 | - | - | | | 27530 | $244.35 | $228.82 | - | - | - | | | 27532 | $476.99 | $442.44 | - | - | - | | | 27535 | - | - | $670.71 | - | - | | | 27536 | - | - | $888.54 | - | - | | | 27538 | $377.91 | $349.78 | - | - | - | | | 27540 | - | - | $615.87 | - | - | | | 27550 | $399.21 | $364.39 | - | - | - | | | 27552 | - | - | $483.37 | - | - | | | 27556 | - | - | $656.12 | - | - | | | 27557 | - | - | $778.77 | - | - | | | 27558 | - | - | $884.48 | - | - | | | 27560 | $293.47 | $266.96 | - | - | - | | | 27562 | - | - | $377.45 | - | - | | | 27566 | - | - | $671.80 | - | - | | | 27570 | - | - | $117.45 | - | - | | | 27580 | - | - | $1,106.20 | - | - | | | 27590 | - | - | $572.02 | - | - | | | 27591 | - | - | $724.25 | - | - | | | 27592 | - | - | $492.24 | - | - | | | 27594 | - | - | $374.99 | - | - | | | 27596 | - | - | $526.81 | - | - | | | 27598 | - | - | $512.58 | - | - | | | 27599 | - | - | I.C. | - | - | | | 27600 | - | - | $300.39 | - | - | | | 27601 | - | - | $333.56 | - | - | | | 27602 | - | - | $350.86 | - | - | | | 27603 | $407.79 | $296.63 | - | - | - | | | 27604 | $347.15 | $243.76 | - | - | - | | | 27605 | $255.54 | $137.69 | - | - | - | | | 27606 | - | - | $203.26 | - | - | | | 27607 | - | - | $451.18 | - | - | | | 27610 | - | - | $487.75 | - | - | | | 27612 | - | - | $428.71 | - | - | | | 27613 | $195.35 | $121.42 | - | - | - | | | 27614 | $454.69 | $315.14 | - | - | - | | | 27615 | - | - | $763.51 | - | - | | | 27616 | - | - | $941.98 | - | - | | | 27618 | $379.59 | $232.55 | - | - | - | | | 27619 | - | - | $352.88 | - | - | | | 27620 | - | - | $337.51 | - | - | | | 27625 | - | - | $431.87 | - | - | | | 27626 | - | - | $460.39 | - | - | | | 27630 | $414.51 | $269.88 | - | - | - | | | 27632 | - | - | $308.23 | - | - | | | 27634 | - | - | $507.11 | - | - | | | 27635 | - | - | $439.34 | - | - | | | 27637 | - | - | $560.13 | - | - | | | 27638 | - | - | $563.40 | - | - | | | 27640 | - | - | $625.44 | - | - | | | 27641 | - | - | $491.14 | - | - | | | 27645 | - | - | $1,312.19 | - | - | | | 27646 | - | - | $1,142.42 | - | - | | | 27647 | - | - | $731.89 | - | - | | | 27648 | $170.27 | $37.42 | - | - | - | | | 27650 | - | - | $498.90 | - | - | | | 27652 | - | - | $497.71 | - | - | | | 27654 | - | - | $539.58 | - | - | | | 27656 | $417.59 | $263.58 | - | - | - | | | 27658 | - | - | $280.84 | - | - | | | 27659 | - | - | $355.35 | - | - | | | 27664 | - | - | $277.31 | - | - | | | 27665 | - | - | $320.70 | - | - | | | 27675 | - | - | $376.33 | - | - | | | 27676 | - | - | $458.22 | - | - | | | 27680 | - | - | $317.31 | - | - | | | 27681 | - | - | $383.10 | - | - | | | 27685 | $506.15 | $352.95 | - | - | - | | | 27686 | - | - | $398.16 | - | - | | | 27687 | - | - | $344.15 | - | - | | | 27690 | - | - | $482.86 | - | - | | | 27691 | - | - | $562.02 | - | - | | | 27692 | - | - | $73.21 | - | - | | | 27695 | - | - | $367.91 | - | - | | | 27696 | - | - | $413.40 | - | - | | | 27698 | - | - | $482.30 | - | - | | | 27700 | - | - | $459.98 | - | - | | | 27702 | - | - | $720.83 | - | - | | | 27703 | - | - | $831.37 | - | - | | | 27704 | - | - | $430.68 | - | - | | | 27705 | - | - | $568.57 | - | - | | | 27707 | - | - | $311.34 | - | - | | | 27709 | - | - | $847.52 | - | - | | | 27712 | - | - | $826.58 | - | - | | | 27715 | - | - | $804.54 | - | - | | | 27720 | - | - | $658.09 | - | - | | | 27722 | - | - | $674.75 | - | - | | | 27724 | - | - | $934.78 | - | - | | | 27725 | - | - | $911.73 | - | - | | | 27726 | - | - | $717.85 | - | - | | | 27727 | - | - | $780.96 | - | - | | | 27730 | - | - | $448.25 | - | - | | | 27732 | - | - | $348.99 | - | - | | | 27734 | - | - | $499.87 | - | - | | | 27740 | - | - | $537.10 | - | - | | | 27742 | - | - | $588.30 | - | - | | | 27745 | - | - | $570.82 | - | - | | | 27750 | $274.16 | $253.53 | - | - | - | | | 27752 | $415.21 | $377.44 | - | - | - | | | 27756 | - | - | $440.67 | - | - | | | 27758 | - | - | $675.88 | - | - | | | 27759 | - | - | $748.39 | - | - | | | 27760 | $262.08 | $240.92 | - | - | - | | | 27762 | $376.62 | $337.79 | - | - | - | | | 27766 | - | - | $462.49 | - | - | | | 27767 | $230.85 | $229.51 | - | - | - | | | 27768 | - | - | $347.05 | - | - | | | 27769 | - | - | $549.61 | - | - | | | 27780 | $245.08 | $224.72 | - | - | - | | | 27781 | $343.24 | $314.05 | - | - | - | | | 27784 | - | - | $538.57 | - | - | | | 27786 | $247.59 | $225.89 | - | - | - | | | 27788 | $332.82 | $299.07 | - | - | - | | | 27792 | - | - | $489.96 | - | - | | | 27808 | $265.37 | $241.00 | - | - | - | | | 27810 | $369.74 | $330.63 | - | - | - | | | 27814 | - | - | $578.49 | - | - | | | 27816 | $261.13 | $230.59 | - | - | - | | | 27818 | $382.87 | $338.95 | - | - | - | | | 27822 | - | - | $665.58 | - | - | | | 27823 | - | - | $746.50 | - | - | | | 27824 | $249.72 | $239.55 | - | - | - | | | 27825 | $420.94 | $376.74 | - | - | - | | | 27826 | - | - | $650.24 | - | - | | | 27827 | - | - | $849.72 | - | - | | | 27828 | - | - | $1,001.25 | - | - | | | 27829 | - | - | $540.47 | - | - | | | 27830 | $306.13 | $281.22 | - | - | - | | | 27831 | - | - | $316.67 | - | - | | | 27832 | - | - | $574.50 | - | - | | | 27840 | - | - | $299.16 | - | - | | | 27842 | - | - | $375.81 | - | - | | | 27846 | - | - | $543.14 | - | - | | | 27848 | - | - | $590.92 | - | - | | | 27860 | - | - | $124.24 | - | - | | | 27870 | - | - | $756.58 | - | - | | | 27871 | - | - | $523.35 | - | - | | | 27880 | - | - | $656.87 | - | - | | | 27881 | - | - | $629.29 | - | - | | | 27882 | - | - | $432.86 | - | - | | | 27884 | - | - | $428.49 | - | - | | | 27886 | - | - | $479.14 | - | - | | | 27888 | - | - | $476.23 | - | - | | | 27889 | - | - | $466.29 | - | - | | | 27892 | - | - | $401.23 | - | - | | | 27893 | - | - | $467.88 | - | - | | | 27894 | - | - | $605.40 | - | - | | | 27899 | - | - | I.C. | - | - | | | 28001 | $131.05 | $70.51 | - | - | - | | | 28002 | $188.75 | $103.04 | - | - | - | | | 28003 | $287.78 | $190.56 | - | - | - | | | 28005 | - | - | $427.92 | - | - | | | 28008 | $328.16 | $221.83 | - | - | - | | | 28010 | $177.89 | $157.27 | - | - | - | | | 28011 | $238.61 | $209.96 | - | - | - | | | 28020 | $421.93 | $279.17 | - | - | - | | | 28022 | $373.44 | $246.75 | - | - | - | | | 28024 | $352.49 | $231.43 | - | - | - | | | 28035 | $406.48 | $270.95 | - | - | - | | | 28039 | $367.74 | $256.05 | - | - | - | | | 28041 | - | - | $338.02 | - | - | | | 28043 | $294.52 | $196.50 | - | - | - | | | 28045 | $367.69 | $261.62 | - | - | - | | | 28046 | - | - | $528.58 | - | - | | | 28047 | - | - | $764.28 | - | - | | | 28050 | $318.05 | $209.57 | - | - | - | | | 28052 | $297.72 | $191.65 | - | - | - | | | 28054 | $281.10 | $176.11 | - | - | - | | | 28055 | - | - | $287.87 | - | - | | | 28060 | $395.99 | $270.64 | - | - | - | | | 28062 | $439.36 | $302.76 | - | - | - | | | 28070 | $388.39 | $258.49 | - | - | - | | | 28072 | $376.26 | $245.29 | - | - | - | | | 28080 | $410.16 | $287.49 | - | - | - | | | 28086 | $409.07 | $267.92 | - | - | - | | | 28088 | $354.67 | $221.01 | - | - | - | | | 28090 | $357.37 | $232.83 | - | - | - | | | 28092 | $324.67 | $205.48 | - | - | - | | | 28100 | $471.77 | $316.69 | - | - | - | | | 28102 | - | - | $465.35 | - | - | | | 28103 | - | - | $289.49 | - | - | | | 28104 | $401.46 | $266.20 | - | - | - | | | 28106 | - | - | $317.58 | - | - | | | 28107 | $385.33 | $259.45 | - | - | - | | | 28108 | $333.05 | $217.34 | - | - | - | | | 28110 | $353.25 | $220.40 | - | - | - | | | 28111 | $364.63 | $239.81 | - | - | - | | | 28112 | $370.78 | $236.59 | - | - | - | | | 28113 | $447.99 | $322.37 | - | - | - | | | 28114 | $813.41 | $631.27 | - | - | - | | | 28116 | $595.38 | $443.51 | - | - | - | | | 28118 | $461.58 | $317.22 | - | - | - | | | 28119 | $400.98 | $273.75 | - | - | - | | | 28120 | $513.22 | $374.22 | - | - | - | | | 28122 | $450.70 | $329.37 | - | - | - | | | 28124 | $363.98 | $251.48 | - | - | - | | | 28126 | $299.81 | $187.59 | - | - | - | | | 28130 | - | - | $455.81 | - | - | | | 28140 | $432.46 | $318.36 | - | - | - | | | 28150 | $320.48 | $209.87 | - | - | - | | | 28153 | $311.63 | $199.41 | - | - | - | | | 28160 | $313.53 | $201.03 | - | - | - | | | 28171 | - | - | $827.20 | - | - | | | 28173 | - | - | $535.23 | - | - | | | 28175 | - | - | $349.36 | - | - | | | 28190 | $186.67 | $99.35 | - | - | - | | | 28192 | $351.09 | $233.24 | - | - | - | | | 28193 | $397.86 | $274.65 | - | - | - | | | 28200 | $379.96 | $247.11 | - | - | - | | | 28202 | $457.36 | $322.37 | - | - | - | | | 28208 | $374.80 | $244.09 | - | - | - | | | 28210 | $455.60 | $320.34 | - | - | - | | | 28220 | $344.71 | $229.54 | - | - | - | | | 28222 | $403.06 | $273.69 | - | - | - | | | 28225 | $318.04 | $199.65 | - | - | - | | | 28226 | $479.99 | $305.89 | - | - | - | | | 28230 | $332.64 | $214.79 | - | - | - | | | 28232 | $289.87 | $181.67 | - | - | - | | | 28234 | $315.45 | $204.02 | - | - | - | | | 28238 | $513.75 | $368.31 | - | - | - | | | 28240 | $339.99 | $221.07 | - | - | - | | | 28250 | $449.75 | $309.67 | - | - | - | | | 28260 | $548.55 | $400.70 | - | - | - | | | 28261 | $917.48 | $706.16 | - | - | - | | | 28262 | $1,059.88 | $841.86 | - | - | - | | | 28264 | $666.40 | $505.43 | - | - | - | | | 28270 | $372.63 | $252.11 | - | - | - | | | 28272 | $292.95 | $188.49 | - | - | - | | | 28280 | $390.32 | $261.76 | - | - | - | | | 28285 | $411.68 | $290.62 | - | - | - | | | 28286 | $336.95 | $222.58 | - | - | - | | | 28288 | $462.79 | $328.87 | - | - | - | | | 28289 | $528.11 | $347.05 | - | - | - | | | 28291 | $531.72 | $363.25 | - | - | - | | | 28292 | $532.17 | $363.43 | - | - | - | | | 28295 | $829.70 | $460.62 | - | - | - | | | 28296 | $681.97 | $384.40 | - | - | - | | | 28297 | $792.84 | $452.68 | - | - | - | | | 28298 | $640.85 | $379.44 | - | - | - | | | 28299 | $776.57 | $443.92 | - | - | - | | | 28300 | - | - | $489.72 | - | - | | | 28302 | - | - | $542.55 | - | - | | | 28304 | $633.31 | $461.89 | - | - | - | | | 28305 | - | - | $502.55 | - | - | | | 28306 | $466.77 | $305.53 | - | - | - | | | 28307 | $608.06 | $394.32 | - | - | - | | | 28308 | $437.78 | $292.07 | - | - | - | | | 28309 | - | - | $673.53 | - | - | | | 28310 | $416.22 | $271.85 | - | - | - | | | 28312 | $411.41 | $256.06 | - | - | - | | | 28313 | $405.79 | $272.41 | - | - | - | | | 28315 | $367.25 | $246.19 | - | - | - | | | 28320 | - | - | $460.04 | - | - | | | 28322 | $602.46 | $436.13 | - | - | - | | | 28340 | $429.53 | $304.72 | - | - | - | | | 28341 | $497.42 | $361.63 | - | - | - | | | 28344 | $320.43 | $209.82 | - | - | - | | | 28345 | $389.46 | $270.80 | - | - | - | | | 28360 | - | - | $829.92 | - | - | | | 28400 | $194.46 | $180.00 | - | - | - | | | 28405 | $351.73 | $313.96 | - | - | - | | | 28406 | - | - | $433.77 | - | - | | | 28415 | - | - | $848.47 | - | - | | | 28420 | - | - | $979.84 | - | - | | | 28430 | $188.84 | $164.74 | - | - | - | | | 28435 | $290.43 | $255.61 | - | - | - | | | 28436 | - | - | $385.98 | - | - | | | 28445 | - | - | $779.68 | - | - | | | 28446 | - | - | $918.00 | - | - | | | 28450 | $165.18 | $148.85 | - | - | - | | | 28455 | $228.15 | $202.17 | - | - | - | | | 28456 | - | - | $292.14 | - | - | | | 28465 | - | - | $482.12 | - | - | | | 28470 | $171.08 | $160.36 | - | - | - | | | 28475 | $200.42 | $174.98 | - | - | - | | | 28476 | - | - | $303.50 | - | - | | | 28485 | - | - | $428.56 | - | - | | | 28490 | $111.59 | $97.93 | - | - | - | | | 28495 | $139.48 | $115.38 | - | - | - | | | 28496 | $357.18 | $192.19 | - | - | - | | | 28505 | $498.27 | $373.45 | - | - | - | | | 28510 | $94.66 | $94.12 | - | - | - | | | 28515 | $128.31 | $111.43 | - | - | - | | | 28525 | $436.52 | $307.69 | - | - | - | | | 28530 | $90.45 | $78.12 | - | - | - | | | 28531 | $255.02 | $137.17 | - | - | - | | | 28540 | $151.50 | $135.43 | - | - | - | | | 28545 | $244.07 | $212.46 | - | - | - | | | 28546 | $461.71 | $273.42 | - | - | - | | | 28555 | $663.40 | $501.36 | - | - | - | | | 28570 | $186.42 | $154.81 | - | - | - | | | 28575 | $297.04 | $264.90 | - | - | - | | | 28576 | - | - | $297.15 | - | - | | | 28585 | $673.08 | $524.16 | - | - | - | | | 28600 | $171.44 | $144.92 | - | - | - | | | 28605 | $269.57 | $239.04 | - | - | - | | | 28606 | - | - | $293.89 | - | - | | | 28615 | - | - | $629.16 | - | - | | | 28630 | $118.76 | $83.13 | - | - | - | | | 28635 | $135.62 | $101.60 | - | - | - | | | 28636 | $241.08 | $150.28 | - | - | - | | | 28645 | $495.53 | $364.82 | - | - | - | | | 28660 | $96.27 | $70.56 | - | - | - | | | 28665 | $113.71 | $93.89 | - | - | - | | | 28666 | - | - | $133.68 | - | - | | | 28675 | $443.48 | $313.31 | - | - | - | | | 28705 | - | - | $908.08 | - | - | | | 28715 | - | - | $708.23 | - | - | | | 28725 | - | - | $586.11 | - | - | | | 28730 | - | - | $548.76 | - | - | | | 28735 | - | - | $584.86 | - | - | | | 28737 | - | - | $514.21 | - | - | | | 28740 | $631.91 | $464.51 | - | - | - | | | 28750 | $598.03 | $434.91 | - | - | - | | | 28755 | $387.61 | $252.08 | - | - | - | | | 28760 | $578.66 | $423.85 | - | - | - | | | 28800 | - | - | $393.64 | - | - | | | 28805 | - | - | $522.91 | - | - | | | 28810 | - | - | $315.29 | - | - | | | 28820 | $227.19 | $130.50 | - | - | - | | | 28825 | $222.60 | $126.45 | - | - | - | | | 28890 | $236.38 | $165.67 | - | - | - | | | 28899 | - | - | I.C. | - | - | | | 29000 | $275.23 | $147.47 | - | - | - | | | 29010 | $213.65 | $120.44 | - | - | - | | | 29015 | $228.70 | $135.23 | - | - | - | | | 29035 | $201.33 | $108.12 | - | - | - | | | 29040 | $228.94 | $129.84 | - | - | - | | | 29044 | $224.96 | $125.86 | - | - | - | | | 29046 | $245.85 | $141.12 | - | - | - | | | 29049 | $77.08 | $52.17 | - | - | - | | | 29055 | $173.99 | $103.28 | - | - | - | | | 29058 | $94.86 | $69.95 | - | - | - | | | 29065 | $74.99 | $51.42 | - | - | - | | | 29075 | $68.05 | $47.43 | - | - | - | | | 29085 | $74.52 | $50.68 | - | - | - | | | 29086 | $59.70 | $37.47 | - | - | - | | | 29105 | $63.97 | $30.75 | - | - | - | | | 29125 | $51.74 | $30.58 | - | - | - | | | 29126 | $60.16 | $37.13 | - | - | - | | | 29130 | $31.92 | $21.74 | - | - | - | | | 29131 | $41.18 | $25.91 | - | - | - | | | 29200 | $24.95 | $13.70 | - | - | - | | | 29240 | $23.07 | $13.43 | - | - | - | | | 29260 | $22.40 | $14.10 | - | - | - | | | 29280 | $22.67 | $14.63 | - | - | - | | | 29305 | $192.62 | $118.97 | - | - | - | | | 29325 | $212.24 | $132.96 | - | - | - | | | 29345 | $104.23 | $74.50 | - | - | - | | | 29355 | $109.15 | $79.42 | - | - | - | | | 29358 | $124.38 | $76.97 | - | - | - | | | 29365 | $95.63 | $65.36 | - | - | - | | | 29405 | $61.63 | $43.95 | - | - | - | | | 29425 | $57.75 | $40.60 | - | - | - | | | 29435 | $88.60 | $60.48 | - | - | - | | | 29440 | $32.43 | $20.38 | - | - | - | | | 29445 | $96.93 | $72.56 | - | - | - | | | 29450 | $109.76 | $83.25 | - | - | - | | | 29505 | $68.84 | $39.11 | - | - | - | | | 29515 | $55.16 | $36.95 | - | - | - | | | 29520 | $26.82 | $13.43 | - | - | - | | | 29530 | $22.81 | $13.43 | - | - | - | | | 29540 | $21.33 | $12.76 | - | - | - | | | 29550 | $14.56 | $8.13 | - | - | - | | | 29580 | $48.88 | $19.15 | - | - | - | | | 29581 | $70.07 | $19.71 | - | - | - | | | 29584 | $64.75 | $11.72 | - | - | - | | | 29700 | $48.10 | $24.26 | - | - | - | | | 29705 | $47.79 | $33.06 | - | - | - | | | 29710 | $93.38 | $60.71 | - | - | - | | | 29720 | $66.59 | $32.30 | - | - | - | | | 29730 | $48.62 | $32.82 | - | - | - | | | 29740 | $75.21 | $50.84 | - | - | - | | | 29750 | $81.38 | $56.74 | - | - | - | | | 29799 | - | - | I.C. | - | - | | | 29800 | - | - | $403.84 | - | - | | | 29804 | - | - | $450.52 | - | - | | | 29805 | - | - | $357.85 | - | - | | | 29806 | - | - | $795.07 | - | - | | | 29807 | - | - | $778.48 | - | - | | | 29819 | - | - | $445.91 | - | - | | | 29820 | - | - | $405.14 | - | - | | | 29821 | - | - | $451.10 | - | - | | | 29822 | - | - | $411.98 | - | - | | | 29823 | - | - | $450.09 | - | - | | | 29824 | - | - | $514.46 | - | - | | | 29825 | - | - | $445.91 | - | - | | | 29826 | - | - | $126.03 | - | - | | | 29827 | - | - | $802.13 | - | - | | | 29828 | - | - | $688.91 | - | - | | | 29830 | - | - | $347.03 | - | - | | | 29834 | - | - | $375.56 | - | - | | | 29835 | - | - | $388.02 | - | - | | | 29836 | - | - | $445.47 | - | - | | | 29837 | - | - | $401.58 | - | - | | | 29838 | - | - | $452.06 | - | - | | | 29840 | - | - | $346.15 | - | - | | | 29843 | - | - | $371.70 | - | - | | | 29844 | - | - | $381.85 | - | - | | | 29845 | - | - | $446.88 | - | - | | | 29846 | - | - | $398.92 | - | - | | | 29847 | - | - | $413.88 | - | - | | | 29848 | - | - | $391.84 | - | - | | | 29850 | - | - | $473.98 | - | - | | | 29851 | - | - | $698.91 | - | - | | | 29855 | - | - | $590.22 | - | - | | | 29856 | - | - | $745.29 | - | - | | | 29860 | - | - | $487.71 | - | - | | | 29861 | - | - | $536.64 | - | - | | | 29862 | - | - | $613.84 | - | - | | | 29863 | - | - | $612.70 | - | - | | | 29866 | - | - | $792.40 | - | - | | | 29867 | - | - | $958.67 | - | - | | | 29868 | - | - | $1,243.83 | - | - | | | 29870 | $425.62 | $310.45 | - | - | - | | | 29871 | - | - | $392.68 | - | - | | | 29873 | - | - | $411.60 | - | - | | | 29874 | - | - | $406.99 | - | - | | | 29875 | - | - | $378.10 | - | - | | | 29876 | - | - | $494.16 | - | - | | | 29877 | - | - | $471.24 | - | - | | | 29879 | - | - | $500.84 | - | - | | | 29880 | - | - | $427.41 | - | - | | | 29881 | - | - | $411.98 | - | - | | | 29882 | - | - | $521.13 | - | - | | | 29883 | - | - | $636.21 | - | - | | | 29884 | - | - | $470.01 | - | - | | | 29885 | - | - | $572.47 | - | - | | | 29886 | - | - | $483.11 | - | - | | | 29887 | - | - | $570.24 | - | - | | | 29888 | - | - | $731.87 | - | - | | | 29889 | - | - | $919.50 | - | - | | | 29891 | - | - | $506.07 | - | - | | | 29892 | - | - | $482.69 | - | - | | | 29893 | $512.46 | $329.80 | - | - | - | | | 29894 | - | - | $374.51 | - | - | | | 29895 | - | - | $349.52 | - | - | | | 29897 | - | - | $376.18 | - | - | | | 29898 | - | - | $422.83 | - | - | | | 29899 | - | - | $753.10 | - | - | | | 29900 | - | - | $387.39 | - | - | | | 29901 | - | - | $414.07 | - | - | | | 29902 | - | - | $438.12 | - | - | | | 29904 | - | - | $484.42 | - | - | | | 29905 | - | - | $383.00 | - | - | | | 29906 | - | - | $485.11 | - | - | | | 29907 | - | - | $661.64 | - | - | | | 29914 | - | - | $745.68 | - | - | | | 29915 | - | - | $762.66 | - | - | | | 29916 | - | - | $763.46 | - | - | | | 29999 | - | - | I.C. | - | - | | | 30000 | $212.59 | $92.86 | - | - | - | | | 30020 | $215.00 | $93.67 | - | - | - | | | 30100 | $111.39 | $51.13 | - | - | - | | | 30110 | $196.26 | $101.18 | - | - | - | | | 30115 | - | - | $365.71 | - | - | | | 30117 | $776.56 | $258.56 | - | - | - | | | 30118 | - | - | $611.37 | - | - | | | 30120 | $392.37 | $319.52 | - | - | - | | | 30124 | - | - | $236.33 | - | - | | | 30125 | - | - | $508.48 | - | - | | | 30130 | - | - | $328.05 | - | - | | | 30140 | $229.90 | $132.67 | - | - | - | | | 30150 | - | - | $620.18 | - | - | | | 30160 | - | - | $628.55 | - | - | | | 30200 | $87.45 | $45.13 | - | - | - | | | 30210 | $118.38 | $79.28 | - | - | - | | | 30220 | $242.60 | $97.70 | - | - | - | | | 30300 | $166.95 | $96.78 | - | - | - | | | 30310 | - | - | $162.28 | - | - | | | 30320 | - | - | $382.32 | - | - | | | 30400 | - | - | $960.22 | - | - | | | 30430 | - | - | $845.36 | - | - | | | 30435 | - | - | $1,042.07 | - | - | | | 30450 | - | - | $1,347.02 | - | - | | | 30460 | - | - | $633.70 | - | - | | | 30462 | - | - | $1,216.08 | - | - | | | 30468 | $2,067.41 | $126.10 | - | - | - | | | 30469 | $2,015.27 | $112.00 | - | - | - | | | 30520 | - | - | $525.09 | - | - | | | 30540 | - | - | $575.15 | - | - | | | 30545 | - | - | $776.78 | - | - | | | 30560 | $258.72 | $117.56 | - | - | - | | | 30580 | $469.51 | $347.91 | - | - | - | | | 30600 | $396.25 | $288.84 | - | - | - | | | 30620 | - | - | $530.00 | - | - | | | 30630 | - | - | $521.63 | - | - | | | 30801 | $174.07 | $119.97 | - | - | - | | | 30802 | $219.04 | $157.70 | - | - | - | | | 30901 | $123.40 | $41.45 | - | - | - | | | 30903 | $193.97 | $56.56 | - | - | - | | | 30905 | $278.07 | $77.73 | - | - | - | | | 30906 | $293.91 | $98.12 | - | - | - | | | 30915 | - | - | $465.04 | - | - | | | 30920 | - | - | $671.22 | - | - | | | 30930 | - | - | $90.78 | - | - | | | 30999 | - | - | I.C. | - | - | | | 31000 | $146.28 | $84.94 | - | - | - | | | 31002 | - | - | $148.81 | - | - | | | 31020 | $344.05 | $277.35 | - | - | - | | | 31030 | $495.88 | $393.84 | - | - | - | | | 31032 | - | - | $461.22 | - | - | | | 31040 | - | - | $620.82 | - | - | | | 31050 | - | - | $402.80 | - | - | | | 31051 | - | - | $540.67 | - | - | | | 31070 | - | - | $373.37 | - | - | | | 31075 | - | - | $641.04 | - | - | | | 31080 | - | - | $842.89 | - | - | | | 31081 | - | - | $900.80 | - | - | | | 31084 | - | - | $930.85 | - | - | | | 31085 | - | - | $959.12 | - | - | | | 31086 | - | - | $907.71 | - | - | | | 31087 | - | - | $860.08 | - | - | | | 31090 | - | - | $863.46 | - | - | | | 31200 | - | - | $489.54 | - | - | | | 31201 | - | - | $617.49 | - | - | | | 31205 | - | - | $724.74 | - | - | | | 31225 | - | - | $1,362.02 | - | - | | | 31230 | - | - | $1,515.07 | - | - | | | 31231 | $148.98 | $48.01 | - | - | - | | | 31233 | $214.72 | $100.62 | - | - | - | | | 31235 | $242.59 | $118.31 | - | - | - | | | 31237 | $198.28 | $119.00 | - | - | - | | | 31238 | $192.80 | $124.24 | - | - | - | | | 31239 | - | - | $456.95 | - | - | | | 31240 | - | - | $118.17 | - | - | | | 31241 | - | - | $327.75 | - | - | | | 31242 | $1999.22 | $117.20 | - | - | - | | | 31243 | $1,940.37 | $117.20 | - | - | - | | | 31253 | - | - | $368.89 | - | - | | | 31254 | $340.26 | $179.82 | - | - | - | | | 31255 | - | - | $238.87 | - | - | | | 31256 | - | - | $133.42 | - | - | | | 31257 | - | - | $328.82 | - | - | | | 31259 | - | - | $347.86 | - | - | | | 31267 | - | - | $196.08 | - | - | | | 31276 | - | - | $278.74 | - | - | | | 31287 | - | - | $149.26 | - | - | | | 31288 | - | - | $173.25 | - | - | | | 31290 | - | - | $856.02 | - | - | | | 31291 | - | - | $908.82 | - | - | | | 31292 | - | - | $745.31 | - | - | | | 31293 | - | - | $805.70 | - | - | | | 31294 | - | - | $918.86 | - | - | | | 31295 | $1,351.64 | $116.90 | - | - | - | | | 31296 | $1,370.87 | $132.91 | - | - | - | | | 31297 | $1,341.12 | $106.65 | - | - | - | | | 31298 | $2,546.32 | $189.33 | - | - | - | | | 31299 | - | - | I.C. | - | - | | | 31300 | - | - | $957.22 | - | - | | | 31360 | - | - | $1,553.39 | - | - | | | 31365 | - | - | $1,909.38 | - | - | | | 31367 | - | - | $1,648.89 | - | - | | | 31368 | - | - | $1,821.58 | - | - | | | 31370 | - | - | $1,552.31 | - | - | | | 31375 | - | - | $1,476.03 | - | - | | | 31380 | - | - | $1,455.96 | - | - | | | 31382 | - | - | $1,591.98 | - | - | | | 31390 | - | - | $2,108.68 | - | - | | | 31395 | - | - | $2,216.72 | - | - | | | 31400 | - | - | $779.77 | - | - | | | 31420 | - | - | $633.66 | - | - | | | 31500 | - | - | $101.87 | - | - | | | 31502 | - | - | $25.68 | - | - | | | 31505 | $71.17 | $37.43 | - | - | - | | | 31510 | $168.12 | $90.44 | - | - | - | | | 31511 | $162.81 | $99.86 | - | - | - | | | 31512 | $168.17 | $96.39 | - | - | - | | | 31513 | - | - | $97.39 | - | - | | | 31515 | $167.72 | $83.09 | - | - | - | | | 31520 | - | - | $115.95 | - | - | | | 31525 | $193.12 | $118.40 | - | - | - | | | 31526 | - | - | $116.39 | - | - | | | 31527 | - | - | $144.44 | - | - | | | 31528 | - | - | $107.08 | - | - | | | 31529 | - | - | $119.08 | - | - | | | 31530 | - | - | $147.06 | - | - | | | 31531 | - | - | $156.78 | - | - | | | 31535 | - | - | $139.74 | - | - | | | 31536 | - | - | $155.77 | - | - | | | 31540 | - | - | $178.56 | - | - | | | 31541 | - | - | $194.64 | - | - | | | 31545 | - | - | $266.53 | - | - | | | 31546 | - | - | $403.30 | - | - | | | 31551 | - | - | $1,172.36 | - | - | | | 31552 | - | - | $1,133.29 | - | - | | | 31553 | - | - | $1,284.30 | - | - | | | 31554 | - | - | $1,285.10 | - | - | | | 31560 | - | - | $230.19 | - | - | | | 31561 | - | - | $251.51 | - | - | | | 31570 | $263.26 | $169.25 | - | - | - | | | 31571 | - | - | $183.60 | - | - | | | 31572 | $416.56 | $133.99 | - | - | - | | | 31573 | $224.25 | $110.69 | - | - | - | | | 31574 | $761.27 | $110.96 | - | - | - | | | 31575 | $101.35 | $51.26 | - | - | - | | | 31576 | $211.37 | $88.70 | - | - | - | | | 31577 | $216.30 | $99.52 | - | - | - | | | 31578 | $239.52 | $110.96 | - | - | - | | | 31579 | $153.88 | $89.33 | - | - | - | | | 31580 | - | - | $989.65 | - | - | | | 31584 | - | - | $1,083.20 | - | - | | | 31587 | - | - | $924.09 | - | - | | | 31590 | - | - | $722.62 | - | - | | | 31591 | - | - | $844.61 | - | - | | | 31592 | - | - | $1,313.45 | - | - | | | 31599 | - | - | I.C. | - | - | | | 31600 | - | - | $222.68 | - | - | | | 31601 | - | - | $332.03 | - | - | | | 31603 | - | - | $233.45 | - | - | | | 31605 | - | - | $240.30 | - | - | | | 31610 | - | - | $733.37 | - | - | | | 31611 | - | - | $413.46 | - | - | | | 31612 | $72.28 | $35.59 | - | - | - | | | 31613 | - | - | $327.04 | - | - | | | 31614 | - | - | $548.05 | - | - | | | 31615 | $132.81 | $85.67 | - | - | - | | | 31622 | $190.15 | $95.33 | - | - | - | | | 31623 | $211.55 | $95.31 | - | - | - | | | 31624 | $195.81 | $96.98 | - | - | - | | | 31625 | $269.70 | $112.48 | - | - | - | | | 31626 | $620.93 | $141.49 | - | - | - | | | 31627 | $866.40 | $69.04 | - | - | - | | | 31628 | $287.10 | $126.94 | - | - | - | | | 31629 | $351.39 | $134.44 | - | - | - | | | 31630 | - | - | $143.46 | - | - | | | 31631 | - | - | $163.62 | - | - | | | 31632 | $48.38 | $35.52 | - | - | - | | | 31633 | $59.63 | $45.17 | - | - | - | | | 31634 | $1,205.13 | $136.45 | - | - | - | | | 31635 | $222.71 | $126.29 | - | - | - | | | 31636 | - | - | $156.13 | - | - | | | 31637 | - | - | $55.48 | - | - | | | 31638 | - | - | $178.43 | - | - | | | 31640 | - | - | $179.39 | - | - | | | 31641 | - | - | $183.86 | - | - | | | 31643 | - | - | $122.46 | - | - | | | 31645 | $209.30 | $106.18 | - | - | - | | | 31646 | - | - | $102.46 | - | - | | | 31647 | - | - | $148.12 | - | - | | | 31648 | - | - | $141.88 | - | - | | | 31649 | - | - | $48.17 | - | - | | | 31651 | - | - | $55.21 | - | - | | | 31652 | $997.19 | $159.12 | - | - | - | | | 31653 | $1,035.61 | $176.38 | - | - | - | | | 31654 | $91.85 | $47.93 | - | - | - | | | 31660 | - | - | $142.90 | - | - | | | 31661 | - | - | $144.34 | - | - | | | 31717 | $224.25 | $77.20 | - | - | - | | | 31720 | - | - | $35.32 | - | - | | | 31725 | - | - | $56.86 | - | - | | | 31730 | $852.42 | $107.29 | - | - | - | | | 31755 | - | - | $1,341.49 | - | - | | | 31760 | - | - | $993.64 | - | - | | | 31766 | - | - | $1,273.53 | - | - | | | 31770 | - | - | $954.07 | - | - | | | 31775 | - | - | $1,005.66 | - | - | | | 31780 | - | - | $895.90 | - | - | | | 31781 | - | - | $1,070.06 | - | - | | | 31785 | - | - | $800.58 | - | - | | | 31786 | - | - | $1,035.94 | - | - | | | 31800 | - | - | $546.15 | - | - | | | 31805 | - | - | $594.83 | - | - | | | 31820 | $344.22 | $251.81 | - | - | - | | | 31825 | $473.12 | $367.86 | - | - | - | | | 31830 | $386.92 | $281.93 | - | - | - | | | 31899 | - | - | I.C. | - | - | | | 32035 | - | - | $538.45 | - | - | | | 32036 | - | - | $580.23 | - | - | | | 32096 | - | - | $577.40 | - | - | | | 32097 | - | - | $579.08 | - | - | | | 32098 | - | - | $550.02 | - | - | | | 32100 | - | - | $585.57 | - | - | | | 32110 | - | - | $1,065.08 | - | - | | | 32120 | - | - | $633.77 | - | - | | | 32124 | - | - | $669.21 | - | - | | | 32140 | - | - | $716.87 | - | - | | | 32141 | - | - | $1,093.81 | - | - | | | 32150 | - | - | $734.19 | - | - | | | 32151 | - | - | $727.27 | - | - | | | 32160 | - | - | $581.13 | - | - | | | 32200 | - | - | $827.75 | - | - | | | 32215 | - | - | $583.91 | - | - | | | 32220 | - | - | $1,157.84 | - | - | | | 32225 | - | - | $722.56 | - | - | | | 32310 | - | - | $666.58 | - | - | | | 32320 | - | - | $1,161.47 | - | - | | | 32400 | $129.45 | $61.16 | - | - | - | | | 32408 | $685.16 | $110.38 | - | - | - | | | 32440 | - | - | $1,128.92 | - | - | | | 32442 | - | - | $2,175.99 | - | - | | | 32445 | - | - | $2,522.93 | - | - | | | 32480 | - | - | $1,065.36 | - | - | | | 32482 | - | - | $1,139.00 | - | - | | | 32484 | - | - | $1,029.55 | - | - | | | 32486 | - | - | $1,671.01 | - | - | | | 32488 | - | - | $1,711.33 | - | - | | | 32491 | - | - | $1,062.41 | - | - | | | 32501 | - | - | $172.00 | - | - | | | 32503 | - | - | $1,288.50 | - | - | | | 32504 | - | - | $1,464.90 | - | - | | | 32505 | - | - | $674.20 | - | - | | | 32506 | - | - | $110.88 | - | - | | | 32507 | - | - | $110.88 | - | - | | | 32540 | - | - | $1,242.27 | - | - | | | 32550 | $623.71 | $148.02 | - | - | - | | | 32551 | - | - | $112.08 | - | - | | | 32552 | $137.44 | $116.02 | - | - | - | | | 32553 | $400.60 | $127.40 | - | - | - | | | 32554 | $182.75 | $64.10 | - | - | - | | | 32555 | $247.60 | $79.40 | - | - | - | | | 32556 | $589.96 | $89.64 | - | - | - | | | 32557 | $528.34 | $108.10 | - | - | - | | | 32560 | $199.79 | $54.63 | - | - | - | | | 32561 | $70.64 | $48.95 | - | - | - | | | 32562 | $63.16 | $43.61 | - | - | - | | | 32601 | - | - | $220.72 | - | - | | | 32604 | - | - | $341.61 | - | - | | | 32606 | - | - | $329.51 | - | - | | | 32607 | - | - | $220.65 | - | - | | | 32608 | - | - | $270.57 | - | - | | | 32609 | - | - | $184.03 | - | - | | | 32650 | - | - | $486.29 | - | - | | | 32651 | - | - | $790.23 | - | - | | | 32652 | - | - | $1,195.87 | - | - | | | 32653 | - | - | $765.01 | - | - | | | 32654 | - | - | $850.36 | - | - | | | 32655 | - | - | $692.64 | - | - | | | 32656 | - | - | $583.56 | - | - | | | 32658 | - | - | $519.52 | - | - | | | 32659 | - | - | $533.66 | - | - | | | 32661 | - | - | $578.77 | - | - | | | 32662 | - | - | $647.23 | - | - | | | 32663 | - | - | $1,004.61 | - | - | | | 32664 | - | - | $613.66 | - | - | | | 32665 | - | - | $885.88 | - | - | | | 32666 | - | - | $630.36 | - | - | | | 32667 | - | - | $110.88 | - | - | | | 32668 | - | - | $110.88 | - | - | | | 32669 | - | - | $964.74 | - | - | | | 32670 | - | - | $1,151.42 | - | - | | | 32671 | - | - | $1,268.93 | - | - | | | 32672 | - | - | $1,085.58 | - | - | | | 32673 | - | - | $874.49 | - | - | | | 32674 | - | - | $151.80 | - | - | | | 32701 | - | - | $150.48 | - | - | | | 32800 | - | - | $688.29 | - | - | | | 32810 | - | - | $653.69 | - | - | | | 32815 | - | - | $2,013.25 | - | - | | | 32820 | - | - | $963.42 | - | - | | | 32850 | - | - | I.C. | - | - | | | 32851 | - | - | $2,337.44 | - | - | | | 32852 | - | - | $2,524.73 | - | - | | | 32853 | - | - | $3,258.37 | - | - | | | 32854 | - | - | $3,450.66 | - | - | | | 32855 | - | - | I.C. | - | - | | | 32856 | - | - | I.C. | - | - | | | 32900 | - | - | $1,037.49 | - | - | | | 32905 | - | - | $960.21 | - | - | | | 32906 | - | - | $1,181.54 | - | - | | | 32940 | - | - | $888.80 | - | - | | | 32960 | $95.59 | $66.40 | - | - | - | | | 32994 | $3,947.00 | $315.90 | - | - | - | | | 32997 | - | - | $243.75 | - | - | | | 32998 | $2,500.39 | $316.69 | - | - | - | | | 32999 | - | - | I.C. | - | - | | | 33016 | - | - | $167.23 | - | - | | | 33017 | - | - | $175.56 | - | - | | | 33018 | - | - | $205.69 | - | - | | | 33019 | - | - | $152.87 | - | - | | | 33020 | - | - | $595.59 | - | - | | | 33025 | - | - | $556.11 | - | - | | | 33030 | - | - | $1,430.29 | - | - | | | 33031 | - | - | $1,766.75 | - | - | | | 33050 | - | - | $727.47 | - | - | | | 33120 | - | - | $1,490.70 | - | - | | | 33130 | - | - | $980.97 | - | - | | | 33140 | - | - | $1,112.43 | - | - | | | 33141 | - | - | $93.20 | - | - | | | 33202 | - | - | $557.19 | - | - | | | 33203 | - | - | $582.97 | - | - | | | 33206 | - | - | $333.70 | - | - | | | 33207 | - | - | $349.04 | - | - | | | 33208 | - | - | $377.83 | - | - | | | 33210 | - | - | $115.59 | - | - | | | 33211 | - | - | $120.34 | - | - | | | 33212 | - | - | $235.52 | - | - | | | 33213 | - | - | $246.34 | - | - | | | 33214 | - | - | $351.33 | - | - | | | 33215 | - | - | $227.02 | - | - | | | 33216 | - | - | $274.01 | - | - | | | 33217 | - | - | $271.20 | - | - | | | 33218 | - | - | $287.81 | - | - | | | 33220 | - | - | $275.84 | - | - | | | 33221 | - | - | $264.00 | - | - | | | 33222 | - | - | $254.17 | - | - | | | 33223 | - | - | $300.96 | - | - | | | 33224 | - | - | $370.26 | - | - | | | 33225 | - | - | $334.08 | - | - | | | 33226 | - | - | $352.15 | - | - | | | 33227 | - | - | $248.89 | - | - | | | 33228 | - | - | $259.78 | - | - | | | 33229 | - | - | $274.76 | - | - | | | 33230 | - | - | $280.81 | - | - | | | 33231 | - | - | $292.70 | - | - | | | 33233 | - | - | $173.84 | - | - | | | 33234 | - | - | $354.72 | - | - | | | 33235 | - | - | $467.23 | - | - | | | 33236 | - | - | $570.74 | - | - | | | 33237 | - | - | $611.02 | - | - | | | 33238 | - | - | $689.75 | - | - | | | 33240 | - | - | $267.90 | - | - | | | 33241 | - | - | $159.07 | - | - | | | 33243 | - | - | $991.84 | - | - | | | 33244 | - | - | $632.75 | - | - | | | 33249 | - | - | $666.37 | - | - | | | 33250 | - | - | $1,043.78 | - | - | | | 33251 | - | - | $1,167.36 | - | - | | | 33254 | - | - | $976.92 | - | - | | | 33255 | - | - | $1,164.18 | - | - | | | 33256 | - | - | $1,377.57 | - | - | | | 33257 | - | - | $422.11 | - | - | | | 33258 | - | - | $469.43 | - | - | | | 33259 | - | - | $612.06 | - | - | | | 33261 | - | - | $1,153.54 | - | - | | | 33262 | - | - | $273.57 | - | - | | | 33263 | - | - | $283.86 | - | - | | | 33264 | - | - | $296.02 | - | - | | | 33265 | - | - | $979.33 | - | - | | | 33266 | - | - | $1,319.18 | - | - | | | 33267 | - | - | $749.65 | - | - | | | 33268 | - | - | $92.76 | - | - | | | 33269 | - | - | $594.06 | - | - | | | 33270 | - | - | $410.57 | - | - | | | 33271 | - | - | $328.57 | - | - | | | 33272 | - | - | $254.12 | - | - | | | 33273 | - | - | $290.78 | - | - | | | 33274 | - | - | $350.11 | - | - | | | 33275 | - | - | $363.20 | - | - | | | 33276 | - | - | $419.13 | - | - | | | 33277 | - | - | $217.39 | - | - | | | 33278 | - | - | $416.54 | - | - | | | 33279 | - | - | $253.25 | - | - | | | 33280 | - | - | $155.79 | - | - | | | 33281 | - | - | $273.21 | - | - | | | 33285 | $3,488.07 | $63.47 | - | - | - | | | 33286 | $99.77 | $62.54 | - | - | - | | | 33287 | - | - | $282.39 | - | - | | | 33288 | - | - | $370.12 | - | | | | 33289 | - | - | $238.65 | - | - | | | 33300 | - | - | $1,735.96 | - | - | | | 33305 | - | - | $2,902.79 | - | - | | | 33310 | - | - | $842.08 | - | - | | | 33315 | - | - | $1,368.53 | - | - | | | 33320 | - | - | $770.43 | - | - | | | 33321 | - | - | $854.31 | - | - | | | 33322 | - | - | $997.05 | - | - | | | 33330 | - | - | $1,021.69 | - | - | | | 33335 | - | - | $1,335.20 | - | - | | | 33340 | - | - | $561.64 | - | - | | | 33361 | - | - | $859.42 | - | - | | | 33362 | - | - | $937.24 | - | - | | | 33363 | - | - | $970.17 | - | - | | | 33364 | - | - | $968.68 | - | - | | | 33365 | - | - | $1,013.31 | - | - | | | 33366 | - | - | $1,116.91 | - | - | | | 33367 | - | - | $431.77 | - | - | | | 33368 | - | - | $522.90 | - | - | | | 33369 | - | - | $690.31 | - | - | | | 33370 | - | - | $95.44 | - | - | | | 33390 | - | - | $1,376.78 | - | - | | | 33391 | - | - | $1,631.47 | - | - | | | 33404 | - | - | $1,251.51 | - | - | | | 33405 | - | - | $1,621.57 | - | - | | | 33406 | - | - | $2,055.49 | - | - | | | 33410 | - | - | $1,814.17 | - | - | | | 33411 | - | - | $2,387.69 | - | - | | | 33412 | - | - | $2,235.22 | - | - | | | 33413 | - | - | $2,292.53 | - | - | | | 33414 | - | - | $1,531.25 | - | - | | | 33415 | - | - | $1,446.50 | - | - | | | 33416 | - | - | $1,447.34 | - | - | | | 33417 | - | - | $1,198.61 | - | - | | | 33418 | - | - | $1,284.03 | - | - | | | 33419 | - | - | $300.59 | - | - | | | 33420 | - | - | $1,040.35 | - | - | | | 33422 | - | - | $1,192.11 | - | - | | | 33425 | - | - | $1,947.14 | - | - | | | 33426 | - | - | $1,701.32 | - | - | | | 33427 | - | - | $1,739.80 | - | - | | | 33430 | - | - | $2,000.94 | - | - | | | 33440 | - | - | $2,416.73 | - | - | | | 33460 | - | - | $1,706.43 | - | - | | | 33463 | - | - | $2,192.87 | - | - | | | 33464 | - | - | $1,739.75 | - | - | | | 33465 | - | - | $1,963.07 | - | - | | | 33468 | - | - | $1,746.27 | - | - | | | 33471 | - | - | $954.41 | - | - | | | 33474 | - | - | $1,558.23 | - | - | | | 33475 | - | - | $1,659.26 | - | - | | | 33476 | - | - | $1,096.41 | - | - | | | 33477 | - | - | $961.70 | - | - | | | 33478 | - | - | $1,132.26 | - | - | | | 33496 | - | - | $1,192.32 | - | - | | | 33500 | - | - | $1,118.25 | - | - | | | 33501 | - | - | $802.36 | - | - | | | 33502 | - | - | $922.70 | - | - | | | 33503 | - | - | $959.94 | - | - | | | 33504 | - | - | $1,056.14 | - | - | | | 33505 | - | - | $1,465.27 | - | - | | | 33506 | - | - | $1,461.66 | - | - | | | 33507 | - | - | $1,228.49 | - | - | | | 33508 | - | - | $11.40 | - | - | | | 33509 | - | - | $122.55 | - | - | | | 33510 | - | - | $1,382.98 | - | - | | | 33511 | - | - | $1,517.75 | - | - | | | 33512 | - | - | $1,729.96 | - | - | | | 33513 | - | - | $1,768.11 | - | - | | | 33514 | - | - | $1,859.15 | - | - | | | 33516 | - | - | $1,924.28 | - | - | | | 33517 | - | - | $132.03 | - | - | | | 33518 | - | - | $290.80 | - | - | | | 33519 | - | - | $384.30 | - | - | | | 33521 | - | - | $460.64 | - | - | | | 33522 | - | - | $517.44 | - | - | | | 33523 | - | - | $584.26 | - | - | | | 33530 | - | - | $371.00 | - | - | | | 33533 | - | - | $1,339.23 | - | - | | | 33534 | - | - | $1,571.28 | - | - | | | 33535 | - | - | $1,745.99 | - | - | | | 33536 | - | - | $1,878.00 | - | - | | | 33542 | - | - | $1,870.59 | - | - | | | 33545 | - | - | $2,181.60 | - | - | | | 33548 | - | - | $2,103.01 | - | - | | | 33572 | - | - | $163.11 | - | - | | | 33600 | - | - | $1,234.44 | - | - | | | 33602 | - | - | $1,198.86 | - | - | | | 33606 | - | - | $1,275.93 | - | - | | | 33608 | - | - | $1,292.06 | - | - | | | 33610 | - | - | $1,274.82 | - | - | | | 33611 | - | - | $1,391.56 | - | - | | | 33612 | - | - | $1,428.34 | - | - | | | 33615 | - | - | $1,429.52 | - | - | | | 33617 | - | - | $1,547.23 | - | - | | | 33619 | - | - | $1,968.51 | - | - | | | 33620 | - | - | $1,176.97 | - | - | | | 33621 | - | - | $668.44 | - | - | | | 33622 | - | - | $2,437.38 | - | - | | | 33641 | - | - | $1,171.18 | - | - | | | 33645 | - | - | $1,237.42 | - | - | | | 33647 | - | - | $1,297.15 | - | - | | | 33660 | - | - | $1,253.94 | - | - | | | 33665 | - | - | $1,364.97 | - | - | | | 33670 | - | - | $1,402.15 | - | - | | | 33675 | - | - | $1,405.94 | - | - | | | 33676 | - | - | $1,443.32 | - | - | | | 33677 | - | - | $1,498.10 | - | - | | | 33681 | - | - | $1,325.27 | - | - | | | 33684 | - | - | $1,347.74 | - | - | | | 33688 | - | - | $1,340.70 | - | - | | | 33690 | - | - | $869.05 | - | - | | | 33692 | - | - | $1,391.75 | - | - | | | 33694 | - | - | $1,391.56 | - | - | | | 33697 | - | - | $1,465.39 | - | - | | | 33702 | - | - | $1,111.73 | - | - | | | 33710 | - | - | $1,463.14 | - | - | | | 33720 | - | - | $1,112.22 | - | - | | | 33724 | - | - | $1,099.85 | - | - | | | 33726 | - | - | $1,448.76 | - | - | | | 33730 | - | - | $1,435.16 | - | - | | | 33732 | - | - | $1,184.81 | - | - | | | 33735 | - | - | $936.35 | - | - | | | 33736 | - | - | $1,014.46 | - | - | | | 33737 | - | - | $936.13 | - | - | | | 33741 | - | - | $533.91 | - | - | | | 33745 | - | - | $762.51 | - | - | | | 33746 | - | - | $304.78 | - | - | | | 33750 | - | - | $907.58 | - | - | | | 33755 | - | - | $951.09 | - | - | | | 33762 | - | - | $921.36 | - | - | | | 33764 | - | - | $951.09 | - | - | | | 33766 | - | - | $957.41 | - | - | | | 33767 | - | - | $1,020.55 | - | - | | | 33768 | - | - | $294.18 | - | - | | | 33770 | - | - | $1,506.63 | - | - | | | 33771 | - | - | $1,547.27 | - | - | | | 33774 | - | - | $1,293.07 | - | - | | | 33775 | - | - | $1,329.85 | - | - | | | 33776 | - | - | $1,406.05 | - | - | | | 33777 | - | - | $1,352.69 | - | - | | | 33778 | - | - | $1,678.34 | - | - | | | 33779 | - | - | $1,652.32 | - | - | | | 33780 | - | - | $1,684.24 | - | - | | | 33781 | - | - | $1,642.19 | - | - | | | 33782 | - | - | $2,293.15 | - | - | | | 33783 | - | - | $2,477.26 | - | - | | | 33786 | - | - | $1,622.80 | - | - | | | 33788 | - | - | $1,098.53 | - | - | | | 33800 | - | - | $708.80 | - | - | | | 33802 | - | - | $785.15 | - | - | | | 33803 | - | - | $827.25 | - | - | | | 33813 | - | - | $895.45 | - | - | | | 33814 | - | - | $1,097.22 | - | - | | | 33820 | - | - | $697.65 | - | - | | | 33822 | - | - | $734.92 | - | - | | | 33824 | - | - | $853.28 | - | - | | | 33840 | - | - | $894.69 | - | - | | | 33845 | - | - | $963.18 | - | - | | | 33851 | - | - | $918.18 | - | - | | | 33852 | - | - | $1,007.69 | - | - | | | 33853 | - | - | $1,315.30 | - | - | | | 33858 | - | - | $2,412.98 | - | - | | | 33859 | - | - | $1,735.06 | - | - | | | 33863 | - | - | $2,235.20 | - | - | | | 33864 | - | - | $2,284.42 | - | - | | | 33866 | - | - | $651.48 | - | - | | | 33871 | - | - | $2,313.84 | - | - | | | 33875 | - | - | $1,951.27 | - | - | | | 33877 | - | - | $2,550.47 | - | - | | | 33880 | - | - | $1,264.51 | - | - | | | 33881 | - | - | $1,083.89 | - | - | | | 33883 | - | - | $787.83 | - | - | | | 33884 | - | - | $275.10 | - | - | | | 33886 | - | - | $681.55 | - | - | | | 33889 | - | - | $557.15 | - | - | | | 33891 | - | - | $671.01 | - | - | | | 33894 | - | - | $696.76 | - | - | | | 33895 | - | - | $554.22 | - | - | | | 33897 | - | - | $412.29 | - | - | | | 33900 | - | - | $418.30 | - | - | | | 33901 | - | - | $549.80 | - | - | | | 33902 | - | - | $531.14 | - | - | | | 33903 | - | - | $625.98 | - | - | | | 33904 | - | - | $210.09 | - | - | | | 33910 | - | - | $1,882.64 | - | - | | | 33915 | - | - | $984.18 | - | - | | | 33916 | - | - | $2,966.17 | - | - | | | 33917 | - | - | $1,050.55 | - | - | | | 33920 | - | - | $1,294.41 | - | - | | | 33922 | - | - | $1,000.23 | - | - | | | 33924 | - | - | $201.79 | - | - | | | 33925 | - | - | $1,225.10 | - | - | | | 33926 | - | - | $1,718.47 | - | - | | | 33927 | - | - | $1,801.83 | - | - | | | 33928 | - | - | I.C. | - | - | | | 33929 | - | - | I.C. | - | - | | | 33930 | - | - | I.C. | - | - | | | 33933 | - | - | I.C. | - | - | | | 33935 | - | - | $3,505.42 | - | - | | | 33940 | - | - | I.C. | - | - | | | 33944 | - | - | I.C. | - | - | | | 33945 | - | - | $3,467.52 | - | - | | | 33946 | - | - | $220.17 | - | - | | | 33947 | - | - | $243.42 | - | - | | | 33948 | - | - | $170.17 | - | - | | | 33949 | - | - | $165.12 | - | - | | | 33951 | - | - | $299.47 | - | - | | | 33952 | - | - | $303.36 | - | - | | | 33953 | - | - | $333.94 | - | - | | | 33954 | - | - | $336.68 | - | - | | | 33955 | - | - | $584.05 | - | - | | | 33956 | - | - | $591.26 | - | - | | | 33957 | - | - | $130.39 | - | - | | | 33958 | - | - | $130.39 | - | - | | | 33959 | - | - | $165.06 | - | - | | | 33962 | - | - | $165.06 | - | - | | | 33963 | - | - | $329.84 | - | - | | | 33964 | - | - | $348.23 | - | - | | | 33965 | - | - | $130.39 | - | - | | | 33966 | - | - | $167.60 | - | - | | | 33967 | - | - | $183.35 | - | - | | | 33968 | - | - | $24.09 | - | - | | | 33969 | - | - | $192.64 | - | - | | | 33970 | - | - | $251.12 | - | - | | | 33971 | - | - | $511.12 | - | - | | | 33973 | - | - | $354.48 | - | - | | | 33974 | - | - | $644.42 | - | - | | | 33975 | - | - | $918.57 | - | - | | | 33976 | - | - | $1,117.29 | - | - | | | 33977 | - | - | $798.34 | - | - | | | 33978 | - | - | $943.48 | - | - | | | 33979 | - | - | $1,374.45 | - | - | | | 33980 | - | - | $1,262.41 | - | - | | | 33981 | - | - | $585.40 | - | - | | | 33982 | - | - | $1,375.52 | - | - | | | 33983 | - | - | $1,635.65 | - | - | | | 33984 | - | - | $200.79 | - | - | | | 33985 | - | - | $362.73 | - | - | | | 33986 | - | - | $370.77 | - | - | | | 33987 | - | - | $146.57 | - | - | | | 33988 | - | - | $547.93 | - | - | | | 33989 | - | - | $348.23 | - | - | | | 33990 | - | - | $256.52 | - | - | | | 33991 | - | - | $321.51 | - | - | | | 33992 | - | - | $132.98 | - | - | | | 33993 | - | - | $118.36 | - | - | | | 33995 | - | - | $254.07 | - | - | | | 33997 | - | - | $112.36 | - | - | | | 33999 | - | - | I.C. | - | - | | | 34001 | - | - | $644.87 | - | - | | | 34051 | - | - | $717.41 | - | - | | | 34101 | - | - | $425.31 | - | - | | | 34111 | - | - | $427.06 | - | - | | | 34151 | - | - | $985.58 | - | - | | | 34201 | - | - | $722.17 | - | - | | | 34203 | - | - | $671.23 | - | - | | | 34401 | - | - | $1,064.17 | - | - | | | 34421 | - | - | $490.96 | - | - | | | 34451 | - | - | $1,009.18 | - | - | | | 34471 | - | - | $760.64 | - | - | | | 34490 | - | - | $468.61 | - | - | | | 34501 | - | - | $633.47 | - | - | | | 34502 | - | - | $1,099.42 | - | - | | | 34510 | - | - | $720.17 | - | - | | | 34520 | - | - | $698.76 | - | - | | | 34530 | - | - | $666.31 | - | - | | | 34701 | - | - | $874.34 | - | - | | | 34702 | - | - | $1,301.18 | - | - | | | 34703 | - | - | $970.79 | - | - | | | 34704 | - | - | $1,612.34 | - | - | | | 34705 | - | - | $1,076.65 | - | - | | | 34706 | - | - | $1,599.61 | - | - | | | 34707 | - | - | $824.56 | - | - | | | 34708 | - | - | $1,274.08 | - | - | | | 34709 | - | - | $226.09 | - | - | | | 34710 | - | - | $562.78 | - | - | | | 34711 | - | - | $205.96 | - | - | | | 34712 | - | - | $466.83 | - | - | | | 34713 | - | - | $86.40 | - | - | | | 34714 | - | - | $189.76 | - | - | | | 34715 | - | - | $209.91 | - | - | | | 34716 | - | - | $262.73 | - | - | | | 34717 | - | - | $310.02 | - | - | | | 34718 | - | - | $870.52 | - | - | | | 34808 | - | - | $141.63 | - | - | | | 34812 | - | - | $144.28 | - | - | | | 34813 | - | - | $164.98 | - | - | | | 34820 | - | - | $234.64 | - | - | | | 34830 | - | - | $1,237.06 | - | - | | | 34831 | - | - | $1,354.82 | - | - | | | 34832 | - | - | $1,329.10 | - | - | | | 34833 | - | - | $273.46 | - | - | | | 34834 | - | - | $90.47 | - | - | | | 34839 | - | - | I.C. | - | - | | | 34841 | - | - | I.C. | - | - | | | 34842 | - | - | I.C. | - | - | | | 34843 | - | - | I.C. | - | - | | | 34844 | - | - | I.C. | - | - | | | 34845 | - | - | I.C. | - | - | | | 34846 | - | - | I.C. | - | - | | | 34847 | - | - | I.C. | - | - | | | 34848 | - | - | I.C. | - | - | | | 35001 | - | - | $799.10 | - | - | | | 35002 | - | - | $802.09 | - | - | | | 35005 | - | - | $703.33 | - | - | | | 35011 | - | - | $718.43 | - | - | | | 35013 | - | - | $903.62 | - | - | | | 35021 | - | - | $905.86 | - | - | | | 35022 | - | - | $1,033.79 | - | - | | | 35045 | - | - | $691.04 | - | - | | | 35081 | - | - | $1,220.26 | - | - | | | 35082 | - | - | $1,523.99 | - | - | | | 35091 | - | - | $1,251.12 | - | - | | | 35092 | - | - | $1,817.20 | - | - | | | 35102 | - | - | $1,321.49 | - | - | | | 35103 | - | - | $1,563.35 | - | - | | | 35111 | - | - | $934.77 | - | - | | | 35112 | - | - | $1,147.69 | - | - | | | 35121 | - | - | $1,109.82 | - | - | | | 35122 | - | - | $1,325.83 | - | - | | | 35131 | - | - | $973.40 | - | - | | | 35132 | - | - | $1,147.69 | - | - | | | 35141 | - | - | $772.89 | - | - | | | 35142 | - | - | $933.83 | - | - | | | 35151 | - | - | $875.17 | - | - | | | 35152 | - | - | $982.79 | - | - | | | 35180 | - | - | $554.90 | - | - | | | 35182 | - | - | $1,285.76 | - | - | | | 35184 | - | - | $680.25 | - | - | | | 35188 | - | - | $946.74 | - | - | | | 35189 | - | - | $1,060.23 | - | - | | | 35190 | - | - | $547.29 | - | - | | | 35201 | - | - | $668.98 | - | - | | | 35206 | - | - | $565.55 | - | - | | | 35207 | - | - | $569.39 | - | - | | | 35211 | - | - | $996.53 | - | - | | | 35216 | - | - | $1,515.55 | - | - | | | 35221 | - | - | $1,057.19 | - | - | | | 35226 | - | - | $592.75 | - | - | | | 35231 | - | - | $917.07 | - | - | | | 35236 | - | - | $712.72 | - | - | | | 35241 | - | - | $1,029.92 | - | - | | | 35246 | - | - | $1,118.38 | - | - | | | 35251 | - | - | $1,252.34 | - | - | | | 35256 | - | - | $725.16 | - | - | | | 35261 | - | - | $691.77 | - | - | | | 35266 | - | - | $613.41 | - | - | | | 35271 | - | - | $993.92 | - | - | | | 35276 | - | - | $1,046.62 | - | - | | | 35281 | - | - | $1,153.52 | - | - | | | 35286 | - | - | $660.94 | - | - | | | 35301 | - | - | $800.08 | - | - | | | 35302 | - | - | $791.22 | - | - | | | 35303 | - | - | $874.31 | - | - | | | 35304 | - | - | $896.63 | - | - | | | 35305 | - | - | $863.26 | - | - | | | 35306 | - | - | $310.76 | - | - | | | 35311 | - | - | $1,109.62 | - | - | | | 35321 | - | - | $636.42 | - | - | | | 35331 | - | - | $1,033.34 | - | - | | | 35341 | - | - | $977.59 | - | - | | | 35351 | - | - | $907.05 | - | - | | | 35355 | - | - | $725.51 | - | - | | | 35361 | - | - | $1,069.54 | - | - | | | 35363 | - | - | $1,139.83 | - | - | | | 35371 | - | - | $577.38 | - | - | | | 35372 | - | - | $689.78 | - | - | | | 35390 | - | - | $111.31 | - | - | | | 35400 | - | - | $103.11 | - | - | | | 35500 | - | - | $222.14 | - | - | | | 35501 | - | - | $1,024.26 | - | - | | | 35506 | - | - | $894.80 | - | - | | | 35508 | - | - | $934.88 | - | - | | | 35509 | - | - | $991.10 | - | - | | | 35510 | - | - | $863.90 | - | - | | | 35511 | - | - | $787.16 | - | - | | | 35512 | - | - | $846.72 | - | - | | | 35515 | - | - | $934.88 | - | - | | | 35516 | - | - | $857.15 | - | - | | | 35518 | - | - | $802.72 | - | - | | | 35521 | - | - | $864.44 | - | - | | | 35522 | - | - | $821.99 | - | - | | | 35523 | - | - | $895.78 | - | - | | | 35525 | - | - | $800.00 | - | - | | | 35526 | - | - | $1,235.56 | - | - | | | 35531 | - | - | $1,367.39 | - | - | | | 35533 | - | - | $1,058.76 | - | - | | | 35535 | - | - | $1,334.65 | - | - | | | 35536 | - | - | $1,186.71 | - | - | | | 35537 | - | - | $1,460.52 | - | - | | | 35538 | - | - | $1,636.52 | - | - | | | 35539 | - | - | $1,535.56 | - | - | | | 35540 | - | - | $1,710.99 | - | - | | | 35556 | - | - | $983.70 | - | - | | | 35558 | - | - | $872.79 | - | - | | | 35560 | - | - | $1,196.39 | - | - | | | 35563 | - | - | $931.06 | - | - | | | 35565 | - | - | $924.59 | - | - | | | 35566 | - | - | $1,170.77 | - | - | | | 35570 | - | - | $1,035.38 | - | - | | | 35571 | - | - | $933.32 | - | - | | | 35572 | - | - | $240.97 | - | - | | | 35583 | - | - | $1,017.87 | - | - | | | 35585 | - | - | $1,175.99 | - | - | | | 35587 | - | - | $963.20 | - | - | | | 35600 | - | - | $131.28 | - | - | | | 35601 | - | - | $989.34 | - | - | | | 35606 | - | - | $829.15 | - | - | | | 35612 | - | - | $737.09 | - | - | | | 35616 | - | - | $774.45 | - | - | | | 35621 | - | - | $774.95 | - | - | | | 35623 | - | - | $924.76 | - | - | | | 35626 | - | - | $1,133.11 | - | - | | | 35631 | - | - | $1,301.50 | - | - | | | 35632 | - | - | $1,267.11 | - | - | | | 35633 | - | - | $1,393.23 | - | - | | | 35634 | - | - | $1,240.51 | - | - | | | 35636 | - | - | $1,120.33 | - | - | | | 35637 | - | - | $1,164.32 | - | - | | | 35638 | - | - | $1,223.04 | - | - | | | 35642 | - | - | $698.52 | - | - | | | 35645 | - | - | $668.10 | - | - | | | 35646 | - | - | $1,202.32 | - | - | | | 35647 | - | - | $1,095.03 | - | - | | | 35650 | - | - | $718.85 | - | - | | | 35654 | - | - | $961.69 | - | - | | | 35656 | - | - | $759.31 | - | - | | | 35661 | - | - | $767.29 | - | - | | | 35663 | - | - | $857.47 | - | - | | | 35665 | - | - | $829.41 | - | - | | | 35666 | - | - | $915.15 | - | - | | | 35671 | - | - | $806.89 | - | - | | | 35681 | - | - | $55.88 | - | - | | | 35682 | - | - | $245.98 | - | - | | | 35683 | - | - | $285.14 | - | - | | | 35685 | - | - | $138.33 | - | - | | | 35686 | - | - | $111.97 | - | - | | | 35691 | - | - | $667.61 | - | - | | | 35693 | - | - | $592.41 | - | - | | | 35694 | - | - | $696.66 | - | - | | | 35695 | - | - | $722.97 | - | - | | | 35697 | - | - | $102.58 | - | - | | | 35700 | - | - | $106.01 | - | - | | | 35701 | - | - | $323.86 | - | - | | | 35702 | - | - | $297.38 | - | - | | | 35703 | - | - | $298.77 | - | - | | | 35800 | - | - | $538.93 | - | - | | | 35820 | - | - | $1,437.54 | - | - | | | 35840 | - | - | $882.48 | - | - | | | 35860 | - | - | $600.09 | - | - | | | 35870 | - | - | $878.91 | - | - | | | 35875 | - | - | $422.06 | - | - | | | 35876 | - | - | $667.24 | - | - | | | 35879 | - | - | $652.59 | - | - | | | 35881 | - | - | $724.35 | - | - | | | 35883 | - | - | $844.55 | - | - | | | 35884 | - | - | $870.39 | - | - | | | 35901 | - | - | $340.84 | - | - | | | 35903 | - | - | $406.81 | - | - | | | 35905 | - | - | $1,179.56 | - | - | | | 35907 | - | - | $1,338.05 | - | - | | | 36000 | $23.82 | $6.68 | - | - | - | | | 36002 | $114.79 | $75.41 | - | - | - | | | 36005 | $203.17 | $34.43 | - | - | - | | | 36010 | $428.72 | $77.04 | - | - | - | | | 36011 | $638.83 | $111.45 | - | - | - | | | 36012 | $661.01 | $123.18 | - | - | - | | | 36013 | $626.41 | $89.66 | - | - | - | | | 36014 | $623.84 | $108.25 | - | - | - | | | 36015 | $675.48 | $122.39 | - | - | - | | | 36100 | $442.09 | $109.17 | - | - | - | | | 36140 | $404.44 | $63.21 | - | - | - | | | 36160 | $445.01 | $88.25 | - | - | - | | | 36200 | $466.91 | $98.10 | - | - | - | | | 36215 | $819.45 | $152.53 | - | - | - | | | 36216 | $837.30 | $192.61 | - | - | - | | | 36217 | $1,410.78 | $234.96 | - | - | - | | | 36218 | $163.52 | $37.10 | - | - | - | | | 36221 | $781.57 | $141.16 | - | - | - | | | 36222 | $959.06 | $202.94 | - | - | - | | | 36223 | $1,297.70 | $233.84 | - | - | - | | | 36224 | $1,614.98 | $263.20 | - | - | - | | | 36225 | $1,224.11 | $231.50 | - | - | - | | | 36226 | $1,569.45 | $261.59 | - | - | - | | | 36227 | $184.03 | $86.00 | - | - | - | | | 36228 | $994.77 | $175.98 | - | - | - | | | 36245 | $985.86 | $167.88 | - | - | - | | | 36246 | $652.74 | $178.13 | - | - | - | | | 36247 | $1,124.73 | $212.20 | - | - | - | | | 36248 | $90.87 | $34.63 | - | - | - | | | 36251 | $1,020.57 | $182.50 | - | - | - | | | 36252 | $1,092.35 | $253.20 | - | - | - | | | 36253 | $1,601.02 | $252.98 | - | - | - | | | 36254 | $1,566.41 | $294.71 | - | - | - | | | 36260 | - | - | $486.40 | - | - | | | 36261 | - | - | $307.59 | - | - | | | 36262 | - | - | $236.12 | - | - | | | 36299 | - | - | I.C. | - | - | | | 36400 | $20.82 | $13.85 | - | - | - | | | 36405 | $17.90 | $10.94 | - | - | - | | | 36406 | $13.45 | $6.48 | - | - | - | | | 36410 | $13.38 | $6.68 | - | - | - | | | 36415 | - | - | I.C. | - | - | | | 36416 | - | - | I.C. | - | - | | | 36420 | - | - | $33.95 | - | - | | | 36425 | - | - | $28.91 | - | - | | | 36430 | - | - | $31.20 | - | - | | | 36440 | - | - | $36.80 | - | - | | | 36450 | - | - | $124.31 | - | - | | | 36455 | - | - | $89.30 | - | - | | | 36456 | - | - | $71.32 | - | - | | | 36460 | - | - | $251.40 | - | - | | | 36465 | $1,049.31 | $84.82 | - | - | - | | | 36466 | $1,130.96 | $109.42 | - | - | - | | | 36468 | - | - | I.C. | - | - | | | 36470 | $89.79 | $27.65 | - | - | - | | | 36471 | $154.75 | $54.31 | - | - | - | | | 36473 | $968.23 | $128.82 | - | - | - | | | 36474 | $200.17 | $64.11 | - | - | - | | | 36475 | $849.95 | $198.03 | - | - | - | | | 36476 | $218.03 | $95.10 | - | - | - | | | 36478 | $769.94 | $198.10 | - | - | - | | | 36479 | $230.76 | $96.30 | - | - | - | | | 36481 | $1,385.53 | $234.89 | - | - | - | | | 36482 | $1,336.64 | $127.08 | - | - | - | | | 36483 | $102.47 | $62.83 | - | - | - | | | 36500 | - | - | $129.74 | - | - | | | 36510 | $65.25 | $39.00 | - | - | - | | | 36511 | - | - | $80.83 | - | - | | | 36512 | - | - | $78.42 | - | - | | | 36513 | - | - | $77.68 | - | - | | | 36514 | $446.47 | $68.28 | - | - | - | | | 36516 | $1,408.84 | $61.60 | - | - | - | | | 36522 | $1,084.73 | $70.96 | - | - | - | | | 36555 | $146.54 | $61.10 | - | - | - | | | 36556 | $166.17 | $60.91 | - | - | - | | | 36557 | $918.51 | $235.52 | - | - | - | | | 36558 | $656.24 | $189.93 | - | - | - | | | 36560 | $976.37 | $281.59 | - | - | - | | | 36561 | $774.71 | $243.05 | - | - | - | | | 36563 | $887.78 | $266.39 | - | - | - | | | 36565 | $641.90 | $243.62 | - | - | - | | | 36566 | $3,416.99 | $260.23 | - | - | - | | | 36568 | - | - | $66.04 | - | - | | | 36569 | - | - | $67.52 | - | - | | | 36570 | $1,159.39 | $244.45 | - | - | - | | | 36571 | $1,001.30 | $228.85 | - | - | - | | | 36572 | $296.98 | $58.07 | - | - | - | | | 36573 | $305.03 | $61.03 | - | - | - | | | 36575 | $114.49 | $24.23 | - | - | - | | | 36576 | $267.41 | $134.56 | - | - | - | | | 36578 | $337.01 | $149.26 | - | - | - | | | 36580 | $148.97 | $47.46 | - | - | - | | | 36581 | $618.14 | $133.89 | - | - | - | | | 36582 | $693.40 | $209.68 | - | - | - | | | 36583 | $910.59 | $241.53 | - | - | - | | | 36584 | $259.98 | $42.49 | - | - | - | | | 36585 | $919.11 | $206.65 | - | - | - | | | 36589 | $124.49 | $100.66 | - | - | - | | | 36590 | $167.85 | $139.73 | - | - | - | | | 36591 | - | - | $21.36 | - | - | | | 36592 | - | - | $23.23 | - | - | | | 36593 | - | - | $26.38 | - | - | | | 36595 | $466.45 | $130.58 | - | - | - | | | 36596 | $89.20 | $32.42 | - | - | - | | | 36597 | $85.79 | $44.01 | - | - | - | | | 36598 | $95.05 | $25.95 | - | - | - | | | 36600 | $21.09 | $10.91 | - | - | - | | | 36620 | - | - | $32.11 | - | - | | | 36625 | - | - | $76.07 | - | - | | | 36640 | - | - | $86.15 | - | - | | | 36660 | - | - | $49.94 | - | - | | | 36680 | - | - | $42.89 | - | - | | | 36800 | - | - | $87.53 | - | - | | | 36810 | - | - | $153.44 | - | - | | | 36815 | - | - | $95.89 | - | - | | | 36818 | - | - | $491.96 | - | - | | | 36819 | - | - | $519.94 | - | - | | | 36820 | - | - | $516.10 | - | - | | | 36821 | - | - | $471.67 | - | - | | | 36823 | - | - | $1,028.66 | - | - | | | 36825 | - | - | $566.50 | - | - | | | 36830 | - | - | $475.26 | - | - | | | 36831 | - | - | $440.02 | - | - | | | 36832 | - | - | $539.67 | - | - | | | 36833 | - | - | $575.98 | - | - | | | 36835 | - | - | $354.05 | - | - | | | 36836 | $5,605.78 | $254.34 | - | - | - | | | 36837 | $7,979.92 | $331.22 | - | - | - | | | 36838 | - | - | $807.56 | - | - | | | 36860 | $178.87 | $79.50 | - | - | - | | | 36861 | - | - | $99.87 | - | - | | | 36901 | $557.17 | $120.32 | - | - | - | | | 36902 | $957.00 | $171.16 | - | - | - | | | 36903 | $3,433.78 | $224.26 | - | - | - | | | 36904 | $1,435.15 | $262.81 | - | - | - | | | 36905 | $1,809.27 | $316.60 | - | - | - | | | 36906 | $4,346.78 | $364.27 | - | - | - | | | 36907 | $465.80 | $104.21 | - | - | - | | | 36908 | $1,128.55 | $146.65 | - | - | - | | | 36909 | $1,530.74 | $143.07 | - | - | - | | | 37140 | - | - | $1,688.24 | - | - | | | 37145 | - | - | $1,567.18 | - | - | | | 37160 | - | - | $1,609.45 | - | - | | | 37180 | - | - | $1,546.65 | - | - | | | 37181 | - | - | $1,688.24 | - | - | | | 37182 | - | - | $585.49 | - | - | | | 37183 | $4,718.14 | $269.05 | - | - | - | | | 37184 | $1,349.24 | $306.00 | - | - | - | | | 37185 | $368.11 | $115.27 | - | - | - | | | 37186 | $938.62 | $171.53 | - | - | - | | | 37187 | $1,348.18 | $280.03 | - | - | - | | | 37188 | $1,168.06 | $200.36 | - | - | - | | | 37191 | $1,629.13 | $158.42 | - | - | - | | | 37192 | $1,001.56 | $240.36 | - | - | - | | | 37193 | $1,186.45 | $247.13 | - | - | - | | | 37195 | - | - | I.C. | - | - | | | 37197 | $1,235.69 | $213.62 | - | - | - | | | 37200 | - | - | $153.82 | - | - | | | 37211 | - | - | $273.79 | - | - | | | 37212 | - | - | $239.95 | - | - | | | 37213 | - | - | $163.70 | - | - | | | 37214 | - | - | $86.70 | - | - | | | 37215 | - | - | $706.09 | - | - | | | 37216 | - | - | $723.24 | - | - | | | 37217 | - | - | $766.42 | - | - | | | 37218 | - | - | $589.01 | - | - | | | 37220 | $1,993.41 | $281.91 | - | - | - | | | 37221 | $2,452.54 | $346.79 | - | - | - | | | 37222 | $480.96 | $130.35 | - | - | - | | | 37223 | $1,012.28 | $148.49 | - | - | - | | | 37224 | $2,327.51 | $312.82 | - | - | - | | | 37225 | $7,035.94 | $421.64 | - | - | - | | | 37226 | $6,550.09 | $365.13 | - | - | - | | | 37227 | $9,014.70 | $505.16 | - | - | - | | | 37228 | $3,311.47 | $381.03 | - | - | - | | | 37229 | $7,143.96 | $489.75 | - | - | - | | | 37230 | $7,153.96 | $488.50 | - | - | - | | | 37231 | $9,464.77 | $519.72 | - | - | - | | | 37232 | $646.46 | $140.25 | - | - | - | | | 37233 | $816.04 | $227.60 | - | - | - | | | 37234 | $2,913.33 | $198.23 | - | - | - | | | 37235 | $3,173.95 | $263.60 | - | - | - | | | 37236 | $2,185.89 | $311.55 | - | - | - | | | 37237 | $1,026.75 | $147.70 | - | - | - | | | 37238 | $2,765.24 | $216.75 | - | - | - | | | 37239 | $1,373.16 | $106.28 | - | - | - | | | 37241 | $3,742.97 | $306.05 | - | - | - | | | 37242 | $5,726.03 | $338.70 | - | - | - | | | 37243 | $6,959.23 | $401.71 | - | - | - | | | 37244 | $5,295.52 | $474.67 | - | - | - | | | 37246 | $1,441.23 | $246.40 | - | - | - | | | 37247 | $441.39 | $121.32 | - | - | - | | | 37248 | $1,075.09 | $211.58 | - | - | - | | | 37249 | $344.86 | $103.00 | - | - | - | | | 37252 | $762.99 | $63.12 | - | - | - | | | 37253 | $132.06 | $50.10 | - | - | - | | | 37500 | - | - | $448.64 | - | - | | | 37501 | - | - | I.C. | - | - | | | 37565 | - | - | $534.85 | - | - | | | 37600 | - | - | $550.31 | - | - | | | 37605 | - | - | $521.85 | - | - | | | 37606 | - | - | $547.60 | - | - | | | 37607 | - | - | $270.67 | - | - | | | 37609 | $240.07 | $151.95 | - | - | - | | | 37615 | - | - | $382.87 | - | - | | | 37616 | - | - | $802.18 | - | - | | | 37617 | - | - | $951.71 | - | - | | | 37618 | - | - | $286.65 | - | - | | | 37619 | - | - | $1,255.41 | - | - | | | 37650 | - | - | $327.46 | - | - | | | 37660 | - | - | $959.45 | - | - | | | 37700 | - | - | $178.95 | - | - | | | 37718 | - | - | $281.21 | - | - | | | 37722 | - | - | $334.39 | - | - | | | 37735 | - | - | $414.13 | - | - | | | 37760 | - | - | $410.26 | - | - | | | 37761 | - | - | $391.00 | - | - | | | 37765 | $320.85 | $194.96 | - | - | - | | | 37766 | $375.18 | $238.32 | - | - | - | | | 37780 | - | - | $170.39 | - | - | | | 37785 | $264.61 | $186.13 | - | - | - | | | 37788 | - | - | $921.50 | - | - | | | 37790 | - | - | $357.64 | - | - | | | 37799 | - | - | I.C. | - | - | | | 38100 | - | - | $842.95 | - | - | | | 38101 | - | - | $852.16 | - | - | | | 38102 | - | - | $189.62 | - | - | | | 38115 | - | - | $944.04 | - | - | | | 38120 | - | - | $779.33 | - | - | | | 38129 | - | - | I.C. | - | - | | | 38200 | - | - | $94.95 | - | - | | | 38204 | - | - | $73.59 | - | - | | | 38205 | - | - | $62.30 | - | - | | | 38206 | - | - | $61.76 | - | - | | | 38207 | - | - | $32.90 | - | - | | | 38208 | - | - | $20.80 | - | - | | | 38209 | - | - | $8.69 | - | - | | | 38210 | - | - | $58.18 | - | - | | | 38211 | - | - | $52.90 | - | - | | | 38212 | - | - | $34.66 | - | - | | | 38213 | - | - | $8.69 | - | - | | | 38214 | - | - | $29.74 | - | - | | | 38215 | - | - | $34.66 | - | - | | | 38220 | $120.84 | $50.13 | - | - | - | | | 38221 | $125.48 | $51.82 | - | - | - | | | 38222 | $135.95 | $55.60 | - | - | - | | | 38230 | - | - | $148.37 | - | - | | | 38232 | - | - | $141.16 | - | - | | | 38240 | - | - | $178.40 | - | - | | | 38241 | - | - | $131.63 | - | - | | | 38242 | - | - | $93.30 | - | - | | | 38243 | - | - | $91.11 | - | - | | | 38300 | $264.03 | $158.77 | - | - | - | | | 38305 | - | - | $370.77 | - | - | | | 38308 | - | - | $347.45 | - | - | | | 38380 | - | - | $429.84 | - | - | | | 38381 | - | - | $585.15 | - | - | | | 38382 | - | - | $501.90 | - | - | | | 38500 | $256.83 | $190.14 | - | - | - | | | 38505 | $137.15 | $63.22 | - | - | - | | | 38510 | $401.67 | $311.68 | - | - | - | | | 38520 | - | - | $349.76 | - | - | | | 38525 | - | - | $328.63 | - | - | | | 38530 | - | - | $421.72 | - | - | | | 38531 | - | - | $332.81 | - | - | | | 38542 | - | - | $392.93 | - | - | | | 38550 | - | - | $391.60 | - | - | | | 38555 | - | - | $760.52 | - | - | | | 38562 | - | - | $525.67 | - | - | | | 38564 | - | - | $518.65 | - | - | | | 38570 | - | - | $381.76 | - | - | | | 38571 | - | - | $486.38 | - | - | | | 38572 | - | - | $668.78 | - | - | | | 38573 | - | - | $868.16 | - | - | | | 38589 | - | - | I.C. | - | - | | | 38700 | - | - | $606.09 | - | - | | | 38720 | - | - | $998.24 | - | - | | | 38724 | - | - | $1,083.51 | - | - | | | 38740 | - | - | $520.66 | - | - | | | 38745 | - | - | $652.04 | - | - | | | 38746 | - | - | $151.60 | - | - | | | 38747 | - | - | $191.82 | - | - | | | 38760 | - | - | $619.06 | - | - | | | 38765 | - | - | $965.29 | - | - | | | 38770 | - | - | $593.15 | - | - | | | 38780 | - | - | $767.74 | - | - | | | 38790 | - | - | $60.76 | - | - | | | 38792 | $64.12 | $23.67 | - | - | - | | | 38794 | - | - | $207.95 | - | - | | | 38900 | - | - | $99.05 | - | - | | | 38999 | - | - | I.C. | - | - | | | 39000 | - | - | $355.74 | - | - | | | 39010 | - | - | $572.75 | - | - | | | 39200 | - | - | $627.92 | - | - | | | 39220 | - | - | $824.03 | - | - | | | 39401 | - | - | $221.46 | - | - | | | 39402 | - | - | $288.50 | - | - | | | 39499 | - | - | I.C. | - | - | | | 39501 | - | - | $622.74 | - | - | | | 39503 | - | - | $4,140.57 | - | - | | | 39540 | - | - | $632.01 | - | - | | | 39541 | - | - | $681.69 | - | - | | | 39545 | - | - | $652.87 | - | - | | | 39560 | - | - | $589.80 | - | - | | | 39561 | - | - | $917.79 | - | - | | | 39599 | - | - | I.C. | - | - | | | 40490 | $94.95 | $51.29 | - | - | - | | | 40500 | $411.38 | $283.09 | - | - | - | | | 40510 | $379.03 | $264.66 | - | - | - | | | 40520 | $392.28 | $272.02 | - | - | - | | | 40525 | - | - | $417.37 | - | - | | | 40527 | - | - | $475.02 | - | - | | | 40530 | $433.07 | $308.52 | - | - | - | | | 40650 | $374.98 | $239.46 | - | - | - | | | 40652 | $404.16 | $275.33 | - | - | - | | | 40654 | $454.03 | $324.13 | - | - | - | | | 40700 | - | - | $757.37 | - | - | | | 40701 | - | - | $892.23 | - | - | | | 40702 | - | - | $750.10 | - | - | | | 40720 | - | - | $770.28 | - | - | | | 40761 | - | - | $807.93 | - | - | | | 40799 | - | - | I.C. | - | - | | | 40800 | $159.20 | $91.17 | - | - | - | | | 40801 | $225.21 | $149.95 | - | - | - | | | 40804 | $146.65 | $86.39 | - | - | - | | | 40805 | $220.02 | $149.31 | - | - | - | | | 40806 | $79.10 | $22.05 | - | - | - | | | 40808 | $133.37 | $67.75 | - | - | - | | | 40810 | $171.09 | $94.48 | - | - | - | | | 40812 | $219.65 | $140.10 | - | - | - | | | 40814 | $290.11 | $216.99 | - | - | - | | | 40816 | $312.16 | $231.27 | - | - | - | | | 40818 | $287.15 | $205.19 | - | - | - | | | 40819 | $208.81 | $151.50 | - | - | - | | | 40820 | $204.62 | $129.35 | - | - | - | | | 40830 | $176.72 | $111.10 | - | - | - | | | 40831 | $231.30 | $153.36 | - | - | - | | | 40840 | $667.78 | $478.68 | - | - | - | | | 40842 | $718.51 | $512.00 | - | - | - | | | 40843 | $921.60 | $652.96 | - | - | - | | | 40844 | $1,152.76 | $884.92 | - | - | - | | | 40845 | $1,128.16 | $904.79 | - | - | - | | | 40899 | - | - | I.C. | - | - | | | 41000 | $114.59 | $80.31 | - | - | - | | | 41005 | $189.48 | $91.99 | - | - | - | | | 41006 | $263.74 | $174.55 | - | - | - | | | 41007 | $254.16 | $166.58 | - | - | - | | | 41008 | $304.58 | $194.76 | - | - | - | | | 41009 | $329.38 | $216.35 | - | - | - | | | 41010 | $172.80 | $85.22 | - | - | - | | | 41015 | $307.91 | $226.49 | - | - | - | | | 41016 | $363.43 | $263.79 | - | - | - | | | 41017 | $363.43 | $262.72 | - | - | - | | | 41018 | $407.11 | $304.53 | - | - | - | | | 41019 | - | - | $363.36 | - | - | | | 41100 | $147.04 | $81.69 | - | - | - | | | 41105 | $146.93 | $83.72 | - | - | - | | | 41108 | $132.91 | $69.97 | - | - | - | | | 41110 | $181.34 | $99.64 | - | - | - | | | 41112 | $265.12 | $186.64 | - | - | - | | | 41113 | $283.41 | $202.79 | - | - | - | | | 41114 | - | - | $470.95 | - | - | | | 41115 | $206.32 | $112.04 | - | - | - | | | 41116 | $262.68 | $165.46 | - | - | - | | | 41120 | - | - | $817.19 | - | - | | | 41130 | - | - | $1,002.47 | - | - | | | 41135 | - | - | $1,634.96 | - | - | | | 41140 | - | - | $1,653.05 | - | - | | | 41145 | - | - | $2,077.89 | - | - | | | 41150 | - | - | $1,661.85 | - | - | | | 41153 | - | - | $1,798.47 | - | - | | | 41155 | - | - | $2,247.04 | - | - | | | 41250 | $223.32 | $116.45 | - | - | - | | | 41251 | $247.12 | $138.92 | - | - | - | | | 41252 | $255.42 | $157.93 | - | - | - | | | 41510 | - | - | $356.28 | - | - | | | 41512 | - | - | $515.73 | - | - | | | 41520 | $287.54 | $193.53 | - | - | - | | | 41530 | $733.09 | $293.03 | - | - | - | | | 41599 | - | - | I.C. | - | - | | | 41800 | $231.02 | $119.33 | - | - | - | | | 41805 | $247.20 | $154.53 | - | - | - | | | 41806 | $323.07 | $215.13 | - | - | - | | | 41820 | - | - | I.C. | - | - | | | 41821 | - | - | I.C. | - | - | | | 41822 | $278.33 | $152.98 | - | - | - | | | 41823 | $413.72 | $280.87 | - | - | - | | | 41825 | $173.72 | $92.83 | - | - | - | | | 41826 | $236.76 | $150.79 | - | - | - | | | 41827 | $335.46 | $218.42 | - | - | - | | | 41828 | $273.42 | $167.09 | - | - | - | | | 41830 | $367.25 | $240.83 | - | - | - | | | 41850 | - | - | I.C. | - | - | | | 41870 | - | - | I.C. | - | - | | | 41872 | $369.41 | $233.34 | - | - | - | | | 41874 | $296.77 | $183.74 | - | - | - | | | 41899 | - | - | I.C. | - | - | | | 42000 | $126.20 | $83.35 | - | - | - | | | 42100 | $114.04 | $84.04 | - | - | - | | | 42104 | $170.32 | $102.83 | - | - | - | | | 42106 | $198.52 | $123.53 | - | - | - | | | 42107 | $351.11 | $249.34 | - | - | - | | | 42120 | - | - | $769.46 | - | - | | | 42140 | $247.23 | $125.10 | - | - | - | | | 42145 | - | - | $522.30 | - | - | | | 42160 | $181.80 | $109.22 | - | - | - | | | 42180 | $198.73 | $142.49 | - | - | - | | | 42182 | $254.67 | $194.94 | - | - | - | | | 42200 | - | - | $700.10 | - | - | | | 42205 | - | - | $725.67 | - | - | | | 42210 | - | - | $810.82 | - | - | | | 42215 | - | - | $533.00 | - | - | | | 42220 | - | - | $440.01 | - | - | | | 42225 | - | - | $757.38 | - | - | | | 42226 | - | - | $697.09 | - | - | | | 42227 | - | - | $648.38 | - | - | | | 42235 | - | - | $572.80 | - | - | | | 42260 | $661.97 | $506.08 | - | - | - | | | 42280 | $138.48 | $82.77 | - | - | - | | | 42281 | $175.49 | $123.26 | - | - | - | | | 42299 | - | - | I.C. | - | - | | | 42300 | $168.38 | $119.63 | - | - | - | | | 42305 | - | - | $320.41 | - | - | | | 42310 | $133.55 | $103.82 | - | - | - | | | 42320 | $204.23 | $136.74 | - | - | - | | | 42330 | $181.86 | $125.88 | - | - | - | | | 42335 | $339.57 | $200.29 | - | - | - | | | 42340 | $416.89 | $262.35 | - | - | - | | | 42400 | $75.87 | $39.71 | - | - | - | | | 42405 | $235.07 | $171.60 | - | - | - | | | 42408 | $425.42 | $265.79 | - | - | - | | | 42409 | $311.86 | $177.41 | - | - | - | | | 42410 | - | - | $475.36 | - | - | | | 42415 | - | - | $793.69 | - | - | | | 42420 | - | - | $887.98 | - | - | | | 42425 | - | - | $631.32 | - | - | | | 42426 | - | - | $1,007.15 | - | - | | | 42440 | - | - | $315.11 | - | - | | | 42450 | $366.35 | $278.77 | - | - | - | | | 42500 | $350.09 | $264.92 | - | - | - | | | 42505 | $444.66 | $349.58 | - | - | - | | | 42507 | - | - | $379.47 | - | - | | | 42509 | - | - | $621.04 | - | - | | | 42510 | - | - | $463.13 | - | - | | | 42550 | $122.00 | $45.13 | - | - | - | | | 42600 | $426.83 | $271.21 | - | - | - | | | 42650 | $57.75 | $44.62 | - | - | - | | | 42660 | $89.57 | $66.27 | - | - | - | | | 42665 | $297.05 | $166.07 | - | - | - | | | 42699 | - | - | I.C. | - | - | | | 42700 | $150.61 | $104.01 | - | - | - | | | 42720 | $339.90 | $288.74 | - | - | - | | | 42725 | - | - | $598.37 | - | - | | | 42800 | $123.36 | $89.07 | - | - | - | | | 42804 | $170.64 | $94.84 | - | - | - | | | 42806 | $189.68 | $108.52 | - | - | - | | | 42808 | $180.31 | $126.21 | - | - | - | | | 42809 | $158.48 | $95.26 | - | - | - | | | 42810 | $304.55 | $216.97 | - | - | - | | | 42815 | - | - | $412.10 | - | - | | | 42820 | - | - | $220.92 | - | - | | | 42821 | - | - | $231.51 | - | - | | | 42825 | - | - | $205.48 | - | - | | | 42826 | - | - | $195.18 | - | - | | | 42830 | - | - | $162.81 | - | - | | | 42831 | - | - | $177.51 | - | - | | | 42835 | - | - | $152.32 | - | - | | | 42836 | - | - | $187.31 | - | - | | | 42842 | - | - | $773.62 | - | - | | | 42844 | - | - | $1,048.32 | - | - | | | 42845 | - | - | $1,661.23 | - | - | | | 42860 | - | - | $149.36 | - | - | | | 42870 | - | - | $458.43 | - | - | | | 42890 | - | - | $1,076.86 | - | - | | | 42892 | - | - | $1,410.64 | - | - | | | 42894 | - | - | $1,787.18 | - | - | | | 42900 | - | - | $248.98 | - | - | | | 42950 | - | - | $617.26 | - | - | | | 42953 | - | - | $739.61 | - | - | | | 42955 | - | - | $586.46 | - | - | | | 42960 | - | - | $121.59 | - | - | | | 42961 | - | - | $319.45 | - | - | | | 42962 | - | - | $394.15 | - | - | | | 42970 | - | - | $312.63 | - | - | | | 42971 | - | - | $343.64 | - | - | | | 42972 | - | - | $383.67 | - | - | | | 42975 | - | - | $71.48 | - | - | | | 42999 | - | - | I.C. | - | - | | | 43020 | - | - | $421.54 | - | - | | | 43030 | - | - | $394.79 | - | - | | | 43045 | - | - | $946.40 | - | - | | | 43100 | - | - | $480.39 | - | - | | | 43101 | - | - | $730.12 | - | - | | | 43107 | - | - | $2,148.04 | - | - | | | 43108 | - | - | $3,166.93 | - | - | | | 43112 | - | - | $2,494.45 | - | - | | | 43113 | - | - | $3,101.28 | - | - | | | 43116 | - | - | $3,539.29 | - | - | | | 43117 | - | - | $2,341.60 | - | - | | | 43118 | - | - | $2,586.20 | - | - | | | 43121 | - | - | $2,047.75 | - | - | | | 43122 | - | - | $1,849.53 | - | - | | | 43123 | - | - | $3,214.23 | - | - | | | 43124 | - | - | $2,724.20 | - | - | | | 43130 | - | - | $592.64 | - | - | | | 43135 | - | - | $1,056.97 | - | - | | | 43180 | - | - | $408.73 | - | - | | | 43191 | - | - | $115.77 | - | - | | | 43192 | - | - | $126.33 | - | - | | | 43193 | - | - | $125.86 | - | - | | | 43194 | - | - | $141.19 | - | - | | | 43195 | - | - | $137.53 | - | - | | | 43196 | - | - | $145.02 | - | - | | | 43197 | $149.49 | $60.03 | - | - | - | | | 43198 | $165.53 | $72.33 | - | - | - | | | 43200 | $208.44 | $64.61 | - | - | - | | | 43201 | $204.33 | $76.04 | - | - | - | | | 43202 | $283.21 | $75.64 | - | - | - | | | 43204 | - | - | $99.14 | - | - | | | 43205 | - | - | $103.17 | - | - | | | 43206 | $236.44 | $97.43 | - | - | - | | | 43210 | - | - | $312.30 | - | - | | | 43211 | - | - | $171.56 | - | - | | | 43212 | - | - | $137.70 | - | - | | | 43213 | $987.72 | $189.56 | - | - | - | | | 43214 | - | - | $142.26 | - | - | | | 43215 | $309.27 | $103.03 | - | - | - | | | 43216 | $323.66 | $97.60 | - | - | - | | | 43217 | $330.27 | $116.81 | - | - | - | | | 43220 | $724.23 | $86.51 | - | - | - | | | 43226 | $304.51 | $95.32 | - | - | - | | | 43227 | $471.15 | $120.54 | - | - | - | | | 43229 | $563.57 | $143.60 | - | - | - | | | 43231 | - | - | $115.54 | - | - | | | 43232 | - | - | $144.25 | - | - | | | 43233 | - | - | $166.36 | - | - | | | 43235 | $225.38 | $89.85 | - | - | - | | | 43236 | $316.22 | $100.88 | - | - | - | | | 43237 | - | - | $143.05 | - | - | | | 43238 | - | - | $169.37 | - | - | | | 43239 | $296.27 | $101.28 | - | - | - | | | 43240 | - | - | $284.94 | - | - | | | 43241 | - | - | $103.66 | - | - | | | 43242 | - | - | $191.89 | - | - | | | 43243 | - | - | $172.93 | - | - | | | 43244 | - | - | $178.80 | - | - | | | 43245 | $470.50 | $128.20 | - | - | - | | | 43246 | - | - | $145.90 | - | - | | | 43247 | $298.95 | $129.14 | - | - | - | | | 43248 | $323.86 | $121.37 | - | - | - | | | 43249 | $867.39 | $112.35 | - | - | - | | | 43250 | $354.24 | $124.17 | - | - | - | | | 43251 | $388.79 | $143.18 | - | - | - | | | 43252 | $262.94 | $122.86 | - | - | - | | | 43253 | - | - | $191.63 | - | - | | | 43254 | - | - | $196.86 | - | - | | | 43255 | $494.98 | $146.25 | - | - | - | | | 43257 | - | - | $169.12 | - | - | | | 43259 | - | - | $164.50 | - | - | | | 43260 | - | - | $234.57 | - | - | | | 43261 | - | - | $246.40 | - | - | | | 43262 | - | - | $259.85 | - | - | | | 43263 | - | - | $260.12 | - | - | | | 43264 | - | - | $264.78 | - | - | | | 43265 | - | - | $314.67 | - | - | | | 43266 | - | - | $158.41 | - | - | | | 43270 | $577.44 | $163.63 | - | - | - | | | 43273 | - | - | $86.09 | - | - | | | 43274 | - | - | $336.24 | - | - | | | 43275 | - | - | $273.49 | - | - | | | 43276 | - | - | $350.14 | - | - | | | 43277 | - | - | $275.27 | - | - | | | 43278 | - | - | $314.43 | - | - | | | 43279 | - | - | $935.51 | - | - | | | 43280 | - | - | $789.65 | - | - | | | 43281 | - | - | $1,120.97 | - | - | | | 43282 | - | - | $1,260.08 | - | - | | | 43283 | - | - | $112.87 | - | - | | | 43284 | - | - | $482.61 | - | - | | | 43285 | - | - | $496.35 | - | - | | | 43286 | - | - | $2,302.13 | - | - | | | 43287 | - | - | $2,552.66 | - | - | | | 43288 | - | - | $2,696.25 | - | - | | | 43289 | - | - | I.C. | - | - | | | 43290 | $2,152.71 | $131.59 | - | - | - | | | 43291 | $362.34 | $117.27 | - | - | - | | | 43300 | - | - | $473.66 | - | - | | | 43305 | - | - | $819.78 | - | - | | | 43310 | - | - | $1,067.07 | - | - | | | 43312 | - | - | $1,135.19 | - | - | | | 43313 | - | - | $2,120.38 | - | - | | | 43314 | - | - | $2,266.29 | - | - | | | 43320 | - | - | $1,024.35 | - | - | | | 43325 | - | - | $996.33 | - | - | | | 43327 | - | - | $603.22 | - | - | | | 43328 | - | - | $808.49 | - | - | | | 43330 | - | - | $980.15 | - | - | | | 43331 | - | - | $969.04 | - | - | | | 43332 | - | - | $836.82 | - | - | | | 43333 | - | - | $916.44 | - | - | | | 43334 | - | - | $894.09 | - | - | | | 43335 | - | - | $957.55 | - | - | | | 43336 | - | - | $1,041.40 | - | - | | | 43337 | - | - | $1,109.17 | - | - | | | 43338 | - | - | $81.51 | - | - | | | 43340 | - | - | $1,011.50 | - | - | | | 43341 | - | - | $1,011.46 | - | - | | | 43351 | - | - | $957.66 | - | - | | | 43352 | - | - | $775.94 | - | - | | | 43360 | - | - | $1,615.91 | - | - | | | 43361 | - | - | $1,968.25 | - | - | | | 43400 | - | - | $1,114.98 | - | - | | | 43405 | - | - | $1,056.69 | - | - | | | 43410 | - | - | $775.88 | - | - | | | 43415 | - | - | $1,860.15 | - | - | | | 43420 | - | - | $762.30 | - | - | | | 43425 | - | - | $1,041.65 | - | - | | | 43450 | $146.96 | $59.11 | - | - | - | | | 43453 | $646.05 | $63.77 | - | - | - | | | 43460 | - | - | $155.16 | - | - | | | 43496 | - | - | I.C. | - | - | | | 43497 | - | - | $586.09 | - | - | | | 43499 | - | - | I.C. | - | - | | | 43500 | - | - | $577.82 | - | - | | | 43501 | - | - | $987.11 | - | - | | | 43502 | - | - | $1,117.38 | - | - | | | 43510 | - | - | $701.24 | - | - | | | 43520 | - | - | $509.27 | - | - | | | 43605 | - | - | $612.88 | - | - | | | 43610 | - | - | $719.36 | - | - | | | 43611 | - | - | $901.21 | - | - | | | 43620 | - | - | $1,446.10 | - | - | | | 43621 | - | - | $1,654.21 | - | - | | | 43622 | - | - | $1,682.21 | - | - | | | 43631 | - | - | $1,059.96 | - | - | | | 43632 | - | - | $1,484.95 | - | - | | | 43633 | - | - | $1,403.29 | - | - | | | 43634 | - | - | $1,548.33 | - | - | | | 43635 | - | - | $81.26 | - | - | | | 43640 | - | - | $875.71 | - | - | | | 43641 | - | - | $885.44 | - | - | | | 43644 | - | - | $1,270.81 | - | - | | | 43645 | - | - | $1,349.77 | - | - | | | 43647 | - | - | I.C. | - | - | | | 43648 | - | - | I.C. | - | - | | | 43651 | - | - | $486.89 | - | - | | | 43652 | - | - | $566.14 | - | - | | | 43653 | - | - | $431.07 | - | - | | | 43659 | - | - | I.C. | - | - | | | 43752 | - | - | $29.33 | - | - | | | 43753 | - | - | $15.56 | - | - | | | 43754 | $189.26 | $28.28 | - | - | - | | | 43755 | $160.47 | $44.23 | - | - | - | | | 43756 | $222.00 | $37.99 | - | - | - | | | 43757 | $297.27 | $57.02 | - | - | - | | | 43761 | $92.37 | $75.76 | - | - | - | | | 43762 | $180.93 | $26.65 | - | - | - | | | 43763 | $267.05 | $64.29 | - | - | - | | | 43770 | - | - | $830.32 | - | - | | | 43771 | - | - | $941.21 | - | - | | | 43772 | - | - | $697.47 | - | - | | | 43773 | - | - | $941.21 | - | - | | | 43774 | - | - | $707.10 | - | - | | | 43775 | - | - | $801.96 | - | - | | | 43800 | - | - | $682.70 | - | - | | | 43810 | - | - | $746.48 | - | - | | | 43820 | - | - | $986.14 | - | - | | | 43825 | - | - | $962.53 | - | - | | | 43830 | - | - | $521.86 | - | - | | | 43831 | - | - | $456.96 | - | - | | | 43832 | - | - | $766.58 | - | - | | | 43840 | - | - | $997.43 | - | - | | | 43842 | - | - | $855.61 | - | - | | | 43843 | - | - | $943.12 | - | - | | | 43845 | - | - | $1,433.04 | - | - | | | 43846 | - | - | $1,212.02 | - | - | | | 43847 | - | - | $1,324.87 | - | - | | | 43848 | - | - | $1,414.77 | - | - | | | 43860 | - | - | $1,197.54 | - | - | | | 43865 | - | - | $1,249.45 | - | - | | | 43870 | - | - | $524.98 | - | - | | | 43880 | - | - | $1,162.06 | - | - | | | 43881 | - | - | I.C. | - | - | | | 43882 | - | - | I.C. | - | - | | | 43886 | - | - | $278.15 | - | - | | | 43887 | - | - | $250.30 | - | - | | | 43888 | - | - | $348.96 | - | - | | | 43999 | - | - | I.C. | - | - | | | 44005 | - | - | $799.55 | - | - | | | 44010 | - | - | $627.58 | - | - | | | 44015 | - | - | $102.32 | - | - | | | 44020 | - | - | $714.75 | - | - | | | 44021 | - | - | $713.74 | - | - | | | 44025 | - | - | $719.19 | - | - | | | 44050 | - | - | $687.85 | - | - | | | 44055 | - | - | $1,085.34 | - | - | | | 44100 | - | - | $77.65 | - | - | | | 44110 | - | - | $624.78 | - | - | | | 44111 | - | - | $724.68 | - | - | | | 44120 | - | - | $893.44 | - | - | | | 44121 | - | - | $173.76 | - | - | | | 44125 | - | - | $860.48 | - | - | | | 44126 | - | - | $1,800.90 | - | - | | | 44127 | - | - | $2,076.82 | - | - | | | 44128 | - | - | $175.03 | - | - | | | 44130 | - | - | $964.37 | - | - | | | 44132 | - | - | I.C. | - | - | | | 44133 | - | - | I.C. | - | - | | | 44135 | - | - | I.C. | - | - | | | 44136 | - | - | I.C. | - | - | | | 44137 | - | - | I.C. | - | - | | | 44139 | - | - | $86.89 | - | - | | | 44140 | - | - | $982.88 | - | - | | | 44141 | - | - | $1,329.41 | - | - | | | 44143 | - | - | $1,210.66 | - | - | | | 44144 | - | - | $1,290.98 | - | - | | | 44145 | - | - | $1,205.94 | - | - | | | 44146 | - | - | $1,536.46 | - | - | | | 44147 | - | - | $1,407.04 | - | - | | | 44150 | - | - | $1,361.97 | - | - | | | 44151 | - | - | $1,576.57 | - | - | | | 44155 | - | - | $1,515.71 | - | - | | | 44156 | - | - | $1,685.73 | - | - | | | 44157 | - | - | $1,601.00 | - | - | | | 44158 | - | - | $1,640.60 | - | - | | | 44160 | - | - | $910.30 | - | - | | | 44180 | - | - | $675.58 | - | - | | | 44186 | - | - | $480.76 | - | - | | | 44187 | - | - | $807.72 | - | - | | | 44188 | - | - | $896.49 | - | - | | | 44202 | - | - | $1,016.31 | - | - | | | 44203 | - | - | $174.36 | - | - | | | 44204 | - | - | $1,123.02 | - | - | | | 44205 | - | - | $976.41 | - | - | | | 44206 | - | - | $1,272.56 | - | - | | | 44207 | - | - | $1,321.24 | - | - | | | 44208 | - | - | $1,441.19 | - | - | | | 44210 | - | - | $1,299.28 | - | - | | | 44211 | - | - | $1,555.13 | - | - | | | 44212 | - | - | $1,485.47 | - | - | | | 44213 | - | - | $134.31 | - | - | | | 44227 | - | - | $1,210.78 | - | - | | | 44238 | - | - | I.C. | - | - | | | 44300 | - | - | $619.24 | - | - | | | 44310 | - | - | $763.25 | - | - | | | 44312 | - | - | $442.36 | - | - | | | 44314 | - | - | $740.67 | - | - | | | 44316 | - | - | $1,037.16 | - | - | | | 44320 | - | - | $881.25 | - | - | | | 44322 | - | - | $753.21 | - | - | | | 44340 | - | - | $468.21 | - | - | | | 44345 | - | - | $774.41 | - | - | | | 44346 | - | - | $869.39 | - | - | | | 44360 | - | - | $105.07 | - | - | | | 44361 | - | - | $115.80 | - | - | | | 44363 | - | - | $140.02 | - | - | | | 44364 | - | - | $149.24 | - | - | | | 44365 | - | - | $132.87 | - | - | | | 44366 | - | - | $175.08 | - | - | | | 44369 | - | - | $179.04 | - | - | | | 44370 | - | - | $194.93 | - | - | | | 44372 | - | - | $174.33 | - | - | | | 44373 | - | - | $139.74 | - | - | | | 44376 | - | - | $207.06 | - | - | | | 44377 | - | - | $218.02 | - | - | | | 44378 | - | - | $279.75 | - | - | | | 44379 | - | - | $297.91 | - | - | | | 44380 | $155.01 | $42.25 | - | - | - | | | 44381 | $794.23 | $62.50 | - | - | - | | | 44382 | $237.75 | $54.81 | - | - | - | | | 44384 | - | - | $112.87 | - | - | | | 44385 | $170.11 | $53.87 | - | - | - | | | 44386 | $246.49 | $65.70 | - | - | - | | | 44388 | $245.14 | $114.17 | - | - | - | | | 44389 | $322.39 | $125.53 | - | - | - | | | 44390 | $313.57 | $153.67 | - | - | - | | | 44391 | $503.19 | $168.39 | - | - | - | | | 44392 | $299.85 | $145.30 | - | - | - | | | 44394 | $339.81 | $164.38 | - | - | - | | | 44401 | $1,910.45 | $176.99 | - | - | - | | | 44402 | - | - | $190.89 | - | - | | | 44403 | - | - | $221.85 | - | - | | | 44404 | $330.16 | $125.80 | - | - | - | | | 44405 | $438.16 | $133.89 | - | - | - | | | 44406 | - | - | $167.37 | - | - | | | 44407 | - | - | $200.80 | - | - | | | 44408 | - | - | $168.89 | - | - | | | 44500 | - | - | $14.10 | - | - | | | 44602 | - | - | $1,025.13 | - | - | | | 44603 | - | - | $1,179.88 | - | - | | | 44604 | - | - | $771.47 | - | - | | | 44605 | - | - | $948.92 | - | - | | | 44615 | - | - | $782.08 | - | - | | | 44620 | - | - | $636.19 | - | - | | | 44625 | - | - | $741.49 | - | - | | | 44626 | - | - | $1,161.15 | - | - | | | 44640 | - | - | $1,018.74 | - | - | | | 44650 | - | - | $1,051.04 | - | - | | | 44660 | - | - | $976.33 | - | - | | | 44661 | - | - | $1,126.24 | - | - | | | 44680 | - | - | $789.97 | - | - | | | 44700 | - | - | $733.31 | - | - | | | 44701 | - | - | $122.03 | - | - | | | 44705 | $85.31 | $52.90 | - | - | - | | | 44715 | - | - | I.C. | - | - | | | 44720 | - | - | $197.16 | - | - | | | 44721 | - | - | $275.54 | - | - | | | 44799 | - | - | I.C. | - | - | | | 44800 | - | - | $574.32 | - | - | | | 44820 | - | - | $627.51 | - | - | | | 44850 | - | - | $550.81 | - | - | | | 44899 | - | - | I.C. | - | - | | | 44900 | - | - | $579.25 | - | - | | | 44950 | - | - | $472.82 | - | - | | | 44955 | - | - | $60.60 | - | - | | | 44960 | - | - | $644.95 | - | - | | | 44970 | - | - | $446.43 | - | - | | | 44979 | - | - | I.C. | - | - | | | 45000 | - | - | $321.40 | - | - | | | 45005 | $248.48 | $126.08 | - | - | - | | | 45020 | - | - | $430.46 | - | - | | | 45100 | - | - | $228.88 | - | - | | | 45108 | - | - | $280.58 | - | - | | | 45110 | - | - | $1,338.65 | - | - | | | 45111 | - | - | $798.87 | - | - | | | 45112 | - | - | $1,330.59 | - | - | | | 45113 | - | - | $1,372.01 | - | - | | | 45114 | - | - | $1,327.57 | - | - | | | 45116 | - | - | $1,135.44 | - | - | | | 45119 | - | - | $1,381.86 | - | - | | | 45120 | - | - | $1,174.05 | - | - | | | 45121 | - | - | $1,279.85 | - | - | | | 45123 | - | - | $822.97 | - | - | | | 45126 | - | - | $1,998.36 | - | - | | | 45130 | - | - | $799.19 | - | - | | | 45135 | - | - | $958.06 | - | - | | | 45136 | - | - | $1,316.76 | - | - | | | 45150 | - | - | $317.72 | - | - | | | 45160 | - | - | $757.20 | - | - | | | 45171 | - | - | $466.95 | - | - | | | 45172 | - | - | $617.40 | - | - | | | 45190 | - | - | $523.62 | - | - | | | 45300 | $101.00 | $35.65 | - | - | - | | | 45303 | $771.15 | $62.98 | - | - | - | | | 45305 | $142.84 | $53.92 | - | - | - | | | 45307 | $167.16 | $73.42 | - | - | - | | | 45308 | $160.76 | $62.20 | - | - | - | | | 45309 | $165.28 | $65.92 | - | - | - | | | 45315 | $177.71 | $77.54 | - | - | - | | | 45317 | $172.18 | $81.11 | - | - | - | | | 45320 | $174.34 | $76.58 | - | - | - | | | 45321 | - | - | $75.58 | - | - | | | 45327 | - | - | $85.38 | - | - | | | 45330 | $147.24 | $41.72 | - | - | - | | | 45331 | $227.57 | $53.21 | - | - | - | | | 45332 | $217.50 | $76.89 | - | - | - | | | 45333 | $260.84 | $68.80 | - | - | - | | | 45334 | $392.25 | $86.38 | - | - | - | | | 45335 | $232.36 | $49.42 | - | - | - | | | 45337 | - | - | $83.33 | - | - | | | 45338 | $234.58 | $88.07 | - | - | - | | | 45340 | $366.06 | $57.77 | - | - | - | | | 45341 | - | - | $90.65 | - | - | | | 45342 | - | - | $124.89 | - | - | | | 45346 | $1,851.58 | $117.58 | - | - | - | | | 45347 | - | - | $112.44 | - | - | | | 45349 | - | - | $144.94 | - | - | | | 45350 | $537.82 | $73.92 | - | - | - | | | 45378 | $262.58 | $134.82 | - | - | - | | | 45379 | $336.09 | $174.05 | - | - | - | | | 45380 | $338.09 | $146.58 | - | - | - | | | 45381 | $345.39 | $146.38 | - | - | - | | | 45382 | $522.30 | $188.84 | - | - | - | | | 45384 | $380.09 | $165.82 | - | - | - | | | 45385 | $350.29 | $185.30 | - | - | - | | | 45386 | $480.70 | $154.47 | - | - | - | | | 45388 | $1,972.88 | $197.37 | - | - | - | | | 45389 | - | - | $211.47 | - | - | | | 45390 | - | - | $242.17 | - | - | | | 45391 | - | - | $188.15 | - | - | | | 45392 | - | - | $221.85 | - | - | | | 45393 | - | - | $182.90 | - | - | | | 45395 | - | - | $1,438.46 | - | - | | | 45397 | - | - | $1,560.04 | - | - | | | 45398 | $654.26 | $171.61 | - | - | - | | | 45399 | - | - | I.C. | - | - | | | 45400 | - | - | $833.11 | - | - | | | 45402 | - | - | $1,110.85 | - | - | | | 45499 | - | - | I.C. | - | - | | | 45500 | - | - | $427.59 | - | - | | | 45505 | - | - | $454.65 | - | - | | | 45520 | $130.04 | $30.40 | - | - | - | | | 45540 | - | - | $775.56 | - | - | | | 45541 | - | - | $697.06 | - | - | | | 45550 | - | - | $1,073.17 | - | - | | | 45560 | - | - | $514.35 | - | - | | | 45562 | - | - | $839.22 | - | - | | | 45563 | - | - | $1,221.24 | - | - | | | 45800 | - | - | $936.71 | - | - | | | 45805 | - | - | $1,081.64 | - | - | | | 45820 | - | - | $939.18 | - | - | | | 45825 | - | - | $1,133.97 | - | - | | | 45900 | - | - | $158.91 | - | - | | | 45905 | - | - | $128.34 | - | - | | | 45910 | - | - | $144.66 | - | - | | | 45915 | $272.90 | $172.46 | - | - | - | | | 45990 | - | - | $77.12 | - | - | | | 45999 | - | - | I.C. | - | - | | | 46020 | - | - | $86.29 | - | - | | | 46030 | $201.94 | $64.27 | - | - | - | | | 46040 | $427.54 | $322.27 | - | - | - | | | 46045 | - | - | $331.84 | - | - | | | 46050 | $186.96 | $76.87 | - | - | - | | | 46060 | - | - | $369.52 | - | - | | | 46070 | - | - | $208.12 | - | - | | | 46080 | $223.83 | $117.76 | - | - | - | | | 46083 | $162.77 | $82.95 | - | - | - | | | 46200 | $371.22 | $259.53 | - | - | - | | | 46220 | $197.35 | $91.82 | - | - | - | | | 46221 | $220.93 | $146.74 | - | - | - | | | 46230 | $243.02 | $129.73 | - | - | - | | | 46250 | $370.82 | $241.45 | - | - | - | | | 46255 | $402.65 | $268.20 | - | - | - | | | 46257 | - | - | $316.19 | - | - | | | 46258 | - | - | $362.22 | - | - | | | 46260 | - | - | $363.53 | - | - | | | 46261 | - | - | $398.38 | - | - | | | 46262 | - | - | $441.03 | - | - | | | 46270 | $413.99 | $304.98 | - | - | - | | | 46275 | $436.35 | $320.64 | - | - | - | | | 46280 | - | - | $364.80 | - | - | | | 46285 | $434.54 | $320.71 | - | - | - | | | 46288 | - | - | $421.78 | - | - | | | 46320 | $166.62 | $84.92 | - | - | - | | | 46500 | $248.41 | $142.88 | - | - | - | | | 46505 | $243.13 | $190.64 | - | - | - | | | 46600 | $94.48 | $31.00 | - | - | - | | | 46601 | $114.82 | $68.75 | - | - | - | | | 46604 | $526.73 | $48.91 | - | - | - | | | 46606 | $223.01 | $55.61 | - | - | - | | | 46607 | $158.96 | $91.47 | - | - | - | | | 46608 | $232.01 | $62.20 | - | - | - | | | 46610 | $220.08 | $59.37 | - | - | - | | | 46611 | $176.24 | $59.47 | - | - | - | | | 46612 | $265.09 | $69.57 | - | - | - | | | 46614 | $133.41 | $47.97 | - | - | - | | | 46615 | $138.56 | $66.77 | - | - | - | | | 46700 | - | - | $492.35 | - | - | | | 46705 | - | - | $431.36 | - | - | | | 46706 | - | - | $134.41 | - | - | | | 46707 | - | - | $380.75 | - | - | | | 46710 | - | - | $822.14 | - | - | | | 46712 | - | - | $1,625.84 | - | - | | | 46715 | - | - | $416.99 | - | - | | | 46716 | - | - | $920.58 | - | - | | | 46730 | - | - | $1,469.51 | - | - | | | 46735 | - | - | $1,685.69 | - | - | | | 46740 | - | - | $1,600.37 | - | - | | | 46742 | - | - | $1,843.26 | - | - | | | 46744 | - | - | $2,587.01 | - | - | | | 46746 | - | - | $2,846.84 | - | - | | | 46748 | - | - | $3,082.24 | - | - | | | 46750 | - | - | $558.38 | - | - | | | 46751 | - | - | $501.88 | - | - | | | 46753 | - | - | $463.59 | - | - | | | 46754 | $271.06 | $184.01 | - | - | - | | | 46760 | - | - | $824.78 | - | - | | | 46761 | - | - | $679.74 | - | - | | | 46900 | $186.42 | $103.66 | - | - | - | | | 46910 | $205.70 | $101.24 | - | - | - | | | 46916 | $204.24 | $107.28 | - | - | - | | | 46917 | $355.22 | $96.76 | - | - | - | | | 46922 | $247.41 | $103.85 | - | - | - | | | 46924 | $434.16 | $134.98 | - | - | - | | | 46930 | $168.90 | $116.40 | - | - | - | | | 46940 | $207.56 | $108.46 | - | - | - | | | 46942 | $198.17 | $97.46 | - | - | - | | | 46945 | - | - | $260.44 | - | - | | | 46946 | - | - | $290.90 | - | - | | | 46947 | - | - | $291.68 | - | - | | | 46948 | - | - | $337.69 | - | - | | | 46999 | - | - | I.C. | - | - | | | 47000 | $238.79 | $64.42 | - | - | - | | | 47001 | - | - | $74.73 | - | - | | | 47010 | - | - | $894.38 | - | - | | | 47015 | - | - | $859.42 | - | - | | | 47100 | - | - | $629.77 | - | - | | | 47120 | - | - | $1,710.86 | - | - | | | 47122 | - | - | $2,492.61 | - | - | | | 47125 | - | - | $2,241.32 | - | - | | | 47130 | - | - | $2,406.51 | - | - | | | 47133 | - | - | I.C. | - | - | | | 47135 | - | - | $3,939.16 | - | - | | | 47140 | - | - | $2,610.18 | - | - | | | 47141 | - | - | $3,117.21 | - | - | | | 47142 | - | - | $3,420.33 | - | - | | | 47143 | - | - | I.C. | - | - | | | 47144 | - | - | I.C. | - | - | | | 47145 | - | - | I.C. | - | - | | | 47146 | - | - | $235.95 | - | - | | | 47147 | - | - | $274.94 | - | - | | | 47300 | - | - | $838.71 | - | - | | | 47350 | - | - | $1,005.53 | - | - | | | 47360 | - | - | $1,372.23 | - | - | | | 47361 | - | - | $2,198.24 | - | - | | | 47362 | - | - | $1,054.11 | - | - | | | 47370 | - | - | $921.12 | - | - | | | 47371 | - | - | $924.59 | - | - | | | 47379 | - | - | I.C. | - | - | | | 47380 | - | - | $1,059.18 | - | - | | | 47381 | - | - | $1,084.85 | - | - | | | 47382 | $2,928.88 | $533.32 | - | - | - | | | 47383 | $4,808.72 | $326.42 | - | - | - | | | 47399 | - | - | I.C. | - | - | | | 47400 | - | - | $1,571.08 | - | - | | | 47420 | - | - | $978.80 | - | - | | | 47425 | - | - | $1,005.31 | - | - | | | 47460 | - | - | $934.54 | - | - | | | 47480 | - | - | $651.75 | - | - | | | 47490 | - | - | $249.22 | - | - | | | 47531 | $340.64 | $51.10 | - | - | - | | | 47532 | $665.68 | $151.69 | - | - | - | | | 47533 | $928.57 | $190.13 | - | - | - | | | 47534 | $1,012.10 | $265.63 | - | - | - | | | 47535 | $707.62 | $141.14 | - | - | - | | | 47536 | $508.09 | $94.82 | - | - | - | | | 47537 | $394.10 | $70.01 | - | - | - | | | 47538 | $3,046.49 | $168.55 | - | - | - | | | 47539 | $3,385.24 | $304.82 | - | - | - | | | 47540 | $3,415.07 | $315.09 | - | - | - | | | 47541 | $919.44 | $241.81 | - | - | - | | | 47542 | $395.11 | $97.54 | - | - | - | | | 47543 | $307.65 | $103.02 | - | - | - | | | 47544 | $668.05 | $112.02 | - | - | - | | | 47550 | - | - | $118.33 | - | - | | | 47552 | - | - | $198.93 | - | - | | | 47553 | - | - | $198.75 | - | - | | | 47554 | - | - | $323.25 | - | - | | | 47555 | - | - | $236.53 | - | - | | | 47556 | - | - | $267.97 | - | - | | | 47562 | - | - | $487.78 | - | - | | | 47563 | - | - | $531.32 | - | - | | | 47564 | - | - | $823.90 | - | - | | | 47570 | - | - | $572.58 | - | - | | | 47579 | - | - | I.C. | - | - | | | 47600 | - | - | $787.69 | - | - | | | 47605 | - | - | $830.08 | - | - | | | 47610 | - | - | $919.50 | - | - | | | 47612 | - | - | $934.01 | - | - | | | 47620 | - | - | $1,007.70 | - | - | | | 47700 | - | - | $783.85 | - | - | | | 47701 | - | - | $1,274.03 | - | - | | | 47711 | - | - | $1,143.83 | - | - | | | 47712 | - | - | $1,459.63 | - | - | | | 47715 | - | - | $979.56 | - | - | | | 47720 | - | - | $853.30 | - | - | | | 47721 | - | - | $997.22 | - | - | | | 47740 | - | - | $966.91 | - | - | | | 47741 | - | - | $1,084.33 | - | - | | | 47760 | - | - | $1,645.98 | - | - | | | 47765 | - | - | $2,156.92 | - | - | | | 47780 | - | - | $1,805.13 | - | - | | | 47785 | - | - | $2,358.08 | - | - | | | 47800 | - | - | $1,144.79 | - | - | | | 47801 | - | - | $824.15 | - | - | | | 47802 | - | - | $1,120.56 | - | - | | | 47900 | - | - | $1,014.99 | - | - | | | 47999 | - | - | I.C. | - | - | | | 48000 | - | - | $1,375.49 | - | - | | | 48001 | - | - | $1,680.65 | - | - | | | 48020 | - | - | $869.03 | - | - | | | 48100 | - | - | $654.22 | - | - | | | 48102 | $401.49 | $171.42 | - | - | - | | | 48105 | - | - | $2,064.89 | - | - | | | 48120 | - | - | $818.79 | - | - | | | 48140 | - | - | $1,148.21 | - | - | | | 48145 | - | - | $1,195.79 | - | - | | | 48146 | - | - | $1,384.73 | - | - | | | 48148 | - | - | $920.32 | - | - | | | 48150 | - | - | $2,276.21 | - | - | | | 48152 | - | - | $2,109.67 | - | - | | | 48153 | - | - | $2,267.06 | - | - | | | 48154 | - | - | $2,118.24 | - | - | | | 48155 | - | - | $1,342.69 | - | - | | | 48160 | - | - | I.C. | - | - | | | 48400 | - | - | $77.09 | - | - | | | 48500 | - | - | $849.23 | - | - | | | 48510 | - | - | $811.04 | - | - | | | 48520 | - | - | $808.81 | - | - | | | 48540 | - | - | $958.03 | - | - | | | 48545 | - | - | $988.83 | - | - | | | 48547 | - | - | $1,310.24 | - | - | | | 48548 | - | - | $1,223.49 | - | - | | | 48550 | - | - | I.C. | - | - | | | 48551 | - | - | I.C. | - | - | | | 48552 | - | - | $169.46 | - | - | | | 48554 | - | - | $1,940.85 | - | - | | | 48556 | - | - | $953.72 | - | - | | | 48999 | - | - | I.C. | - | - | | | 49000 | - | - | $566.49 | - | - | | | 49002 | - | - | $763.85 | - | - | | | 49010 | - | - | $672.69 | - | - | | | 49013 | - | - | $328.52 | - | - | | | 49014 | - | - | $274.23 | - | - | | | 49020 | - | - | $1,168.93 | - | - | | | 49040 | - | - | $739.52 | - | - | | | 49060 | - | - | $803.97 | - | - | | | 49062 | - | - | $567.68 | - | - | | | 49082 | $166.74 | $53.71 | - | - | - | | | 49083 | $231.15 | $77.68 | - | - | - | | | 49084 | - | - | $77.58 | - | - | | | 49180 | $135.42 | $60.42 | - | - | - | | | 49185 | $1,020.87 | $86.11 | - | - | - | | | 49203 | - | - | $878.87 | - | - | | | 49204 | - | - | $1,117.06 | - | - | | | 49205 | - | - | $1,281.41 | - | - | | | 49215 | - | - | $1,613.17 | - | - | | | 49250 | - | - | $442.17 | - | - | | | 49255 | - | - | $587.42 | - | - | | | 49320 | - | - | $243.72 | - | - | | | 49321 | - | - | $255.48 | - | - | | | 49322 | - | - | $277.72 | - | - | | | 49323 | - | - | $471.22 | - | - | | | 49324 | - | - | $285.03 | - | - | | | 49325 | - | - | $303.75 | - | - | | | 49326 | - | - | $135.30 | - | - | | | 49327 | - | - | $93.64 | - | - | | | 49329 | - | - | I.C. | - | - | | | 49400 | $114.58 | $65.30 | - | - | - | | | 49402 | - | - | $628.50 | - | - | | | 49405 | $706.84 | $140.36 | - | - | - | | | 49406 | $707.11 | $140.36 | - | - | - | | | 49407 | $594.43 | $148.48 | - | - | - | | | 49411 | $378.39 | $134.92 | - | - | - | | | 49412 | - | - | $59.12 | - | - | | | 49418 | $785.60 | $145.73 | - | - | - | | | 49419 | - | - | $308.47 | - | - | | | 49421 | - | - | $163.11 | - | - | | | 49422 | - | - | $160.05 | - | - | | | 49423 | $475.19 | $51.20 | - | - | - | | | 49424 | $145.56 | $27.17 | - | - | - | | | 49425 | - | - | $577.59 | - | - | | | 49426 | - | - | $496.89 | - | - | | | 49427 | - | - | $28.01 | - | - | | | 49428 | - | - | $318.03 | - | - | | | 49429 | - | - | $337.59 | - | - | | | 49435 | - | - | $84.83 | - | - | | | 49436 | $428.52 | $138.18 | - | - | - | | | 49440 | $663.40 | $147.55 | - | - | - | | | 49441 | $752.69 | $173.36 | - | - | - | | | 49442 | $633.70 | $151.32 | - | - | - | | | 49446 | $638.76 | $105.50 | - | - | - | | | 49450 | $481.31 | $47.95 | - | - | - | | | 49451 | $513.02 | $63.85 | - | - | - | | | 49452 | $621.15 | $98.59 | - | - | - | | | 49460 | $567.21 | $36.08 | - | - | - | | | 49465 | $108.25 | $22.27 | - | - | - | | | 49491 | - | - | $591.53 | - | - | | | 49492 | - | - | $708.26 | - | - | | | 49495 | - | - | $304.59 | - | - | | | 49496 | - | - | $457.27 | - | - | | | 49500 | - | - | $312.12 | - | - | | | 49501 | - | - | $450.78 | - | - | | | 49505 | - | - | $389.09 | - | - | | | 49507 | - | - | $436.88 | - | - | | | 49520 | - | - | $469.21 | - | - | | | 49521 | - | - | $530.30 | - | - | | | 49525 | - | - | $426.34 | - | - | | | 49540 | - | - | $503.70 | - | - | | | 49550 | - | - | $429.15 | - | - | | | 49553 | - | - | $469.51 | - | - | | | 49555 | - | - | $449.04 | - | - | | | 49557 | - | - | $535.26 | - | - | | | 49591 | - | - | $249.64 | - | - | | | 49592 | - | - | $346.48 | - | - | | | 49593 | - | - | $417.30 | - | - | | | 49594 | - | - | $542.64 | - | - | | | 49595 | - | - | $560.55 | - | - | | | 49596 | - | - | $744.02 | - | - | | | 49600 | - | - | $544.39 | - | - | | | 49605 | - | - | $3,566.76 | - | - | | | 49606 | - | - | $833.29 | - | - | | | 49610 | - | - | $514.47 | - | - | | | 49611 | - | - | $454.58 | - | - | | | 49613 | - | - | $307.59 | - | - | | | 49614 | - | - | $416.25 | - | - | | | 49615 | - | - | $465.60 | - | - | | | 49616 | - | - | $624.50 | - | - | | | 49617 | - | - | $644.02 | - | - | | | 49618 | - | - | $901.19 | - | - | | | 49621 | - | - | $540.79 | - | - | | | 49622 | - | - | $666.91 | - | - | | | 49623 | - | - | $143.50 | - | - | | | 49650 | - | - | $322.97 | - | - | | | 49651 | - | - | $421.39 | - | - | | | 49659 | - | - | I.C. | - | - | | | 49900 | - | - | $610.12 | - | - | | | 49904 | - | - | $1,026.46 | - | - | | | 49905 | - | - | $254.80 | - | - | | | 49906 | - | - | I.C. | - | - | | | 49999 | - | - | I.C. | - | - | | | 50010 | - | - | $550.01 | - | - | | | 50020 | - | - | $744.94 | - | - | | | 50040 | - | - | $678.27 | - | - | | | 50045 | - | - | $683.17 | - | - | | | 50060 | - | - | $831.99 | - | - | | | 50065 | - | - | $881.65 | - | - | | | 50070 | - | - | $864.92 | - | - | | | 50075 | - | - | $1,061.67 | - | - | | | 50080 | - | - | $511.76 | - | - | | | 50081 | - | - | $821.90 | - | - | | | 50100 | - | - | $796.64 | - | - | | | 50120 | - | - | $694.92 | - | - | | | 50125 | - | - | $718.82 | - | - | | | 50130 | - | - | $755.41 | - | - | | | 50135 | - | - | $819.36 | - | - | | | 50200 | $409.73 | $92.34 | - | - | - | | | 50205 | - | - | $556.02 | - | - | | | 50220 | - | - | $771.41 | - | - | | | 50225 | - | - | $879.27 | - | - | | | 50230 | - | - | $932.55 | - | - | | | 50234 | - | - | $950.88 | - | - | | | 50236 | - | - | $1,068.84 | - | - | | | 50240 | - | - | $969.21 | - | - | | | 50250 | - | - | $889.25 | - | - | | | 50280 | - | - | $704.67 | - | - | | | 50290 | - | - | $659.27 | - | - | | | 50300 | - | - | I.C. | - | - | | | 50320 | - | - | $1,128.57 | - | - | | | 50323 | - | - | I.C. | - | - | | | 50325 | - | - | I.C. | - | - | | | 50327 | - | - | $156.03 | - | - | | | 50328 | - | - | $136.37 | - | - | | | 50329 | - | - | $129.85 | - | - | | | 50340 | - | - | $713.04 | - | - | | | 50360 | - | - | $1,785.58 | - | - | | | 50365 | - | - | $2,133.67 | - | - | | | 50370 | - | - | $898.62 | - | - | | | 50380 | - | - | $1,511.95 | - | - | | | 50382 | $799.23 | $181.33 | - | - | - | | | 50384 | $682.00 | $163.46 | - | - | - | | | 50385 | $804.62 | $156.72 | - | - | - | | | 50386 | $595.33 | $117.50 | - | - | - | | | 50387 | $445.53 | $59.84 | - | - | - | | | 50389 | $333.93 | $38.51 | - | - | - | | | 50390 | - | - | $68.40 | - | - | | | 50391 | $93.03 | $70.53 | - | - | - | | | 50396 | - | - | $85.24 | - | - | | | 50400 | - | - | $843.57 | - | - | | | 50405 | - | - | $1,017.70 | - | - | | | 50430 | $501.80 | $111.56 | - | - | - | | | 50431 | $257.87 | $48.42 | - | - | - | | | 50432 | $723.04 | $148.26 | - | - | - | | | 50433 | $900.67 | $183.66 | - | - | - | | | 50434 | $724.09 | $138.05 | - | - | - | | | 50435 | $481.73 | $72.73 | - | - | - | | | 50436 | - | - | $108.42 | - | - | | | 50437 | - | - | $180.38 | - | - | | | 50500 | - | - | $917.19 | - | - | | | 50520 | - | - | $853.52 | - | - | | | 50525 | - | - | $1,079.02 | - | - | | | 50526 | - | - | $1,154.91 | - | - | | | 50540 | - | - | $837.40 | - | - | | | 50541 | - | - | $670.61 | - | - | | | 50542 | - | - | $853.19 | - | - | | | 50543 | - | - | $1,087.24 | - | - | | | 50544 | - | - | $904.07 | - | - | | | 50545 | - | - | $971.47 | - | - | | | 50546 | - | - | $879.52 | - | - | | | 50547 | - | - | $1,191.00 | - | - | | | 50548 | - | - | $976.20 | - | - | | | 50549 | - | - | I.C. | - | - | | | 50551 | $269.19 | $212.94 | - | - | - | | | 50553 | $288.57 | $227.51 | - | - | - | | | 50555 | $306.21 | $246.48 | - | - | - | | | 50557 | $311.83 | $249.69 | - | - | - | | | 50561 | $353.24 | $284.41 | - | - | - | | | 50562 | - | - | $418.83 | - | - | | | 50570 | - | - | $353.69 | - | - | | | 50572 | - | - | $382.38 | - | - | | | 50574 | - | - | $406.75 | - | - | | | 50575 | - | - | $513.67 | - | - | | | 50576 | - | - | $405.74 | - | - | | | 50580 | - | - | $436.88 | - | - | | | 50590 | $559.24 | $421.57 | - | - | - | | | 50592 | $2,273.50 | $249.44 | - | - | - | | | 50593 | $3,043.25 | $332.45 | - | - | - | | | 50600 | - | - | $685.64 | - | - | | | 50605 | - | - | $738.63 | - | - | | | 50606 | $381.00 | $98.96 | - | - | - | | | 50610 | - | - | $690.74 | - | - | | | 50620 | - | - | $661.10 | - | - | | | 50630 | - | - | $653.24 | - | - | | | 50650 | - | - | $758.42 | - | - | | | 50660 | - | - | $834.24 | - | - | | | 50684 | $99.89 | $37.75 | - | - | - | | | 50686 | $109.14 | $64.68 | - | - | - | | | 50688 | - | - | $57.49 | - | - | | | 50690 | $92.14 | $51.69 | - | - | - | | | 50693 | $793.44 | $147.14 | - | - | - | | | 50694 | $887.62 | $192.58 | - | - | - | | | 50695 | $1,063.36 | $246.45 | - | - | - | | | 50700 | - | - | $678.51 | - | - | | | 50705 | $1,480.08 | $126.42 | - | - | - | | | 50706 | $667.39 | $129.57 | - | - | - | | | 50715 | - | - | $887.70 | - | - | | | 50722 | - | - | $755.00 | - | - | | | 50725 | - | - | $805.26 | - | - | | | 50727 | - | - | $379.01 | - | - | | | 50728 | - | - | $515.77 | - | - | | | 50740 | - | - | $899.84 | - | - | | | 50750 | - | - | $841.61 | - | - | | | 50760 | - | - | $829.44 | - | - | | | 50770 | - | - | $841.61 | - | - | | | 50780 | - | - | $812.08 | - | - | | | 50782 | - | - | $785.55 | - | - | | | 50783 | - | - | $823.05 | - | - | | | 50785 | - | - | $887.19 | - | - | | | 50800 | - | - | $679.95 | - | - | | | 50810 | - | - | $1,035.42 | - | - | | | 50815 | - | - | $895.58 | - | - | | | 50820 | - | - | $959.28 | - | - | | | 50825 | - | - | $1,199.41 | - | - | | | 50830 | - | - | $1,310.86 | - | - | | | 50840 | - | - | $900.51 | - | - | | | 50845 | - | - | $919.09 | - | - | | | 50860 | - | - | $692.34 | - | - | | | 50900 | - | - | $618.91 | - | - | | | 50920 | - | - | $646.73 | - | - | | | 50930 | - | - | $805.01 | - | - | | | 50940 | - | - | $651.61 | - | - | | | 50945 | - | - | $708.57 | - | - | | | 50947 | - | - | $1,008.11 | - | - | | | 50948 | - | - | $927.60 | - | - | | | 50949 | - | - | I.C. | - | - | | | 50951 | $281.35 | $221.36 | - | - | - | | | 50953 | $297.77 | $235.90 | - | - | - | | | 50955 | $316.88 | $254.21 | - | - | - | | | 50957 | $319.94 | $255.66 | - | - | - | | | 50961 | $289.24 | $228.98 | - | - | - | | | 50970 | - | - | $267.17 | - | - | | | 50972 | - | - | $258.51 | - | - | | | 50974 | - | - | $340.55 | - | - | | | 50976 | - | - | $335.50 | - | - | | | 50980 | - | - | $256.99 | - | - | | | 51020 | - | - | $349.24 | - | - | | | 51030 | - | - | $351.11 | - | - | | | 51040 | - | - | $217.42 | - | - | | | 51045 | - | - | $372.16 | - | - | | | 51050 | - | - | $349.13 | - | - | | | 51060 | - | - | $431.07 | - | - | | | 51065 | - | - | $428.92 | - | - | | | 51080 | - | - | $303.83 | - | - | | | 51100 | $56.18 | $28.33 | - | - | - | | | 51101 | $120.85 | $36.75 | - | - | - | | | 51102 | $184.60 | $104.78 | - | - | - | | | 51500 | - | - | $470.31 | - | - | | | 51520 | - | - | $440.24 | - | - | | | 51525 | - | - | $630.75 | - | - | | | 51530 | - | - | $565.94 | - | - | | | 51535 | - | - | $573.07 | - | - | | | 51550 | - | - | $705.22 | - | - | | | 51555 | - | - | $919.69 | - | - | | | 51565 | - | - | $941.25 | - | - | | | 51570 | - | - | $1,073.45 | - | - | | | 51575 | - | - | $1,323.90 | - | - | | | 51580 | - | - | $1,379.88 | - | - | | | 51585 | - | - | $1,533.80 | - | - | | | 51590 | - | - | $1,403.16 | - | - | | | 51595 | - | - | $1,587.43 | - | - | | | 51596 | - | - | $1,714.07 | - | - | | | 51597 | - | - | $1,671.89 | - | - | | | 51600 | $168.98 | $31.85 | - | - | - | | | 51605 | - | - | $28.25 | - | - | | | 51610 | $100.42 | $47.39 | - | - | - | | | 51700 | $59.14 | $21.91 | - | - | - | | | 51701 | $34.00 | $18.46 | - | - | - | | | 51702 | $47.73 | $18.26 | - | - | - | | | 51703 | $115.39 | $55.66 | - | - | - | | | 51705 | $74.86 | $37.90 | - | - | - | | | 51710 | $104.68 | $58.88 | - | - | - | | | 51715 | $286.33 | $145.45 | - | - | - | | | 51720 | $67.43 | $31.80 | - | - | - | | | 51725 | - | - | $178.98 | $55.37 | $123.61 | | | 51726 | - | - | $236.91 | $61.61 | $175.30 | | | 51727 | - | - | $287.34 | $76.95 | $210.39 | | | 51728 | - | - | $286.74 | $75.28 | $211.46 | | | 51729 | - | - | $302.49 | $91.30 | $211.19 | | | 51736 | - | - | $10.19 | $5.97 | $4.22 | | | 51741 | - | - | $10.65 | $6.17 | $4.49 | | | 51784 | - | - | $48.89 | $26.99 | $21.89 | | | 51785 | - | - | $344.29 | $66.81 | $277.48 | | | 51792 | - | - | $214.81 | $39.38 | $175.43 | | | 51797 | - | - | $152.43 | $28.95 | $123.47 | | | 51798 | - | - | $8.50 | - | - | | | 51800 | - | - | $759.74 | - | - | | | 51820 | - | - | $794.88 | - | - | | | 51840 | - | - | $517.59 | - | - | | | 51841 | - | - | $596.08 | - | - | | | 51845 | - | - | $429.73 | - | - | | | 51860 | - | - | $550.52 | - | - | | | 51865 | - | - | $658.65 | - | - | | | 51880 | - | - | $343.33 | - | - | | | 51900 | - | - | $605.67 | - | - | | | 51920 | - | - | $562.01 | - | - | | | 51925 | - | - | $806.32 | - | - | | | 51940 | - | - | $1,194.64 | - | - | | | 51960 | - | - | $1,010.93 | - | - | | | 51980 | - | - | $525.45 | - | - | | | 51990 | - | - | $546.66 | - | - | | | 51992 | - | - | $614.37 | - | - | | | 51999 | - | - | I.C. | - | - | | | 52000 | $188.30 | $58.40 | - | - | - | | | 52001 | $333.95 | $207.53 | - | - | - | | | 52005 | $236.45 | $96.37 | - | - | - | | | 52007 | $354.00 | $120.45 | - | - | - | | | 52010 | $297.56 | $119.98 | - | - | - | | | 52204 | $296.01 | $102.36 | - | - | - | | | 52214 | $592.28 | $126.23 | - | - | - | | | 52224 | $617.32 | $146.19 | - | - | - | | | 52234 | - | - | $177.95 | - | - | | | 52235 | - | - | $208.60 | - | - | | | 52240 | - | - | $282.79 | - | - | | | 52250 | - | - | $173.23 | - | - | | | 52260 | - | - | $152.87 | - | - | | | 52265 | $291.71 | $118.15 | - | - | - | | | 52270 | $327.84 | $131.51 | - | - | - | | | 52275 | $418.85 | $179.40 | - | - | - | | | 52276 | - | - | $191.02 | - | - | | | 52277 | - | - | $233.45 | - | - | | | 52281 | $253.58 | $110.56 | - | - | - | | | 52282 | - | - | $243.03 | - | - | | | 52283 | $272.08 | $145.93 | - | - | - | | | 52284 | $2,137.50 | $120.13 | - | - | - | | | 52285 | $269.97 | $141.94 | - | - | - | | | 52287 | $302.43 | $122.71 | - | - | - | | | 52290 | - | - | $176.44 | - | - | | | 52300 | - | - | $202.76 | - | - | | | 52301 | - | - | $209.53 | - | - | | | 52305 | - | - | $201.42 | - | - | | | 52310 | $246.95 | $109.82 | - | - | - | | | 52315 | $360.01 | $198.77 | - | - | - | | | 52317 | $690.86 | $249.99 | - | - | - | | | 52318 | - | - | $341.04 | - | - | | | 52320 | - | - | $177.79 | - | - | | | 52325 | - | - | $231.07 | - | - | | | 52327 | - | - | $186.50 | - | - | | | 52330 | $468.95 | $190.13 | - | - | - | | | 52332 | $313.89 | $113.01 | - | - | - | | | 52334 | - | - | $132.76 | - | - | | | 52341 | - | - | $205.59 | - | - | | | 52342 | - | - | $223.19 | - | - | | | 52343 | - | - | $248.55 | - | - | | | 52344 | - | - | $266.08 | - | - | | | 52345 | - | - | $284.28 | - | - | | | 52346 | - | - | $321.54 | - | - | | | 52351 | - | - | $218.46 | - | - | | | 52352 | - | - | $255.73 | - | - | | | 52353 | - | - | $282.79 | - | - | | | 52354 | - | - | $300.58 | - | - | | | 52355 | - | - | $336.64 | - | - | | | 52356 | - | - | $299.51 | - | - | | | 52400 | - | - | $349.07 | - | - | | | 52402 | - | - | $191.65 | - | - | | | 52441 | $1,010.76 | $151.53 | - | - | - | | | 52442 | $696.46 | $36.50 | - | - | - | | | 52450 | - | - | $351.71 | - | - | | | 52500 | - | - | $364.94 | - | - | | | 52601 | - | - | $533.93 | - | - | | | 52630 | - | - | $301.32 | - | - | | | 52640 | - | - | $241.10 | - | - | | | 52647 | $1,220.89 | $478.70 | - | - | - | | | 52648 | $1,257.76 | $509.68 | - | - | - | | | 52649 | - | - | $606.97 | - | - | | | 52700 | - | - | $327.54 | - | - | | | 53000 | - | - | $110.39 | - | - | | | 53010 | - | - | $222.14 | - | - | | | 53020 | - | - | $70.50 | - | - | | | 53025 | - | - | $50.55 | - | - | | | 53040 | - | - | $291.14 | - | - | | | 53060 | $142.98 | $123.97 | - | - | - | | | 53080 | - | - | $312.25 | - | - | | | 53085 | - | - | $478.51 | - | - | | | 53200 | $117.89 | $103.43 | - | - | - | | | 53210 | - | - | $570.87 | - | - | | | 53215 | - | - | $679.55 | - | - | | | 53220 | - | - | $334.65 | - | - | | | 53230 | - | - | $450.21 | - | - | | | 53235 | - | - | $467.84 | - | - | | | 53240 | - | - | $315.23 | - | - | | | 53250 | - | - | $294.42 | - | - | | | 53260 | $155.77 | $134.61 | - | - | - | | | 53265 | $172.93 | $140.25 | - | - | - | | | 53270 | $158.74 | $136.78 | - | - | - | | | 53275 | - | - | $194.13 | - | - | | | 53400 | - | - | $588.54 | - | - | | | 53405 | - | - | $640.98 | - | - | | | 53410 | - | - | $717.54 | - | - | | | 53415 | - | - | $825.66 | - | - | | | 53420 | - | - | $616.67 | - | - | | | 53425 | - | - | $685.40 | - | - | | | 53430 | - | - | $714.60 | - | - | | | 53431 | - | - | $841.97 | - | - | | | 53440 | - | - | $553.63 | - | - | | | 53442 | - | - | $579.77 | - | - | | | 53444 | - | - | $582.51 | - | - | | | 53445 | - | - | $558.47 | - | - | | | 53446 | - | - | $474.39 | - | - | | | 53447 | - | - | $592.88 | - | - | | | 53448 | - | - | $932.36 | - | - | | | 53449 | - | - | $453.43 | - | - | | | 53450 | - | - | $303.62 | - | - | | | 53451 | - | - | I.C. | - | - | | | 53452 | - | - | I.C. | - | - | | | 53453 | - | - | I.C. | - | - | | | 53454 | - | - | I.C. | - | - | | | 53460 | - | - | $338.66 | - | - | | | 53500 | - | - | $552.95 | - | - | | | 53502 | - | - | $359.51 | - | - | | | 53505 | - | - | $359.24 | - | - | | | 53510 | - | - | $466.83 | - | - | | | 53515 | - | - | $584.18 | - | - | | | 53520 | - | - | $413.54 | - | - | | | 53600 | $67.04 | $46.69 | - | - | - | | | 53601 | $64.96 | $38.98 | - | - | - | | | 53605 | - | - | $46.52 | - | - | | | 53620 | $131.32 | $63.28 | - | - | - | | | 53621 | $126.18 | $52.26 | - | - | - | | | 53660 | $58.22 | $30.63 | - | - | - | | | 53661 | $57.13 | $29.81 | - | - | - | | | 53665 | - | - | $27.57 | - | - | | | 53850 | $1,123.85 | $265.16 | - | - | - | | | 53852 | $1,095.42 | $283.87 | - | - | - | | | 53854 | $1,327.97 | $283.67 | - | - | - | | | 53855 | $523.12 | $59.22 | - | - | - | | | 53860 | $1,915.86 | $163.38 | - | - | - | | | 53899 | - | - | I.C. | - | - | | | 54000 | $125.22 | $82.91 | - | - | - | | | 54001 | $151.58 | $104.44 | - | - | - | | | 54015 | - | - | $224.32 | - | - | | | 54050 | $111.59 | $81.32 | - | - | - | | | 54055 | $106.32 | $72.57 | - | - | - | | | 54056 | $111.52 | $85.01 | - | - | - | | | 54057 | $110.51 | $74.09 | - | - | - | | | 54060 | $149.77 | $98.08 | - | - | - | | | 54065 | $170.40 | $129.15 | - | - | - | | | 54100 | $156.58 | $90.16 | - | - | - | | | 54105 | $209.17 | $157.48 | - | - | - | | | 54110 | - | - | $460.03 | - | - | | | 54111 | - | - | $586.26 | - | - | | | 54112 | - | - | $686.75 | - | - | | | 54115 | $341.91 | $316.73 | - | - | - | | | 54120 | - | - | $466.11 | - | - | | | 54125 | - | - | $606.49 | - | - | | | 54130 | - | - | $872.45 | - | - | | | 54135 | - | - | $1,100.62 | - | - | | | 54150 | $112.85 | $70.27 | - | - | - | | | 54160 | $168.12 | $107.32 | - | - | - | | | 54161 | - | - | $146.07 | - | - | | | 54162 | $194.82 | $148.75 | - | - | - | | | 54163 | - | - | $163.48 | - | - | | | 54164 | - | - | $145.22 | - | - | | | 54200 | $89.17 | $65.33 | - | - | - | | | 54205 | - | - | $393.76 | - | - | | | 54220 | $168.16 | $97.45 | - | - | - | | | 54230 | $80.40 | $58.71 | - | - | - | | | 54231 | $107.71 | $84.68 | - | - | - | | | 54235 | $67.89 | $54.77 | - | - | - | | | 54240 | - | - | $81.14 | $47.79 | $33.34 | | | 54250 | - | - | $90.23 | $78.78 | $11.45 | | | 54300 | - | - | $475.65 | - | - | | | 54304 | - | - | $549.66 | - | - | | | 54308 | - | - | $527.48 | - | - | | | 54312 | - | - | $601.79 | - | - | | | 54316 | - | - | $728.13 | - | - | | | 54318 | - | - | $524.84 | - | - | | | 54322 | - | - | $573.89 | - | - | | | 54324 | - | - | $709.14 | - | - | | | 54326 | - | - | $690.67 | - | - | | | 54328 | - | - | $686.22 | - | - | | | 54332 | - | - | $739.38 | - | - | | | 54336 | - | - | $869.01 | - | - | | | 54340 | - | - | $420.91 | - | - | | | 54344 | - | - | $691.92 | - | - | | | 54348 | - | - | $739.50 | - | - | | | 54352 | - | - | $1,031.94 | - | - | | | 54360 | - | - | $530.73 | - | - | | | 54380 | - | - | $587.62 | - | - | | | 54385 | - | - | $683.50 | - | - | | | 54390 | - | - | $907.66 | - | - | | | 54400 | - | - | $393.03 | - | - | | | 54401 | - | - | $494.62 | - | - | | | 54405 | - | - | $593.67 | - | - | | | 54406 | - | - | $538.44 | - | - | | | 54408 | - | - | $582.22 | - | - | | | 54410 | - | - | $635.06 | - | - | | | 54411 | - | - | $756.36 | - | - | | | 54415 | - | - | $393.70 | - | - | | | 54416 | - | - | $529.40 | - | - | | | 54417 | - | - | $660.19 | - | - | | | 54420 | - | - | $517.23 | - | - | | | 54430 | - | - | $471.36 | - | - | | | 54435 | - | - | $307.82 | - | - | | | 54437 | - | - | $501.34 | - | - | | | 54438 | - | - | $976.65 | - | - | | | 54440 | - | - | I.C. | - | - | | | 54450 | $50.85 | $41.47 | - | - | - | | | 54500 | - | - | $54.76 | - | - | | | 54505 | - | - | $155.43 | - | - | | | 54512 | - | - | $396.47 | - | - | | | 54520 | - | - | $243.74 | - | - | | | 54522 | - | - | $433.45 | - | - | | | 54530 | - | - | $377.25 | - | - | | | 54535 | - | - | $547.52 | - | - | | | 54550 | - | - | $363.58 | - | - | | | 54560 | - | - | $506.58 | - | - | | | 54600 | - | - | $335.43 | - | - | | | 54620 | - | - | $220.18 | - | - | | | 54640 | - | - | $317.34 | - | - | | | 54650 | - | - | $525.27 | - | - | | | 54660 | - | - | $266.97 | - | - | | | 54670 | - | - | $304.50 | - | - | | | 54680 | - | - | $578.84 | - | - | | | 54690 | - | - | $481.73 | - | - | | | 54692 | - | - | $554.09 | - | - | | | 54699 | - | - | I.C. | - | - | | | 54700 | - | - | $157.77 | - | - | | | 54800 | - | - | $90.84 | - | - | | | 54830 | - | - | $277.26 | - | - | | | 54840 | - | - | $239.79 | - | - | | | 54860 | - | - | $311.11 | - | - | | | 54861 | - | - | $420.13 | - | - | | | 54865 | - | - | $268.37 | - | - | | | 54900 | - | - | $588.78 | - | - | | | 54901 | - | - | $775.99 | - | - | | | 55000 | $91.64 | $62.18 | - | - | - | | | 55040 | - | - | $251.56 | - | - | | | 55041 | - | - | $379.42 | - | - | | | 55060 | - | - | $282.89 | - | - | | | 55100 | $176.53 | $125.37 | - | - | - | | | 55110 | - | - | $288.63 | - | - | | | 55120 | - | - | $264.33 | - | - | | | 55150 | - | - | $366.41 | - | - | | | 55175 | - | - | $272.15 | - | - | | | 55180 | - | - | $508.99 | - | - | | | 55200 | $292.48 | $206.24 | - | - | - | | | 55250 | $422.22 | $244.77 | - | - | - | | | 55300 | - | - | $135.34 | - | - | | | 55400 | - | - | $369.14 | - | - | | | 55500 | - | - | $292.35 | - | - | | | 55520 | - | - | $342.16 | - | - | | | 55530 | - | - | $261.85 | - | - | | | 55535 | - | - | $319.46 | - | - | | | 55540 | - | - | $413.00 | - | - | | | 55550 | - | - | $318.63 | - | - | | | 55559 | - | - | I.C. | - | - | | | 55600 | - | - | $313.31 | - | - | | | 55605 | - | - | $388.62 | - | - | | | 55650 | - | - | $528.95 | - | - | | | 55680 | - | - | $258.29 | - | - | | | 55700 | $185.33 | $94.26 | - | - | - | | | 55705 | - | - | $195.38 | - | - | | | 55706 | - | - | $278.44 | - | - | | | 55720 | - | - | $334.15 | - | - | | | 55725 | - | - | $440.95 | - | - | | | 55801 | - | - | $802.50 | - | - | | | 55810 | - | - | $953.10 | - | - | | | 55812 | - | - | $1,172.04 | - | - | | | 55815 | - | - | $1,282.29 | - | - | | | 55821 | - | - | $615.04 | - | - | | | 55831 | - | - | $631.14 | - | - | | | 55840 | - | - | $854.67 | - | - | | | 55842 | - | - | $855.07 | - | - | | | 55845 | - | - | $992.96 | - | - | | | 55860 | - | - | $641.70 | - | - | | | 55862 | - | - | $801.41 | - | - | | | 55865 | - | - | $974.48 | - | - | | | 55866 | - | - | $872.42 | - | - | | | 55867 | - | - | $766.63 | - | - | | | 55870 | $132.38 | $102.92 | - | - | - | | | 55873 | $4,588.75 | $562.04 | - | - | - | | | 55874 | $2,322.54 | $120.36 | - | - | - | | | 55875 | - | - | $576.18 | - | - | | | 55876 | $115.80 | $75.08 | - | - | - | | | 55880 | - | - | $717.42 | - | - | | | 55899 | - | - | I.C. | - | - | | | 55920 | - | - | $342.48 | - | - | | | 55970 | - | - | I.C. | - | - | | | 55980 | - | - | I.C. | - | - | | | 56405 | $114.33 | $97.46 | - | - | - | | | 56420 | $145.78 | $84.72 | - | - | - | | | 56440 | - | - | $135.60 | - | - | | | 56441 | $141.43 | $117.86 | - | - | - | | | 56442 | - | - | $35.65 | - | - | | | 56501 | $151.09 | $102.61 | - | - | - | | | 56515 | $213.97 | $160.94 | - | - | - | | | 56605 | $74.19 | $43.66 | - | - | - | | | 56606 | $29.13 | $21.63 | - | - | - | | | 56620 | - | - | $446.93 | - | - | | | 56625 | - | - | $504.17 | - | - | | | 56630 | - | - | $721.24 | - | - | | | 56631 | - | - | $886.04 | - | - | | | 56632 | - | - | $1,077.19 | - | - | | | 56633 | - | - | $921.61 | - | - | | | 56634 | - | - | $966.48 | - | - | | | 56637 | - | - | $1,129.83 | - | - | | | 56640 | - | - | $1,137.26 | - | - | | | 56700 | - | - | $154.53 | - | - | | | 56740 | - | - | $237.12 | - | - | | | 56800 | - | - | $190.64 | - | - | | | 56805 | - | - | $869.45 | - | - | | | 56810 | - | - | $204.27 | - | - | | | 56820 | $95.83 | $62.35 | - | - | - | | | 56821 | $128.17 | $83.44 | - | - | - | | | 57000 | - | - | $152.77 | - | - | | | 57010 | - | - | $345.95 | - | - | | | 57020 | $96.63 | $58.33 | - | - | - | | | 57022 | - | - | $136.97 | - | - | | | 57023 | - | - | $239.71 | - | - | | | 57061 | $131.31 | $88.72 | - | - | - | | | 57065 | $191.04 | $140.95 | - | - | - | | | 57100 | $79.25 | $47.91 | - | - | - | | | 57105 | $137.19 | $112.28 | - | - | - | | | 57106 | - | - | $406.90 | - | - | | | 57107 | - | - | $1,084.28 | - | - | | | 57109 | - | - | $1,287.71 | - | - | | | 57110 | - | - | $673.94 | - | - | | | 57111 | - | - | $1,287.71 | - | - | | | 57120 | - | - | $399.60 | - | - | | | 57130 | $179.05 | $131.37 | - | - | - | | | 57135 | $191.68 | $142.40 | - | - | - | | | 57150 | $45.18 | $18.93 | - | - | - | | | 57155 | $303.10 | $211.23 | - | - | - | | | 57156 | $176.06 | $113.12 | - | - | - | | | 57160 | $57.00 | $33.70 | - | - | - | | | 57170 | $85.07 | $49.73 | - | - | - | | | 57180 | $156.26 | $92.52 | - | - | - | | | 57200 | - | - | $252.25 | - | - | | | 57210 | - | - | $297.54 | - | - | | | 57220 | - | - | $262.84 | - | - | | | 57230 | - | - | $317.13 | - | - | | | 57240 | - | - | $459.46 | - | - | | | 57250 | - | - | $461.46 | - | - | | | 57260 | - | - | $581.01 | - | - | | | 57265 | - | - | $649.47 | - | - | | | 57267 | - | - | $183.03 | - | - | | | 57268 | - | - | $382.77 | - | - | | | 57270 | - | - | $607.96 | - | - | | | 57280 | - | - | $718.22 | - | - | | | 57282 | - | - | $518.74 | - | - | | | 57283 | - | - | $522.88 | - | - | | | 57284 | - | - | $618.83 | - | - | | | 57285 | - | - | $517.68 | - | - | | | 57287 | - | - | $559.50 | - | - | | | 57288 | - | - | $555.90 | - | - | | | 57289 | - | - | $595.37 | - | - | | | 57291 | - | - | $413.36 | - | - | | | 57292 | - | - | $618.68 | - | - | | | 57295 | - | - | $377.64 | - | - | | | 57296 | - | - | $713.89 | - | - | | | 57300 | - | - | $462.48 | - | - | | | 57305 | - | - | $736.54 | - | - | | | 57307 | - | - | $812.57 | - | - | | | 57308 | - | - | $498.14 | - | - | | | 57310 | - | - | $369.69 | - | - | | | 57311 | - | - | $415.32 | - | - | | | 57320 | - | - | $425.39 | - | - | | | 57330 | - | - | $568.64 | - | - | | | 57335 | - | - | $878.37 | - | - | | | 57400 | - | - | $95.65 | - | - | | | 57410 | - | - | $78.24 | - | - | | | 57415 | - | - | $132.85 | - | - | | | 57420 | $101.22 | $65.87 | - | - | - | | | 57421 | $135.52 | $89.19 | - | - | - | | | 57423 | - | - | $690.77 | - | - | | | 57425 | - | - | $722.53 | - | - | | | 57426 | - | - | $651.58 | - | - | | | 57452 | $97.17 | $67.44 | - | - | - | | | 57454 | $128.19 | $98.19 | - | - | - | | | 57455 | $123.22 | $79.83 | - | - | - | | | 57456 | $116.38 | $74.33 | - | - | - | | | 57460 | $245.35 | $117.59 | - | - | - | | | 57461 | $272.49 | $134.55 | - | - | - | | | 57465 | $41.38 | $31.47 | - | - | - | | | 57500 | $120.50 | $55.68 | - | - | - | | | 57505 | $121.59 | $84.09 | - | - | - | | | 57510 | $128.85 | $83.59 | - | - | - | | | 57511 | $154.92 | $112.06 | - | - | - | | | 57513 | $160.27 | $111.80 | - | - | - | | | 57520 | $271.52 | $224.91 | - | - | - | | | 57522 | $232.63 | $192.99 | - | - | - | | | 57530 | - | - | $283.70 | - | - | | | 57531 | - | - | $1,341.69 | - | - | | | 57540 | - | - | $591.76 | - | - | | | 57545 | - | - | $622.69 | - | - | | | 57550 | - | - | $326.95 | - | - | | | 57555 | - | - | $465.19 | - | - | | | 57556 | - | - | $442.03 | - | - | | | 57558 | $122.24 | $98.13 | - | - | - | | | 57700 | - | - | $273.84 | - | - | | | 57720 | - | - | $254.56 | - | - | | | 57800 | $60.09 | $35.45 | - | - | - | | | 58100 | $77.89 | $46.28 | - | - | - | | | 58110 | $37.32 | $29.29 | - | - | - | | | 58120 | $228.26 | $175.49 | - | - | - | | | 58140 | - | - | $696.17 | - | - | | | 58145 | - | - | $426.93 | - | - | | | 58146 | - | - | $858.21 | - | - | | | 58150 | - | - | $753.93 | - | - | | | 58152 | - | - | $918.97 | - | - | | | 58180 | - | - | $712.66 | - | - | | | 58200 | - | - | $998.13 | - | - | | | 58210 | - | - | $1,351.53 | - | - | | | 58240 | - | - | $2,176.55 | - | - | | | 58260 | - | - | $626.66 | - | - | | | 58262 | - | - | $690.76 | - | - | | | 58263 | - | - | $740.33 | - | - | | | 58267 | - | - | $797.50 | - | - | | | 58270 | - | - | $667.79 | - | - | | | 58275 | - | - | $736.98 | - | - | | | 58280 | - | - | $789.54 | - | - | | | 58285 | - | - | $1,058.27 | - | - | | | 58290 | - | - | $855.49 | - | - | | | 58291 | - | - | $923.79 | - | - | | | 58292 | - | - | $973.17 | - | - | | | 58294 | - | - | $904.35 | - | - | | | 58300 | $288.45 | $248.71 | - | - | - | | | 58301 | $120.09 | $70.41 | - | - | - | | | 58321 | $63.15 | $35.57 | - | - | - | | | 58322 | $69.84 | $42.25 | - | - | - | | | 58323 | $11.25 | $8.84 | - | - | - | | | 58340 | $195.76 | $42.83 | - | - | - | | | 58345 | - | - | $216.65 | - | - | | | 58346 | - | - | $376.16 | - | - | | | 58350 | $121.42 | $73.48 | - | - | - | | | 58353 | $748.11 | $174.13 | - | - | - | | | 58356 | $1,343.51 | $262.51 | - | - | - | | | 58400 | - | - | $349.48 | - | - | | | 58410 | - | - | $609.53 | - | - | | | 58520 | - | - | $597.68 | - | - | | | 58540 | - | - | $683.52 | - | - | | | 58541 | - | - | $545.81 | - | - | | | 58542 | - | - | $619.68 | - | - | | | 58543 | - | - | $628.92 | - | - | | | 58544 | - | - | $676.41 | - | - | | | 58545 | - | - | $670.08 | - | - | | | 58546 | - | - | $825.85 | - | - | | | 58548 | - | - | $1,397.75 | - | - | | | 58550 | - | - | $656.87 | - | - | | | 58552 | - | - | $730.15 | - | - | | | 58553 | - | - | $830.26 | - | - | | | 58554 | - | - | $966.30 | - | - | | | 58555 | $284.74 | $111.71 | - | - | - | | | 58558 | $1,070.48 | $170.27 | - | - | - | | | 58559 | - | - | $208.66 | - | - | | | 58560 | - | - | $229.49 | - | - | | | 58561 | - | - | $262.60 | - | - | | | 58562 | $336.65 | $163.09 | - | - | - | | | 58563 | $1,710.92 | $181.02 | - | - | - | | | 58565 | $2,085.42 | $489.03 | - | - | - | | | 58570 | - | - | $603.11 | - | - | | | 58571 | - | - | $677.26 | - | - | | | 58572 | - | - | $772.29 | - | - | | | 58573 | - | - | $904.24 | - | - | | | 58575 | - | - | $1,434.41 | - | - | | | 58578 | - | - | I.C. | - | - | | | 58579 | - | - | I.C. | - | - | | | 58580 | $2,468.04 | $297.94 | - | - | - | | | 58600 | - | - | $395.44 | - | - | | | 58605 | - | - | $359.99 | - | - | | | 58611 | - | - | $80.33 | - | - | | | 58615 | - | - | $270.82 | - | - | | | 58660 | - | - | $506.41 | - | - | | | 58661 | - | - | $484.89 | - | - | | | 58662 | - | - | $530.11 | - | - | | | 58670 | - | - | $279.27 | - | - | | | 58671 | - | - | $279.27 | - | - | | | 58672 | - | - | $542.95 | - | - | | | 58673 | - | - | $589.15 | - | - | | | 58674 | - | - | $605.60 | - | - | | | 58679 | - | - | I.C. | - | - | | | 58700 | - | - | $597.81 | - | - | | | 58720 | - | - | $567.25 | - | - | | | 58740 | - | - | $672.91 | - | - | | | 58750 | - | - | $677.85 | - | - | | | 58752 | - | - | $675.98 | - | - | | | 58760 | - | - | $613.18 | - | - | | | 58770 | - | - | $643.44 | - | - | | | 58800 | $277.57 | $239.00 | - | - | - | | | 58805 | - | - | $323.82 | - | - | | | 58820 | - | - | $258.16 | - | - | | | 58822 | - | - | $535.26 | - | - | | | 58825 | - | - | $531.04 | - | - | | | 58900 | - | - | $330.66 | - | - | | | 58920 | - | - | $534.73 | - | - | | | 58925 | - | - | $573.64 | - | - | | | 58940 | - | - | $418.93 | - | - | | | 58943 | - | - | $871.95 | - | - | | | 58950 | - | - | $861.29 | - | - | | | 58951 | - | - | $1,071.77 | - | - | | | 58952 | - | - | $1,225.39 | - | - | | | 58953 | - | - | $1,484.42 | - | - | | | 58954 | - | - | $1,604.03 | - | - | | | 58956 | - | - | $1,010.67 | - | - | | | 58957 | - | - | $1,181.19 | - | - | | | 58958 | - | - | $1,230.50 | - | - | | | 58960 | - | - | $744.06 | - | - | | | 58970 | $181.61 | $144.39 | - | - | - | | | 58974 | - | - | I.C. | - | - | | | 58976 | $194.91 | $156.34 | - | - | - | | | 58999 | - | - | I.C. | - | - | | | 59000 | $134.97 | $84.03 | - | - | - | | | 59001 | - | - | $185.91 | - | - | | | 59012 | - | - | $209.45 | - | - | | | 59015 | $166.20 | $136.53 | - | - | - | | | 59020 | - | - | $76.83 | $38.21 | $38.62 | | | 59025 | - | - | $53.42 | $30.72 | $22.70 | | | 59030 | - | - | $116.09 | - | - | | | 59050 | - | - | $52.69 | - | - | | | 59051 | - | - | $43.51 | - | - | | | 59070 | $297.95 | $224.03 | - | - | - | | | 59072 | - | - | $377.27 | - | - | | | 59074 | $285.37 | $224.03 | - | - | - | | | 59076 | - | - | $377.27 | - | - | | | 59100 | - | - | $632.97 | - | - | | | 59120 | - | - | $857.76 | - | - | | | 59121 | - | - | $857.53 | - | - | | | 59130 | - | - | $700.43 | - | - | | | 59136 | - | - | $942.69 | - | - | | | 59140 | - | - | $312.13 | - | - | | | 59150 | - | - | $832.42 | - | - | | | 59151 | - | - | $814.02 | - | - | | | 59160 | $298.48 | $199.68 | - | - | - | | | 59200 | $305.08 | $256.76 | - | - | - | | | 59300 | $250.05 | $154.10 | - | - | - | | | 59320 | - | - | $158.12 | - | - | | | 59325 | - | - | $250.86 | - | - | | | 59350 | - | - | $201.89 | - | - | | | 59400 | - | - | $2,176.78 | - | - | | | 59409 | - | - | $839.04 | - | - | | | 59410 | - | - | $1,098.64 | - | - | | | 59412 | - | - | $74.83 | - | - | | | 59414 | - | - | $94.25 | - | - | | | 59425 | $594.97 | $447.54 | - | - | - | | | 59426 | $1,088.69 | $821.94 | - | - | - | | | 59430 | $284.15 | $185.35 | - | - | - | | | 59510 | - | - | $2,405.36 | - | - | | | 59514 | - | - | $943.39 | - | - | | | 59515 | - | - | $1,349.66 | - | - | | | 59525 | - | - | $347.94 | - | - | | | 59610 | - | - | $2,281.10 | - | - | | | 59612 | - | - | $942.04 | - | - | | | 59614 | - | - | $1,180.08 | - | - | | | 59618 | - | - | $2,435.34 | - | - | | | 59620 | - | - | $974.84 | - | - | | | 59622 | - | - | $1,402.33 | - | - | | | 59812 | $390.21 | $325.23 | - | - | - | | | 59820 | $476.09 | $413.78 | - | - | - | | | 59821 | $467.19 | $402.21 | - | - | - | | | 59830 | - | - | $347.24 | - | - | | | 59840 | $189.45 | $166.68 | - | - | - | | | 59841 | $321.17 | $276.44 | - | - | - | | | 59850 | - | - | $290.86 | - | - | | | 59851 | - | - | $321.01 | - | - | | | 59852 | - | - | $441.65 | - | - | | | 59855 | - | - | $316.01 | - | - | | | 59856 | - | - | $368.28 | - | - | | | 59857 | - | - | $428.04 | - | - | | | 59866 | - | - | $173.17 | - | - | | | 59870 | - | - | $406.75 | - | - | | | 59871 | - | - | $97.29 | - | - | | | 59897 | - | - | I.C. | - | - | | | 59898 | - | - | I.C. | - | - | | | 59899 | - | - | I.C. | - | - | | | 60000 | $143.86 | $120.83 | - | - | - | | | 60100 | $83.58 | $56.26 | - | - | - | | | 60200 | - | - | $501.40 | - | - | | | 60210 | - | - | $527.05 | - | - | | | 60212 | - | - | $757.23 | - | - | | | 60220 | - | - | $527.89 | - | - | | | 60225 | - | - | $697.46 | - | - | | | 60240 | - | - | $680.66 | - | - | | | 60252 | - | - | $978.41 | - | - | | | 60254 | - | - | $1,235.71 | - | - | | | 60260 | - | - | $807.00 | - | - | | | 60270 | - | - | $1,005.97 | - | - | | | 60271 | - | - | $781.89 | - | - | | | 60280 | - | - | $345.72 | - | - | | | 60281 | - | - | $451.67 | - | - | | | 60300 | $83.34 | $35.39 | - | - | - | | | 60500 | - | - | $719.31 | - | - | | | 60502 | - | - | $962.27 | - | - | | | 60505 | - | - | $1,035.10 | - | - | | | 60512 | - | - | $175.92 | - | - | | | 60520 | - | - | $772.84 | - | - | | | 60521 | - | - | $815.89 | - | - | | | 60522 | - | - | $987.29 | - | - | | | 60540 | - | - | $791.98 | - | - | | | 60545 | - | - | $916.24 | - | - | | | 60600 | - | - | $988.01 | - | - | | | 60605 | - | - | $1,164.17 | - | - | | | 60650 | - | - | $870.94 | - | - | | | 60659 | - | - | I.C. | - | - | | | 60699 | - | - | I.C. | - | - | | | 61000 | - | - | $83.28 | - | - | | | 61001 | - | - | $78.81 | - | - | | | 61020 | - | - | $77.96 | - | - | | | 61026 | - | - | $78.84 | - | - | | | 61050 | - | - | $59.19 | - | - | | | 61055 | - | - | $86.81 | - | - | | | 61070 | - | - | $41.80 | - | - | | | 61105 | - | - | $350.50 | - | - | | | 61107 | - | - | $225.57 | - | - | | | 61108 | - | - | $678.07 | - | - | | | 61120 | - | - | $561.16 | - | - | | | 61140 | - | - | $942.39 | - | - | | | 61150 | - | - | $998.41 | - | - | | | 61151 | - | - | $738.34 | - | - | | | 61154 | - | - | $949.79 | - | - | | | 61156 | - | - | $910.82 | - | - | | | 61210 | - | - | $264.98 | - | - | | | 61215 | - | - | $390.75 | - | - | | | 61250 | - | - | $647.87 | - | - | | | 61253 | - | - | $738.34 | - | - | | | 61304 | - | - | $1,207.17 | - | - | | | 61305 | - | - | $1,477.34 | - | - | | | 61312 | - | - | $1,520.78 | - | - | | | 61313 | - | - | $1,462.50 | - | - | | | 61314 | - | - | $1,344.43 | - | - | | | 61315 | - | - | $1,522.59 | - | - | | | 61316 | - | - | $63.17 | - | - | | | 61320 | - | - | $1,392.03 | - | - | | | 61321 | - | - | $1,563.45 | - | - | | | 61322 | - | - | $1,751.32 | - | - | | | 61323 | - | - | $1,754.14 | - | - | | | 61330 | - | - | $1,323.92 | - | - | | | 61333 | - | - | $1,481.76 | - | - | | | 61340 | - | - | $1,065.35 | - | - | | | 61343 | - | - | $1,615.34 | - | - | | | 61345 | - | - | $1,504.42 | - | - | | | 61450 | - | - | $1,412.00 | - | - | | | 61458 | - | - | $1,485.38 | - | - | | | 61460 | - | - | $1,550.47 | - | - | | | 61500 | - | - | $967.77 | - | - | | | 61501 | - | - | $845.40 | - | - | | | 61510 | - | - | $1,624.96 | - | - | | | 61512 | - | - | $1,875.56 | - | - | | | 61514 | - | - | $1,413.82 | - | - | | | 61516 | - | - | $1,380.46 | - | - | | | 61517 | - | - | $62.73 | - | - | | | 61518 | - | - | $2,035.46 | - | - | | | 61519 | - | - | $2,160.16 | - | - | | | 61520 | - | - | $2,737.57 | - | - | | | 61521 | - | - | $2,320.30 | - | - | | | 61522 | - | - | $1,609.10 | - | - | | | 61524 | - | - | $1,534.75 | - | - | | | 61526 | - | - | $2,462.74 | - | - | | | 61530 | - | - | $2,247.56 | - | - | | | 61531 | - | - | $912.16 | - | - | | | 61533 | - | - | $1,128.74 | - | - | | | 61534 | - | - | $1,221.87 | - | - | | | 61535 | - | - | $750.58 | - | - | | | 61536 | - | - | $1,890.60 | - | - | | | 61537 | - | - | $1,799.16 | - | - | | | 61538 | - | - | $1,946.95 | - | - | | | 61539 | - | - | $1,734.20 | - | - | | | 61540 | - | - | $1,600.45 | - | - | | | 61541 | - | - | $1,582.71 | - | - | | | 61543 | - | - | $1,599.19 | - | - | | | 61544 | - | - | $1,396.84 | - | - | | | 61545 | - | - | $2,337.53 | - | - | | | 61546 | - | - | $1,696.45 | - | - | | | 61548 | - | - | $1,156.24 | - | - | | | 61550 | - | - | $893.72 | - | - | | | 61552 | - | - | $1,102.97 | - | - | | | 61556 | - | - | $1,262.07 | - | - | | | 61557 | - | - | $1,249.50 | - | - | | | 61558 | - | - | $1,390.28 | - | - | | | 61559 | - | - | $1,768.42 | - | - | | | 61563 | - | - | $1,459.47 | - | - | | | 61564 | - | - | $1,769.28 | - | - | | | 61566 | - | - | $1,646.54 | - | - | | | 61567 | - | - | $1,875.08 | - | - | | | 61570 | - | - | $1,381.15 | - | - | | | 61571 | - | - | $1,467.55 | - | - | | | 61575 | - | - | $1,838.00 | - | - | | | 61576 | - | - | $3,091.88 | - | - | | | 61580 | - | - | $1,874.51 | - | - | | | 61581 | - | - | $2,060.79 | - | - | | | 61582 | - | - | $2,373.12 | - | - | | | 61583 | - | - | $2,182.75 | - | - | | | 61584 | - | - | $2,160.31 | - | - | | | 61585 | - | - | $2,440.37 | - | - | | | 61586 | - | - | $1,916.77 | - | - | | | 61590 | - | - | $2,261.54 | - | - | | | 61591 | - | - | $2,294.68 | - | - | | | 61592 | - | - | $2,349.20 | - | - | | | 61595 | - | - | $1,787.85 | - | - | | | 61596 | - | - | $1,830.29 | - | - | | | 61597 | - | - | $2,190.40 | - | - | | | 61598 | - | - | $2,126.60 | - | - | | | 61600 | - | - | $1,604.10 | - | - | | | 61601 | - | - | $1,816.62 | - | - | | | 61605 | - | - | $1,636.43 | - | - | | | 61606 | - | - | $2,165.43 | - | - | | | 61607 | - | - | $1,979.06 | - | - | | | 61608 | - | - | $2,425.99 | - | - | | | 61611 | - | - | $337.01 | - | - | | | 61613 | - | - | $2,429.73 | - | - | | | 61615 | - | - | $2,100.19 | - | - | | | 61616 | - | - | $2,475.85 | - | - | | | 61618 | - | - | $956.86 | - | - | | | 61619 | - | - | $1,060.66 | - | - | | | 61623 | - | - | $416.82 | - | - | | | 61624 | - | - | $837.94 | - | - | | | 61626 | - | - | $649.41 | - | - | | | 61630 | - | - | $998.87 | - | - | | | 61635 | - | - | $1,078.39 | - | - | | | 61640 | - | - | $335.44 | - | - | | | 61641 | - | - | $117.81 | - | - | | | 61642 | - | - | $235.63 | - | - | | | 61645 | - | - | $608.20 | - | - | | | 61650 | - | - | $413.23 | - | - | | | 61651 | - | - | $177.58 | - | - | | | 61680 | - | - | $1,644.42 | - | - | | | 61682 | - | - | $3,024.55 | - | - | | | 61684 | - | - | $2,083.18 | - | - | | | 61686 | - | - | $3,272.67 | - | - | | | 61690 | - | - | $1,603.94 | - | - | | | 61692 | - | - | $2,662.41 | - | - | | | 61697 | - | - | $3,082.13 | - | - | | | 61698 | - | - | $3,369.73 | - | - | | | 61700 | - | - | $2,480.13 | - | - | | | 61702 | - | - | $2,933.50 | - | - | | | 61703 | - | - | $1,007.48 | - | - | | | 61705 | - | - | $1,907.99 | - | - | | | 61708 | - | - | $1,866.77 | - | - | | | 61710 | - | - | $1,575.67 | - | - | | | 61711 | - | - | $1,885.54 | - | - | | | 61720 | - | - | $942.48 | - | - | | | 61735 | - | - | $1,180.23 | - | - | | | 61736 | - | - | $649.42 | - | - | | | 61737 | - | - | $774.44 | - | - | | | 61750 | - | - | $1,040.23 | - | - | | | 61751 | - | - | $1,030.20 | - | - | | | 61760 | - | - | $1,171.97 | - | - | | | 61770 | - | - | $1,195.61 | - | - | | | 61781 | - | - | $170.21 | - | - | | | 61782 | - | - | $127.23 | - | - | | | 61783 | - | - | $167.48 | - | - | | | 61790 | - | - | $659.67 | - | - | | | 61791 | - | - | $837.16 | - | - | | | 61796 | - | - | $755.66 | - | - | | | 61797 | - | - | $157.72 | - | - | | | 61798 | - | - | $1,017.56 | - | - | | | 61799 | - | - | $218.22 | - | - | | | 61800 | - | - | $109.71 | - | - | | | 61850 | - | - | $733.53 | - | - | | | 61860 | - | - | $1,153.66 | - | - | | | 61863 | - | - | $1,115.04 | - | - | | | 61864 | - | - | $203.77 | - | - | | | 61867 | - | - | $1,676.12 | - | - | | | 61868 | - | - | $359.48 | - | - | | | 61880 | - | - | $442.48 | - | - | | | 61885 | - | - | $398.39 | - | - | | | 61886 | - | - | $663.04 | - | - | | | 61888 | - | - | $297.39 | - | - | | | 61889 | - | - | $933.62 | - | - | | | 61891 | - | - | $445.53 | - | - | | | 61892 | - | - | $618.17 | - | - | | | 62000 | - | - | $770.12 | - | - | | | 62005 | - | - | $943.19 | - | - | | | 62010 | - | - | $1,138.06 | - | - | | | 62100 | - | - | $1,162.33 | - | - | | | 62115 | - | - | $1,251.37 | - | - | | | 62117 | - | - | $1,446.15 | - | - | | | 62120 | - | - | $1,559.74 | - | - | | | 62121 | - | - | $1,166.43 | - | - | | | 62140 | - | - | $759.73 | - | - | | | 62141 | - | - | $847.74 | - | - | | | 62142 | - | - | $665.65 | - | - | | | 62143 | - | - | $777.86 | - | - | | | 62145 | - | - | $1,046.46 | - | - | | | 62146 | - | - | $927.07 | - | - | | | 62147 | - | - | $1,047.67 | - | - | | | 62148 | - | - | $90.67 | - | - | | | 62160 | - | - | $135.74 | - | - | | | 62161 | - | - | $1,125.34 | - | - | | | 62162 | - | - | $1,393.73 | - | - | | | 62164 | - | - | $1,546.47 | - | - | | | 62165 | - | - | $1,126.36 | - | - | | | 62180 | - | - | $1,181.23 | - | - | | | 62190 | - | - | $694.42 | - | - | | | 62192 | - | - | $726.04 | - | - | | | 62194 | - | - | $373.57 | - | - | | | 62200 | - | - | $1,018.38 | - | - | | | 62201 | - | - | $907.07 | - | - | | | 62220 | - | - | $716.75 | - | - | | | 62223 | - | - | $772.84 | - | - | | | 62225 | - | - | $404.82 | - | - | | | 62230 | - | - | $626.34 | - | - | | | 62252 | - | - | $63.89 | $33.16 | $30.73 | | | 62256 | - | - | $459.36 | - | - | | | 62258 | - | - | $825.62 | - | - | | | 62263 | $497.16 | $237.35 | - | - | - | | | 62264 | $339.86 | $180.23 | - | - | - | | | 62267 | $205.67 | $113.00 | - | - | - | | | 62268 | - | - | $188.15 | - | - | | | 62269 | - | - | $191.46 | - | - | | | 62270 | $102.23 | $45.45 | - | - | - | | | 62272 | $136.74 | $65.76 | - | - | - | | | 62273 | $128.55 | $83.02 | - | - | - | | | 62280 | $254.34 | $118.00 | - | - | - | | | 62281 | $185.03 | $118.34 | - | - | - | | | 62282 | $245.32 | $105.51 | - | - | - | | | 62284 | $148.71 | $61.93 | - | - | - | | | 62287 | - | - | $422.83 | - | - | | | 62290 | $272.77 | $115.82 | - | - | - | | | 62291 | $250.88 | $107.05 | - | - | - | | | 62292 | - | - | $431.12 | - | - | | | 62294 | - | - | $708.72 | - | - | | | 62302 | $200.55 | $87.52 | - | - | - | | | 62303 | $204.30 | $87.52 | - | - | - | | | 62304 | $199.30 | $86.27 | - | - | - | | | 62305 | $217.02 | $89.79 | - | - | - | | | 62320 | $126.68 | $73.91 | - | - | - | | | 62321 | $204.48 | $78.60 | - | - | - | | | 62322 | $106.10 | $58.96 | - | - | - | | | 62323 | $201.95 | $72.85 | - | - | - | | | 62324 | $105.12 | $65.21 | - | - | - | | | 62325 | $197.14 | $81.44 | - | - | - | | | 62326 | $106.17 | $62.78 | - | - | - | | | 62327 | $209.95 | $77.91 | - | - | - | | | 62328 | $180.88 | $63.03 | - | - | - | | | 62329 | $222.83 | $78.73 | - | - | - | | | 62350 | - | - | $296.87 | - | - | | | 62351 | - | - | $676.59 | - | - | | | 62355 | - | - | $207.50 | - | - | | | 62360 | - | - | $239.17 | - | - | | | 62361 | - | - | $327.52 | - | - | | | 62362 | - | - | $287.78 | - | - | | | 62365 | - | - | $222.75 | - | - | | | 62367 | $23.93 | $18.04 | - | - | - | | | 62368 | $33.00 | $25.24 | - | - | - | | | 62369 | $71.57 | $25.50 | - | - | - | | | 62370 | $71.44 | $33.68 | - | - | - | | | 62380 | - | - | I.C. | - | - | | | 63001 | - | - | $913.12 | - | - | | | 63003 | - | - | $914.11 | - | - | | | 63005 | - | - | $891.78 | - | - | | | 63011 | - | - | $815.67 | - | - | | | 63012 | - | - | $888.62 | - | - | | | 63015 | - | - | $1,096.77 | - | - | | | 63016 | - | - | $1,130.74 | - | - | | | 63017 | - | - | $940.07 | - | - | | | 63020 | - | - | $818.71 | - | - | | | 63030 | - | - | $684.08 | - | - | | | 63035 | - | - | $169.72 | - | - | | | 63040 | - | - | $1,023.85 | - | - | | | 63042 | - | - | $962.53 | - | - | | | 63043 | - | - | I.C. | - | - | | | 63044 | - | - | I.C. | - | - | | | 63045 | - | - | $956.47 | - | - | | | 63046 | - | - | $913.89 | - | - | | | 63047 | - | - | $824.41 | - | - | | | 63048 | - | - | $152.49 | - | - | | | 63050 | - | - | $1,094.07 | - | - | | | 63051 | - | - | $1,252.75 | - | - | | | 63052 | - | - | $187.23 | - | - | | | 63053 | - | - | $165.89 | - | - | | | 63055 | - | - | $1,200.70 | - | - | | | 63056 | - | - | $1,104.09 | - | - | | | 63057 | - | - | $232.69 | - | - | | | 63064 | - | - | $1,314.21 | - | - | | | 63066 | - | - | $148.25 | - | - | | | 63075 | - | - | $1,006.38 | - | - | | | 63076 | - | - | $176.41 | - | - | | | 63077 | - | - | $1,126.63 | - | - | | | 63078 | - | - | $149.01 | - | - | | | 63081 | - | - | $1,298.71 | - | - | | | 63082 | - | - | $192.06 | - | - | | | 63085 | - | - | $1,417.69 | - | - | | | 63086 | - | - | $137.21 | - | - | | | 63087 | - | - | $1,772.23 | - | - | | | 63088 | - | - | $186.79 | - | - | | | 63090 | - | - | $1,432.52 | - | - | | | 63091 | - | - | $127.68 | - | - | | | 63101 | - | - | $1,713.65 | - | - | | | 63102 | - | - | $1,688.38 | - | - | | | 63103 | - | - | $213.41 | - | - | | | 63170 | - | - | $1,179.42 | - | - | | | 63172 | - | - | $1,045.74 | - | - | | | 63173 | - | - | $1,274.88 | - | - | | | 63185 | - | - | $851.73 | - | - | | | 63190 | - | - | $924.30 | - | - | | | 63191 | - | - | $1,025.41 | - | - | | | 63197 | - | - | $1,264.50 | - | - | | | 63200 | - | - | $1,130.81 | - | - | | | 63250 | - | - | $2,169.78 | - | - | | | 63251 | - | - | $2,219.58 | - | - | | | 63252 | - | - | $2,218.94 | - | - | | | 63265 | - | - | $1,235.19 | - | - | | | 63266 | - | - | $1,269.89 | - | - | | | 63267 | - | - | $1,018.95 | - | - | | | 63268 | - | - | $1,039.79 | - | - | | | 63270 | - | - | $1,530.67 | - | - | | | 63271 | - | - | $1,530.28 | - | - | | | 63272 | - | - | $1,379.95 | - | - | | | 63273 | - | - | $1,379.23 | - | - | | | 63275 | - | - | $1,334.99 | - | - | | | 63276 | - | - | $1,320.14 | - | - | | | 63277 | - | - | $1,158.23 | - | - | | | 63278 | - | - | $1,181.17 | - | - | | | 63280 | - | - | $1,561.68 | - | - | | | 63281 | - | - | $1,546.92 | - | - | | | 63282 | - | - | $1,462.38 | - | - | | | 63283 | - | - | $1,406.41 | - | - | | | 63285 | - | - | $1,919.56 | - | - | | | 63286 | - | - | $1,900.67 | - | - | | | 63287 | - | - | $2,011.83 | - | - | | | 63290 | - | - | $2,045.59 | - | - | | | 63295 | - | - | $238.55 | - | - | | | 63300 | - | - | $1,341.43 | - | - | | | 63301 | - | - | $1,625.10 | - | - | | | 63302 | - | - | $1,605.66 | - | - | | | 63303 | - | - | $1,701.08 | - | - | | | 63304 | - | - | $1,728.57 | - | - | | | 63305 | - | - | $1,837.28 | - | - | | | 63306 | - | - | $1,806.15 | - | - | | | 63307 | - | - | $1,767.49 | - | - | | | 63308 | - | - | $231.17 | - | - | | | 63600 | - | - | $810.79 | - | - | | | 63610 | - | - | $421.73 | - | - | | | 63620 | - | - | $833.97 | - | - | | | 63621 | - | - | $181.81 | - | - | | | 63650 | $1,828.43 | $306.84 | - | - | - | | | 63655 | - | - | $627.71 | - | - | | | 63661 | $531.60 | $244.21 | - | - | - | | | 63662 | - | - | $635.22 | - | - | | | 63663 | $698.95 | $333.88 | - | - | - | | | 63664 | - | - | $661.72 | - | - | | | 63685 | - | - | $270.86 | - | - | | | 63688 | - | - | $279.98 | - | - | | | 63700 | - | - | $977.78 | - | - | | | 63702 | - | - | $1,065.78 | - | - | | | 63704 | - | - | $1,239.84 | - | - | | | 63706 | - | - | $1,372.88 | - | - | | | 63707 | - | - | $702.83 | - | - | | | 63709 | - | - | $830.92 | - | - | | | 63710 | - | - | $805.98 | - | - | | | 63740 | - | - | $738.34 | - | - | | | 63741 | - | - | $514.72 | - | - | | | 63744 | - | - | $509.77 | - | - | | | 63746 | - | - | $460.41 | - | - | | | 64400 | $86.98 | $37.16 | - | - | - | | | 64405 | $56.34 | $38.39 | - | - | - | | | 64408 | $63.42 | $33.42 | - | - | - | | | 64415 | $103.68 | $50.64 | - | - | - | | | 64416 | - | - | $56.58 | - | - | | | 64417 | $124.47 | $46.26 | - | - | - | | | 64418 | $66.29 | $40.85 | - | - | - | | | 64420 | $74.78 | $43.17 | - | - | - | | | 64421 | $24.83 | $17.86 | - | - | - | | | 64425 | $85.68 | $40.41 | - | - | - | | | 64430 | $75.90 | $40.28 | - | - | - | | | 64435 | $62.55 | $32.01 | - | - | - | | | 64445 | $124.75 | $53.77 | - | - | - | | | 64446 | - | - | $55.35 | - | - | | | 64447 | $89.38 | $45.99 | - | - | - | | | 64448 | - | - | $52.24 | - | - | | | 64449 | - | - | $45.28 | - | - | | | 64450 | $57.73 | $30.94 | - | - | - | | | 64451 | $178.22 | $60.10 | - | - | - | | | 64454 | $172.86 | $60.37 | - | - | - | | | 64455 | $37.51 | $24.38 | - | - | - | | | 64461 | $103.03 | $56.69 | - | - | - | | | 64462 | $54.38 | $35.36 | - | - | - | | | 64463 | $181.16 | $59.29 | - | - | - | | | 64479 | $205.64 | $96.36 | - | - | - | | | 64480 | $104.10 | $44.91 | - | - | - | | | 64483 | $191.54 | $81.99 | - | - | - | | | 64484 | $86.48 | $37.73 | - | - | - | | | 64486 | $86.33 | $39.99 | - | - | - | | | 64487 | $170.15 | $45.87 | - | - | - | | | 64488 | $106.66 | $49.61 | - | - | - | | | 64489 | $279.69 | $56.58 | - | - | - | | | 64490 | $147.26 | $77.62 | - | - | - | | | 64491 | $73.92 | $43.39 | - | - | - | | | 64492 | $74.46 | $44.19 | - | - | - | | | 64493 | $136.50 | $66.86 | - | - | - | | | 64494 | $69.34 | $37.47 | - | - | - | | | 64495 | $69.34 | $38.00 | - | - | - | | | 64505 | $109.60 | $77.72 | - | - | - | | | 64510 | $113.49 | $57.25 | - | - | - | | | 64517 | $148.73 | $93.56 | - | - | - | | | 64520 | $180.09 | $62.77 | - | - | - | | | 64530 | $180.56 | $70.21 | - | - | - | | | 64553 | $2,014.98 | $293.31 | - | - | - | | | 64555 | $1,718.82 | $240.88 | - | - | - | | | 64561 | $577.21 | $223.12 | - | - | - | | | 64566 | $92.09 | $21.91 | - | - | - | | | 64568 | - | - | $449.12 | - | - | | | 64569 | - | - | $571.57 | - | - | | | 64570 | - | - | $552.08 | - | - | | | 64575 | - | - | $230.15 | - | - | | | 64580 | - | - | $236.54 | - | - | | | 64581 | - | - | $481.83 | - | - | | | 64582 | - | - | $639.22 | - | - | | | 64583 | - | - | $644.43 | - | - | | | 64584 | - | - | $544.29 | - | - | | | 64585 | $187.36 | $107.28 | - | - | - | | | 64590 | $202.78 | $120.28 | - | - | - | | | 64595 | $180.09 | $95.72 | - | - | - | | | 64596 | - | - | I.C. | - | - | | | 64597 | - | - | I.C. | - | - | | | 64598 | - | - | I.C. | - | - | | | 64600 | $361.26 | $172.16 | - | - | - | | | 64605 | $500.28 | $260.30 | - | - | - | | | 64610 | $598.43 | $354.97 | - | - | - | | | 64611 | $99.24 | $84.24 | - | - | - | | | 64612 | $104.33 | $89.60 | - | - | - | | | 64615 | $115.34 | $89.89 | - | - | - | | | 64616 | $103.10 | $80.06 | - | - | - | | | 64617 | $124.77 | $80.31 | - | - | - | | | 64620 | $157.91 | $131.93 | - | - | - | | | 64624 | $304.46 | $108.13 | - | - | - | | | 64625 | $368.63 | $144.18 | - | - | - | | | 64628 | - | - | $337.62 | - | - | | | 64629 | - | - | $154.83 | - | - | | | 64630 | $194.42 | $142.19 | - | - | - | | | 64632 | $68.27 | $49.53 | - | - | - | | | 64633 | $341.20 | $141.66 | - | - | - | | | 64634 | $202.65 | $48.91 | - | - | - | | | 64635 | $344.41 | $141.93 | - | - | - | | | 64636 | $190.77 | $43.19 | - | - | - | | | 64640 | $191.56 | $87.90 | - | - | - | | | 64642 | $114.42 | $78.26 | - | - | - | | | 64643 | $69.69 | $51.47 | - | - | - | | | 64644 | $134.45 | $85.43 | - | - | - | | | 64645 | $90.92 | $59.58 | - | - | - | | | 64646 | $120.56 | $84.94 | - | - | - | | | 64647 | $137.38 | $97.74 | - | - | - | | | 64650 | $68.82 | $29.98 | - | - | - | | | 64653 | $80.86 | $38.00 | - | - | - | | | 64680 | $270.92 | $120.39 | - | - | - | | | 64681 | $357.81 | $165.24 | - | - | - | | | 64702 | - | - | $393.02 | - | - | | | 64704 | - | - | $245.62 | - | - | | | 64708 | - | - | $381.81 | - | - | | | 64712 | - | - | $449.27 | - | - | | | 64713 | - | - | $596.26 | - | - | | | 64714 | - | - | $571.66 | - | - | | | 64718 | - | - | $460.92 | - | - | | | 64719 | - | - | $312.17 | - | - | | | 64721 | $341.96 | $335.53 | - | - | - | | | 64722 | - | - | $276.75 | - | - | | | 64726 | - | - | $203.48 | - | - | | | 64727 | - | - | $132.51 | - | - | | | 64732 | - | - | $344.72 | - | - | | | 64734 | - | - | $389.44 | - | - | | | 64736 | - | - | $249.47 | - | - | | | 64738 | - | - | $341.74 | - | - | | | 64740 | - | - | $350.70 | - | - | | | 64742 | - | - | $373.04 | - | - | | | 64744 | - | - | $382.75 | - | - | | | 64746 | - | - | $318.96 | - | - | | | 64755 | - | - | $677.88 | - | - | | | 64760 | - | - | $388.94 | - | - | | | 64763 | - | - | $384.79 | - | - | | | 64766 | - | - | $473.90 | - | - | | | 64772 | - | - | $422.82 | - | - | | | 64774 | - | - | $323.03 | - | - | | | 64776 | - | - | $301.75 | - | - | | | 64778 | - | - | $132.06 | - | - | | | 64782 | - | - | $343.18 | - | - | | | 64783 | - | - | $157.26 | - | - | | | 64784 | - | - | $544.75 | - | - | | | 64786 | - | - | $740.91 | - | - | | | 64787 | - | - | $172.47 | - | - | | | 64788 | - | - | $306.98 | - | - | | | 64790 | - | - | $632.77 | - | - | | | 64792 | - | - | $791.91 | - | - | | | 64795 | - | - | $142.45 | - | - | | | 64802 | - | - | $635.15 | - | - | | | 64804 | - | - | $887.55 | - | - | | | 64809 | - | - | $810.28 | - | - | | | 64818 | - | - | $584.04 | - | - | | | 64820 | - | - | $577.76 | - | - | | | 64821 | - | - | $526.58 | - | - | | | 64822 | - | - | $529.58 | - | - | | | 64823 | - | - | $597.63 | - | - | | | 64831 | - | - | $526.58 | - | - | | | 64832 | - | - | $243.90 | - | - | | | 64834 | - | - | $552.55 | - | - | | | 64835 | - | - | $613.20 | - | - | | | 64836 | - | - | $613.20 | - | - | | | 64837 | - | - | $265.00 | - | - | | | 64840 | - | - | $720.99 | - | - | | | 64856 | - | - | $755.10 | - | - | | | 64857 | - | - | $787.14 | - | - | | | 64858 | - | - | $875.09 | - | - | | | 64859 | - | - | $180.24 | - | - | | | 64861 | - | - | $1,128.07 | - | - | | | 64862 | - | - | $1,020.38 | - | - | | | 64864 | - | - | $645.59 | - | - | | | 64865 | - | - | $820.07 | - | - | | | 64866 | - | - | $939.23 | - | - | | | 64868 | - | - | $751.52 | - | - | | | 64872 | - | - | $84.31 | - | - | | | 64874 | - | - | $126.01 | - | - | | | 64876 | - | - | $142.78 | - | - | | | 64885 | - | - | $802.46 | - | - | | | 64886 | - | - | $964.14 | - | - | | | 64890 | - | - | $804.76 | - | - | | | 64891 | - | - | $855.09 | - | - | | | 64892 | - | - | $783.76 | - | - | | | 64893 | - | - | $834.84 | - | - | | | 64895 | - | - | $984.43 | - | - | | | 64896 | - | - | $1,060.54 | - | - | | | 64897 | - | - | $941.11 | - | - | | | 64898 | - | - | $1,018.85 | - | - | | | 64901 | - | - | $432.41 | - | - | | | 64902 | - | - | $500.93 | - | - | | | 64905 | - | - | $751.36 | - | - | | | 64907 | - | - | $965.25 | - | - | | | 64910 | - | - | $574.00 | - | - | | | 64911 | - | - | $769.78 | - | - | | | 64912 | - | - | $674.53 | - | - | | | 64913 | - | - | $126.90 | - | - | | | 64999 | - | - | I.C. | - | - | | | 65091 | - | - | $574.72 | - | - | | | 65093 | - | - | $570.67 | - | - | | | 65101 | - | - | $657.09 | - | - | | | 65103 | - | - | $675.80 | - | - | | | 65105 | - | - | $735.29 | - | - | | | 65110 | - | - | $1,006.23 | - | - | | | 65112 | - | - | $1,149.74 | - | - | | | 65114 | - | - | $1,199.34 | - | - | | | 65125 | $354.51 | $222.73 | - | - | - | | | 65130 | - | - | $658.95 | - | - | | | 65135 | - | - | $666.51 | - | - | | | 65140 | - | - | $715.01 | - | - | | | 65150 | - | - | $544.55 | - | - | | | 65155 | - | - | $742.86 | - | - | | | 65175 | - | - | $603.65 | - | - | | | 65205 | - | - | $21.64 | - | - | | | 65210 | $28.86 | $26.72 | - | - | - | | | 65220 | $45.90 | $30.63 | - | - | - | | | 65222 | $51.37 | $37.17 | - | - | - | | | 65235 | - | - | $552.33 | - | - | | | 65260 | - | - | $740.05 | - | - | | | 65265 | - | - | $832.12 | - | - | | | 65270 | $222.83 | $106.05 | - | - | - | | | 65272 | $408.05 | $265.29 | - | - | - | | | 65273 | - | - | $284.87 | - | - | | | 65275 | $450.40 | $345.40 | - | - | - | | | 65280 | - | - | $502.71 | - | - | | | 65285 | - | - | $826.82 | - | - | | | 65286 | $536.80 | $371.81 | - | - | - | | | 65290 | - | - | $367.82 | - | - | | | 65400 | $528.43 | $454.24 | - | - | - | | | 65410 | $109.17 | $75.96 | - | - | - | | | 65420 | $417.55 | $287.38 | - | - | - | | | 65426 | $516.37 | $359.69 | - | - | - | | | 65430 | $86.94 | $75.42 | - | - | - | | | 65435 | $62.76 | $51.78 | - | - | - | | | 65436 | $292.82 | $277.55 | - | - | - | | | 65450 | $250.60 | $244.97 | - | - | - | | | 65600 | $336.23 | $256.15 | - | - | - | | | 65710 | - | - | $860.53 | - | - | | | 65730 | - | - | $942.19 | - | - | | | 65750 | - | - | $946.95 | - | - | | | 65755 | - | - | $943.72 | - | - | | | 65756 | - | - | $880.06 | - | - | | | 65757 | - | - | I.C. | - | - | | | 65760 | - | - | I.C. | - | - | | | 65765 | - | - | I.C. | - | - | | | 65767 | - | - | I.C. | - | - | | | 65770 | - | - | $1,052.48 | - | - | | | 65771 | - | - | I.C. | - | - | | | 65772 | $347.30 | $304.72 | - | - | - | | | 65775 | - | - | $434.24 | - | - | | | 65778 | $1,061.02 | $38.95 | - | - | - | | | 65779 | $908.17 | $108.40 | - | - | - | | | 65780 | - | - | $505.95 | - | - | | | 65781 | - | - | $992.16 | - | - | | | 65782 | - | - | $857.53 | - | - | | | 65785 | $1,716.14 | $334.36 | - | - | - | | | 65800 | $90.48 | $65.57 | - | - | - | | | 65810 | - | - | $349.23 | - | - | | | 65815 | $494.26 | $358.46 | - | - | - | | | 65820 | - | - | $628.76 | - | - | | | 65850 | - | - | $633.15 | - | - | | | 65855 | $185.99 | $153.32 | - | - | - | | | 65860 | $233.38 | $185.17 | - | - | - | | | 65865 | - | - | $361.67 | - | - | | | 65870 | - | - | $448.73 | - | - | | | 65875 | - | - | $478.90 | - | - | | | 65880 | - | - | $502.67 | - | - | | | 65900 | - | - | $748.15 | - | - | | | 65920 | - | - | $596.68 | - | - | | | 65930 | - | - | $483.32 | - | - | | | 66020 | $152.64 | $98.80 | - | - | - | | | 66030 | $138.02 | $84.18 | - | - | - | | | 66130 | $538.58 | $422.34 | - | - | - | | | 66150 | - | - | $662.73 | - | - | | | 66155 | - | - | $662.21 | - | - | | | 66160 | - | - | $742.87 | - | - | | | 66170 | - | - | $822.40 | - | - | | | 66172 | - | - | $899.13 | - | - | | | 66174 | - | - | $470.30 | - | - | | | 66175 | - | - | $544.67 | - | - | | | 66179 | - | - | $811.55 | - | - | | | 66180 | - | - | $854.77 | - | - | | | 66183 | - | - | $773.82 | - | - | | | 66184 | - | - | $597.62 | - | - | | | 66185 | - | - | $641.05 | - | - | | | 66225 | - | - | $701.27 | - | - | | | 66250 | $578.57 | $418.13 | - | - | - | | | 66500 | - | - | $303.40 | - | - | | | 66505 | - | - | $329.15 | - | - | | | 66600 | - | - | $690.59 | - | - | | | 66605 | - | - | $820.68 | - | - | | | 66625 | - | - | $323.31 | - | - | | | 66630 | - | - | $426.02 | - | - | | | 66635 | - | - | $429.76 | - | - | | | 66680 | - | - | $393.65 | - | - | | | 66682 | - | - | $546.36 | - | - | | | 66700 | $343.71 | $293.62 | - | - | - | | | 66710 | $335.94 | $293.62 | - | - | - | | | 66711 | - | - | $383.51 | - | - | | | 66720 | $356.79 | $310.45 | - | - | - | | | 66740 | $333.53 | $293.62 | - | - | - | | | 66761 | $229.12 | $177.69 | - | - | - | | | 66762 | $363.04 | $319.38 | - | - | - | | | 66770 | $401.69 | $361.78 | - | - | - | | | 66820 | - | - | $363.72 | - | - | | | 66821 | $255.33 | $236.59 | - | - | - | | | 66825 | - | - | $636.43 | - | - | | | 66830 | - | - | $531.25 | - | - | | | 66840 | - | - | $519.66 | - | - | | | 66850 | - | - | $590.63 | - | - | | | 66852 | - | - | $627.75 | - | - | | | 66920 | - | - | $560.93 | - | - | | | 66930 | - | - | $641.96 | - | - | | | 66940 | - | - | $588.17 | - | - | | | 66982 | - | - | $557.51 | - | - | | | 66983 | - | - | I.C. | - | - | | | 66984 | - | - | $407.64 | - | - | | | 66985 | - | - | $577.55 | - | - | | | 66986 | - | - | $675.88 | - | - | | | 66987 | - | - | I.C. | - | - | | | 66988 | - | - | I.C. | - | - | | | 66989 | - | - | $638.21 | - | - | | | 66990 | - | - | $64.82 | - | - | | | 66991 | - | - | $511.52 | - | - | | | 66999 | - | - | I.C. | - | - | | | 67005 | - | - | $358.45 | - | - | | | 67010 | - | - | $409.38 | - | - | | | 67015 | - | - | $458.48 | - | - | | | 67025 | $565.19 | $474.39 | - | - | - | | | 67027 | - | - | $633.83 | - | - | | | 67028 | $85.67 | $67.99 | - | - | - | | | 67030 | - | - | $424.23 | - | - | | | 67031 | $295.36 | $266.44 | - | - | - | | | 67036 | - | - | $670.35 | - | - | | | 67039 | - | - | $717.03 | - | - | | | 67040 | - | - | $773.03 | - | - | | | 67041 | - | - | $851.97 | - | - | | | 67042 | - | - | $851.70 | - | - | | | 67043 | - | - | $897.31 | - | - | | | 67101 | $255.28 | $214.57 | - | - | - | | | 67105 | $224.80 | $207.12 | - | - | - | | | 67107 | - | - | $837.27 | - | - | | | 67108 | - | - | $885.68 | - | - | | | 67110 | $675.76 | $611.75 | - | - | - | | | 67113 | - | - | $990.85 | - | - | | | 67115 | - | - | $375.75 | - | - | | | 67120 | $512.14 | $416.79 | - | - | - | | | 67121 | - | - | $675.64 | - | - | | | 67141 | $206.63 | $163.51 | - | - | - | | | 67145 | $185.20 | $163.51 | - | - | - | | | 67208 | $453.89 | $432.20 | - | - | - | | | 67210 | $389.37 | $374.64 | - | - | - | | | 67218 | - | - | $1,037.80 | - | - | | | 67220 | $401.22 | $374.44 | - | - | - | | | 67221 | $205.91 | $153.95 | - | - | - | | | 67225 | $21.68 | $20.34 | - | - | - | | | 67227 | $223.68 | $190.20 | - | - | - | | | 67228 | $255.91 | $226.18 | - | - | - | | | 67229 | - | - | $863.89 | - | - | | | 67250 | - | - | $694.71 | - | - | | | 67255 | - | - | $519.50 | - | - | | | 67299 | - | - | I.C. | - | - | | | 67311 | - | - | $342.02 | - | - | | | 67312 | - | - | $496.03 | - | - | | | 67314 | - | - | $342.02 | - | - | | | 67316 | - | - | $531.52 | - | - | | | 67318 | - | - | $513.41 | - | - | | | 67320 | - | - | $151.71 | - | - | | | 67331 | - | - | $146.65 | - | - | | | 67332 | - | - | $155.11 | - | - | | | 67334 | - | - | $144.37 | - | - | | | 67335 | - | - | $138.19 | - | - | | | 67340 | - | - | $214.73 | - | - | | | 67343 | - | - | $505.09 | - | - | | | 67345 | $182.54 | $160.57 | - | - | - | | | 67346 | - | - | $142.43 | - | - | | | 67399 | - | - | I.C. | - | - | | | 67400 | - | - | $795.30 | - | - | | | 67405 | - | - | $695.91 | - | - | | | 67412 | - | - | $762.42 | - | - | | | 67413 | - | - | $741.86 | - | - | | | 67414 | - | - | $1,105.69 | - | - | | | 67415 | - | - | $75.62 | - | - | | | 67420 | - | - | $1,328.15 | - | - | | | 67430 | - | - | $1,061.21 | - | - | | | 67440 | - | - | $1,029.57 | - | - | | | 67445 | - | - | $1,160.85 | - | - | | | 67450 | - | - | $1,066.49 | - | - | | | 67500 | $57.41 | $46.96 | - | - | - | | | 67505 | $65.18 | $53.66 | - | - | - | | | 67515 | $38.85 | $35.10 | - | - | - | | | 67516 | $91.35 | $72.35 | - | - | - | | | 67550 | - | - | $832.55 | - | - | | | 67560 | - | - | $848.68 | - | - | | | 67570 | - | - | $974.20 | - | - | | | 67599 | - | - | I.C. | - | - | | | 67700 | $224.50 | $87.90 | - | - | - | | | 67710 | $192.38 | $74.53 | - | - | - | | | 67715 | $208.79 | $81.83 | - | - | - | | | 67800 | $98.59 | $76.63 | - | - | - | | | 67801 | $124.62 | $98.64 | - | - | - | | | 67805 | $155.07 | $122.66 | - | - | - | | | 67808 | - | - | $277.05 | - | - | | | 67810 | $145.19 | $50.38 | - | - | - | | | 67820 | $14.40 | $16.54 | - | - | - | | | 67825 | $103.64 | $92.12 | - | - | - | | | 67830 | $211.44 | $103.50 | - | - | - | | | 67835 | - | - | $331.83 | - | - | | | 67840 | $218.96 | $118.25 | - | - | - | | | 67850 | $169.21 | $99.03 | - | - | - | | | 67875 | $142.05 | $71.08 | - | - | - | | | 67880 | $359.21 | $276.98 | - | - | - | | | 67882 | $437.49 | $353.93 | - | - | - | | | 67900 | $497.98 | $378.52 | - | - | - | | | 67901 | $613.79 | $443.98 | - | - | - | | | 67902 | - | - | $543.90 | - | - | | | 67903 | $461.54 | $359.49 | - | - | - | | | 67904 | $566.44 | $445.92 | - | - | - | | | 67906 | - | - | $377.88 | - | - | | | 67908 | $416.79 | $325.99 | - | - | - | | | 67909 | $422.32 | $329.65 | - | - | - | | | 67911 | - | - | $418.81 | - | - | | | 67912 | $706.21 | $365.25 | - | - | - | | | 67914 | $379.78 | $248.28 | - | - | - | | | 67915 | $247.82 | $151.67 | - | - | - | | | 67916 | $471.61 | $322.70 | - | - | - | | | 67917 | $481.22 | $342.48 | - | - | - | | | 67921 | $372.66 | $236.33 | - | - | - | | | 67922 | $240.32 | $151.94 | - | - | - | | | 67923 | $471.88 | $322.96 | - | - | - | | | 67924 | $501.71 | $342.35 | - | - | - | | | 67930 | $285.27 | $175.18 | - | - | - | | | 67935 | $458.60 | $327.36 | - | - | - | | | 67938 | $215.24 | $89.62 | - | - | - | | | 67950 | $448.94 | $347.16 | - | - | - | | | 67961 | $451.59 | $340.70 | - | - | - | | | 67966 | $592.33 | $488.94 | - | - | - | | | 67971 | - | - | $537.37 | - | - | | | 67973 | - | - | $689.53 | - | - | | | 67974 | - | - | $688.00 | - | - | | | 67975 | - | - | $509.49 | - | - | | | 67999 | - | - | I.C. | - | - | | | 68020 | $92.48 | $83.10 | - | - | - | | | 68040 | $46.79 | $35.00 | - | - | - | | | 68100 | $140.25 | $71.14 | - | - | - | | | 68110 | $183.96 | $111.64 | - | - | - | | | 68115 | $259.40 | $137.27 | - | - | - | | | 68130 | $425.22 | $309.78 | - | - | - | | | 68135 | $120.12 | $112.89 | - | - | - | | | 68200 | $31.55 | $25.39 | - | - | - | | | 68320 | $573.60 | $406.20 | - | - | - | | | 68325 | - | - | $491.54 | - | - | | | 68326 | - | - | $482.91 | - | - | | | 68328 | - | - | $527.87 | - | - | | | 68330 | $480.03 | $345.84 | - | - | - | | | 68335 | - | - | $484.23 | - | - | | | 68340 | $468.03 | $299.56 | - | - | - | | | 68360 | $417.69 | $308.41 | - | - | - | | | 68362 | - | - | $490.98 | - | - | | | 68371 | - | - | $310.07 | - | - | | | 68399 | - | - | I.C. | - | - | | | 68400 | $233.43 | $98.44 | - | - | - | | | 68420 | $259.27 | $124.28 | - | - | - | | | 68440 | $80.21 | $76.19 | - | - | - | | | 68500 | - | - | $806.61 | - | - | | | 68505 | - | - | $803.12 | - | - | | | 68510 | $347.29 | $212.30 | - | - | - | | | 68520 | - | - | $561.16 | - | - | | | 68525 | - | - | $189.81 | - | - | | | 68530 | $336.11 | $189.07 | - | - | - | | | 68540 | - | - | $744.63 | - | - | | | 68550 | - | - | $927.19 | - | - | | | 68700 | - | - | $451.64 | - | - | | | 68705 | $203.91 | $124.63 | - | - | - | | | 68720 | - | - | $614.49 | - | - | | | 68745 | - | - | $617.91 | - | - | | | 68750 | - | - | $653.07 | - | - | | | 68760 | $171.20 | $109.86 | - | - | - | | | 68761 | $112.73 | $88.89 | - | - | - | | | 68770 | - | - | $470.43 | - | - | | | 68801 | $74.45 | $60.25 | - | - | - | | | 68810 | $123.94 | $96.62 | - | - | - | | | 68811 | - | - | $101.38 | - | - | | | 68815 | $293.35 | $167.47 | - | - | - | | | 68816 | $684.17 | $117.96 | - | - | - | | | 68840 | $102.40 | $89.01 | - | - | - | | | 68841 | $28.87 | $24.31 | - | - | - | | | 68850 | $44.29 | $38.67 | - | - | - | | | 68899 | - | - | I.C. | - | - | | | 69000 | $145.85 | $95.50 | - | - | - | | | 69005 | $170.04 | $121.83 | - | - | - | | | 69020 | $185.15 | $111.50 | - | - | - | | | 69090 | - | - | I.C. | - | - | | | 69100 | $75.13 | $34.69 | - | - | - | | | 69105 | $114.81 | $48.12 | - | - | - | | | 69110 | $369.29 | $253.05 | - | - | - | | | 69120 | - | - | $300.92 | - | - | | | 69140 | - | - | $704.74 | - | - | | | 69145 | $325.21 | $199.59 | - | - | - | | | 69150 | - | - | $769.56 | - | - | | | 69155 | - | - | $1,234.91 | - | - | | | 69200 | $62.03 | $35.25 | - | - | - | | | 69205 | - | - | $73.13 | - | - | | | 69209 | - | - | $12.25 | - | - | | | 69210 | $36.09 | $24.03 | - | - | - | | | 69220 | $60.22 | $38.26 | - | - | - | | | 69222 | $170.47 | $105.39 | - | - | - | | | 69300 | $504.25 | $355.86 | - | - | - | | | 69310 | - | - | $869.94 | - | - | | | 69320 | - | - | $1,207.53 | - | - | | | 69399 | - | - | I.C. | - | - | | | 69420 | $150.35 | $92.49 | - | - | - | | | 69421 | - | - | $116.88 | - | - | | | 69424 | $100.75 | $45.58 | - | - | - | | | 69433 | $158.55 | $101.50 | - | - | - | | | 69436 | - | - | $122.11 | - | - | | | 69440 | - | - | $536.13 | - | - | | | 69450 | - | - | $425.69 | - | - | | | 69501 | - | - | $545.25 | - | - | | | 69502 | - | - | $722.64 | - | - | | | 69505 | - | - | $953.05 | - | - | | | 69511 | - | - | $974.19 | - | - | | | 69530 | - | - | $1,288.51 | - | - | | | 69535 | - | - | $2,026.58 | - | - | | | 69540 | $167.79 | $101.36 | - | - | - | | | 69550 | - | - | $825.74 | - | - | | | 69552 | - | - | $1,218.52 | - | - | | | 69554 | - | - | $1,922.39 | - | - | | | 69601 | - | - | $779.84 | - | - | | | 69602 | - | - | $836.24 | - | - | | | 69603 | - | - | $994.19 | - | - | | | 69604 | - | - | $853.84 | - | - | | | 69610 | $295.20 | $216.45 | - | - | - | | | 69620 | $582.67 | $379.91 | - | - | - | | | 69631 | - | - | $688.87 | - | - | | | 69632 | - | - | $835.14 | - | - | | | 69633 | - | - | $811.13 | - | - | | | 69635 | - | - | $990.38 | - | - | | | 69636 | - | - | $1,090.91 | - | - | | | 69637 | - | - | $1,086.28 | - | - | | | 69641 | - | - | $802.56 | - | - | | | 69642 | - | - | $1,027.21 | - | - | | | 69643 | - | - | $940.15 | - | - | | | 69644 | - | - | $1,163.82 | - | - | | | 69645 | - | - | $1,142.66 | - | - | | | 69646 | - | - | $1,210.80 | - | - | | | 69650 | - | - | $618.68 | - | - | | | 69660 | - | - | $709.13 | - | - | | | 69661 | - | - | $922.85 | - | - | | | 69662 | - | - | $882.73 | - | - | | | 69666 | - | - | $622.15 | - | - | | | 69667 | - | - | $622.40 | - | - | | | 69670 | - | - | $725.83 | - | - | | | 69676 | - | - | $644.18 | - | - | | | 69700 | - | - | $511.57 | - | - | | | 69705 | $2,217.54 | $129.19 | - | - | - | | | 69706 | $2,288.46 | $179.76 | - | - | - | | | 69710 | - | - | I.C. | - | - | | | 69711 | - | - | $644.23 | - | - | | | 69714 | - | - | $375.66 | - | - | | | 69716 | - | - | $469.53 | - | - | | | 69717 | - | - | $424.91 | - | - | | | 69719 | - | - | $486.41 | - | - | | | 69720 | - | - | $914.18 | - | - | | | 69725 | - | - | $1,414.68 | - | - | | | 69726 | - | - | $363.01 | - | - | | | 69727 | - | - | $403.84 | - | - | | | 69728 | - | - | $449.06 | - | - | | | 69729 | - | - | $507.53 | - | - | | | 69730 | - | - | $519.07 | - | - | | | 69740 | - | - | $883.74 | - | - | | | 69745 | - | - | $943.47 | - | - | | | 69799 | - | - | I.C. | - | - | | | 69801 | $177.84 | $92.66 | - | - | - | | | 69805 | - | - | $781.55 | - | - | | | 69806 | - | - | $703.13 | - | - | | | 69905 | - | - | $707.03 | - | - | | | 69910 | - | - | $754.41 | - | - | | | 69915 | - | - | $1,135.74 | - | - | | | 69930 | - | - | $922.41 | - | - | | | 69949 | - | - | I.C. | - | - | | | 69950 | - | - | $1,312.39 | - | - | | | 69955 | - | - | $1,486.56 | - | - | | | 69960 | - | - | $1,418.80 | - | - | | | 69970 | - | - | $1,604.93 | - | - | | | 69979 | - | - | I.C. | - | - | | | 69990 | - | - | $156.63 | - | - | | | 80503 | $20.30 | $16.29 | | | | | | 80504 | $39.69 | $35.13 | - | - | - | | | 80505 | $71.46 | $66.64 | - | - | - | | | 80506 | - | - | $31.91 | - | - | | | 83020 | - | - | - | $13.01 | - | | | 84165 | - | - | - | $13.01 | - | | | 84166 | - | - | - | $13.01 | - | | | 84181 | - | - | - | $13.01 | - | | | 84182 | - | - | - | $13.01 | - | | | 85060 | - | - | $17.71 | - | - | | | 85097 | $52.21 | $35.33 | - | - | - | | | 85390 | - | - | - | $26.53 | - | | | 85396 | - | - | $14.28 | - | - | | | 85576 | - | - | - | $13.01 | - | | | 86077 | $39.62 | $36.14 | - | - | - | | | 86078 | $39.62 | $36.14 | - | - | - | | | 86079 | $39.89 | $36.40 | - | - | - | | | 86153 | - | - | $24.53 | $24.53 | - | | | 86255 | - | - | - | $13.01 | - | | | 86256 | - | - | - | $13.01 | - | | | 86320 | - | - | - | $13.01 | - | | | 86325 | - | - | - | $13.01 | - | | | 86327 | - | - | - | $16.11 | - | | | 86334 | - | - | - | $13.01 | - | | | 86335 | - | - | - | $13.01 | - | | | 86486 | - | - | $5.02 | - | - | | | 86490 | - | - | $62.34 | - | - | | | 86510 | - | - | $5.82 | - | - | | | 86580 | - | - | $7.97 | - | - | | | 87164 | - | - | - | $14.08 | - | | | 87207 | - | - | - | $13.01 | - | | | 88104 | - | - | $53.68 | $19.80 | $33.88 | | | 88106 | - | - | $54.72 | $14.08 | $40.64 | | | 88108 | - | - | $51.62 | $16.33 | $35.29 | | | 88112 | - | - | $51.88 | $20.07 | $31.80 | | | 88120 | - | - | $474.12 | $42.37 | $431.75 | | | 88121 | - | - | $332.83 | $35.06 | $297.77 | | | 88125 | - | - | $21.77 | $10.05 | $11.72 | | | 88141 | - | - | $17.55 | - | - | | | 88160 | - | - | $58.64 | $18.87 | $39.77 | | | 88161 | - | - | $59.98 | $18.60 | $41.38 | | | 88162 | - | - | $92.86 | $28.72 | $64.15 | | | 88172 | - | - | $42.47 | $25.93 | $16.54 | | | 88173 | - | - | $125.23 | $51.04 | $74.19 | | | 88177 | - | - | $22.27 | $15.84 | $6.43 | | | 88182 | - | - | $125.92 | $28.43 | $97.49 | | | 88184 | - | - | $59.32 | - | - | | | 88185 | - | - | $19.02 | - | - | | | 88187 | - | - | $25.88 | - | - | | | 88188 | - | - | $45.58 | - | - | | | 88189 | - | - | $61.44 | - | - | | | 88199 | - | - | I.C. | - | - | | | 88291 | - | - | $24.38 | - | - | | | 88299 | - | - | I.C. | - | - | | | 88300 | - | - | $12.54 | $3.23 | $9.31 | | | 88302 | - | - | $25.81 | $4.99 | $20.82 | | | 88304 | - | - | $33.37 | $8.27 | $25.11 | | | 88305 | - | - | $54.92 | $27.14 | $27.79 | | | 88307 | - | - | $227.22 | $60.09 | $167.13 | | | 88309 | - | - | $342.02 | $105.79 | $236.23 | | | 88311 | - | - | $15.65 | $9.02 | $6.63 | | | 88312 | - | - | $88.35 | $19.31 | $69.03 | | | 88313 | - | - | $64.67 | $8.75 | $55.91 | | | 88314 | - | - | $71.15 | $14.97 | $56.18 | | | 88319 | - | - | $106.79 | $19.61 | $87.18 | | | 88321 | $72.58 | $61.33 | - | - | - | | | 88323 | - | - | $86.19 | $63.76 | $22.43 | | | 88325 | $116.11 | $97.63 | - | - | - | | | 88329 | $42.92 | $26.04 | - | - | - | | | 88331 | - | - | $78.22 | $45.34 | $32.88 | | | 88332 | - | - | $42.17 | $22.41 | $19.75 | | | 88333 | - | - | $70.96 | $45.32 | $25.64 | | | 88334 | - | - | $42.98 | $27.45 | $15.53 | | | 88341 | - | - | $67.48 | $20.61 | $46.87 | | | 88344 | - | - | $132.28 | $27.89 | $104.39 | | | 88346 | - | - | $119.49 | $26.09 | $93.41 | | | 88348 | - | - | $373.50 | $56.39 | $317.11 | | | 88350 | - | - | $91.45 | $21.07 | $70.37 | | | 88355 | - | - | $107.77 | $59.43 | $48.34 | | | 88356 | - | - | $179.04 | $89.58 | $89.45 | | | 88358 | - | - | $108.77 | $36.25 | $72.52 | | | 88360 | - | - | $92.19 | $30.39 | $61.80 | | | 88361 | - | - | $91.96 | $31.76 | $60.20 | | | 88362 | - | - | $176.60 | $80.72 | $95.88 | | | 88363 | $17.23 | $14.28 | - | - | - | | | 88365 | - | - | $141.87 | $31.39 | $110.48 | | | 88366 | - | - | $219.45 | $45.23 | $174.23 | | | 88367 | - | - | $88.98 | $24.23 | $64.75 | | | 88368 | - | - | $111.34 | $30.32 | $81.02 | | | 88369 | - | - | $95.75 | $24.04 | $71.71 | | | 88371 | - | - | - | $14.08 | - | | | 88372 | - | - | - | $13.01 | - | | | 88374 | - | - | $239.85 | $31.01 | $208.85 | | | 88375 | - | - | $35.13 | - | - | | | 88377 | - | - | $312.90 | $46.26 | $266.63 | | | 88380 | - | - | $95.21 | $38.56 | $56.65 | | | 88381 | - | - | $159.68 | $17.19 | $142.49 | | | 88387 | - | - | $25.49 | $19.40 | $6.09 | | | 88388 | - | - | $28.02 | $17.11 | $10.91 | | | 88399 | - | - | I.C. | - | - | | | 89049 | $219.27 | $44.64 | - | - | - | | | 89060 | - | - | - | $13.01 | - | | | 89220 | - | - | $14.40 | - | - | | | 89230 | - | - | $2.07 | - | - | | | 89240 | - | - | I.C. | - | - | | | 14301* | $826.94 | $649.90 | - | - | - | | | 14302* | - | - | $158.36 | - | - | | | 20912* | - | - | $366.14 | - | - | | | 21120* | $516.70 | $391.08 | - | - | - | | | 21123* | - | - | $645.50 | - | - | | | 21137* | - | - | $566.99 | - | - | | | 21139* | - | - | $821.82 | - | - | | | 21208* | $1,288.87 | $553.11 | - | - | - | | | 21209* | $635.47 | $473.96 | - | - | - | | | 21210* | $1,385.87 | $569.50 | | | | | | 21296* | - | - | $313.37 | - | - | | | 30410* | - | - | $1,097.92 | - | - | | | 30420* | - | - | $1,122.86 | - | - | | | 30465* | - | - | $792.47 | - | - | | | 31750* | - | - | $1,042.44 | - | - | | | 64716* | - | - | $388.19 | - | - | | | 64771* | - | - | $437.32 | - | - | | | G0105 | $414.57 | $204.78 | - | - | - | | | G0121 | $414.80 | $205.01 | - | - | - | | | S2260 | - | - | I.C. | - | - | | | S2265 | - | - | I.C. | - | - | | | S2266 | - | - | I.C. | - | - | | | S2267 | - | - | I.C. | - | - | |

See 101 CMR 316.05(1)

NFAC - "Non-facility". These amounts apply when service is performed in a non-facility setting.

FAC - "Facility". These amounts, also known as the Facility Setting Fee, apply when service is performed in a facility setting.

Global Fee. These amounts apply when no site of service differential rate is specified.

| Code | NFAC | FAC | Global | PC | TC | Description ( see surgery services code spreadsheet at www.mass.gov/regulations/101-CMR-31600-surgery) | | --- | --- | --- | --- | --- | --- | --- | | 14301 | $1,182.78 | $929.56 | - | - | - | | | 14302 | - | - | $226.50 | - | - | | | 20912 | - | - | $523.69 | - | - | | | 21120 | $739.04 | $559.37 | - | - | - | | | 21123 | - | - | $923.26 | - | - | | | 21137 | - | - | $810.98 | - | - | | | 21139 | - | - | $1,175.46 | - | - | | | 21208 | $1,843.49 | $791.12 | - | - | - | | | 21209 | $908.92 | $677.91 | - | - | - | | | 21210 | $1,982.23 | $814.56 | - | - | - | | | 21296 | - | - | $448.21 | - | - | | | 30410 | - | - | $1,570.36 | - | - | | | 30420 | - | - | $1,606.04 | - | - | | | 30465 | - | - | $1,133.49 | - | - | | | 31750 | - | - | $1,491.02 | - | - | | | 64716 | - | - | $555.23 | - | - | | | 64771 | - | - | $625.51 | - | - | |

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 316.06 Severability

The provisions of 101 CMR 316.00 are hereby declared to be severable, and if any such provisions or the application of such provisions to any person or circumstances shall be held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions to eligible providers or circumstances other than those held invalid.

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

Rates for Medicine Services Rates for Medicine Services

101 CMR, § 317.01 General Provisions

(1) Scope and Purpose. 101 CMR 317.00 governs the payment rates used by all governmental units for medical services provided to publicly aided patients. Rates for services provided to individuals covered by the Workers' Compensation Act, M.G.L. c. 152, are not set forth in 101 CMR 317.00, but are at 114.3 CMR 40.00: Rates for Services under M.G.L. c. 152, Worker's Compensation Act .

(2) Applicable Dates of Service. Rates contained in 101 CMR 317.00 apply for dates of service on or after January 1, 2025, except as otherwise noted.

(3) Coverage.

(a) Payment rates in 101 CMR 317.00 are used to pay for medical services rendered to patients in a private medical office, licensed clinic, hospital, or other inpatient or outpatient facility or department, independent diagnostic testing facility, patient's residence, or other appropriate setting by an individual eligible provider, when an eligible provider bills for the medical services rendered and no other payment method applies.

(b) The rates of payment under 101 CMR 317.00 are full compensation for patient care rendered to publicly aided patients as well as for any related administrative or supervisory duties in connection with patient care. The rates of payment also reimburse all overhead expenses associated with the service provided, without regard to where the care is rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 317.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 317.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided patients.

(a) The publication of such updates and corrections will list

codes for which the code numbers change, with the corresponding cross references between the new codes and the codes being replaced. Rates for such updated codes are set at the rate of the code that is being replaced;
deleted codes for which there are no corresponding new codes; and
codes for entirely new services that require pricing. EOHHS will list these codes and apply Individual Consideration (I.C.) reimbursement for these codes until appropriate rates can be developed.

(b) For entirely new codes that require new pricing and have Medicare assigned relative value units (RVUs) (or, for applicable services, Medicare rates), EOHHS may list these codes and price them according to the rate methodology used in setting physician rates. When Medicare RVUs (or, for applicable services, Medicare rates) are not available, EOHHS may apply Individual Consideration in reimbursing for these new codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue Administrative Bulletins to add, delete, or otherwise update codes or modifiers, and to clarify its policy on and understanding of substantive provisions of 101 CMR 317.00. EOHHS may also issue Administrative Bulletins to clarify to which duly licensed or certified health care professionals or students the rate methods in this regulation apply, including in the event that the Department of Public Health issues an Order pursuant to M.G.L. c. 94C, and 105 CMR 700.003(H).

History

Amended by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 317.02 General Definitions

Meaning of Terms. The five-digit procedure codes, and two-digit modifier codes included in 101 CMR 317.00, and their corresponding descriptions, utilize the Healthcare Common Procedure Code System (HCPCS) for Level I and Level II coding. Level I CPT-4 codes are obtained from the Physicians' 2023 Current Procedural Terminology (CPT) , copyright 2022 by the American Medical Association (AMA), unless otherwise specified. Level II codes are obtained from the 2023 HCPCS, maintained jointly by the Centers for Medicare & Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and the Health Insurance Association of America. HCPCS is a listing of descriptive terms and identifying codes and modifiers for reporting medical services and procedures performed by physicians and other health care professionals, as well as associated nonphysician services. No fee schedules, basic unit value, relative value guides, conversion factors, or scales are included in any part of the Physicians' Current Procedure Terminology. For code descriptions, see the medicine services code spreadsheet at www.mass.gov/regulations/101-CMR-31700-medicine.

In addition, terms used in 101 CMR 317.00 have the meanings set forth in 101 CMR 317.02.

Child and Adolescent Needs and Strengths (CANS). A tool that provides a standardized way to organize information gathered during a psychiatric diagnostic assessment and is a treatment and service decision support tool for children and adolescents younger than 21 years old.

CMS. Centers for Medicare & Medicaid Services.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT). A program of health screening and other medical services for publicly assisted individuals younger than 21 years old as required by federal law.

Eligible Provider. The rates established in 101 CMR 317.00 apply in accordance with 101 CMR 317.01 to the following types of providers who meet conditions of participation of the governmental unit purchasing such services, and to the extent specified by such governmental unit. Eligible providers must provide such services in accordance with generally accepted professional standards and in accordance with state licensing requirements and certification by national credentialing bodies as required by law.

(a) A licensed physician (other than an intern, resident, fellow, or house officer), licensed podiatrist, licensed dentist, licensed chiropractor, and licensed optometrist.

(b) A provider of diagnostic medical services. Such medical diagnostic services may be rendered by eligible providers such as, but not limited to, independent diagnostic testing facilities (IDTFs). These eligible providers must be physically and financially independent of a hospital or a physician's office.

(c) A provider of radiation oncology services. Radiation oncology services may be rendered by eligible providers such as, but not limited to, independent radiation oncology centers. These eligible providers must be physically and financially independent of a hospital or a physician's office.

(d) A clinic licensed by the Massachusetts Department of Public Health in accordance with 105 CMR 140.000 : Licensure of Clinics to provide medical diagnostic services.

(e) A freestanding birth center facility that is not operating under a hospital's license, and is licensed as a birth center by the Massachusetts Department of Public Health pursuant to 105 CMR 140.000 : Licensure of Clinics .

(f) An advanced practice registered nurse who is authorized by the Board of Registration in Nursing to practice as a certified nurse practitioner, certified nurse midwife, clinical nurse specialist, psychiatric clinical nurse specialist, or a certified registered nurse anesthetist (CRNA).

(g) A licensed physician assistant, who is authorized by the Board of Registration for Physician Assistants to practice as a physician assistant.

(h) A registered nurse providing tobacco cessation services.

(i) A tobacco cessation counselor, who has completed appropriate training in tobacco cessation counseling according to the qualification criteria established by the purchasing governmental unit.

(j) A pharmacist who is registered by the Board of Registration in Pharmacy.

(k) An acupuncturist who is licensed by the Board of Registration in Medicine to practice acupuncture.

Eligible Provider for Administration of Vaccines. A licensed physician, certified nurse practitioner, certified nurse midwife, clinical nurse specialist, psychiatric clinical nurse specialist, physician assistant, registered pharmacist or other health care professional certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C , and any home health agency certified as a provider of home health services under the Medicare Health Insurance Program for the Aged (Title XVIII) is eligible to administer vaccines, if it otherwise meets such conditions of participation and coverage set forth by a purchasing governmental unit. Any other providers authorized by the Massachusetts Department of Public Health to possess and administer vaccines are also eligible if they otherwise meet such conditions of participation and coverage set forth by a purchasing governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any department, agency, board or commission of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration. Medical services that are authorized but not listed in 101 CMR 317.00, medical services performed in unusual circumstances, and services designated "I.C." are Individually Considered items. The governmental unit or purchaser analyzes the eligible provider's report of services rendered and charges submitted under the appropriate unlisted services or procedures category. The governmental unit or purchaser determines appropriate payment for procedures designated I.C. in accordance with the following standards and criteria:

(a) the amount of time required to perform the service;

(b) the degree of skill required to perform the service;

(d) any applicable relative-value studies;

(e) any complications or other circumstances that may be deemed relevant;

(f) the policies, procedures, and practices of other third-party insurers;

(g) the payment rate for prescribed drugs as set forth in 101 CMR 331.00: Prescribed Drugs ; and

(h) a copy of the current invoice from the supplier.

Physical Medicine. The physical medicine procedure codes apply only when

(a) the physician prescribed the needed therapy; and

(b) the services are provided by the physician or a licensed physical or occupational therapist employed by the physician.

Primary Care Clinician (PCC) Plan. A managed care option administered by the MassHealth agency through which enrolled members receive primary care and certain other medical services.

Referral. The transfer of the total or specific care from one eligible provider to another.

Unlisted Procedure or Service. A service or procedure may be provided that is not listed in 101 CMR 317.04. When reporting such a service, the appropriate "Unlisted Procedure" code may be used to indicate the service.

History

Amended by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 317.03 General Rate Provisions

(1) Rate Determination. Rates of payment for services for which 101 CMR 317.00 applies are the lowest of

(a) the eligible provider's usual fee to patients other than publicly aided individuals;

(b) the eligible provider's actual charge submitted; or

(c)

the schedule of allowable fees set forth in 101 CMR 317.04(4), taking into account appropriate modifiers and any other applicable rate provision(s) in accordance with 101 CMR 317.03 or 317.04(1); or
for drugs, vaccines, and immune globulins administered in a physician's office, the fee specified in 101 CMR 317.04(1)(a), taking into account any other applicable rate provision(s) in accordance with 101 CMR 317.04(1).

(2) Supplemental Payment.

the eligible provider is employed by a nonprofit group practice that was established in accordance with St. 1997, c. 163 and is affiliated with a Commonwealth-owned medical school;
such nonprofit group practice must have been established on or before January 1, 2000, in order to support the purposes of a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school; and
the services are provided at a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school.

(b) Payment Method. This supplemental payment may not exceed the difference between

payments to the eligible provider made pursuant to the rates applicable under 101 CMR 316.03(1): Rate Determination , 101 CMR 317.03(1), and 101 CMR 318.03(1): Rate Determination ; and
the federal upper payment limit established by the Centers for Medicare & Medicaid Services.

(3) Rate Variations Based on Practice Site. Payments for certain services provided by individual eligible providers that can be routinely furnished in physicians' offices are reduced when such services are furnished in facility settings. 101 CMR 317.04 establishes facility setting fees applied to services rendered in a facility when a practice site differential is warranted.

(4) The sum of the professional and technical components of an individual procedure will not be greater than the allowable global fee set forth in 101 CMR 317.04(4).

(5) Allowable Fee for Certain Eligible Providers. Payment for services provided by eligible providers who are certified nurse practitioners, psychiatric clinical nurse specialists, clinical nurse specialists, physician assistants, registered nurses, tobacco cessation counselors, pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C , and home health agencies as specified in 101 CMR 317.02 is 85% of the fees contained in 101 CMR 317.04. 101 CMR 317.03(5) does not apply to the EPSDT add-on code S0302 described in 101 CMR 317.03(7) or for tobacco cessation services, for medical nutrition therapy (97802, 97803, 97804, G0270, G0271), for diabetes self-management training (G0108, G0109), for the administration of behavioral health or developmental screenings (96110, 96127, and related modifiers), or for the perinatal depression screening (S3005 and related modifiers) services listed in 101 CMR 317.04(4). The rates listed in 101 CMR 317.04(4) for tobacco cessation services performed by certain eligible providers already reflect the appropriate rate and no further rate adjustment applies ( see codes 99407, 99407-SA, -TD, -TF, -HQ, -U1, -U2, and -U3).

(6) Behavioral Health and Developmental Screening Services. Payment for the administration and scoring of standardized behavioral health and developmental screening tools is available to certain eligible providers (physicians, certified nurse midwives, certified nurse practitioners, physician assistants, community health centers, hospital outpatient departments, or such eligible providers employed by a physician or community health center if authorized by the governmental unit) and is allowed for MassHealth purchase only when accompanied by a modifier. Appropriate codes and related modifiers for the standardized behavioral health screening tools are listed in a separate fee table in 101 CMR 317.04(4). For purposes of these modifiers, "Behavioral health need identified" or "Developmental services need identified" means the provider administering the screening tool, in her or his professional judgment, identifies a child with a potential behavioral health or developmental services need.

(7) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Add-on Code. To identify a completed well child office visit including all age-appropriate components of the EPSDT schedule, use code S0302 in addition to the appropriate preventive medicine service in 101 CMR 317.04(4). S0302 is always performed in addition to the primary procedure and must never be reported as a stand-alone code.

(8) Services and Payments Covered under Other Regulations. Rules and reimbursement rates for the Medicine service codes listed in the chart below are contained in other EOHHS regulations, except when an eligible provider that is a licensed physician is billing those codes in conjunction with a medical (nonroutine) diagnosis code.

| Regulation Title | Regulation Number | Affected Services | | --- | --- | --- | | Rates for Hearing Services | 101 CMR 323.00 | Audiologic Codes 92590 to 92595 | | Rates for Vision Care Services and Ophthalmic Materials | 101 CMR 315.00 | Ophthalmological Service Codes 92002, 92004, 92012, 92014, 92015; Spectacle Service Codes 92340-92342, 92370 and Screening Code 99173 |

(9) CPT Category III Codes. All medicine related CPT category III codes are included as a part of 101 CMR 317.00 and have an assigned fee of I.C.

(10) PCC Plan Enhanced Fee. Primary Care Clinicians (PCCs) receive an enhanced rate for certain types of primary and preventive care visits provided to PCC Plan members enrolled with the PCC on the date of service. The enhanced fee specified in 101 CMR 353.03: General Payment Provisions is added to the rate for the procedure code billed. The MassHealth agency pays PCCs an enhanced fee for delivering primary care services in accordance with the terms of the PCC provider contract.

(11) Child and Adolescent Needs and Strengths (CANS): Psychiatric Diagnostic Interview Examination for Children and Adolescents Younger than 21 Years Old. Psychiatrists or psychiatric clinical nurse specialists who complete the CANS for a MassHealth child or adolescent younger than 21 years old during a Psychiatric Diagnostic Interview Examination should bill using procedure code 90791 accompanied by modifier HA.

History

Amended by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 317.04 Maximum Allowable Fees - Medical Services

(1) Drugs, Medications, Supplies, and Laboratory Specimen Collections.

(a) Payment rates for drugs, vaccines, and immune globulins administered in a physician's office are equal to the fee listed in the Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File. For drugs, vaccines, and immune globulins administered in a physician's office that are not listed in the Quarterly ASP Medicare Part B Drug Pricing File, codes are listed in 101 CMR 317.04(4) with payment set by I.C., which will apply until such time as the code is listed in the Quarterly ASP Medicare Part B Drug Pricing File.

(b) Supplies and materials used in preparation for or as part of a procedure ( e.g. , bandages, laboratory kits, syringes, or disposable gloves) are not reimbursed separately, but are included in the office visit rate. In addition, no supplemental charge can be submitted nor payment allowed for routine specimen collection in a physician's office and preparation for clinical laboratory analysis (and activities related thereto), e.g. , venipuncture, urine, fecal and sputum samples, culturing, swabbing, and scraping for removal of tissues.

(c) Where applicable, payments for drugs, medicines, supplies, and related materials dispensed to patients are in accordance with rates that are the subject matter of other regulations that may be in effect and germane to the item in question ( e.g. , laboratory, pharmacy, medical supplies, etc. ). In other instances where the use of another regulation is not appropriate, certain supplies and materials (except eyeglasses) provided by the physician over and above those usually included with the office visit or other services rendered should be billed under code 99070.

(d) Payment for drugs and/or biologicals may be claimed in addition to an office visit. Drugs that are considered routine and integral to the delivery of a physician's professional services in the course of diagnosis or treatment are not reimbursable. Such drugs are commonly provided without charge or are included in the physician's fee for the service. Drugs and/or biologicals available free of charge from the Massachusetts Department of Public Health are not payable items. When an immunization or injection is the primary purpose of an office or other outpatient visit, the provider may bill only for the injectable material and its administration. Payment for both vaccine administration and an office visit is allowable only when the vaccine administration is a medically necessary, separately identifiable service.

(e) Allowable Fee for COVID-19 Treatment. The allowable fees for monoclonal antibodies and their administration for the treatment of COVID-19 are 100% of the corresponding Medicare Part B payment rates, without geographic adjustment. Payment for the administration of monoclonal antibodies provided by eligible providers who are certified nurse practitioners, psychiatric clinical nurse specialists, clinical nurse specialists, physician assistants, registered nurses, pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C , and home health agencies as specified in 101 CMR 317.02 is 85% of the allowable fee.

(f) Allowable Fee for COVID-19 Vaccine and Vaccine Administration. The allowable fees for COVID-19 vaccines and their administration are 100% of the corresponding Medicare Part B payment rates, without geographic adjustment. Payment for administration of the COVID-19 vaccine provided by eligible providers who are certified nurse practitioners, psychiatric clinical nurse specialists, clinical nurse specialists, physician assistants, registered nurses, pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C , and home health agencies as specified in 101 CMR 317.02 is 85% of the allowable fee.

(2) Unless otherwise specified, guidelines, notes, and definitions provided in the 2023 CPT Coding Handbook are applicable to the use of the procedure codes and modifiers listed below, as well as their corresponding descriptions. For code descriptions, see the medicine services code spreadsheet at www.mass.gov/regulations/101-CMR-31700-medicine.

(3) Modifiers.

(a) 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional during Postoperative Period.

(b) 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualifed Health Care Professional on the Same Day of the Procedure or Other Service. Modifier 25 is used to facilitate billing of evaluation and management services on the day of a procedure for which separate payment may be made. The physician or other qualified health care professional may indicate that on the day a procedure or service code was performed, the patient's condition required a significant, separately identifiable evaluation and management service above and beyond the usual preoperative and postoperative care associated with the procedure or service that was performed.

(c) 26: Professional Component. The component of a service or procedure representing the physician's or other qualified health care professional's work interpreting or performing the service or procedure. (When the physician or other qualified health care professional component is reported separately, the addition of modifier 26 to the appropriate procedure code will allow payment of the professional component allowable fee (PC Fee) contained in 101 CMR 317.04(4), adjusted by 101 CMR 317.03 as applicable.)

(d) 50: Bilateral Procedures. Payment for bilateral procedures performed at the same operative session must be identified by the appropriate service code and modifier 50. Only one claim line is billed for both procedures. (The addition of modifier 50 to the bilateral code will allow payment of 150% of the allowable fee contained in 101 CMR 317.04(4), adjusted by 101 CMR 317.03 as applicable, to the eligible provider for performance of both bilateral procedures.)

(e) 51: Multiple Procedures. This modifier must be used to report multiple procedures performed at the same session. The service code for the major procedure or service must be reported without a modifier. The secondary, additional, or lesser procedure(s) must be identified by adding modifier 51 to the end of the service code for the secondary procedure(s). (The addition of modifier 51 to the second and subsequent procedure codes allows payment of 50% of the allowable fee contained in 101 CMR 317.04(4), adjusted by 101 CMR 317.03 as applicable, to the eligible provider. Note: This modifier should not be used with designated "add-on" codes or with codes in which the narrative begins with "each additional.")

(f) 52: Reduced Services. Under certain circumstances a service or procedure is partially reduced or eliminated at the physician's or other qualified health care professional's election. Under these circumstances, the service provided can be identified by its usual procedure number and addition of modifier 52 signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.

(g) 57: Decision for Surgery.

(i) GO: Services Delivered Personally by an Occupational Therapist or under an Outpatient Occupational Therapy Plan of Care.

(j) GP: Services Delivered Personally by a Physical Therapist or under an Outpatient Physical Therapy Plan of Care.

(k) HA: Child and Adolescent Needs and Strengths (CANS): Psychiatric Diagnostic Interview Examination for Children and Adolescents Younger than 21 Years Old. This modifier should only be applied to service code 90791 billed by psychiatrists or psychiatric clinical nurse specialists to identify a Psychiatric Diagnostic Interview Examination for a MassHealth child or adolescent younger than 21 years old using the CANS.

(l) LM: Left Main Coronary Artery.

(m) PA: Surgical or Other Invasive Procedure Performed on the Wrong Body Part. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26, and results in nonpayment for services.

(n) PB: Surgical or Other Invasive Procedure Performed on the Wrong Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26, and results in nonpayment for services.

(o) PC: Wrong Surgical or Other Invasive Procedure Performed on a Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 , and results in nonpayment for services.

(p) RI: Ramus Intermedius Coronary Artery.

(q) SA: Nurse Practitioner Rendering Service in Collaboration with a Physician. This modifier is to be applied to service codes billed by a physician that were performed by a certified nurse practitioner employed by the physician (the physician employer must be practicing as an individual and not practicing as a professional corporation or as a member of a group practice). A certified nurse practitioner billing under his or her own individual provider number, or a group practice, should not use this modifier.

(r) SL: State Supplied Vaccine. This modifier is to be applied to the vaccine code to identify the administration of vaccines provided at no cost by the Massachusetts Department of Public Health for individuals younger than 18 years old, including those administered under the Vaccine for Children Program (VFC).

(s) TC: Technical Component. The component of a service or procedure representing the cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits, and other overhead expenses of the service or procedures, excluding the physician's or other qualified health care professional's professional component. (When the technical component is reported separately, the addition of modifier TC to the procedure code will allow payment of the technical component allowable fee (TC Fee) contained in 101 CMR 317.04(4), as adjusted by 101 CMR 317.03 as applicable.)

(t) XE: Separate Encounter. A service that is distinct because it occurred during a separate encounter.

(u) XS: Separate Structure. A service that is distinct because it was performed on a separate organ/structure.

(v) XP: Separate Practitioner. A service that is distinct because it was performed by a different practitioner.

(w) XU: Unusual Non-overlapping Service. The use of a service that is distinct because it does not overlap usual components of the main service.

(4) Fee Schedule.

(a) NFAC - "Nonfacility". These amounts apply when the service is performed in a nonfacility setting.

(b) FAC - "Facility". These amounts, also known as the Facility Setting Fee, apply when the service is performed in a facility setting.

| Code | NFAC | FAC | Global | PC | TC | Description ( see medicine services code spreadsheet at www.mass.gov/regulations/101-CMR-31700-medicine) | | --- | --- | --- | --- | --- | --- | --- | | 0121A | - | - | I.C. | - | - | | | 0141A | - | - | I.C. | - | - | | | 0142A | - | - | I.C. | - | - | | | 0151A | - | - | I.C. | - | - | | | 0171A | - | - | I.C. | - | - | | | 0172A | - | - | I.C. | - | - | | | 0173A | - | - | I.C. | - | - | | | 0174A | - | - | I.C. | - | - | | | 90281 | - | - | I.C. | - | - | | | 90283 | - | - | I.C. | - | - | | | 90284 | - | - | I.C. | - | - | | | 90287 | - | - | I.C. | - | - | | | 90288 | - | - | I.C. | - | - | | | 90291 | - | - | I.C. | - | - | | | 90296 | - | - | I.C. | - | - | | | 90377 | - | - | I.C. | - | - | | | 90378 | - | - | I.C. | - | - | | | 90384 | - | - | I.C. | - | - | | | 90385 | - | - | I.C. | - | - | | | 90386 | - | - | I.C. | - | - | | | 90389 | - | - | I.C. | - | - | | | 90393 | - | - | I.C. | - | - | | | 90396 | - | - | I.C. | - | - | | | 90399 | - | - | I.C. | - | - | | | 90460 | - | - | $20.45 | - | - | | | 90461 | - | - | $9.84 | - | - | | | 90471 | - | - | $20.45 | - | - | | | 90472 | - | - | $9.84 | - | - | | | 90473 | - | - | $20.45 | - | - | | | 90474 | - | - | $9.84 | - | - | | | 90476 | - | - | I.C. | - | - | | | 90477 | - | - | I.C. | - | - | | | 90581 | - | - | I.C. | - | - | | | 90586 | - | - | I.C. | - | - | | | 90587 | - | - | I.C. | - | - | | | 90589 | - | - | I.C. | - | - | | | 90619 | - | - | I.C. | - | - | | | 90620 | - | - | I.C. | - | - | | | 90621 | - | - | I.C. | - | - | | | 90623 | - | - | I.C. | - | - | | | 90625 | - | - | I.C. | - | - | | | 90626 | - | - | I.C. | - | - | | | 90627 | - | - | I.C. | - | - | | | 90630 | - | - | I.C. | - | - | | | 90633 | - | - | I.C. | - | - | | | 90634 | - | - | I.C. | - | - | | | 90636 | - | - | $122.36 | - | - | | | 90644 | - | - | I.C. | - | - | | | 90647 | - | - | I.C. | - | - | | | 90648 | - | - | I.C. | - | - | | | 90649 | - | - | I.C. | - | - | | | 90650 | - | - | I.C. | - | - | | | 90651 | - | - | I.C. | - | - | | | 90653 | - | - | I.C. | - | - | | | 90654 | - | - | I.C. | - | - | | | 90655 | - | - | I.C. | - | - | | | 90656 | - | - | I.C. | - | - | | | 90657 | - | - | I.C. | - | - | | | 90658 | - | - | I.C. | - | - | | | 90660 | - | - | I.C. | - | - | | | 90661 | - | - | I.C. | - | - | | | 90664 | - | - | I.C. | - | - | | | 90666 | - | - | I.C. | - | - | | | 90667 | - | - | I.C. | - | - | | | 90668 | - | - | I.C. | - | - | | | 90671 | - | - | I.C. | - | - | | | 90672 | - | - | I.C. | - | - | | | 90673 | - | - | I.C. | - | - | | | 90674 | - | - | I.C. | - | - | | | 90676 | - | - | I.C. | - | - | | | 90677 | - | - | I.C. | - | - | | | 90678 | - | - | I.C. | - | - | | | 90680 | - | - | I.C. | - | - | | | 90681 | - | - | I.C. | - | - | | | 90682 | - | - | I.C. | - | - | | | 90683 | - | - | I.C. | - | - | | | 90685 | - | - | I.C. | - | - | | | 90687 | - | - | I.C. | - | - | | | 90689 | - | - | I.C. | - | - | | | 90690 | - | - | I.C. | - | - | | | 90694 | - | - | I.C. | - | - | | | 90696 | - | - | I.C. | - | - | | | 90697 | - | - | I.C. | - | - | | | 90698 | - | - | I.C. | - | - | | | 90700 | - | - | I.C. | - | - | | | 90702 | - | - | I.C. | - | - | | | 90707 | - | - | I.C. | - | - | | | 90710 | - | - | I.C. | - | - | | | 90713 | - | - | I.C. | - | - | | | 90716 | - | - | I.C. | - | - | | | 90717 | - | - | I.C. | - | - | | | 90723 | - | - | I.C. | - | - | | | 90733 | - | - | I.C. | - | - | | | 90734 | - | - | I.C. | - | - | | | 90736 | - | - | I.C. | - | - | | | 90738 | - | - | I.C. | - | - | | | 90739 | - | - | I.C. | - | - | | | 90743 | - | - | I.C. | - | - | | | 90744 | - | - | I.C. | - | - | | | 90748 | - | - | I.C. | - | - | | | 90749 | - | - | I.C. | - | - | | | 90750 | - | - | I.C. | - | - | | | 90756 | - | - | I.C. | - | - | | | 90758 | - | - | I.C. | - | - | | | 90759 | - | - | I.C. | - | - | | | 90785 | $10.96 | $9.62 | - | - | - | | | 90791 | $128.70 | $109.68 | - | - | - | | | 90792 | $144.56 | $125.28 | - | - | - | | | 90832 | $55.55 | $48.32 | - | - | - | | | 90833 | $51.05 | $45.16 | - | - | - | | | 90834 | $73.46 | $64.08 | - | - | - | | | 90836 | $64.73 | $57.23 | - | - | - | | | 90837 | $108.09 | $94.16 | - | - | - | | | 90838 | $85.64 | $76.00 | - | - | - | | | 90839 | $103.82 | $90.96 | - | - | - | | | 90840 | $51.45 | $45.56 | - | - | - | | | 90845 | $69.49 | $60.92 | - | - | - | | | 90846 | $69.54 | $69.27 | - | - | - | | | 90847 | $72.52 | $72.26 | - | - | - | | | 90849 | $27.97 | $21.27 | - | - | - | | | 90853 | $19.67 | $16.99 | - | - | - | | | 90863 | $18.71 | $17.64 | - | - | - | | | 90865 | $122.02 | $89.88 | - | - | - | | | 90867 | - | - | I.C. | - | - | | | 90868 | - | - | I.C. | - | - | | | 90869 | - | - | I.C. | - | - | | | 90870 | $130.44 | $76.87 | - | - | - | | | 90875 | $43.64 | $43.10 | - | - | - | | | 90876 | $76.58 | $68.54 | - | - | - | | | 90880 | $77.05 | $63.66 | - | - | - | | | 90882 | - | - | I.C. | - | - | | | 90885 | - | - | $35.13 | - | - | | | 90887 | $63.68 | $53.50 | - | - | - | | | 90889 | - | - | I.C. | - | - | | | 90899 | - | - | I.C. | - | - | | | 90901 | $31.67 | $13.99 | - | - | - | | | 90912 | $61.94 | $31.41 | - | - | - | | | 90913 | $24.29 | $17.86 | - | - | - | | | 90935 | - | - | $52.43 | - | - | | | 90937 | - | - | $74.69 | - | - | | | 90940 | - | - | I.C. | - | - | | | 90945 | - | - | $63.23 | - | - | | | 90947 | - | - | $89.67 | - | - | | | 90951 | - | - | $861.41 | - | - | | | 90952 | - | - | I.C. | - | - | | | 90953 | - | - | I.C. | - | - | | | 90954 | - | - | $738.30 | - | - | | | 90955 | - | - | $383.14 | - | - | | | 90956 | - | - | $256.16 | - | - | | | 90957 | - | - | $565.67 | - | - | | | 90958 | - | - | $368.30 | - | - | | | 90959 | - | - | $239.78 | - | - | | | 90960 | - | - | $260.54 | - | - | | | 90961 | - | - | $216.95 | - | - | | | 90962 | - | - | $149.93 | - | - | | | 90963 | - | - | $446.55 | - | - | | | 90964 | - | - | $383.43 | - | - | | | 90965 | - | - | $367.46 | - | - | | | 90966 | - | - | $216.68 | - | - | | | 90967 | - | - | $12.99 | - | - | | | 90968 | - | - | $12.74 | - | - | | | 90969 | - | - | $12.50 | - | - | | | 90970 | - | - | $7.02 | - | - | | | 90989 | - | - | I.C. | - | - | | | 90993 | - | - | I.C. | - | - | | | 90997 | - | - | $64.39 | - | - | | | 90999 | - | - | I.C. | - | - | | | 91010 | - | - | $174.09 | $47.27 | $126.82 | | | 91013 | - | - | $20.14 | $6.75 | $13.39 | | | 91020 | - | - | $216.71 | $53.20 | $163.51 | | | 91022 | - | - | $133.68 | $53.20 | $80.48 | | | 91030 | - | - | $113.21 | $33.80 | $79.41 | | | 91034 | - | - | $151.77 | $36.47 | $115.30 | | | 91035 | - | - | $366.69 | $59.54 | $307.14 | | | 91037 | - | - | $132.62 | $35.80 | $96.82 | | | 91038 | - | - | $325.44 | $40.59 | $284.85 | | | 91040 | - | - | $420.41 | $36.13 | $384.28 | | | 91065 | - | - | $66.90 | $7.24 | $59.66 | | | 91110 | - | - | $592.39 | $82.50 | $509.90 | | | 91111 | - | - | $685.67 | $33.28 | $652.39 | | | 91112 | - | - | $1,318.43 | $77.66 | $1,240.77 | | | 91113 | - | - | $726.59 | $89.00 | $637.59 | | | 91117 | - | - | $100.28 | - | - | | | 91120 | - | - | $407.76 | $35.26 | $372.50 | | | 91122 | - | - | $215.28 | $64.35 | $150.93 | | | 91132 | - | - | $356.43 | $19.29 | $337.14 | | | 91133 | - | - | $374.86 | $24.33 | $350.53 | | | 91200 | - | - | $23.75 | $7.75 | $16.00 | | | 91299 | - | - | I.C. | - | - | | | 91318 | - | - | I.C. | - | - | | | 91319 | - | - | I.C. | - | - | | | 91320 | - | - | I.C. | - | - | | | 91321 | - | - | I.C. | - | - | | | 91322 | - | - | I.C. | - | - | | | 92002 | $65.87 | $34.00 | - | - | - | | | 92004 | $114.47 | $69.74 | - | - | - | | | 92012 | $69.13 | $37.52 | - | - | - | | | 92014 | $96.90 | $56.46 | - | - | - | | | 92018 | - | - | $102.85 | - | - | | | 92019 | - | - | $53.23 | - | - | | | 92020 | $21.04 | $15.15 | - | - | - | | | 92025 | - | - | $27.99 | $14.39 | $13.59 | | | 92060 | - | - | $48.63 | $27.27 | $21.36 | | | 92065 | - | - | $30.91 | $24.28 | $6.63 | | | 92066 | - | - | $20.56 | - | - | | | 92071 | $27.39 | $23.91 | - | - | - | | | 92072 | $95.78 | $69.80 | - | - | - | | | 92081 | - | - | $25.69 | $11.83 | $13.86 | | | 92082 | - | - | $36.17 | $15.35 | $20.82 | | | 92083 | - | - | $48.53 | $19.94 | $28.59 | | | 92100 | $66.49 | $23.91 | - | - | - | | | 92132 | - | - | $24.35 | $12.10 | $12.25 | | | 92133 | - | - | $28.14 | $15.89 | $12.25 | | | 92134 | - | - | $30.97 | $18.45 | $12.52 | | | 92136 | - | - | $36.12 | $22.53 | $13.59 | | | 92145 | - | - | $9.81 | $3.99 | $5.82 | | | 92201 | $18.50 | $16.62 | - | - | - | | | 92202 | $11.66 | $10.85 | - | - | - | | | 92227 | - | - | $13.32 | - | - | | | 92228 | - | - | $22.43 | $12.32 | $10.11 | | | 92229 | - | - | $36.09 | - | - | | | 92230 | $88.08 | $25.67 | - | - | - | | | 92235 | - | - | $107.69 | $31.42 | $76.27 | | | 92240 | - | - | $149.95 | $34.85 | $115.10 | | | 92242 | - | - | $204.25 | $40.40 | $163.85 | | | 92250 | - | - | $28.67 | $15.62 | $13.06 | | | 92260 | $15.27 | $7.78 | - | - | - | | | 92265 | - | - | $67.11 | $33.96 | $33.14 | | | 92270 | - | - | $84.98 | $31.01 | $53.97 | | | 92273 | - | - | $99.45 | $27.01 | $72.45 | | | 92274 | - | - | $69.44 | $24.51 | $44.93 | | | 92283 | - | - | $42.60 | $6.51 | $36.09 | | | 92284 | - | - | $36.89 | - | - | | | 92285 | - | - | $18.23 | $2.23 | $16.00 | | | 92286 | - | - | $30.01 | $15.89 | $14.13 | | | 92287 | - | - | $114.38 | $27.67 | $86.71 | | | 92310 | $76.65 | $42.10 | - | - | - | | | 92311 | $81.28 | $38.43 | - | - | - | | | 92312 | $94.26 | $44.44 | - | - | - | | | 92313 | $77.37 | $31.83 | - | - | - | | | 92314 | $67.51 | $24.93 | - | - | - | | | 92315 | $64.79 | $15.50 | - | - | - | | | 92316 | $79.79 | $23.28 | - | - | - | | | 92317 | $68.27 | $15.50 | - | - | - | | | 92325 | - | - | $36.09 | - | - | | | 92326 | - | - | $31.00 | - | - | | | 92352 | $34.37 | $13.21 | - | - | - | | | 92353 | $39.02 | $18.13 | - | - | - | | | 92354 | - | - | $10.65 | - | - | | | 92355 | - | - | $16.54 | - | - | | | 92358 | - | - | $8.77 | - | - | | | 92371 | - | - | $9.31 | - | - | | | 92499 | - | - | I.C. | - | - | | | 92502 | - | - | $71.11 | - | - | | | 92504 | $22.82 | $7.02 | - | - | - | | | 92507 | - | - | $57.81 | - | - | | | 92508 | - | - | $18.19 | - | - | | | 92511 | $93.14 | $28.32 | - | - | - | | | 92512 | $49.09 | $20.16 | - | - | - | | | 92516 | $55.52 | $16.95 | - | - | - | | | 92517 | $59.76 | $31.37 | - | - | - | | | 92518 | $61.90 | $31.64 | - | - | - | | | 92519 | $103.30 | $47.59 | - | - | - | | | 92520 | $66.04 | $29.61 | - | - | - | | | 92521 | - | - | $100.51 | - | - | | | 92522 | - | - | $83.77 | - | - | | | 92523 | - | - | $172.36 | - | - | | | 92524 | - | - | $82.70 | - | - | | | 92526 | - | - | $64.41 | - | - | | | 92531 | - | - | I.C. | - | - | | | 92532 | - | - | I.C. | - | - | | | 92533 | - | - | I.C. | - | - | | | 92534 | - | - | I.C. | - | - | | | 92537 | - | - | $30.63 | $22.93 | $7.70 | | | 92538 | - | - | $17.12 | $11.83 | $5.29 | | | 92540 | - | - | $82.99 | $57.62 | $25.38 | | | 92541 | - | - | $19.03 | $15.62 | $3.41 | | | 92542 | - | - | $21.80 | $18.38 | $3.41 | | | 92544 | - | - | $13.44 | $10.56 | $2.88 | | | 92545 | - | - | $12.68 | $9.80 | $2.88 | | | 92546 | - | - | $100.64 | $11.05 | $89.59 | | | 92547 | - | - | $8.57 | - | - | | | 92548 | - | - | $36.02 | $24.84 | $11.18 | | | 92549 | - | - | $49.56 | $33.29 | $16.27 | | | 92550 | - | - | $16.81 | - | - | | | 92551 | - | - | $9.57 | - | - | | | 92552 | - | - | $28.32 | - | - | | | 92553 | - | - | $34.75 | - | - | | | 92555 | - | - | $21.89 | - | - | | | 92556 | - | - | $33.95 | - | - | | | 92557 | $27.95 | $23.66 | - | - | - | | | 92558 | $7.04 | $6.24 | - | - | - | | | 92562 | - | - | $38.23 | - | - | | | 92563 | - | - | $26.45 | - | - | | | 92565 | - | - | $16.00 | - | - | | | 92567 | $12.60 | $8.04 | - | - | - | | | 92568 | $11.52 | $11.25 | - | - | - | | | 92570 | $24.31 | $21.63 | - | - | - | | | 92571 | - | - | $24.04 | - | - | | | 92572 | - | - | $37.70 | - | - | | | 92575 | - | - | $59.59 | - | - | | | 92576 | - | - | $31.80 | - | - | | | 92577 | - | - | $16.27 | - | - | | | 92579 | $34.15 | $27.72 | - | - | - | | | 92582 | - | - | $65.55 | - | - | | | 92583 | - | - | $43.32 | - | - | | | 92584 | - | - | $87.96 | - | - | | | 92587 | - | - | $16.47 | $13.32 | $3.15 | | | 92588 | - | - | $25.65 | $21.43 | $4.22 | | | 92596 | - | - | $58.59 | - | - | | | 92597 | - | - | $54.15 | - | - | | | 92601 | $122.87 | $91.53 | - | - | - | | | 92602 | $78.16 | $51.92 | - | - | - | | | 92603 | $114.95 | $88.97 | - | - | - | | | 92604 | $69.71 | $49.62 | - | - | - | | | 92605 | $67.81 | $63.26 | - | - | - | | | 92606 | $59.45 | $50.34 | - | - | - | | | 92607 | - | - | $94.31 | - | - | | | 92608 | - | - | $37.09 | - | - | | | 92609 | - | - | $78.78 | - | - | | | 92610 | $64.50 | $52.45 | - | - | - | | | 92611 | - | - | $69.50 | - | - | | | 92612 | $154.16 | $49.44 | - | - | - | | | 92613 | - | - | $27.29 | - | - | | | 92614 | $114.19 | $48.83 | - | - | - | | | 92615 | - | - | $24.26 | - | - | | | 92616 | $174.45 | $73.48 | - | - | - | | | 92617 | $30.32 | $30.05 | - | - | - | | | 92618 | $23.68 | $23.41 | - | - | - | | | 92620 | $66.85 | $59.09 | - | - | - | | | 92621 | $16.54 | $13.86 | - | - | - | | | 92622 | $60.24 | $49.28 | - | - | - | | | 92623 | $15.47 | $13.06 | - | - | - | | | 92625 | $51.46 | $45.56 | - | - | - | | | 92626 | $65.88 | $55.70 | - | - | - | | | 92627 | $15.51 | $13.10 | - | - | - | | | 92630 | - | - | I.C. | - | - | | | 92633 | - | - | I.C. | - | - | | | 92640 | $83.27 | $69.87 | - | - | - | | | 92650 | - | - | $21.52 | - | - | | | 92651 | - | - | $65.19 | - | - | | | 92652 | - | - | $86.54 | - | - | | | 92653 | - | - | $64.67 | - | - | | | 92700 | - | - | I.C. | - | - | | | 92920 | - | - | $374.88 | - | - | | | 92921 | - | - | I.C. | - | - | | | 92924 | - | - | $447.76 | - | - | | | 92925 | - | - | I.C. | - | - | | | 92928 | - | - | $417.83 | - | - | | | 92929 | - | - | I.C. | - | - | | | 92933 | - | - | $468.25 | - | - | | | 92934 | - | - | I.C. | - | - | | | 92937 | - | - | $417.32 | - | - | | | 92938 | - | - | I.C. | - | - | | | 92941 | - | - | $468.87 | - | - | | | 92943 | - | - | $469.21 | - | - | | | 92944 | - | - | I.C. | - | - | | | 92950 | $249.10 | $132.32 | - | - | - | | | 92953 | - | - | $0.71 | - | - | | | 92960 | $117.99 | $79.69 | - | - | - | | | 92961 | - | - | $175.61 | - | - | | | 92970 | - | - | $133.61 | - | - | | | 92971 | - | - | $71.69 | - | - | | | 92972 | - | - | $105.80 | - | - | | | 92973 | - | - | $124.70 | - | - | | | 92974 | - | - | $114.23 | - | - | | | 92975 | - | - | $266.55 | - | - | | | 92977 | - | - | $41.50 | - | - | | | 92978 | - | - | - | $67.48 | - | | | 92979 | - | - | - | $53.85 | - | | | 92986 | - | - | $949.60 | - | - | | | 92987 | - | - | $982.07 | - | - | | | 92990 | - | - | $785.14 | - | - | | | 92997 | - | - | $454.34 | - | - | | | 92998 | - | - | $225.95 | - | - | | | 93000 | - | - | $10.99 | - | - | | | 93005 | - | - | $5.02 | - | - | | | 93010 | - | - | $5.97 | - | - | | | 93015 | - | - | $54.25 | - | - | | | 93016 | - | - | $15.50 | - | - | | | 93017 | - | - | $28.52 | - | - | | | 93018 | - | - | $10.22 | - | - | | | 93024 | - | - | $84.35 | $40.16 | $44.19 | | | 93025 | - | - | $94.96 | $27.07 | $67.90 | | | 93040 | - | - | $9.70 | - | - | | | 93041 | - | - | $4.75 | - | - | | | 93042 | - | - | $4.94 | - | - | | | 93050 | - | - | $12.06 | $5.97 | $6.09 | | | 93150 | $77.57 | $31.30 | - | - | - | | | 93151 | $67.52 | $29.54 | - | - | - | | | 93152 | $121.09 | $69.20 | - | - | - | | | 93153 | $40.18 | $15.84 | - | - | - | | | 93224 | - | - | $57.02 | - | - | | | 93225 | - | - | $14.66 | - | - | | | 93226 | - | - | $28.86 | - | - | | | 93227 | - | - | $13.50 | - | - | | | 93228 | - | - | $18.71 | - | - | | | 93229 | - | - | $670.79 | - | - | | | 93241 | - | - | $209.90 | - | - | | | 93242 | - | - | $9.57 | - | - | | | 93243 | - | - | $183.13 | - | - | | | 93244 | - | - | $17.20 | - | - | | | 93245 | - | - | $221.04 | - | - | | | 93246 | - | - | $9.57 | - | - | | | 93247 | - | - | $192.51 | - | - | | | 93248 | - | - | $18.96 | - | - | | | 93260 | - | - | $59.04 | $30.99 | $28.06 | | | 93261 | - | - | $54.34 | $26.55 | $27.79 | | | 93264 | $38.09 | $25.77 | - | - | - | | | 93268 | - | - | $141.29 | - | - | | | 93270 | - | - | $6.63 | - | - | | | 93271 | - | - | $116.98 | - | - | | | 93272 | - | - | $17.69 | - | - | | | 93278 | - | - | $22.32 | $9.00 | $13.32 | | | 93279 | - | - | $52.67 | $23.01 | $29.66 | | | 93280 | - | - | $61.77 | $27.29 | $34.48 | | | 93281 | - | - | $65.74 | $30.72 | $35.02 | | | 93282 | - | - | $62.52 | $30.72 | $31.80 | | | 93283 | - | - | $76.03 | $41.28 | $34.75 | | | 93284 | - | - | $81.96 | $44.80 | $37.16 | | | 93285 | - | - | $47.35 | $18.76 | $28.59 | | | 93286 | - | - | $36.14 | $10.76 | $25.38 | | | 93287 | - | - | $41.68 | $16.31 | $25.38 | | | 93288 | - | - | $44.14 | $15.01 | $29.13 | | | 93289 | - | - | $56.33 | $26.93 | $29.39 | | | 93290 | - | - | $41.93 | $15.48 | $26.45 | | | 93291 | - | - | $38.92 | $13.28 | $25.64 | | | 93292 | - | - | $39.79 | $15.21 | $24.57 | | | 93293 | - | - | $35.58 | $10.47 | $25.11 | | | 93294 | - | - | $21.92 | - | - | | | 93295 | - | - | $26.95 | - | - | | | 93296 | - | - | $17.88 | - | - | | | 93297 | - | - | $18.89 | - | - | | | 93298 | - | - | $19.16 | - | - | | | 93303 | - | - | $172.97 | $44.95 | $128.02 | | | 93304 | - | - | $122.41 | $26.40 | $96.02 | | | 93306 | - | - | $153.05 | $50.21 | $102.85 | | | 93307 | - | - | $107.02 | $31.90 | $75.13 | | | 93308 | - | - | $77.25 | $18.20 | $59.06 | | | 93312 | - | - | $183.13 | $77.74 | $105.39 | | | 93313 | - | - | $8.11 | - | - | | | 93314 | - | - | $176.79 | $64.97 | $111.82 | | | 93315 | - | - | - | $92.24 | $397.67 | | | 93316 | - | - | $18.44 | - | - | | | 93317 | - | - | - | $64.19 | - | | | 93318 | - | - | - | $74.33 | $397.67 | | | 93319 | $42.77 | $17.60 | - | - | - | | | 93320 | - | - | $39.43 | $12.99 | $26.45 | | | 93321 | - | - | $19.68 | $5.21 | $14.46 | | | 93325 | - | - | $18.59 | $2.25 | $16.34 | | | 93350 | - | - | $144.62 | $50.21 | $94.41 | | | 93351 | - | - | $180.91 | $60.39 | $120.52 | | | 93352 | - | - | $26.48 | - | - | | | 93355 | - | - | $163.15 | - | - | | | 93356 | $29.04 | $8.42 | - | - | - | | | 93451 | - | - | $687.51 | $93.45 | $594.06 | | | 93452 | - | - | $707.11 | $167.96 | $539.16 | | | 93453 | - | - | $898.18 | $224.56 | $673.61 | | | 93454 | - | - | $709.76 | $169.54 | $540.23 | | | 93455 | - | - | $789.85 | $197.66 | $592.19 | | | 93456 | - | - | $882.25 | $220.96 | $661.29 | | | 93457 | - | - | $960.55 | $248.10 | $712.45 | | | 93458 | - | - | $814.18 | $209.13 | $605.05 | | | 93459 | - | - | $874.71 | $237.26 | $637.45 | | | 93460 | - | - | $971.40 | $265.65 | $705.75 | | | 93461 | - | - | $1,071.17 | $293.51 | $777.67 | | | 93462 | - | - | $149.50 | - | - | | | 93463 | - | - | $71.12 | - | - | | | 93464 | - | - | $170.21 | $64.22 | $106.00 | | | 93503 | - | - | $63.28 | - | - | | | 93505 | - | - | $503.03 | $162.21 | $340.82 | | | 93563 | - | - | $37.26 | - | - | | | 93564 | - | - | $39.19 | - | - | | | 93565 | - | - | $19.19 | - | - | | | 93566 | - | - | $19.06 | - | - | | | 93567 | - | - | $26.97 | - | - | | | 93568 | - | - | $33.65 | - | - | | | 93569 | - | - | $27.53 | - | - | | | 93571 | - | - | - | $51.64 | - | | | 93572 | - | - | - | $37.39 | - | | | 93573 | - | - | $45.88 | - | - | | | 93574 | - | - | $50.65 | - | - | | | 93575 | - | - | $67.76 | - | - | | | 93580 | - | - | $692.85 | - | - | | | 93581 | - | - | $939.34 | - | - | | | 93582 | - | - | $469.27 | - | - | | | 93583 | - | - | $526.06 | - | - | | | 93584 | - | - | $42.77 | - | - | | | 93585 | - | - | $40.26 | - | - | | | 93586 | - | - | $50.92 | - | - | | | 93587 | - | - | $75.13 | - | - | | | 93588 | - | - | $75.89 | - | - | | | 93590 | - | - | $775.77 | - | - | | | 93591 | - | - | $639.81 | - | - | | | 93592 | - | - | $282.00 | - | - | | | 93593 | - | - | - | $137.73 | - | | | 93594 | - | - | - | $215.10 | - | | | 93595 | - | - | - | $193.85 | - | | | 93596 | - | - | - | $236.03 | - | | | 93597 | - | - | - | $312.83 | - | | | 93598 | - | - | - | $51.06 | - | | | 93600 | - | - | - | $84.54 | - | | | 93602 | - | - | - | $82.34 | - | | | 93603 | - | - | - | $82.34 | - | | | 93609 | - | - | - | $197.42 | - | | | 93610 | - | - | - | $116.34 | - | | | 93612 | - | - | - | $114.41 | - | | | 93613 | - | - | $210.50 | - | - | | | 93615 | - | - | - | $27.09 | - | | | 93616 | - | - | - | $42.68 | - | | | 93618 | - | - | - | $156.53 | - | | | 93619 | - | - | - | $277.46 | - | | | 93620 | - | - | - | $446.44 | - | | | 93621 | - | - | - | $59.27 | - | | | 93622 | - | - | - | $122.32 | - | | | 93623 | - | - | - | $61.81 | - | | | 93624 | - | - | - | $177.95 | - | | | 93631 | - | - | - | $282.12 | - | | | 93640 | - | - | - | $126.70 | - | | | 93641 | - | - | - | $222.16 | - | | | 93642 | - | - | $247.13 | $181.25 | $65.88 | | | 93644 | - | - | $144.40 | $104.02 | $40.38 | | | 93650 | - | - | $421.65 | - | - | | | 93653 | - | - | $604.45 | - | - | | | 93654 | - | - | $728.43 | - | - | | | 93655 | - | - | $221.80 | - | - | | | 93656 | - | - | $685.45 | - | - | | | 93657 | - | - | $221.80 | - | - | | | 93660 | - | - | $123.00 | $67.03 | $55.97 | | | 93662 | - | - | - | $54.27 | - | | | 93668 | - | - | $11.45 | - | - | | | 93701 | - | - | $21.09 | - | - | | | 93702 | - | - | $102.71 | - | - | | | 93724 | - | - | $212.01 | $174.85 | $37.16 | | | 93740 | - | - | $5.72 | - | - | | | 93745 | - | - | I.C. | - | - | | | 93750 | $37.64 | $29.07 | - | - | - | | | 93770 | - | - | $5.72 | - | - | | | 93784 | - | - | $35.35 | - | - | | | 93786 | - | - | $17.88 | - | - | | | 93788 | - | - | $4.22 | - | - | | | 93790 | - | - | $13.25 | - | - | | | 93792 | - | - | $55.97 | - | - | | | 93793 | - | - | $8.62 | - | - | | | 93797 | $12.91 | $6.48 | - | - | - | | | 93798 | $19.58 | $9.93 | - | - | - | | | 93799 | - | - | I.C. | - | - | | | 93880 | - | - | $150.89 | $27.95 | $122.93 | | | 93882 | - | - | $97.88 | $17.39 | $80.48 | | | 93886 | - | - | $214.05 | $33.53 | $180.52 | | | 93888 | - | - | $102.90 | $18.40 | $84.50 | | | 93890 | - | - | $220.00 | $37.07 | $182.93 | | | 93892 | - | - | $127.79 | $43.29 | $84.50 | | | 93893 | - | - | $128.25 | $43.95 | $84.30 | | | 93895 | - | - | I.C. | - | - | | | 93922 | - | - | $64.91 | $8.80 | $56.11 | | | 93923 | - | - | $101.27 | $15.70 | $85.57 | | | 93924 | - | - | $124.59 | $17.46 | $107.13 | | | 93925 | - | - | $190.33 | $27.22 | $163.11 | | | 93926 | - | - | $101.03 | $16.52 | $84.50 | | | 93930 | - | - | $154.57 | $27.62 | $126.95 | | | 93931 | - | - | $97.54 | $16.79 | $80.75 | | | 93970 | - | - | $149.04 | $24.23 | $124.81 | | | 93971 | - | - | $94.44 | $15.57 | $78.88 | | | 93975 | - | - | $210.12 | $40.58 | $169.54 | | | 93976 | - | - | $112.39 | $27.89 | $84.50 | | | 93978 | - | - | $142.11 | $27.48 | $114.63 | | | 93979 | - | - | $92.45 | $16.79 | $75.66 | | | 93980 | - | - | $89.46 | $43.46 | $46.00 | | | 93981 | - | - | $54.90 | $15.59 | $39.30 | | | 93985 | - | - | $196.35 | $27.34 | $169.00 | | | 93986 | - | - | $101.63 | $17.12 | $84.50 | | | 93990 | - | - | $101.29 | $16.79 | $84.50 | | | 93998 | - | - | I.C. | - | - | | | 94002 | - | - | $66.59 | - | - | | | 94003 | - | - | $46.73 | - | - | | | 94004 | - | - | $34.66 | - | - | | | 94005 | - | - | $67.39 | - | - | | | 94010 | - | - | $20.90 | $5.97 | $14.93 | | | 94011 | - | - | $62.39 | - | - | | | 94012 | - | - | $101.17 | - | - | | | 94013 | - | - | $13.78 | - | - | | | 94014 | - | - | $42.53 | - | - | | | 94015 | - | - | $24.57 | - | - | | | 94016 | - | - | $17.95 | - | - | | | 94060 | - | - | $30.16 | $7.46 | $22.70 | | | 94070 | - | - | $47.16 | $20.18 | $26.98 | | | 94150 | - | - | $19.52 | $2.72 | $16.81 | | | 94200 | - | - | $11.53 | $1.96 | $9.57 | | | 94375 | - | - | $29.69 | $10.47 | $19.22 | | | 94450 | - | - | $64.43 | $14.48 | $49.95 | | | 94452 | - | - | $37.99 | $10.20 | $27.79 | | | 94453 | - | - | $51.84 | $13.41 | $38.43 | | | 94610 | - | - | $41.25 | - | - | | | 94617 | - | - | $67.83 | $23.23 | $44.59 | | | 94618 | - | - | $25.48 | $16.17 | $9.31 | | | 94619 | - | - | $59.67 | $16.42 | $43.25 | | | 94621 | - | - | $118.06 | $49.49 | $68.56 | | | 94625 | $45.24 | $12.29 | - | - | - | | | 94626 | $60.04 | $19.87 | - | - | - | | | 94640 | - | - | $7.16 | - | - | | | 94642 | - | - | I.C. | - | - | | | 94644 | - | - | $47.61 | - | - | | | 94645 | - | - | $12.52 | - | - | | | 94660 | $48.20 | $27.04 | - | - | - | | | 94662 | - | - | $25.43 | - | - | | | 94664 | - | - | $13.59 | - | - | | | 94667 | - | - | $18.61 | - | - | | | 94668 | - | - | $29.06 | - | - | | | 94669 | - | - | $15.40 | - | - | | | 94680 | - | - | $41.18 | $9.18 | $32.00 | | | 94681 | - | - | $36.83 | $6.97 | $29.86 | | | 94690 | - | - | $37.74 | $2.72 | $35.02 | | | 94726 | - | - | $42.59 | $8.71 | $33.88 | | | 94727 | - | - | $34.09 | $8.71 | $25.38 | | | 94728 | - | - | $30.87 | $8.98 | $21.89 | | | 94729 | - | - | $44.69 | $6.46 | $38.23 | | | 94760 | - | - | $1.81 | - | - | | | 94761 | - | - | $2.88 | - | - | | | 94762 | - | - | $20.29 | - | - | | | 94772 | - | - | I.C. | - | - | | | 94774 | - | - | I.C. | - | - | | | 94775 | - | - | I.C. | - | - | | | 94776 | - | - | I.C. | - | - | | | 94777 | - | - | I.C. | - | - | | | 94780 | $39.87 | $17.37 | - | - | - | | | 94781 | $15.88 | $5.97 | - | - | - | | | 94799 | - | - | I.C. | - | - | | | 95004 | - | - | $3.12 | - | - | | | 95012 | - | - | $14.93 | - | - | | | 95017 | $6.73 | $2.72 | - | - | - | | | 95018 | $15.68 | $5.23 | - | - | - | | | 95024 | $6.34 | $0.71 | - | - | - | | | 95027 | - | - | $3.93 | - | - | | | 95028 | - | - | $10.11 | - | - | | | 95044 | - | - | $3.95 | - | - | | | 95052 | - | - | $5.02 | - | - | | | 95056 | - | - | $40.58 | - | - | | | 95060 | - | - | $29.93 | - | - | | | 95065 | - | - | $22.16 | - | - | | | 95070 | - | - | $27.45 | - | - | | | 95076 | $92.57 | $54.27 | - | - | - | | | 95079 | $63.65 | $49.99 | - | - | - | | | 95115 | - | - | $7.97 | - | - | | | 95117 | - | - | $9.31 | - | - | | | 95120 | - | - | I.C. | - | - | | | 95125 | - | - | I.C. | - | - | | | 95130 | - | - | I.C. | - | - | | | 95131 | - | - | I.C. | - | - | | | 95132 | - | - | I.C. | - | - | | | 95133 | - | - | I.C. | - | - | | | 95134 | - | - | I.C. | - | - | | | 95144 | $13.19 | $2.47 | - | - | - | | | 95145 | $26.31 | $2.20 | - | - | - | | | 95146 | $48.54 | $2.20 | - | - | - | | | 95147 | $46.93 | $2.20 | - | - | - | | | 95148 | $69.43 | $2.20 | - | - | - | | | 95149 | $91.93 | $2.20 | - | - | - | | | 95165 | $11.85 | $2.47 | - | - | - | | | 95170 | $8.90 | $2.20 | - | - | - | | | 95180 | $103.85 | $75.46 | - | - | - | | | 95199 | - | - | I.C. | - | - | | | 95249 | - | - | $48.47 | - | - | | | 95250 | - | - | $115.97 | - | - | | | 95251 | - | - | $25.44 | - | - | | | 95700 | - | - | I.C. | - | - | | | 95705 | - | - | I.C. | - | - | | | 95706 | - | - | I.C. | - | - | | | 95707 | - | - | I.C. | - | - | | | 95708 | - | - | I.C. | - | - | | | 95709 | - | - | I.C. | - | - | | | 95710 | - | - | I.C. | - | - | | | 95711 | - | - | I.C. | - | - | | | 95712 | - | - | I.C. | - | - | | | 95713 | - | - | I.C. | - | - | | | 95714 | - | - | I.C. | - | - | | | 95715 | - | - | I.C. | - | - | | | 95716 | - | - | I.C. | - | - | | | 95717 | $74.94 | $74.14 | - | - | - | | | 95718 | $99.30 | $97.42 | - | - | - | | | 95719 | $116.42 | $114.82 | - | - | - | | | 95720 | $153.54 | $150.60 | - | - | - | | | 95721 | $153.08 | $149.86 | - | - | - | | | 95722 | $186.22 | $182.47 | - | - | - | | | 95723 | $187.05 | $183.30 | - | - | - | | | 95724 | $235.52 | $231.24 | - | - | - | | | 95725 | $214.07 | $209.25 | - | - | - | | | 95726 | $299.51 | $293.62 | - | - | - | | | 95782 | - | - | $752.45 | $90.44 | $662.01 | | | 95783 | - | - | $796.98 | $98.61 | $698.37 | | | 95800 | - | - | $116.83 | $29.65 | $87.18 | | | 95801 | - | - | $71.83 | $29.65 | $42.18 | | | 95803 | - | - | $108.88 | $31.28 | $77.61 | | | 95805 | - | - | $330.75 | $41.70 | $289.05 | | | 95806 | - | - | $70.84 | $32.14 | $38.70 | | | 95807 | - | - | $305.46 | $43.12 | $262.34 | | | 95808 | - | - | $434.30 | $60.68 | $373.62 | | | 95810 | - | - | $478.75 | $86.52 | $392.24 | | | 95811 | - | - | $500.82 | $89.77 | $411.05 | | | 95812 | - | - | $273.38 | $41.44 | $231.95 | | | 95813 | - | - | $338.88 | $62.74 | $276.14 | | | 95816 | - | - | $303.38 | $41.44 | $261.94 | | | 95819 | - | - | $352.40 | $41.44 | $310.96 | | | 95822 | - | - | $329.90 | $41.71 | $288.19 | | | 95824 | - | - | - | $28.56 | - | | | 95829 | - | - | $1,400.03 | $242.03 | $1,157.99 | | | 95830 | $550.37 | $67.19 | - | - | - | | | 95836 | - | - | $77.79 | - | - | | | 95851 | $16.44 | $5.72 | - | - | - | | | 95852 | $13.61 | $3.96 | - | - | - | | | 95857 | $48.33 | $21.01 | - | - | - | | | 95860 | - | - | $87.18 | $37.16 | $50.02 | | | 95861 | - | - | $124.21 | $59.46 | $64.75 | | | 95863 | - | - | $161.69 | $72.56 | $89.12 | | | 95864 | - | - | $181.36 | $77.24 | $104.12 | | | 95865 | - | - | $115.37 | $60.27 | $55.11 | | | 95866 | - | - | $98.03 | $46.94 | $51.09 | | | 95867 | - | - | $83.55 | $30.59 | $52.96 | | | 95868 | - | - | $108.37 | $45.50 | $62.87 | | | 95869 | - | - | $75.82 | $14.55 | $61.27 | | | 95870 | - | - | $65.64 | $14.28 | $51.36 | | | 95872 | - | - | $149.65 | $109.81 | $39.84 | | | 95873 | - | - | $56.67 | $14.35 | $42.32 | | | 95874 | - | - | $60.95 | $14.35 | $46.60 | | | 95875 | - | - | $106.41 | $42.46 | $63.95 | | | 95885 | - | - | $48.68 | $13.32 | $35.35 | | | 95886 | - | - | $75.69 | $33.37 | $42.32 | | | 95887 | - | - | $65.06 | $27.29 | $37.77 | | | 95905 | - | - | $27.34 | $1.96 | $25.38 | | | 95907 | - | - | $68.88 | $38.68 | $30.20 | | | 95908 | - | - | $85.71 | $48.28 | $37.43 | | | 95909 | - | - | $102.94 | $58.02 | $44.93 | | | 95910 | - | - | $134.60 | $77.09 | $57.52 | | | 95911 | - | - | $162.25 | $96.16 | $66.09 | | | 95912 | - | - | $189.55 | $115.23 | $74.32 | | | 95913 | - | - | $218.66 | $136.57 | $82.09 | | | 95919 | - | - | $11.77 | $7.29 | $4.49 | | | 95921 | - | - | $67.50 | $32.75 | $34.75 | | | 95922 | - | - | $74.79 | $33.68 | $41.11 | | | 95923 | - | - | $96.16 | $32.75 | $63.41 | | | 95924 | - | - | $116.54 | $63.91 | $52.63 | | | 95925 | - | - | $140.71 | $20.72 | $119.99 | | | 95926 | - | - | $122.63 | $20.05 | $102.58 | | | 95927 | - | - | $131.20 | $19.78 | $111.42 | | | 95928 | - | - | $184.50 | $57.95 | $126.55 | | | 95929 | - | - | $187.51 | $57.75 | $129.77 | | | 95930 | - | - | $52.09 | $13.59 | $38.50 | | | 95933 | - | - | $64.19 | $23.01 | $41.18 | | | 95937 | - | - | $82.54 | $25.29 | $57.25 | | | 95938 | - | - | $288.89 | $33.11 | $255.78 | | | 95939 | - | - | $430.72 | $86.55 | $344.17 | | | 95940 | - | - | $23.79 | - | - | | | 95941 | - | - | I.C. | - | - | | | 95954 | - | - | $316.16 | $78.79 | $237.37 | | | 95955 | - | - | $151.35 | $38.92 | $112.42 | | | 95957 | - | - | $214.80 | $74.45 | $140.34 | | | 95958 | - | - | $524.64 | $164.40 | $360.24 | | | 95961 | - | - | $240.69 | $117.09 | $123.61 | | | 95962 | - | - | $207.07 | $125.78 | $81.29 | | | 95965 | - | - | - | $302.54 | - | | | 95966 | - | - | - | $154.60 | - | | | 95967 | - | - | - | $135.46 | - | | | 95970 | $13.92 | $13.65 | - | - | - | | | 95971 | $35.76 | $28.53 | - | - | - | | | 95972 | $42.48 | $29.62 | - | - | - | | | 95976 | $29.45 | $28.65 | - | - | - | | | 95977 | $38.87 | $38.34 | - | - | - | | | 95980 | - | - | $33.03 | - | - | | | 95981 | $29.70 | $13.10 | - | - | - | | | 95982 | $44.56 | $26.62 | - | - | - | | | 95983 | $37.14 | $36.33 | - | - | - | | | 95984 | $32.17 | $31.90 | - | - | - | | | 95990 | - | - | $71.51 | - | - | | | 95991 | $85.94 | $29.42 | - | - | - | | | 95992 | $32.56 | $26.66 | - | - | - | | | 95999 | - | - | I.C. | - | - | | | 96000 | - | - | $61.34 | - | - | | | 96001 | - | - | $81.22 | - | - | | | 96002 | - | - | $15.93 | - | - | | | 96003 | - | - | $12.21 | - | - | | | 96004 | - | - | $79.90 | - | - | | | 96020 | - | - | - | $116.25 | - | | | 96040 | - | - | $38.83 | - | - | | | 96105 | - | - | $72.97 | - | - | | | 96110 | - | - | $10.27 | - | - | | | 96112 | $93.34 | $92.27 | - | - | - | | | 96113 | $44.33 | $41.39 | - | - | - | | | 96116 | $68.84 | $58.66 | - | - | - | | | 96121 | $55.79 | $48.83 | - | - | - | | | 96125 | - | - | $77.38 | - | - | | | 96127 | - | - | $10.27 | - | - | | | 96130 | $88.52 | $79.41 | - | - | - | | | 96131 | $63.79 | $55.76 | - | - | - | | | 96132 | $96.29 | $77.27 | - | - | - | | | 96133 | $73.43 | $55.76 | - | - | - | | | 96136 | $32.35 | $17.08 | - | - | - | | | 96137 | $29.94 | $13.07 | - | - | - | | | 96138 | - | - | $26.98 | - | - | | | 96139 | - | - | $27.79 | - | - | | | 96146 | - | - | $1.81 | - | - | | | 96156 | $70.03 | $61.46 | - | - | - | | | 96158 | $47.82 | $41.66 | - | - | - | | | 96159 | $16.46 | $14.32 | - | - | - | | | 96160 | - | - | $2.14 | - | - | | | 96161 | - | - | $2.14 | - | - | | | 96164 | $7.22 | $6.41 | - | - | - | | | 96165 | $3.25 | $2.98 | - | - | - | | | 96167 | $50.81 | $44.11 | - | - | - | | | 96168 | $17.95 | $15.54 | - | - | - | | | 96170 | $58.01 | $54.26 | - | - | - | | | 96171 | $20.99 | $19.65 | - | - | - | | | 96202 | $17.49 | $15.88 | - | - | - | | | 96203 | - | - | $4.48 | - | - | | | 96360 | - | - | $25.52 | - | - | | | 96361 | - | - | $9.90 | - | - | | | 96365 | - | - | $50.40 | - | - | | | 96366 | - | - | $15.86 | - | - | | | 96367 | - | - | $22.53 | - | - | | | 96368 | - | - | $15.34 | - | - | | | 96369 | - | - | $111.20 | - | - | | | 96370 | - | - | $11.84 | - | - | | | 96371 | - | - | $45.00 | - | - | | | 96372 | - | - | $10.79 | - | - | | | 96373 | - | - | $14.00 | - | - | | | 96374 | - | - | $29.18 | - | - | | | 96375 | - | - | $12.02 | - | - | | | 96376 | - | - | I.C. | - | - | | | 96377 | - | - | $14.27 | - | - | | | 96379 | - | - | I.C. | - | - | | | 96380 | - | - | $17.56 | - | - | | | 96381 | - | - | $15.31 | - | - | | | 96401 | - | - | $57.37 | - | - | | | 96402 | - | - | $26.48 | - | - | | | 96405 | $65.76 | $21.57 | - | - | - | | | 96406 | $102.75 | $33.11 | - | - | - | | | 96409 | - | - | $79.66 | - | - | | | 96411 | - | - | $43.46 | - | - | | | 96413 | - | - | $103.34 | - | - | | | 96415 | - | - | $21.93 | - | - | | | 96416 | - | - | $101.62 | - | - | | | 96417 | - | - | $50.67 | - | - | | | 96420 | - | - | $81.43 | - | - | | | 96422 | - | - | $125.35 | - | - | | | 96423 | - | - | $57.73 | - | - | | | 96425 | - | - | $134.39 | - | - | | | 96440 | $597.89 | $99.70 | - | - | - | | | 96446 | $150.39 | $18.08 | - | - | - | | | 96450 | $127.58 | $56.33 | - | - | - | | | 96521 | - | - | $100.02 | - | - | | | 96522 | - | - | $92.25 | - | - | | | 96523 | - | - | $20.20 | - | - | | | 96542 | $101.52 | $31.08 | - | - | - | | | 96547 | - | - | I.C. | - | - | | | 96548 | - | - | I.C. | - | - | | | 96549 | - | - | I.C. | - | - | | | 96567 | - | - | $112.69 | - | - | | | 96570 | - | - | $39.57 | - | - | | | 96571 | - | - | $18.28 | - | - | | | 96573 | - | - | $183.57 | - | - | | | 96574 | - | - | $223.20 | - | - | | | 96900 | - | - | $19.48 | - | - | | | 96902 | $16.33 | $14.72 | - | - | - | | | 96904 | - | - | $56.18 | - | - | | | 96910 | - | - | $94.41 | - | - | | | 96912 | - | - | $80.55 | - | - | | | 96913 | - | - | $122.00 | - | - | | | 96920 | $122.17 | $47.17 | - | - | - | | | 96921 | $134.01 | $53.39 | - | - | - | | | 96922 | $181.71 | $86.36 | - | - | - | | | 96931 | - | - | $135.22 | - | - | | | 96932 | - | - | $102.51 | - | - | | | 96933 | - | - | $32.71 | - | - | | | 96934 | - | - | $93.33 | - | - | | | 96935 | - | - | $62.41 | - | - | | | 96936 | - | - | $30.93 | - | - | | | 96999 | - | - | I.C. | - | - | | | 97010 | - | - | $4.88 | - | - | | | 97012 | - | - | $10.87 | - | - | | | 97014 | - | - | $9.43 | - | - | | | 97016 | - | - | $8.89 | - | - | | | 97018 | - | - | $4.35 | - | - | | | 97022 | - | - | $13.20 | - | - | | | 97024 | - | - | $5.69 | - | - | | | 97026 | - | - | $5.15 | - | - | | | 97028 | - | - | $6.44 | - | - | | | 97032 | - | - | $10.87 | - | - | | | 97033 | - | - | $15.14 | - | - | | | 97034 | - | - | $10.97 | - | - | | | 97035 | - | - | $10.97 | - | - | | | 97036 | - | - | $27.14 | - | - | | | 97037 | - | - | I.C. | - | - | | | 97039 | - | - | I.C. | - | - | | | 97110 | - | - | $22.47 | - | - | | | 97112 | - | - | $25.83 | - | - | | | 97113 | - | - | $28.29 | - | - | | | 97116 | - | - | $22.47 | - | - | | | 97124 | - | - | $23.23 | - | - | | | 97129 | $16.73 | $16.46 | - | - | - | | | 97130 | - | - | $15.97 | - | - | | | 97139 | - | - | I.C. | - | - | | | 97140 | - | - | $20.64 | - | - | | | 97150 | - | - | $13.46 | - | - | | | 97151 | - | - | I.C. | - | - | | | 97152 | - | - | I.C. | - | - | | | 97153 | - | - | I.C. | - | - | | | 97154 | - | - | I.C. | - | - | | | 97155 | - | - | I.C. | - | - | | | 97156 | - | - | I.C. | - | - | | | 97157 | - | - | I.C. | - | - | | | 97158 | - | - | I.C. | - | - | | | 97161 | - | - | $76.54 | - | - | | | 97162 | - | - | $76.54 | - | - | | | 97163 | - | - | $76.54 | - | - | | | 97164 | - | - | $53.23 | - | - | | | 97165 | - | - | $76.54 | - | - | | | 97166 | - | - | $76.54 | - | - | | | 97167 | - | - | $76.54 | - | - | | | 97168 | - | - | $52.96 | - | - | | | 97169 | - | - | I.C. | - | - | | | 97170 | - | - | I.C. | - | - | | | 97171 | - | - | I.C. | - | - | | | 97172 | - | - | I.C. | - | - | | | 97530 | - | - | $28.65 | - | - | | | 97533 | - | - | $49.72 | - | - | | | 97535 | - | - | $25.15 | - | - | | | 97537 | - | - | $24.27 | - | - | | | 97542 | - | - | $24.27 | - | - | | | 97545 | - | - | I.C. | - | - | | | 97546 | - | - | I.C. | - | - | | | 97550 | - | - | $39.97 | - | - | | | 97551 | $19.79 | $18.19 | - | - | - | | | 97552 | - | - | $17.31 | - | - | | | 97597 | $78.44 | $25.95 | - | - | - | | | 97598 | $34.33 | $18.00 | - | - | - | | | 97602 | - | - | I.C. | - | - | | | 97605 | $32.68 | $18.22 | - | - | - | | | 97606 | $39.26 | $19.71 | - | - | - | | | 97607 | $292.13 | $15.99 | - | - | - | | | 97608 | $292.89 | $18.35 | - | - | - | | | 97610 | $355.78 | $13.21 | - | - | - | | | 97750 | - | - | $25.95 | - | - | | | 97755 | - | - | $29.24 | - | - | | | 97760 | - | - | $37.62 | - | - | | | 97761 | - | - | $32.26 | - | - | | | 97763 | - | - | $41.42 | - | - | | | 97799 | - | - | I.C. | - | - | | | 97802 | $27.91 | $24.43 | - | - | - | | | 97803 | $24.34 | $20.59 | - | - | - | | | 97804 | $12.75 | $11.68 | - | - | - | | | 97810 | $28.88 | $22.72 | - | - | - | | | 97811 | $21.61 | $19.20 | - | - | - | | | 97813 | $34.39 | $24.75 | - | - | - | | | 97814 | $27.93 | $20.96 | - | - | - | | | 98925 | $23.58 | $17.15 | - | - | - | | | 98926 | $33.72 | $25.68 | - | - | - | | | 98927 | $43.59 | $33.68 | - | - | - | | | 98928 | $53.53 | $42.81 | - | - | - | | | 98929 | $62.79 | $51.28 | - | - | - | | | 98940 | $20.84 | $16.28 | - | - | - | | | 98941 | $29.91 | $25.08 | - | - | - | | | 98942 | $38.71 | $33.88 | - | - | - | | | 98943 | $19.56 | $16.88 | - | - | - | | | 98960 | - | - | $23.17 | - | - | | | 98961 | - | - | $11.18 | - | - | | | 98962 | - | - | $8.24 | - | - | | | 98966 | $9.80 | $8.20 | - | - | - | | | 98967 | $17.73 | $16.12 | - | - | - | | | 98968 | $24.66 | $22.78 | - | - | - | | | 98970 | - | - | $8.46 | - | - | | | 98971 | $14.99 | $14.72 | - | - | - | | | 98972 | $22.92 | $22.65 | - | - | - | | | 98975 | - | - | $15.13 | - | - | | | 98976 | - | - | $39.57 | - | - | | | 98977 | - | - | $39.57 | - | - | | | 98978 | - | - | I.C. | - | - | | | 98980 | $37.41 | $22.68 | - | - | - | | | 98981 | $29.66 | $22.16 | - | - | - | | | 99000 | - | - | I.C. | - | - | | | 99001 | - | - | I.C. | - | - | | | 99002 | - | - | I.C. | - | - | | | 99024 | - | - | I.C. | - | - | | | 99026 | - | - | I.C. | - | - | | | 99027 | - | - | I.C. | - | - | | | 99050 | - | - | I.C. | - | - | | | 99051 | - | - | I.C. | - | - | | | 99053 | - | - | I.C. | - | - | | | 99056 | - | - | I.C. | - | - | | | 99058 | - | - | I.C. | - | - | | | 99060 | - | - | I.C. | - | - | | | 99070 | - | - | I.C. | - | - | | | 99071 | - | - | I.C. | - | - | | | 99075 | - | - | I.C. | - | - | | | 99078 | - | - | I.C. | - | - | | | 99080 | - | - | I.C. | - | - | | | 99082 | - | - | I.C. | - | - | | | 99091 | - | - | $39.78 | - | - | | | 99100 | - | - | I.C. | - | - | | | 99116 | - | - | I.C. | - | - | | | 99135 | - | - | I.C. | - | - | | | 99140 | - | - | I.C. | - | - | | | 99151 | $46.79 | $17.86 | - | - | - | | | 99152 | $39.33 | $9.06 | - | - | - | | | 99153 | - | - | $8.70 | - | - | | | 99155 | - | - | $59.63 | - | - | | | 99156 | - | - | $54.98 | - | - | | | 99157 | - | - | $45.39 | - | - | | | 99170 | $124.80 | $62.39 | - | - | - | | | 99172 | - | - | I.C. | - | - | | | 99174 | - | - | $4.75 | - | - | | | 99175 | - | - | $24.04 | - | - | | | 99177 | - | - | $3.68 | - | - | | | 99183 | - | - | $77.48 | - | - | | | 99184 | - | - | $157.16 | - | - | | | 99188 | - | - | $28.00 | - | - | | | 99190 | - | - | I.C. | - | - | | | 99191 | - | - | I.C. | - | - | | | 99192 | - | - | I.C. | - | - | | | 99195 | - | - | $77.27 | - | - | | | 99199 | - | - | I.C. | - | - | | | 99202 | $59.34 | $38.76 | - | - | - | | | 99203 | $84.36 | $60.79 | - | - | - | | | 99204 | $128.18 | $99.46 | - | - | - | | | 99205 | $164.48 | $133.14 | - | - | - | | | 99211 | $18.35 | $7.10 | - | - | - | | | 99212 | $42.98 | $26.11 | - | - | - | | | 99213 | $68.11 | $48.56 | - | - | - | | | 99214 | $96.15 | $71.77 | - | - | - | | | 99215 | $134.43 | $105.50 | - | - | - | | | 99221 | - | - | $60.92 | - | - | | | 99222 | - | - | $95.65 | - | - | | | 99223 | - | - | $127.59 | - | - | | | 99231 | - | - | $36.39 | - | - | | | 99232 | - | - | $58.20 | - | - | | | 99233 | - | - | $87.54 | - | - | | | 99234 | - | - | $72.39 | - | - | | | 99235 | - | - | $117.14 | - | - | | | 99236 | - | - | $153.34 | - | - | | | 99238 | - | - | $59.82 | - | - | | | 99239 | - | - | $84.70 | - | - | | | 99242 | $57.31 | $41.50 | - | - | - | | | 99243 | $85.38 | $65.29 | - | - | - | | | 99244 | $121.76 | $99.80 | - | - | - | | | 99245 | $157.82 | $133.18 | - | - | - | | | 99252 | - | - | $52.65 | - | - | | | 99253 | - | - | $73.87 | - | - | | | 99254 | - | - | $102.94 | - | - | | | 99255 | - | - | $137.48 | - | - | | | 99281 | - | - | $8.53 | - | - | | | 99282 | - | - | $30.39 | - | - | | | 99283 | - | - | $52.15 | - | - | | | 99284 | - | - | $87.75 | - | - | | | 99285 | - | - | $127.50 | - | - | | | 99288 | - | - | I.C. | - | - | | | 99291 | $204.56 | $155.81 | - | - | - | | | 99292 | $88.42 | $78.24 | - | - | - | | | 99304 | - | - | $59.55 | - | - | | | 99305 | - | - | $98.56 | - | - | | | 99306 | - | - | $134.56 | - | - | | | 99307 | - | - | $29.46 | - | - | | | 99308 | - | - | $55.26 | - | - | | | 99309 | - | - | $79.14 | - | - | | | 99310 | - | - | $113.60 | - | - | | | 99315 | - | - | $60.42 | - | - | | | 99316 | - | - | $96.95 | - | - | | | 99341 | - | - | $36.00 | - | - | | | 99342 | - | - | $57.27 | - | - | | | 99344 | - | - | $106.01 | - | - | | | 99345 | - | - | $149.55 | - | - | | | 99347 | - | - | $33.01 | - | - | | | 99348 | - | - | $56.27 | - | - | | | 99349 | - | - | $94.21 | - | - | | | 99350 | - | - | $137.34 | - | - | | | 99358 | $67.76 | $66.69 | - | - | - | | | 99359 | - | - | $31.82 | - | - | | | 99360 | - | - | $43.10 | - | - | | | 99366 | $30.25 | $29.45 | - | - | - | | | 99367 | - | - | $39.85 | - | - | | | 99368 | - | - | $25.93 | - | - | | | 99374 | $50.83 | $39.85 | - | - | - | | | 99375 | $75.43 | $62.30 | - | - | - | | | 99377 | $50.83 | $39.85 | - | - | - | | | 99378 | $75.43 | $62.30 | - | - | - | | | 99379 | $50.83 | $39.85 | - | - | - | | | 99380 | $75.43 | $62.30 | - | - | - | | | 99381 | $86.71 | $59.30 | - | - | - | | | 99382 | $90.60 | $63.35 | - | - | - | | | 99383 | $94.36 | $67.12 | - | - | - | | | 99384 | $106.53 | $79.29 | - | - | - | | | 99385 | $103.30 | $76.05 | - | - | - | | | 99386 | $119.26 | $92.30 | - | - | - | | | 99387 | $129.72 | $99.28 | - | - | - | | | 99391 | $78.16 | $54.40 | - | - | - | | | 99392 | $83.15 | $59.30 | - | - | - | | | 99393 | $82.86 | $59.30 | - | - | - | | | 99394 | $90.89 | $67.12 | - | - | - | | | 99395 | $93.08 | $69.03 | - | - | - | | | 99396 | $99.00 | $75.23 | - | - | - | | | 99397 | $106.53 | $79.29 | - | - | - | | | 99401 | $29.43 | $17.64 | - | - | - | | | 99402 | $47.16 | $35.37 | - | - | - | | | 99403 | $64.53 | $53.01 | - | - | - | | | 99404 | $82.02 | $70.50 | - | - | - | | | 99406 | $11.10 | $8.69 | - | - | - | | | 99407 | $58.08 | $54.04 | - | - | - | | | 99408 | $25.82 | $23.41 | - | - | - | | | 99409 | $49.23 | $46.82 | - | - | - | | | 99411 | $15.66 | $5.48 | - | - | - | | | 99412 | $19.38 | $9.20 | - | - | - | | | 99415 | - | - | $14.93 | - | - | | | 99416 | - | - | $6.90 | - | - | | | 99417 | $22.97 | $22.16 | - | - | - | | | 99418 | - | - | $28.94 | - | - | | | 99421 | $11.07 | $9.47 | - | - | - | | | 99422 | $21.88 | $18.67 | - | - | - | | | 99423 | $34.98 | $29.63 | - | - | - | | | 99424 | $60.27 | $54.11 | - | - | - | | | 99425 | $43.29 | $37.40 | - | - | - | | | 99426 | $45.64 | $35.99 | - | - | - | | | 99427 | $35.46 | $25.55 | - | - | - | | | 99429 | - | - | I.C. | - | - | | | 99437 | $44.63 | $37.13 | - | - | - | | | 99439 | $35.62 | $25.71 | - | - | - | | | 99441 | $42.58 | $25.71 | - | - | - | | | 99442 | $68.11 | $48.56 | - | - | - | | | 99443 | $95.75 | $71.37 | - | - | - | | | 99446 | - | - | $13.12 | - | - | | | 99447 | - | - | $26.11 | - | - | | | 99448 | - | - | $39.76 | - | - | | | 99449 | - | - | $52.82 | - | - | | | 99450 | - | - | I.C. | - | - | | | 99451 | - | - | $26.24 | - | - | | | 99452 | - | - | $24.37 | - | - | | | 99453 | - | - | $15.13 | - | - | | | 99454 | - | - | $39.57 | - | - | | | 99455 | - | - | I.C. | - | - | | | 99456 | - | - | I.C. | - | - | | | 99457 | $36.90 | $22.16 | - | - | - | | | 99458 | $29.66 | $22.16 | - | - | - | | | 99459 | - | - | $18.19 | - | - | | | 99460 | - | - | $100.99 | - | - | | | 99461 | $69.28 | $45.17 | - | - | - | | | 99462 | - | - | $43.82 | - | - | | | 99463 | - | - | $125.76 | - | - | | | 99464 | - | - | $53.46 | - | - | | | 99465 | - | - | $160.43 | - | - | | | 99466 | - | - | $170.09 | - | - | | | 99467 | - | - | $85.93 | - | - | | | 99468 | - | - | $656.51 | - | - | | | 99469 | - | - | $284.11 | - | - | | | 99471 | - | - | $568.08 | - | - | | | 99472 | - | - | $287.98 | - | - | | | 99473 | - | - | $10.11 | - | - | | | 99474 | $11.57 | $6.48 | - | - | - | | | 99475 | - | - | $409.16 | - | - | | | 99476 | - | - | $246.71 | - | - | | | 99477 | - | - | $248.89 | - | - | | | 99478 | - | - | $97.92 | - | - | | | 99479 | - | - | $89.19 | - | - | | | 99480 | - | - | $85.93 | - | - | | | 99483 | $205.02 | $142.88 | - | - | - | | | 99484 | $32.34 | $21.63 | - | - | - | | | 99485 | - | - | $54.26 | - | - | | | 99486 | - | - | $46.82 | - | - | | | 99487 | $100.29 | $66.81 | - | - | - | | | 99489 | $52.94 | $36.87 | - | - | - | | | 99490 | $46.78 | $37.13 | - | - | - | | | 99491 | $63.10 | $55.60 | - | - | - | | | 99492 | $114.05 | $68.25 | - | - | - | | | 99493 | $107.23 | $74.56 | - | - | - | | | 99494 | $43.51 | $29.85 | - | - | - | | | 99495 | $154.70 | $103.01 | - | - | - | | | 99496 | $209.49 | $140.38 | - | - | - | | | 99497 | $61.49 | $55.60 | - | - | - | | | 99498 | $52.88 | $52.62 | - | - | - | | | 99499 | - | - | I.C. | - | - | | | 99500 | - | - | I.C. | - | - | | | 99501 | - | - | I.C. | - | - | | | 99502 | - | - | I.C. | - | - | | | 99503 | - | - | I.C. | - | - | | | 99504 | - | - | I.C. | - | - | | | 99505 | - | - | I.C. | - | - | | | 99506 | - | - | I.C. | - | - | | | 99507 | - | - | I.C. | - | - | | | 99509 | - | - | I.C. | - | - | | | 99510 | - | - | I.C. | - | - | | | 99511 | - | - | I.C. | - | - | | | 99512 | - | - | I.C. | - | - | | | 99600 | - | - | I.C. | - | - | | | 99601 | - | - | I.C. | - | - | | | 99602 | - | - | I.C. | - | - | | | 99605 | - | - | I.C. | - | - | | | 99606 | - | - | I.C. | - | - | | | 99607 | - | - | I.C. | - | - | | | A9593 | - | - | I.C. | - | - | | | A9594 | - | - | I.C. | - | - | | | A9595 | - | - | I.C. | - | - | | | A9596 | - | - | I.C. | - | - | | | A9800 | - | - | I.C. | - | - | | | G0108 | - | - | $41.05 | - | - | | | G0109 | - | - | $11.68 | - | - | | | G0270 | $24.34 | $20.59 | - | - | - | | | G0271 | $12.75 | $11.68 | - | - | - | | | G0310 | $29.43 | $17.64 | - | - | - | | | G0311 | $47.16 | $35.37 | - | - | - | | | G0312 | $29.43 | $17.64 | - | - | - | | | G0313 | $47.16 | $35.37 | - | - | - | | | G0314 | $47.16 | $35.37 | - | - | - | | | G0315 | $29.43 | $17.64 | - | - | - | | | G0399 | - | - | I.C. | - | - | | | S0302 | - | - | I.C. | - | - | | | S3005-U1 | - | - | $10.27 | - | - | | | S3005-U2 | - | - | $10.27 | - | - | | | T1023 | - | - | I.C. | - | - | | | T2023 | - | - | $241.88 | - | - | | | J0131 | - | - | I.C. | - | - | | | J0134 | - | - | I.C. | - | - | | | J0135 | - | - | I.C. | - | - | | | J0136 | - | - | I.C. | - | - | | | J0172 | - | - | I.C. | - | - | | | J0173 | - | - | I.C. | - | - | | | J0177 | - | - | I.C. | - | - | | | J0179 | - | - | I.C. | - | - | | | J0184 | - | - | I.C. | - | - | | | J0208 | - | - | I.C. | - | - | | | J0215 | - | - | I.C. | - | - | | | J0217 | - | - | I.C. | - | - | | | J0219 | - | - | I.C. | - | - | | | J0222 | - | - | I.C. | - | - | | | J0223 | - | - | I.C. | - | - | | | J0224 | - | - | I.C. | - | - | | | J0225 | - | - | I.C. | - | - | | | J0282 | - | - | I.C. | - | - | | | J0283 | - | - | I.C. | - | - | | | J0291 | - | - | I.C. | - | - | | | J0364 | - | - | I.C. | - | - | | | J0391 | - | - | I.C. | - | - | | | J0400 | - | - | I.C. | - | - | | | J0401 | - | - | I.C. | - | - | | | J0402 | - | - | I.C. | - | - | | | J0491 | - | - | I.C. | - | - | | | J0565 | - | - | I.C. | - | - | | | J0567 | - | - | I.C. | - | - | | | J0570 | - | - | I.C. | - | - | | | J0571 | - | - | I.C. | - | - | | | J0572 | - | - | I.C. | - | - | | | J0573 | - | - | I.C. | - | - | | | J0574 | - | - | I.C. | - | - | | | J0575 | - | - | I.C. | - | - | | | J0576 | - | - | I.C. | - | - | | | J0577 | - | - | I.C. | - | - | | | J0578 | - | - | I.C. | - | - | | | J0584 | - | - | I.C. | - | - | | | J0593 | - | - | I.C. | - | - | | | J0599 | - | - | I.C. | - | - | | | J0604 | - | - | I.C. | - | - | | | J0611 | - | - | I.C. | - | - | | | J0636 | - | - | I.C. | - | - | | | J0650 | - | - | I.C. | - | - | | | J0651 | - | - | I.C. | - | - | | | J0652 | - | - | I.C. | - | - | | | J0687 | - | - | I.C. | - | - | | | J0688 | - | - | I.C. | - | - | | | J0689 | - | - | I.C. | - | - | | | J0691 | - | - | I.C. | - | - | | | J0692 | - | - | I.C. | - | - | | | J0695 | - | - | I.C. | - | - | | | J0699 | - | - | I.C. | - | - | | | J0701 | - | - | I.C. | - | - | | | J0703 | - | - | I.C. | - | - | | | J0706 | - | - | I.C. | - | - | | | J0714 | - | - | I.C. | - | - | | | J0715 | - | - | I.C. | - | - | | | J0716 | - | - | I.C. | - | - | | | J0720 | - | - | I.C. | - | - | | | J0739 | - | - | I.C. | - | - | | | J0741 | - | - | I.C. | - | - | | | J0742 | - | - | I.C. | - | - | | | J0750 | - | - | I.C. | - | - | | | J0751 | - | - | I.C. | - | - | | | J0799 | - | - | I.C. | - | - | | | J0841 | - | - | I.C. | - | - | | | J0872 | - | - | I.C. | - | - | | | J0873 | - | - | I.C. | - | - | | | J0877 | - | - | I.C. | - | - | | | J0878 | - | - | I.C. | - | - | | | J0879 | - | - | I.C. | - | - | | | J0883 | - | - | I.C. | - | - | | | J0884 | - | - | I.C. | - | - | | | J0889 | - | - | I.C. | - | - | | | J0890 | - | - | I.C. | - | - | | | J0891 | - | - | I.C. | - | - | | | J0892 | - | - | I.C. | - | - | | | J0893 | - | - | I.C. | - | - | | | J0898 | - | - | I.C. | - | - | | | J0899 | - | - | I.C. | - | - | | | J1010 | - | - | I.C. | - | - | | | J1094 | - | - | I.C. | - | - | | | J1096 | - | - | I.C. | - | - | | | J1097 | - | - | I.C. | - | - | | | J1105 | - | - | I.C. | - | - | | | J1130 | - | - | I.C. | - | - | | | J1201 | - | - | I.C. | - | - | | | J1202 | - | - | I.C. | - | - | | | J1203 | - | - | I.C. | - | - | | | J1246 | - | - | I.C. | - | - | | | J1260 | - | - | I.C. | - | - | | | J1290 | - | - | I.C. | - | - | | | J1301 | - | - | I.C. | - | - | | | J1302 | - | - | I.C. | - | - | | | J1304 | - | - | I.C. | - | - | | | J1305 | - | - | I.C. | - | - | | | J1306 | - | - | I.C. | - | - | | | J1320 | - | - | I.C. | - | - | | | J1322 | - | - | I.C. | - | - | | | J1323 | - | - | I.C. | - | - | | | J1324 | - | - | I.C. | - | - | | | J1412 | - | - | I.C. | - | - | | | J1413 | - | - | I.C. | - | - | | | J1426 | - | - | I.C. | - | - | | | J1427 | - | - | I.C. | - | - | | | J1428 | - | - | I.C. | - | - | | | J1429 | - | - | I.C. | - | - | | | J1437 | - | - | I.C. | - | - | | | J1438 | - | - | I.C. | - | - | | | J1444 | - | - | I.C. | - | - | | | J1445 | - | - | I.C. | - | - | | | J1448 | - | - | I.C. | - | - | | | J1455 | - | - | I.C. | - | - | | | J1456 | - | - | I.C. | - | - | | | J1554 | - | - | I.C. | - | - | | | J1562 | - | - | I.C. | - | - | | | J1573 | - | - | I.C. | - | - | | | J1574 | - | - | I.C. | - | - | | | J1595 | - | - | I.C. | - | - | | | J1596 | - | - | I.C. | - | - | | | J1599 | - | - | I.C. | - | - | | | J1610 | - | - | I.C. | - | - | | | J1611 | - | - | I.C. | - | - | | | J1628 | - | - | I.C. | - | - | | | J1631 | - | - | I.C. | - | - | | | J1643 | - | - | I.C. | - | - | | | J1655 | - | - | I.C. | - | - | | | J1700 | - | - | I.C. | - | - | | | J1710 | - | - | I.C. | - | - | | | J1726 | - | - | I.C. | - | - | | | J1741 | - | - | I.C. | - | - | | | J1744 | - | - | I.C. | - | - | | | J1746 | - | - | I.C. | - | - | | | J1790 | - | - | I.C. | - | - | | | J1812 | - | - | I.C. | - | - | | | J1814 | - | - | I.C. | - | - | | | J1815 | - | - | I.C. | - | - | | | J1823 | - | - | I.C. | - | - | | | J1826 | - | - | I.C. | - | - | | | J1830 | - | - | I.C. | - | - | | | J1840 | - | - | I.C. | - | - | | | J1850 | - | - | I.C. | - | - | | | J1890 | - | - | I.C. | - | - | | | J1939 | - | - | I.C. | - | - | | | J1941 | - | - | I.C. | - | - | | | J1943 | - | - | I.C. | - | - | | | J1951 | - | - | I.C. | - | - | | | J1952 | - | - | I.C. | - | - | | | J1956 | - | - | I.C. | - | - | | | J1990 | - | - | I.C. | - | - | | | J2021 | - | - | I.C. | - | - | | | J2060 | - | - | I.C. | - | - | | | J2062 | - | - | I.C. | - | - | | | J2170 | - | - | I.C. | - | - | | | J2182 | - | - | I.C. | - | - | | | J2183 | - | - | I.C. | - | - | | | J2184 | - | - | I.C. | - | - | | | J2186 | - | - | I.C. | - | - | | | J2212 | - | - | I.C. | - | - | | | J2246 | - | - | I.C. | - | - | | | J2247 | - | - | I.C. | - | - | | | J2249 | - | - | I.C. | - | - | | | J2250 | - | - | I.C. | - | - | | | J2251 | - | - | I.C. | - | - | | | J2265 | - | - | I.C. | - | - | | | J2272 | - | - | I.C. | - | - | | | J2277 | - | - | I.C. | - | - | | | J2281 | - | - | I.C. | - | - | | | J2311 | - | - | I.C. | - | - | | | J2326 | - | - | I.C. | - | - | | | J2327 | - | - | I.C. | - | - | | | J2354 | - | - | I.C. | - | - | | | J2356 | - | - | I.C. | - | - | | | J2358 | - | - | I.C. | - | - | | | J2401 | - | - | I.C. | - | - | | | J2402 | - | - | I.C. | - | - | | | J2403 | - | - | I.C. | - | - | | | J2404 | - | - | I.C. | - | - | | | J2406 | - | - | I.C. | - | - | | | J2425 | - | - | I.C. | - | - | | | J2426 | - | - | I.C. | - | - | | | J2427 | - | - | I.C. | - | - | | | J2440 | - | - | I.C. | - | - | | | J2460 | - | - | I.C. | - | - | | | J2468 | - | - | I.C. | - | - | | | J2470 | - | - | I.C. | - | - | | | J2471 | - | - | I.C. | - | - | | | J2502 | - | - | I.C. | - | - | | | J2506 | - | - | I.C. | - | - | | | J2508 | - | - | I.C. | - | - | | | J2561 | - | - | I.C. | - | - | | | J2679 | - | - | I.C. | - | - | | | J2680 | - | - | I.C. | - | - | | | J2760 | - | - | I.C. | - | - | | | J2777 | - | - | I.C. | - | - | | | J2779 | - | - | I.C. | - | - | | | J2782 | - | - | I.C. | - | - | | | J2786 | - | - | I.C. | - | - | | | J2793 | - | - | I.C. | - | - | | | J2794 | - | - | I.C. | - | - | | | J2798 | - | - | I.C. | - | - | | | J2799 | - | - | I.C. | - | - | | | J2801 | - | - | I.C. | - | - | | | J2840 | - | - | I.C. | - | - | | | J2910 | - | - | I.C. | - | - | | | J2919 | - | - | I.C. | - | - | | | J2940 | - | - | I.C. | - | - | | | J2941 | - | - | I.C. | - | - | | | J2998 | - | - | I.C. | - | - | | | J3030 | - | - | I.C. | - | - | | | J3031 | - | - | I.C. | - | - | | | J3032 | - | - | I.C. | - | - | | | J3055 | - | - | I.C. | - | - | | | J3110 | - | - | I.C. | - | - | | | J3145 | - | - | I.C. | - | - | | | J3241 | - | - | I.C. | - | - | | | J3244 | - | - | I.C. | - | - | | | J3245 | - | - | I.C. | - | - | | | J3263 | - | - | I.C. | - | - | | | J3302 | - | - | I.C. | - | - | | | J3303 | - | - | I.C. | - | - | | | J3316 | - | - | I.C. | - | - | | | J3360 | - | - | I.C. | - | - | | | J3371 | - | - | I.C. | - | - | | | J3372 | - | - | I.C. | - | - | | | J3393 | - | - | I.C. | - | - | | | J3394 | - | - | I.C. | - | - | | | J3397 | - | - | I.C. | - | - | | | J3398 | - | - | I.C. | - | - | | | J3401 | - | - | I.C. | - | - | | | J3424 | - | - | I.C. | - | - | | | J3425 | - | - | I.C. | - | - | | | J3470 | - | - | I.C. | - | - | | | J3471 | - | - | I.C. | - | - | | | J3472 | - | - | I.C. | - | - | | | J3490 | - | - | I.C. | - | - | | | J3590 | - | - | I.C. | - | - | | | J3591 | - | - | I.C. | - | - | | | J7131 | - | - | I.C. | - | - | | | J7165 | - | - | I.C. | - | - | | | J7168 | - | - | I.C. | - | - | | | J7175 | - | - | I.C. | - | - | | | J7177 | - | - | I.C. | - | - | | | J7178 | - | - | I.C. | - | - | | | J7179 | - | - | I.C. | - | - | | | J7181 | - | - | I.C. | - | - | | | J7192 | - | - | I.C. | - | - | | | J7202 | - | - | I.C. | - | - | | | J7203 | - | - | I.C. | - | - | | | J7207 | - | - | I.C. | - | - | | | J7209 | - | - | I.C. | - | - | | | J7210 | - | - | I.C. | - | - | | | J7211 | - | - | I.C. | - | - | | | J7212 | - | - | I.C. | - | - | | | J7294 | - | - | I.C. | - | - | | | J7295 | - | - | I.C. | - | - | | | J7296 | - | - | I.C. | - | - | | | J7297 | - | - | I.C. | - | - | | | J7298 | - | - | I.C. | - | - | | | J7301 | - | - | I.C. | - | - | | | J7304 | - | - | I.C. | - | - | | | J7307 | - | - | I.C. | - | - | | | J7309 | - | - | I.C. | - | - | | | J7310 | - | - | I.C. | - | - | | | J7314 | - | - | I.C. | - | - | | | J7315 | - | - | I.C. | - | - | | | J7318 | - | - | I.C. | - | - | | | J7320 | - | - | I.C. | - | - | | | J7322 | - | - | I.C. | - | - | | | J7328 | - | - | I.C. | - | - | | | J7329 | - | - | I.C. | - | - | | | J7331 | - | - | I.C. | - | - | | | J7332 | - | - | I.C. | - | - | | | J7340 | - | - | I.C. | - | - | | | J7342 | - | - | I.C. | - | - | | | J7345 | - | - | I.C. | - | - | | | J7351 | - | - | I.C. | - | - | | | J7352 | - | - | I.C. | - | - | | | J7353 | - | - | I.C. | - | - | | | J7354 | - | - | I.C. | - | - | | | J7402 | - | - | I.C. | - | - | | | J7501 | - | - | I.C. | - | - | | | J7599 | - | - | I.C. | - | - | | | J7633 | - | - | I.C. | - | - | | | J7665 | - | - | I.C. | - | - | | | J7669 | - | - | I.C. | - | - | | | J7676 | - | - | I.C. | - | - | | | J7677 | - | - | I.C. | - | - | | | J7699 | - | - | I.C. | - | - | | | J7799 | - | - | I.C. | - | - | | | J7999 | - | - | I.C. | - | - | | | J8499 | - | - | I.C. | - | - | | | J8562 | - | - | I.C. | - | - | | | J8611 | - | - | I.C. | - | - | | | J8612 | - | - | I.C. | - | - | | | J8670 | - | - | I.C. | - | - | | | J8999 | - | - | I.C. | - | - | | | J9015 | - | - | I.C. | - | - | | | J9020 | - | - | I.C. | - | - | | | J9021 | - | - | I.C. | - | - | | | J9022 | - | - | I.C. | - | - | | | J9023 | - | - | I.C. | - | - | | | J9025 | - | - | I.C. | - | - | | | J9034 | - | - | I.C. | - | - | | | J9037 | - | - | I.C. | - | - | | | J9046 | - | - | I.C. | - | - | | | J9048 | - | - | I.C. | - | - | | | J9049 | - | - | I.C. | - | - | | | J9052 | - | - | I.C. | - | - | | | J9057 | - | - | I.C. | - | - | | | J9061 | - | - | I.C. | - | - | | | J9070 | - | - | I.C. | - | - | | | J9072 | - | - | I.C. | - | - | | | J9073 | - | - | I.C. | - | - | | | J9074 | - | - | I.C. | - | - | | | J9075 | - | - | I.C. | - | - | | | J9118 | - | - | I.C. | - | - | | | J9144 | - | - | I.C. | - | - | | | J9145 | - | - | I.C. | - | - | | | J9172 | - | - | I.C. | - | - | | | J9173 | - | - | I.C. | - | - | | | J9176 | - | - | I.C. | - | - | | | J9177 | - | - | I.C. | - | - | | | J9198 | - | - | I.C. | - | - | | | J9203 | - | - | I.C. | - | - | | | J9205 | - | - | I.C. | - | - | | | J9210 | - | - | I.C. | - | - | | | J9212 | - | - | I.C. | - | - | | | J9213 | - | - | I.C. | - | - | | | J9215 | - | - | I.C. | - | - | | | J9216 | - | - | I.C. | - | - | | | J9219 | - | - | I.C. | - | - | | | J9223 | - | - | I.C. | - | - | | | J9227 | - | - | I.C. | - | - | | | J9229 | - | - | I.C. | - | - | | | J9247 | - | - | I.C. | - | - | | | J9248 | - | - | I.C. | - | - | | | J9249 | - | - | I.C. | - | - | | | J9255 | - | - | I.C. | - | - | | | J9258 | - | - | I.C. | - | - | | | J9259 | - | - | I.C. | - | - | | | J9262 | - | - | I.C. | - | - | | | J9268 | - | - | I.C. | - | - | | | J9269 | - | - | I.C. | - | - | | | J9272 | - | - | I.C. | - | - | | | J9273 | - | - | I.C. | - | - | | | J9274 | - | - | I.C. | - | - | | | J9281 | - | - | I.C. | - | - | | | J9286 | - | - | I.C. | - | - | | | J9295 | - | - | I.C. | - | - | | | J9296 | - | - | I.C. | - | - | | | J9298 | - | - | I.C. | - | - | | | J9302 | - | - | I.C. | - | - | | | J9304 | - | - | I.C. | - | - | | | J9316 | - | - | I.C. | - | - | | | J9317 | - | - | I.C. | - | - | | | J9318 | - | - | I.C. | - | - | | | J9319 | - | - | I.C. | - | - | | | J9320 | - | - | I.C. | - | - | | | J9321 | - | - | I.C. | - | - | | | J9322 | - | - | I.C. | - | - | | | J9323 | - | - | I.C. | - | - | | | J9324 | - | - | I.C. | - | - | | | J9325 | - | - | I.C. | - | - | | | J9331 | - | - | I.C. | - | - | | | J9332 | - | - | I.C. | - | - | | | J9333 | - | - | I.C. | - | - | | | J9334 | - | - | I.C. | - | - | | | J9340 | - | - | I.C. | - | - | | | J9348 | - | - | I.C. | - | - | | | J9349 | - | - | I.C. | - | - | | | J9352 | - | - | I.C. | - | - | | | J9353 | - | - | I.C. | - | - | | | J9356 | - | - | I.C. | - | - | | | J9358 | - | - | I.C. | - | - | | | J9371 | - | - | I.C. | - | - | | | J9376 | - | - | I.C. | - | - | | | J9380 | - | - | I.C. | - | - | | | J9393 | - | - | I.C. | - | - | | | J9394 | - | - | I.C. | - | - | | | J9999 | - | - | I.C. | - | - | | | Q0220 | - | - | I.C. | - | - | | | Q0240 | - | - | I.C. | - | - | | | Q0243 | - | - | I.C. | - | - | | | Q0244 | - | - | I.C. | - | - | | | Q0245 | - | - | I.C. | - | - | | | Q0247 | - | - | I.C. | - | - | | | Q0249 | - | - | I.C. | - | - | | | Q0516 | - | - | I.C. | - | - | | | Q0517 | - | - | I.C. | - | - | | | Q0518 | - | - | I.C. | - | - | | | Q2009 | - | - | I.C. | - | - | | | Q2017 | - | - | I.C. | - | - | | | Q2028 | - | - | I.C. | - | - | | | Q2036 | - | - | I.C. | - | - | | | Q2038 | - | - | I.C. | - | - | | | Q2041 | - | - | I.C. | - | - | | | Q2042 | - | - | I.C. | - | - | | | Q2049 | - | - | I.C. | - | - | | | Q2053 | - | - | I.C. | - | - | | | Q2054 | - | - | I.C. | - | - | | | Q2055 | - | - | I.C. | - | - | | | Q2056 | - | - | I.C. | - | - | | | Q4101 | - | - | I.C. | - | - | | | Q4103 | - | - | I.C. | - | - | | | Q4104 | - | - | I.C. | - | - | | | Q4108 | - | - | I.C. | - | - | | | Q4110 | - | - | I.C. | - | - | | | Q4161 | - | - | I.C. | - | - | | | Q4162 | - | - | I.C. | - | - | | | Q4163 | - | - | I.C. | - | - | | | Q4164 | - | - | I.C. | - | - | | | Q4165 | - | - | I.C. | - | - | | | Q4183 | - | - | I.C. | - | - | | | Q4184 | - | - | I.C. | - | - | | | Q4185 | - | - | I.C. | - | - | | | Q4187 | - | - | I.C. | - | - | | | Q4188 | - | - | I.C. | - | - | | | Q4189 | - | - | I.C. | - | - | | | Q4190 | - | - | I.C. | - | - | | | Q4191 | - | - | I.C. | - | - | | | Q4192 | - | - | I.C. | - | - | | | Q4193 | - | - | I.C. | - | - | | | Q4194 | - | - | I.C. | - | - | | | Q4197 | - | - | I.C. | - | - | | | Q4198 | - | - | I.C. | - | - | | | Q4199 | - | - | I.C. | - | - | | | Q4200 | - | - | I.C. | - | - | | | Q4201 | - | - | I.C. | - | - | | | Q4202 | - | - | I.C. | - | - | | | Q4203 | - | - | I.C. | - | - | | | Q4204 | - | - | I.C. | - | - | | | Q4205 | - | - | I.C. | - | - | | | Q4206 | - | - | I.C. | - | - | | | Q4208 | - | - | I.C. | - | - | | | Q4209 | - | - | I.C. | - | - | | | Q4210 | - | - | I.C. | - | - | | | Q4211 | - | - | I.C. | - | - | | | Q4212 | - | - | I.C. | - | - | | | Q4213 | - | - | I.C. | - | - | | | Q4214 | - | - | I.C. | - | - | | | Q4215 | - | - | I.C. | - | - | | | Q4216 | - | - | I.C. | - | - | | | Q4217 | - | - | I.C. | - | - | | | Q4218 | - | - | I.C. | - | - | | | Q4219 | - | - | I.C. | - | - | | | Q4220 | - | - | I.C. | - | - | | | Q4221 | - | - | I.C. | - | - | | | Q4222 | - | - | I.C. | - | - | | | Q4226 | - | - | I.C. | - | - | | | Q4251 | - | - | I.C. | - | - | | | Q4252 | - | - | I.C. | - | - | | | Q4253 | - | - | I.C. | - | - | | | Q4262 | - | - | I.C. | - | - | | | Q4263 | - | - | I.C. | - | - | | | Q4264 | - | - | I.C. | - | - | | | Q4279 | - | - | I.C. | - | - | | | Q4287 | - | - | I.C. | - | - | | | Q4288 | - | - | I.C. | - | - | | | Q4289 | - | - | I.C. | - | - | | | Q4290 | - | - | I.C. | - | - | | | Q4291 | - | - | I.C. | - | - | | | Q4292 | - | - | I.C. | - | - | | | Q4293 | - | - | I.C. | - | - | | | Q4294 | - | - | I.C. | - | - | | | Q4295 | - | - | I.C. | - | - | | | Q4296 | - | - | I.C. | - | - | | | Q4297 | - | - | I.C. | - | - | | | Q4298 | - | - | I.C. | - | - | | | Q4299 | - | - | I.C. | - | - | | | Q4300 | - | - | I.C. | - | - | | | Q4301 | - | - | I.C. | - | - | | | Q4302 | - | - | I.C. | - | - | | | Q4303 | - | - | I.C. | - | - | | | Q4304 | - | - | I.C. | - | - | | | Q5101 | - | - | I.C. | - | - | | | Q5107 | - | - | I.C. | - | - | | | Q5109 | - | - | I.C. | - | - | | | Q5112 | - | - | I.C. | - | - | | | Q5113 | - | - | I.C. | - | - | | | Q5114 | - | - | I.C. | - | - | | | Q5115 | - | - | I.C. | - | - | | | Q5116 | - | - | I.C. | - | - | | | Q5117 | - | - | I.C. | - | - | | | Q5118 | - | - | I.C. | - | - | | | Q5119 | - | - | I.C. | - | - | | | Q5121 | - | - | I.C. | - | - | | | Q5122 | - | - | I.C. | - | - | | | Q5123 | - | - | I.C. | - | - | | | Q5125 | - | - | I.C. | - | - | | | Q5126 | - | - | I.C. | - | - | | | Q5131 | - | - | I.C. | - | - | | | Q5132 | - | - | I.C. | - | - | | | Q9950 | - | - | I.C. | - | - | | | Q9980 | - | - | I.C. | - | - | | | S0013 | - | - | I.C. | - | - | |

Behavioral Health and Developmental Screening Services

Tobacco Cessation Codes

| Code | NFAC | FAC | Description ( see medicine services code spreadsheet at www.mass.gov/regulations/101-CMR-31700-medicine) | | --- | --- | --- | --- | | 99407 | $58.08 | $54.04 | | | 99407 SA | $58.08 | $54.04 | | | 99407 TD | $49.37 | $45.93 | | | 99407 U1 | $49.37 | $45.93 | | | 99407 TF | $87.12 | $81.06 | | | 99407 U2 | $74.05 | $68.90 | | | 99407 HQ | $37.03 | $34.45 | | | 99407 U3 | $31.47 | $29.28 | |

History

Amended by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 317.05 Severability

The provisions of 101 CMR 317.00 are severable. If any provision of 101 CMR 317.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 317.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue S1345, eff. 8/11/2017.

Rates for Radiology Services Rates for Radiology Services

101 CMR, § 318.01 General Provisions

(1) Scope and Purpose. 101 CMR 318.00 governs the payment rates used by all governmental units for radiology care and services provided to publicly aided patients. Rates for services provided to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act) are not set forth in 101 CMR 318.00, but are at 114.3 CMR 40.00: Rates for Services under M.G.L. c. 152, Worker's Compensation Act .

(2) Applicable Dates of Service. Rates contained in 101 CMR 318.00 apply for dates of service on or after January 1, 2025, except as otherwise noted.

(3) Coverage.

(a) Payment rates in 101 CMR 318.00 are used to pay for radiology services rendered to patients in a private medical office, licensed clinic, hospital or other inpatient or outpatient facility or department, independent diagnostic testing facility, patient's residence, or other appropriate setting by an individual eligible provider, when an eligible provider bills for the medical services rendered and no other payment method applies.

(b) The rates of payment under 101 CMR 318.00 are full compensation for patient care rendered to publicly aided patients as well as for any related administrative or supervisory duties in connection with patient care. The rates of payment also reimburse all overhead expenses associated with the service provided, without regard to where the care is rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 318.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 318.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided patients.

(a) The publication of such updates and corrections will list

codes for which the code numbers change, with the corresponding cross-references between the new codes and the codes being replaced. Rates for such updated codes are set at the rate of the code that is being replaced;
deleted codes for which there are no corresponding new codes; and

codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) reimbursement for these codes until appropriate rates can be developed.

(b) For entirely new codes that require new pricing and have Medicare assigned relative value units (RVUs) (or, for applicable services, Medicare rates), EOHHS may list these codes and price them according to the appropriate rate methodology used in setting physician rates. When Medicare RVUs (or, for applicable services, Medicare rates) are not available, EOHHS may apply individual consideration in reimbursing for these new codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, and to clarify its policy on and understanding of substantive provisions of 101 CMR 318.00. EOHHS may also issue administrative bulletins to clarify to which duly licensed or certified health care professionals or students the rate methods in this regulation apply.

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 318.02 General Definitions

Meaning of Terms: The five-digit procedure codes and two-digit modifiers included in 101 CMR 318.00, and their corresponding descriptions, utilize the Healthcare Common Procedure Code System (HCPCS) for Level I and Level II coding. Level I CPT-4 codes are obtained from the Physicians' 2023 Current Procedural Terminology (CPT) , copyright 2022 by the American Medical Association (AMA), unless otherwise specified. Level II codes are obtained from the 2020 HCPCS, maintained jointly by the Centers for Medicare and Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and the Health Insurance Association of America. HCPCS is a listing of descriptive terms and identifying codes and modifiers for reporting medical services and procedures performed by physicians and other health care professionals, as well as associated nonphysician services. No fee schedules, basic unit value, relative value guides, conversion factors, or scales are included in any part of the Physicians' Current Procedure Terminology . For code descriptions, see the radiology services code spreadsheet at www.mass.gov/regulations/101-CMR-31800-radiology.

In addition, terms used in 101 CMR 318.00 have the meanings set forth in 101 CMR 318.02.

Eligible Provider. The established rates apply in accordance with 101 CMR 318.01 to the following types of providers who meet conditions of participation of the governmental unit purchasing such services, and to the extent specified by such governmental unit. Eligible providers must provide such services in accordance with accepted professional standards and in accordance with state licensing requirements and certification by national credentialing bodies as required by law.

(a) A licensed physician (other than an intern, resident, fellow, or house officer), licensed podiatrist, licensed dentist, licensed chiropractor, and licensed optometrist.

(b) A provider of therapeutic and diagnostic radiology services. Such radiology services may be rendered by eligible providers such as, but not limited to, independent diagnostic testing facilities (IDTFs). These eligible providers must be independent of a hospital or a physician's office.

(d) A clinic licensed by the Massachusetts Department of Public Health in accordance with 105 CMR 140.000 : Licensure of Clinics to provide radiology services.

(g) A licensed physician assistant who is authorized by the Board of Registration for Physician Assistants to practice as a physician assistant.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration (I.C.). Radiology services that are authorized but not listed in 101 CMR 318.00, radiology services performed in unusual circumstances, and services designated "I.C." are individually considered items. The governmental unit or purchaser analyzes the eligible provider's report of services rendered and charges submitted under the appropriate unlisted services or procedures category. The governmental unit or purchaser determines appropriate payment for procedures designated I.C. in accordance with the following standards and criteria:

(a) the amount of time required to perform the service;

(b) the degree of skill required to perform the service;

(d) any applicable relative value studies;

(e) any complications or other circumstances that may be deemed relevant;

(f) the policies, procedures, and practices of other third-party insurers;

(g) the payment rate for prescribed drugs as set forth in 101 CMR 331.00: Prescribed Drugs ; and

(h) a copy of the current invoice from the supplier.

Modifiers. Listed services and procedures may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of the appropriate two-digit number.

Radiology Services. Radiology services including diagnostic ultrasound, radiation oncology, and nuclear medicine provided for the assessment and/or treatment of a medical condition, injury, or illness.

Supervision and Interpretation Only. When a procedure is performed by two eligible physicians, the radiologic portion of the procedure is designated as "radiological supervision and interpretation". When an eligible physician performs both the procedure and the imaging supervision and interpretation, a combination of procedure codes outside the 70000 series and imaging supervision and interpretation codes are to be used. The radiological supervision and interpretation codes are not applicable to the Radiology Oncology subsection.

Unlisted Procedure or Service. A service or procedure that may be provided that is covered, but not listed in 101 CMR 318.04. When reporting such a service, the appropriate "Unlisted Procedure" code may be used to indicate the service.

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 318.03 General Rate Provisions

(1) Rate Determination. Rates of payment for services for which 101 CMR 318.00 applies are the lowest of

(a) the eligible provider's usual fee to patients other than publicly aided individuals;

(b) the eligible provider's actual charge submitted; or

(c) the schedule of allowable fees set forth in 101 CMR 318.04(3), taking into account appropriate modifiers and any other applicable rate provision(s) in accordance with 101 CMR 318.03.

(2) Supplemental Payment.

the eligible provider is employed by a nonprofit group practice that was established in accordance with St.1997, c.163 and is affiliated with a Commonwealth-owned medical school;
such nonprofit group practice must have been established on or before January 1, 2000, in order to support the purposes of a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school; and
the services are provided at a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school.

(b) Payment Method. This supplemental payment may not exceed the difference between

payments to the eligible provider made pursuant to the rates applicable under 101 CMR 316.03(1): Rate Determination , 101 CMR 317.03(1): Rate Determination and 318.03(1); and
the federal upper payment established by the Centers for Medicare & Medicaid Services.

(3) The sum of the professional and technical components of an individual procedure will not be greater than the allowable global fee set forth in 101 CMR 318.04(3).

(4) Allowable Fee for Certain Eligible Providers. Payment for services provided by eligible providers who are certified nurse practitioners, psychiatric clinical nurse specialists, clinical nurse specialists, and physician assistants as specified in 101 CMR 318.02, is 85% of the fees contained in 101 CMR 318.04.

(5) CPT Category III Codes. All radiology-related CPT category III codes are included as a part of 101 CMR 318.00 and have an assigned fee of I.C.

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 318.04 Maximum Allowable Fees - Radiology Services

(1) Unless otherwise specified, guidelines, notes, and definitions provided in the 2023 CPT Coding Handbook are applicable to the use of the procedure codes and modifiers listed below, as well as their corresponding descriptions. For code descriptions, see the radiology services code spreadsheet at www.mass.gov/regulations/101-CMR-31800-radiology.

(2) Modifiers.

(a) 26: Professional Component. The component of a service or procedure representing the physician's or other qualified health care professional's work interpreting or performing the service or procedure. (When the physician or other qualified health care professional component is reported separately, the addition of modifier 26 to the procedure code will allow payment of the professional component allowable fee (PC Fee) contained in 101 CMR 318.04(3), adjusted by 101 CMR 318.03 as applicable.)

(b) 51: Multiple Procedures. Most radiology services do not require modifier 51. Modifier 51 applies only to nuclear medicine procedure codes 78306, 78320, 78802, 78803, 78806 and 78807 and should be used only when a whole body bone, tumor, or infection study is performed on the same day prior to a SPECT bone, tumor, or infection study, respectively. Under these circumstances, the modifier must be used to report multiple procedures performed at the same session. The service code for the major procedure or service must be reported without a modifier. The secondary, additional, or lesser procedure(s) must be identified by adding modifier 51 to the end of the service code for the secondary procedure(s). (The addition of modifier 51 to the second and subsequent procedure codes allows payment of 50% of the allowable fee contained in 101 CMR 318.04(3), adjusted by 101 CMR 318.03 as applicable, to the eligible provider. Note: This modifier should not be used with designated "add-on" codes or with codes in which the narrative begins with "each additional".)

(c) 52: Reduced Services. Under certain circumstances, a service or procedure is partially reduced or eliminated at the physician's or other qualified health care professional's election. Under these circumstances, the service provided can be identified by its usual procedure number and addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.

(d) 59: Distinct Procedural Service. To identify a procedure distinct or independent from other services performed on the same day, add modifier 59 to the end of the appropriate service code. Modifier 59 is used to identify services/procedures that are not normally reported together, but are appropriate under certain circumstances, for example, different site or organ system. However, when another already established modifier is appropriate, it should be used rather than modifier 59.

(e) PA: Surgical or Other Invasive Procedure Performed on the Wrong Body Part. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services.

(f) PB: Surgical or Other Invasive Procedure Performed on the Wrong Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services.

(g) PC: Wrong Surgical or Other Invasive Procedure Performed on a Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26 and results in nonpayment for services.

(h) SA: Nurse Practitioner Rendering Service in Collaboration with a Physician. This modifier is to be applied to service codes billed by a physician that were performed by a certified nurse practitioner employed by the physician (the physician employer must be practicing as an individual and not practicing as a professional corporation or as a member of a group practice). A certified nurse practitioner billing under his/her own individual provider number, or a group practice, should not use this modifier.

(i) TC: Technical Component. The component of a service or procedure representing the cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits, and other overhead expenses of the service or procedures, excluding the physician's or other qualified health care professional's professional component. (When the technical component is reported separately, the addition of modifier TC to the procedure code will allow payment of the technical component allowable fee (TC Fee) contained in 101 CMR 318.04(3), adjusted by 101 CMR 318.03 as applicable.)

(j) XE: Separate Encounter. A service that is distinct because it occurred during a separate encounter.

(k) XS: Separate Structure. A service that is distinct because it was performed on a separate organ/structure.

(l) XP: Separate Practitioner. A service that is distinct because it was performed by a different practitioner.

(m) XU: Unusual Non-overlapping Service. The use of a service that is distinct because it does not overlap usual components of the main service.

(3) Fee Schedule.

(a) NFAC - "Non-facility ". These amounts apply when the service is performed in a nonfacility setting.

(b) FAC - "Facility ". These amounts, also known as the Facility Setting Fee, apply when the service is performed in a facility setting.

| Code | NFAC | FAC | Global | PC | TC | Description ( see radiology services code spreadsheet at www.mass.gov/regulations/101-CMR-31800-radiology) | | --- | --- | --- | --- | --- | --- | --- | | 70010 | - | - | $43.12 | - | - | | | 70015 | - | - | $132.32 | $42.12 | $90.19 | | | 70030 | - | - | $25.70 | $6.48 | $19.22 | | | 70100 | - | - | $30.52 | $6.48 | $24.04 | | | 70110 | - | - | $34.11 | $8.73 | $25.38 | | | 70120 | - | - | $30.52 | $6.48 | $24.04 | | | 70130 | - | - | $49.37 | $12.21 | $37.16 | | | 70134 | - | - | $48.63 | $12.81 | $35.82 | | | 70140 | - | - | $25.41 | $7.26 | $18.15 | | | 70150 | - | - | $37.03 | $9.24 | $27.79 | | | 70160 | - | - | $30.27 | $6.24 | $24.04 | | | 70170 | - | - | - | $10.69 | $184.47 | | | 70190 | - | - | $29.65 | $8.02 | $21.63 | | | 70200 | - | - | $37.79 | $10.00 | $27.79 | | | 70210 | - | - | $25.45 | $6.24 | $19.22 | | | 70220 | - | - | $29.62 | $7.73 | $21.89 | | | 70240 | - | - | $25.94 | $6.73 | $19.22 | | | 70250 | - | - | $28.38 | $6.48 | $21.89 | | | 70260 | - | - | $35.11 | $10.00 | $25.11 | | | 70300 | - | - | $10.08 | $3.72 | $6.36 | | | 70310 | - | - | $31.10 | $5.72 | $25.38 | | | 70320 | - | - | $41.68 | $8.00 | $33.68 | | | 70328 | - | - | $27.31 | $6.48 | $20.82 | | | 70330 | - | - | $41.90 | $8.49 | $33.41 | | | 70332 | - | - | $66.72 | $19.38 | $47.34 | | | 70336 | - | - | $372.12 | $51.77 | $320.35 | | | 70350 | - | - | $12.60 | $6.24 | $6.36 | | | 70355 | - | - | $13.87 | $7.24 | $6.63 | | | 70360 | - | - | $24.90 | $6.48 | $18.41 | | | 70370 | - | - | $79.41 | $10.91 | $68.50 | | | 70371 | - | - | $84.78 | $30.47 | $54.30 | | | 70380 | - | - | $29.74 | $5.97 | $23.77 | | | 70390 | - | - | $94.01 | $13.45 | $80.55 | | | 70450 | - | - | $85.83 | $29.92 | $55.91 | | | 70460 | - | - | $119.87 | $39.85 | $80.02 | | | 70470 | - | - | $141.10 | $44.82 | $96.29 | | | 70480 | - | - | $128.29 | $45.33 | $82.96 | | | 70481 | - | - | $147.39 | $39.85 | $107.54 | | | 70482 | - | - | $172.17 | $44.55 | $127.62 | | | 70486 | - | - | $104.31 | $30.18 | $74.12 | | | 70487 | - | - | $123.35 | $39.85 | $83.50 | | | 70488 | - | - | $150.48 | $44.82 | $105.66 | | | 70490 | - | - | $121.33 | $45.33 | $76.00 | | | 70491 | - | - | $149.96 | $48.85 | $101.11 | | | 70492 | - | - | $180.41 | $56.80 | $123.61 | | | 70496 | - | - | $204.01 | $61.72 | $142.29 | | | 70498 | - | - | $204.01 | $61.72 | $142.29 | | | 70540 | - | - | $313.62 | $47.31 | $266.31 | | | 70542 | - | - | $425.84 | $57.07 | $368.77 | | | 70543 | - | - | $465.54 | $75.47 | $390.07 | | | 70544 | - | - | $300.45 | $42.37 | $258.08 | | | 70545 | - | - | $319.99 | $42.10 | $277.89 | | | 70546 | - | - | $483.49 | $52.03 | $431.46 | | | 70547 | - | - | $300.96 | $42.37 | $258.59 | | | 70548 | - | - | $345.34 | $52.79 | $292.55 | | | 70549 | - | - | $495.98 | $63.48 | $432.50 | | | 70551 | - | - | $260.60 | $52.30 | $208.30 | | | 70552 | - | - | $367.64 | $62.99 | $304.65 | | | 70553 | - | - | $458.09 | $80.70 | $377.39 | | | 70554 | - | - | $530.36 | $74.42 | $455.94 | | | 70555 | - | - | - | $88.16 | - | | | 70557 | - | - | - | $115.94 | $397.67 | | | 70558 | - | - | - | $123.74 | $142.42 | | | 70559 | - | - | - | $117.29 | $142.42 | | | 71045 | - | - | $20.34 | $6.48 | $13.86 | | | 71046 | - | - | $26.41 | $7.73 | $18.68 | | | 71047 | - | - | $33.26 | $9.76 | $23.50 | | | 71048 | - | - | $36.38 | $11.00 | $25.38 | | | 71100 | - | - | $29.09 | $8.00 | $21.09 | | | 71101 | - | - | $33.26 | $9.49 | $23.77 | | | 71110 | - | - | $34.55 | $10.25 | $24.31 | | | 71111 | - | - | $41.38 | $11.45 | $29.93 | | | 71120 | - | - | $26.46 | $6.97 | $19.48 | | | 71130 | - | - | $32.57 | $7.73 | $24.84 | | | 71250 | - | - | $107.66 | $38.09 | $69.57 | | | 71260 | - | - | $135.53 | $41.12 | $94.41 | | | 71270 | - | - | $160.23 | $43.86 | $116.37 | | | 71271 | - | - | $111.41 | $38.09 | $73.32 | | | 71275 | - | - | $206.26 | $63.97 | $142.29 | | | 71550 | - | - | $405.72 | $51.54 | $354.18 | | | 71551 | - | - | $616.27 | $60.97 | $555.30 | | | 71552 | - | - | $639.08 | $79.70 | $559.38 | | | 71555 | - | - | $469.22 | $63.19 | $406.03 | | | 72020 | - | - | $19.32 | $5.72 | $13.59 | | | 72040 | - | - | $31.23 | $8.00 | $23.23 | | | 72050 | - | - | $42.10 | $9.76 | $32.34 | | | 72052 | - | - | $49.19 | $10.69 | $38.50 | | | 72070 | - | - | $25.92 | $7.24 | $18.68 | | | 72072 | - | - | $30.94 | $7.97 | $22.97 | | | 72074 | - | - | $34.91 | $8.73 | $26.18 | | | 72080 | - | - | $27.24 | $7.48 | $19.75 | | | 72081 | - | - | $33.55 | $9.24 | $24.31 | | | 72082 | - | - | $55.60 | $11.20 | $44.39 | | | 72083 | - | - | $62.54 | $12.79 | $49.75 | | | 72084 | - | - | $78.60 | $14.99 | $63.61 | | | 72100 | - | - | $31.50 | $8.00 | $23.50 | | | 72110 | - | - | $40.51 | $9.24 | $31.27 | | | 72114 | - | - | $48.92 | $10.96 | $37.97 | | | 72120 | - | - | $32.03 | $8.00 | $24.04 | | | 72125 | - | - | $105.03 | $34.93 | $70.11 | | | 72126 | - | - | $137.00 | $42.86 | $94.14 | | | 72127 | - | - | $160.92 | $44.55 | $116.37 | | | 72128 | - | - | $105.03 | $34.93 | $70.11 | | | 72129 | - | - | $138.00 | $43.06 | $94.95 | | | 72130 | - | - | $162.53 | $44.82 | $117.71 | | | 72131 | - | - | $104.50 | $34.93 | $69.57 | | | 72132 | - | - | $137.27 | $42.86 | $94.41 | | | 72133 | - | - | $161.46 | $44.82 | $116.64 | | | 72141 | - | - | $258.25 | $52.30 | $205.95 | | | 72142 | - | - | $430.72 | $63.26 | $367.46 | | | 72146 | - | - | $258.38 | $52.30 | $206.08 | | | 72147 | - | - | $429.67 | $62.99 | $366.68 | | | 72148 | - | - | $258.25 | $52.30 | $205.95 | | | 72149 | - | - | $428.88 | $62.99 | $365.89 | | | 72156 | - | - | $458.87 | $80.70 | $378.17 | | | 72157 | - | - | $459.13 | $80.70 | $378.43 | | | 72158 | - | - | $458.48 | $80.70 | $377.78 | | | 72159 | - | - | $488.82 | $63.75 | $425.07 | | | 72170 | - | - | $21.97 | $6.24 | $15.73 | | | 72190 | - | - | $33.31 | $9.00 | $24.31 | | | 72191 | - | - | $205.21 | $62.92 | $142.29 | | | 72192 | - | - | $107.64 | $38.33 | $69.30 | | | 72193 | - | - | $183.21 | $40.85 | $142.35 | | | 72194 | - | - | $185.48 | $42.86 | $142.62 | | | 72195 | - | - | $313.73 | $51.54 | $262.19 | | | 72196 | - | - | $437.57 | $61.23 | $376.34 | | | 72197 | - | - | $473.95 | $77.23 | $396.72 | | | 72198 | - | - | $476.18 | $62.95 | $413.23 | | | 72200 | - | - | $25.99 | $5.97 | $20.02 | | | 72202 | - | - | $30.94 | $7.97 | $22.97 | | | 72220 | - | - | $25.72 | $6.24 | $19.48 | | | 72240 | - | - | $89.77 | $32.79 | $56.98 | | | 72255 | - | - | $93.85 | $34.46 | $59.39 | | | 72265 | - | - | $85.87 | $29.43 | $56.45 | | | 72270 | - | - | $128.71 | $48.96 | $79.75 | | | 72285 | - | - | $100.38 | $41.26 | $59.12 | | | 72295 | - | - | $86.94 | $29.43 | $57.52 | | | 73000 | - | - | $25.48 | $5.99 | $19.48 | | | 73010 | - | - | $18.49 | $6.51 | $11.98 | | | 73020 | - | - | $16.93 | $5.48 | $11.45 | | | 73030 | - | - | $27.31 | $6.75 | $20.56 | | | 73040 | - | - | $104.48 | $19.91 | $84.57 | | | 73050 | - | - | $22.48 | $6.75 | $15.73 | | | 73060 | - | - | $25.48 | $5.99 | $19.48 | | | 73070 | - | - | $23.07 | $5.99 | $17.07 | | | 73080 | - | - | $25.72 | $6.24 | $19.48 | | | 73085 | - | - | $88.41 | $20.18 | $68.23 | | | 73090 | - | - | $23.07 | $5.72 | $17.34 | | | 73092 | - | - | $24.94 | $5.72 | $19.22 | | | 73100 | - | - | $26.82 | $5.99 | $20.82 | | | 73110 | - | - | $32.42 | $6.24 | $26.18 | | | 73115 | - | - | $107.70 | $20.18 | $87.52 | | | 73120 | - | - | $24.67 | $5.99 | $18.68 | | | 73130 | - | - | $29.20 | $6.24 | $22.97 | | | 73140 | - | - | $30.10 | $4.99 | $25.11 | | | 73200 | - | - | $119.50 | $34.93 | $84.57 | | | 73201 | - | - | $164.99 | $40.85 | $124.14 | | | 73202 | - | - | $185.21 | $42.86 | $142.35 | | | 73206 | - | - | $205.21 | $62.92 | $142.29 | | | 73218 | - | - | $402.41 | $47.85 | $354.56 | | | 73219 | - | - | $475.45 | $57.07 | $418.38 | | | 73220 | - | - | $582.11 | $75.73 | $506.38 | | | 73221 | - | - | $273.77 | $48.11 | $225.66 | | | 73222 | - | - | $585.74 | $57.34 | $528.40 | | | 73223 | - | - | $544.81 | $76.00 | $468.81 | | | 73225 | - | - | $486.30 | $61.23 | $425.07 | | | 73501 | - | - | $25.97 | $6.75 | $19.22 | | | 73502 | - | - | $37.12 | $8.00 | $29.13 | | | 73503 | - | - | $46.92 | $9.76 | $37.16 | | | 73521 | - | - | $32.57 | $8.00 | $24.57 | | | 73522 | - | - | $42.32 | $10.51 | $31.80 | | | 73523 | - | - | $48.90 | $11.20 | $37.70 | | | 73525 | - | - | $103.68 | $20.72 | $82.96 | | | 73551 | - | - | $23.07 | $5.99 | $17.07 | | | 73552 | - | - | $28.11 | $6.48 | $21.63 | | | 73560 | - | - | $27.08 | $5.99 | $21.09 | | | 73562 | - | - | $32.13 | $6.75 | $25.38 | | | 73564 | - | - | $36.86 | $8.27 | $28.59 | | | 73565 | - | - | $31.64 | $6.26 | $25.38 | | | 73580 | - | - | $101.02 | $22.34 | $78.68 | | | 73590 | - | - | $24.94 | $5.72 | $19.22 | | | 73592 | - | - | $24.94 | $5.72 | $19.22 | | | 73600 | - | - | $25.74 | $5.99 | $19.75 | | | 73610 | - | - | $29.20 | $6.24 | $22.97 | | | 73615 | - | - | $102.88 | $20.18 | $82.69 | | | 73620 | - | - | $22.26 | $5.46 | $16.81 | | | 73630 | - | - | $27.06 | $5.97 | $21.09 | | | 73650 | - | - | $22.53 | $5.72 | $16.81 | | | 73660 | - | - | $23.14 | $4.72 | $18.41 | | | 73700 | - | - | $104.77 | $34.93 | $69.84 | | | 73701 | - | - | $135.53 | $40.85 | $94.68 | | | 73702 | - | - | $159.23 | $42.59 | $116.64 | | | 73706 | - | - | $208.49 | $66.20 | $142.29 | | | 73718 | - | - | $309.26 | $47.58 | $261.68 | | | 73719 | - | - | $361.98 | $57.07 | $304.91 | | | 73720 | - | - | $473.24 | $75.73 | $397.51 | | | 73721 | - | - | $273.51 | $47.85 | $225.66 | | | 73722 | - | - | $586.65 | $57.34 | $529.31 | | | 73723 | - | - | $543.00 | $75.73 | $467.27 | | | 73725 | - | - | $471.77 | $63.17 | $408.60 | | | 74018 | - | - | $23.56 | $6.48 | $17.07 | | | 74019 | - | - | $29.07 | $8.24 | $20.82 | | | 74021 | - | - | $33.79 | $9.49 | $24.31 | | | 74022 | - | - | $39.24 | $11.45 | $27.79 | | | 74150 | - | - | $110.35 | $41.85 | $68.50 | | | 74160 | - | - | $187.17 | $44.82 | $142.35 | | | 74170 | - | - | $191.69 | $49.07 | $142.62 | | | 74174 | - | - | $311.51 | $76.89 | $234.62 | | | 74175 | - | - | $205.99 | $63.70 | $142.29 | | | 74176 | - | - | $147.32 | $61.48 | $85.84 | | | 74177 | - | - | $249.98 | $64.24 | $185.74 | | | 74178 | - | - | $280.08 | $70.50 | $209.58 | | | 74181 | - | - | $279.30 | $51.54 | $227.76 | | | 74182 | - | - | $423.25 | $60.97 | $362.28 | | | 74183 | - | - | $463.19 | $77.23 | $385.96 | | | 74185 | - | - | $475.15 | $62.95 | $412.20 | | | 74190 | - | - | - | $16.30 | $397.67 | | | 74210 | - | - | $76.51 | $20.87 | $55.64 | | | 74220 | - | - | $78.37 | $21.38 | $56.98 | | | 74221 | - | - | $88.05 | $24.64 | $63.41 | | | 74230 | - | - | $100.76 | $18.87 | $81.89 | | | 74235 | - | - | - | $42.12 | - | | | 74240 | - | - | $97.99 | $28.42 | $69.57 | | | 74246 | - | - | $111.16 | $31.41 | $79.75 | | | 74248 | - | - | $65.28 | $24.64 | $40.64 | | | 74250 | - | - | $97.43 | $28.40 | $69.03 | | | 74251 | - | - | $184.06 | $41.36 | $142.69 | | | 74261 | - | - | $168.77 | $84.47 | $84.30 | | | 74262 | - | - | $230.34 | $87.99 | $142.35 | | | 74263 | - | - | $544.89 | $80.20 | $464.70 | | | 74270 | - | - | $122.35 | $36.44 | $85.91 | | | 74280 | - | - | $176.75 | $44.30 | $132.44 | | | 74283 | - | - | $200.78 | $73.89 | $126.89 | | | 74290 | - | - | $69.23 | $11.45 | $57.79 | | | 74300 | - | - | - | $9.69 | - | | | 74301 | - | - | - | $7.48 | - | | | 74328 | - | - | - | $17.00 | - | | | 74329 | - | - | - | $17.26 | - | | | 74330 | - | - | - | $20.40 | - | | | 74340 | - | - | - | $19.11 | - | | | 74355 | - | - | - | $26.91 | - | | | 74360 | - | - | - | $19.65 | - | | | 74363 | - | - | - | $30.65 | - | | | 74400 | - | - | $108.28 | $17.35 | $90.93 | | | 74410 | - | - | $112.43 | $16.95 | $95.48 | | | 74415 | - | - | $123.68 | $17.22 | $106.46 | | | 74420 | - | - | $60.47 | $17.95 | $42.52 | | | 74425 | - | - | $108.97 | $17.71 | $91.27 | | | 74430 | - | - | $32.27 | $11.18 | $21.09 | | | 74440 | - | - | $77.20 | $12.99 | $64.21 | | | 74445 | - | - | - | $39.16 | $84.30 | | | 74450 | - | - | - | $11.69 | $184.47 | | | 74455 | - | - | $83.48 | $11.49 | $71.98 | | | 74470 | - | - | - | $18.58 | $397.67 | | | 74485 | - | - | $93.64 | $28.89 | $64.75 | | | 74712 | - | - | $460.23 | $106.05 | $354.18 | | | 74713 | - | - | $250.13 | $65.51 | $184.62 | | | 74740 | - | - | $76.06 | $13.45 | $62.61 | | | 74742 | - | - | - | $21.63 | - | | | 74775 | - | - | - | $22.14 | $184.47 | | | 75557 | - | - | $359.92 | $81.77 | $278.15 | | | 75559 | - | - | $491.87 | $101.02 | $390.85 | | | 75561 | - | - | $489.07 | $90.50 | $398.57 | | | 75563 | - | - | $571.08 | $102.78 | $468.30 | | | 75565 | - | - | $63.79 | $8.73 | $55.06 | | | 75571 | - | - | $81.09 | $20.63 | $60.46 | | | 75572 | - | - | $183.45 | $61.06 | $122.40 | | | 75573 | - | - | $231.43 | $88.94 | $142.49 | | | 75574 | - | - | $226.02 | $83.73 | $142.29 | | | 75580 | - | - | $723.05 | $25.85 | $697.20 | | | 75600 | - | - | $146.58 | $17.08 | $129.50 | | | 75605 | - | - | $93.19 | $38.68 | $54.50 | | | 75625 | - | - | $96.57 | $48.43 | $48.14 | | | 75630 | - | - | $119.59 | $67.97 | $51.63 | | | 75635 | - | - | $225.21 | $82.86 | $142.35 | | | 75705 | - | - | $191.07 | $84.20 | $106.86 | | | 75710 | - | - | $114.87 | $59.57 | $55.31 | | | 75716 | - | - | $124.15 | $66.70 | $57.45 | | | 75726 | - | - | $131.40 | $69.13 | $62.27 | | | 75731 | - | - | $119.64 | $40.36 | $79.28 | | | 75733 | - | - | $131.97 | $44.93 | $87.04 | | | 75736 | - | - | $111.06 | $38.22 | $72.85 | | | 75741 | - | - | $101.17 | $44.25 | $56.91 | | | 75743 | - | - | $114.15 | $56.17 | $57.99 | | | 75746 | - | - | $104.91 | $38.89 | $66.02 | | | 75756 | - | - | $125.93 | $40.22 | $85.70 | | | 75774 | - | - | $75.01 | $33.83 | $41.18 | | | 75801 | - | - | - | $30.80 | $457.13 | | | 75803 | - | - | - | $41.36 | $1,176.02 | | | 75805 | - | - | - | $28.67 | $2,354.51 | | | 75807 | - | - | - | $38.55 | $2,354.51 | | | 75809 | - | - | $64.74 | $17.13 | $47.61 | | | 75810 | - | - | - | $35.00 | $2,354.51 | | | 75820 | - | - | $84.56 | $36.15 | $48.41 | | | 75822 | - | - | $102.32 | $49.89 | $52.43 | | | 75825 | - | - | $87.96 | $38.48 | $49.48 | | | 75827 | - | - | $92.25 | $39.01 | $53.23 | | | 75831 | - | - | $93.25 | $37.95 | $55.31 | | | 75833 | - | - | $113.07 | $50.53 | $62.54 | | | 75840 | - | - | $100.76 | $40.36 | $60.40 | | | 75842 | - | - | $123.66 | $52.81 | $70.84 | | | 75860 | - | - | $97.81 | $39.29 | $58.52 | | | 75870 | - | - | $121.90 | $43.03 | $78.88 | | | 75872 | - | - | $100.76 | $40.36 | $60.40 | | | 75880 | - | - | $85.03 | $24.90 | $60.13 | | | 75885 | - | - | $105.42 | $47.44 | $57.99 | | | 75887 | - | - | $107.03 | $48.24 | $58.79 | | | 75889 | - | - | $96.07 | $37.82 | $58.25 | | | 75891 | - | - | $96.67 | $38.15 | $58.52 | | | 75893 | - | - | $81.65 | $18.31 | $63.34 | | | 75894 | - | - | - | $51.47 | - | | | 75898 | - | - | - | $65.34 | $2,354.51 | | | 75901 | - | - | $184.35 | $16.55 | $167.80 | | | 75902 | - | - | $71.62 | $13.56 | $58.05 | | | 75956 | - | - | - | $236.95 | - | | | 75957 | - | - | - | $202.98 | - | | | 75958 | - | - | - | $134.63 | - | | | 75959 | - | - | - | $117.97 | - | | | 75970 | - | - | - | $27.68 | - | | | 75984 | - | - | $74.89 | $27.55 | $47.34 | | | 75989 | - | - | $87.18 | $40.65 | $46.54 | | | 76000 | - | - | $33.79 | $11.36 | $22.43 | | | 76010 | - | - | $23.56 | $6.48 | $17.07 | | | 76080 | - | - | $46.63 | $18.31 | $28.32 | | | 76098 | - | - | $32.83 | $11.20 | $21.63 | | | 76100 | - | - | $70.64 | $20.89 | $49.75 | | | 76120 | - | - | $93.07 | $14.12 | $78.94 | | | 76125 | - | - | - | $9.49 | - | | | 76140 | - | - | I.C. | - | - | | | 76145 | - | - | $727.73 | - | - | | | 76376 | - | - | $18.69 | $6.97 | $11.72 | | | 76377 | - | - | $58.64 | $27.91 | $30.73 | | | 76380 | - | - | $165.11 | $33.50 | $131.61 | | | 76390 | - | - | $368.70 | - | $368.70 | | | 76391 | - | - | $284.06 | $38.85 | $245.21 | | | 76496 | - | - | - | - | $68.50 | | | 76497 | - | - | - | - | $68.50 | | | 76498 | - | - | $131.61 | - | $131.61 | | | 76499 | - | - | I.C. | - | - | | | 76506 | - | - | $89.55 | $22.39 | $67.16 | | | 76510 | - | - | $53.43 | $29.12 | $24.31 | | | 76511 | - | - | $43.93 | $26.58 | $17.34 | | | 76512 | - | - | $36.88 | $22.75 | $14.13 | | | 76513 | - | - | $58.48 | $24.00 | $34.48 | | | 76514 | - | - | $8.65 | $5.77 | $2.88 | | | 76516 | - | - | $36.17 | $16.69 | $19.48 | | | 76519 | - | - | $52.46 | $22.53 | $29.93 | | | 76529 | - | - | $67.12 | $23.80 | $43.32 | | | 76536 | - | - | $88.10 | $20.14 | $67.96 | | | 76604 | - | - | $43.84 | $20.33 | $23.50 | | | 76641 | - | - | $81.28 | $25.91 | $55.37 | | | 76642 | - | - | $66.66 | $24.15 | $42.52 | | | 76700 | - | - | $91.81 | $28.40 | $63.41 | | | 76705 | - | - | $69.28 | $20.87 | $48.41 | | | 76706 | - | - | $84.37 | $19.36 | $65.02 | | | 76770 | - | - | $85.54 | $25.88 | $59.66 | | | 76775 | - | - | $45.73 | $20.36 | $25.38 | | | 76776 | - | - | $117.30 | $26.64 | $90.66 | | | 76800 | - | - | $122.00 | $44.39 | $77.61 | | | 76801 | - | - | $92.20 | $34.95 | $57.25 | | | 76802 | - | - | $46.84 | $29.69 | $17.14 | | | 76805 | - | - | $106.60 | $35.22 | $71.38 | | | 76810 | - | - | $68.39 | $34.97 | $33.41 | | | 76811 | - | - | $136.24 | $67.14 | $69.10 | | | 76812 | - | - | $149.51 | $62.87 | $86.64 | | | 76813 | - | - | $91.23 | $42.01 | $49.21 | | | 76814 | - | - | $57.52 | $34.82 | $22.70 | | | 76815 | - | - | $63.79 | $23.14 | $40.64 | | | 76816 | - | - | $85.96 | $30.05 | $55.91 | | | 76817 | - | - | $72.66 | $26.66 | $46.00 | | | 76818 | - | - | $90.92 | $37.49 | $53.43 | | | 76819 | - | - | $65.52 | $27.02 | $38.50 | | | 76820 | - | - | $34.61 | $17.53 | $17.07 | | | 76821 | - | - | $69.43 | $24.77 | $44.66 | | | 76825 | - | - | $206.41 | $58.56 | $147.84 | | | 76826 | - | - | $123.97 | $29.03 | $94.95 | | | 76827 | - | - | $54.44 | $20.49 | $33.95 | | | 76828 | - | - | $37.95 | $19.54 | $18.41 | | | 76830 | - | - | $94.76 | $24.66 | $70.11 | | | 76831 | - | - | $91.89 | $25.53 | $66.36 | | | 76856 | - | - | $83.25 | $24.39 | $58.86 | | | 76857 | - | - | $37.75 | $17.46 | $20.29 | | | 76870 | - | - | $79.61 | $22.63 | $56.98 | | | 76872 | - | - | $108.02 | $23.72 | $84.30 | | | 76873 | - | - | $135.97 | $56.56 | $79.41 | | | 76881 | - | - | $40.71 | $31.94 | $8.77 | | | 76882 | - | - | $31.82 | $24.39 | $7.43 | | | 76883 | - | - | $54.33 | $42.61 | $11.72 | | | 76885 | - | - | $94.85 | $26.15 | $68.70 | | | 76886 | - | - | $79.66 | $22.14 | $57.52 | | | 76932 | - | - | - | $26.17 | - | | | 76936 | - | - | $201.50 | $67.85 | $133.65 | | | 76937 | - | - | $30.64 | $10.29 | $20.36 | | | 76940 | - | - | - | $72.58 | - | | | 76941 | - | - | - | $47.54 | - | | | 76942 | - | - | $44.72 | $22.29 | $22.43 | | | 76945 | - | - | - | $23.57 | - | | | 76946 | - | - | $25.24 | $13.52 | $11.72 | | | 76948 | - | - | $62.87 | $23.57 | $39.30 | | | 76965 | - | - | $71.31 | $49.68 | $21.63 | | | 76975 | - | - | - | $30.28 | $184.47 | | | 76977 | - | - | $5.37 | $1.96 | $3.41 | | | 76978 | - | - | $201.30 | $57.07 | $144.23 | | | 76979 | - | - | $132.16 | $29.92 | $102.25 | | | 76981 | - | - | $82.14 | $21.14 | $61.00 | | | 76982 | - | - | $73.57 | $21.14 | $52.43 | | | 76983 | - | - | $47.53 | $18.40 | $29.13 | | | 76984 | - | - | - | $22.45 | - | | | 76987 | - | - | - | $68.93 | - | | | 76988 | - | - | - | $43.84 | - | | | 76989 | - | - | - | $25.70 | - | | | 76998 | - | - | - | $44.36 | - | | | 76999 | - | - | I.C. | - | - | | | 77001 | - | - | $79.67 | $13.05 | $66.62 | | | 77002 | - | - | $92.16 | $19.91 | $72.25 | | | 77003 | - | - | $83.45 | $21.12 | $62.34 | | | 77011 | - | - | $176.60 | $45.69 | $130.91 | | | 77012 | - | - | $109.37 | $51.58 | $57.79 | | | 77013 | - | - | - | $133.76 | - | | | 77014 | - | - | $94.40 | $33.40 | $61.00 | | | 77021 | - | - | $340.38 | $52.06 | $288.33 | | | 77022 | - | - | - | $148.99 | - | | | 77046 | - | - | $286.78 | $50.83 | $235.95 | | | 77047 | - | - | $293.29 | $56.31 | $236.98 | | | 77048 | - | - | $463.01 | $73.97 | $389.04 | | | 77049 | - | - | $466.91 | $80.95 | $385.96 | | | 77053 | - | - | $41.82 | $12.70 | $29.13 | | | 77054 | - | - | $54.20 | $15.70 | $38.50 | | | 77061 | - | - | I.C. | - | - | | | 77062 | - | - | I.C. | - | - | | | 77063 | - | - | $40.67 | $21.38 | $19.28 | | | 77065 | - | - | $98.51 | $28.40 | $70.11 | | | 77066 | - | - | $124.32 | $34.93 | $89.39 | | | 77067 | - | - | $148.95 | $42.79 | $106.16 | | | 77071 | - | - | $42.51 | - | - | | | 77072 | - | - | $20.32 | $6.73 | $13.59 | | | 77073 | - | - | $35.36 | $9.71 | $25.64 | | | 77074 | - | - | $51.01 | $15.46 | $35.55 | | | 77075 | - | - | $78.68 | $19.62 | $59.06 | | | 77076 | - | - | $84.50 | $24.90 | $59.59 | | | 77077 | - | - | $36.80 | $12.23 | $24.57 | | | 77078 | - | - | $77.23 | $8.73 | $68.50 | | | 77080 | - | - | $29.94 | $6.97 | $22.97 | | | 77081 | - | - | $24.58 | $7.24 | $17.34 | | | 77084 | - | - | $411.14 | $56.58 | $354.56 | | | 77085 | - | - | $40.69 | $10.76 | $29.93 | | | 77086 | - | - | $25.99 | $5.97 | $20.02 | | | 77089 | - | - | $31.74 | - | - | | | 77090 | - | - | $2.07 | - | - | | | 77091 | - | - | $22.43 | - | - | | | 77092 | - | - | $7.24 | - | - | | | 77261 | - | - | $52.71 | - | - | | | 77262 | - | - | $80.43 | - | - | | | 77263 | - | - | $125.54 | - | - | | | 77280 | - | - | $214.20 | $28.39 | $185.81 | | | 77285 | - | - | $351.00 | $42.58 | $308.42 | | | 77290 | - | - | $358.46 | $61.56 | $296.90 | | | 77293 | - | - | $325.64 | $78.43 | $247.21 | | | 77295 | - | - | $371.18 | $168.37 | $202.81 | | | 77299 | - | - | I.C. | - | - | | | 77300 | - | - | $51.00 | $24.55 | $26.45 | | | 77301 | - | - | $1,448.73 | $313.86 | $1,134.87 | | | 77306 | - | - | $114.36 | $55.03 | $59.32 | | | 77307 | - | - | $220.98 | $113.85 | $107.13 | | | 77316 | - | - | $191.63 | $55.03 | $136.59 | | | 77317 | - | - | $251.97 | $71.85 | $180.12 | | | 77318 | - | - | $357.04 | $113.58 | $243.46 | | | 77321 | - | - | $72.47 | $37.45 | $35.02 | | | 77331 | - | - | $49.35 | $34.15 | $15.20 | | | 77332 | - | - | $29.30 | $17.85 | $11.45 | | | 77333 | - | - | $108.29 | $29.61 | $78.68 | | | 77334 | - | - | $96.92 | $45.03 | $51.89 | | | 77336 | - | - | $68.56 | - | - | | | 77338 | - | - | $359.60 | $168.37 | $191.23 | | | 77370 | - | - | $110.20 | - | - | | | 77371 | - | - | I.C. | - | - | | | 77372 | - | - | $773.84 | - | - | | | 77373 | - | - | $803.83 | - | - | | | 77385 | - | - | I.C. | - | - | | | 77386 | - | - | I.C. | - | - | | | 77387 | - | - | I.C. | - | - | | | 77399 | - | - | I.C. | - | - | | | 77401 | - | - | $32.88 | - | - | | | 77402 | - | - | I.C. | - | - | | | 77407 | - | - | I.C. | - | - | | | 77412 | - | - | I.C. | - | - | | | 77417 | - | - | $10.91 | - | - | | | 77423 | - | - | I.C. | - | - | | | 77424 | - | - | I.C. | - | - | | | 77425 | - | - | I.C. | - | - | | | 77427 | - | - | $142.89 | - | - | | | 77431 | - | - | $80.33 | - | - | | | 77432 | - | - | $316.27 | - | - | | | 77435 | - | - | $477.84 | - | - | | | 77469 | - | - | $237.97 | - | - | | | 77470 | - | - | $105.67 | $79.83 | $25.84 | | | 77499 | - | - | I.C. | - | - | | | 77520 | - | - | I.C. | - | - | | | 77522 | - | - | I.C. | - | - | | | 77523 | - | - | I.C. | - | - | | | 77525 | - | - | I.C. | - | - | | | 77600 | - | - | $420.43 | $53.10 | $367.34 | | | 77605 | - | - | $764.97 | $73.28 | $691.69 | | | 77610 | - | - | $549.67 | $51.36 | $498.31 | | | 77615 | - | - | $860.34 | $72.10 | $788.24 | | | 77620 | - | - | $507.41 | $60.53 | $446.88 | | | 77750 | - | - | $299.98 | $196.33 | $103.65 | | | 77761 | - | - | $324.05 | $151.50 | $172.55 | | | 77762 | - | - | $423.78 | $225.99 | $197.79 | | | 77763 | - | - | $596.42 | $340.11 | $256.31 | | | 77767 | - | - | $196.32 | $41.24 | $155.08 | | | 77768 | - | - | $287.04 | $55.03 | $232.01 | | | 77770 | - | - | $271.65 | $76.40 | $195.25 | | | 77771 | - | - | $470.74 | $149.48 | $321.26 | | | 77772 | - | - | $701.41 | $210.28 | $491.13 | | | 77778 | - | - | $706.08 | $343.78 | $362.30 | | | 77789 | - | - | $102.23 | $44.78 | $57.45 | | | 77790 | - | - | $13.79 | - | - | | | 77799 | - | - | I.C. | - | - | | | 78012 | - | - | $64.04 | $6.46 | $57.58 | | | 78013 | - | - | $141.77 | $12.94 | $128.83 | | | 78014 | - | - | $176.82 | $17.20 | $159.63 | | | 78015 | - | - | $171.21 | $23.90 | $147.31 | | | 78016 | - | - | $204.68 | $24.03 | $180.65 | | | 78018 | - | - | $230.50 | $28.82 | $201.68 | | | 78020 | - | - | $61.29 | $19.38 | $41.91 | | | 78070 | - | - | $216.98 | $27.62 | $189.36 | | | 78071 | - | - | $258.51 | $41.30 | $217.21 | | | 78072 | - | - | $322.14 | $54.04 | $268.10 | | | 78075 | - | - | $330.48 | $26.15 | $304.33 | | | 78099 | - | - | I.C. | - | - | | | 78102 | - | - | $128.50 | $18.42 | $110.08 | | | 78103 | - | - | $137.75 | $21.78 | $115.97 | | | 78104 | - | - | $185.64 | $27.35 | $158.29 | | | 78110 | - | - | $54.40 | $5.66 | $48.74 | | | 78111 | - | - | $57.81 | $6.66 | $51.15 | | | 78120 | - | - | $55.65 | $6.90 | $48.74 | | | 78121 | - | - | $60.53 | $9.37 | $51.15 | | | 78122 | - | - | $77.84 | $15.17 | $62.67 | | | 78130 | - | - | $96.96 | $17.81 | $79.14 | | | 78140 | - | - | $85.57 | $17.81 | $67.76 | | | 78185 | - | - | $125.70 | $11.87 | $113.83 | | | 78191 | - | - | $96.96 | $17.81 | $79.14 | | | 78195 | - | - | $260.92 | $41.03 | $219.89 | | | 78199 | - | - | I.C. | - | - | | | 78201 | - | - | $142.14 | $14.92 | $127.22 | | | 78202 | - | - | $155.11 | $17.17 | $137.93 | | | 78215 | - | - | $146.31 | $16.95 | $129.36 | | | 78216 | - | - | $101.26 | $19.58 | $81.69 | | | 78226 | - | - | $240.69 | $25.61 | $215.07 | | | 78227 | - | - | $323.68 | $31.14 | $292.54 | | | 78230 | - | - | $131.94 | $15.70 | $116.24 | | | 78231 | - | - | $81.50 | $15.34 | $66.15 | | | 78232 | - | - | $80.27 | $13.85 | $66.42 | | | 78258 | - | - | $158.73 | $24.81 | $133.92 | | | 78261 | - | - | $148.87 | $20.04 | $128.83 | | | 78262 | - | - | $182.70 | $24.15 | $158.56 | | | 78264 | - | - | $244.59 | $27.37 | $217.21 | | | 78265 | - | - | $289.28 | $33.63 | $255.65 | | | 78266 | - | - | $328.89 | $35.81 | $293.08 | | | 78267 | - | - | I.C. | - | - | | | 78268 | - | - | I.C. | - | - | | | 78278 | - | - | $257.52 | $34.15 | $223.37 | | | 78282 | - | - | - | $11.11 | $307.14 | | | 78290 | - | - | $244.57 | $23.61 | $220.96 | | | 78291 | - | - | $194.56 | $30.92 | $163.65 | | | 78299 | - | - | I.C. | - | - | | | 78300 | - | - | $168.11 | $21.87 | $146.24 | | | 78305 | - | - | $204.32 | $28.89 | $175.43 | | | 78306 | - | - | $218.45 | $29.62 | $188.82 | | | 78315 | - | - | $255.85 | $35.15 | $220.70 | | | 78350 | - | - | $24.80 | $8.00 | $16.81 | | | 78351 | - | - | $10.96 | - | - | | | 78399 | - | - | I.C. | - | - | | | 78414 | - | - | - | $15.50 | - | | | 78428 | - | - | $138.55 | $26.59 | $111.95 | | | 78429 | - | - | - | $58.22 | $1,177.09 | | | 78430 | - | - | - | $55.08 | $1,177.09 | | | 78431 | - | - | - | $64.60 | $2,173.99 | | | 78432 | - | - | - | $68.69 | $1,462.61 | | | 78433 | - | - | - | $74.95 | $1,541.62 | | | 78434 | - | - | - | $21.45 | - | | | 78445 | - | - | $156.09 | $17.89 | $138.20 | | | 78451 | - | - | $249.39 | $47.18 | $202.21 | | | 78452 | - | - | $346.53 | $55.87 | $290.67 | | | 78453 | - | - | $215.72 | $34.12 | $181.59 | | | 78454 | - | - | $321.93 | $47.07 | $274.86 | | | 78456 | - | - | $230.18 | $34.39 | $195.79 | | | 78457 | - | - | $122.89 | $25.94 | $96.95 | | | 78458 | - | - | $154.07 | $31.68 | $122.40 | | | 78459 | - | - | - | $53.35 | $1,049.06 | | | 78466 | - | - | $137.41 | $24.39 | $113.02 | | | 78468 | - | - | $144.53 | $27.22 | $117.31 | | | 78469 | - | - | $164.21 | $31.63 | $132.58 | | | 78472 | - | - | $167.82 | $33.63 | $134.18 | | | 78473 | - | - | $212.49 | $50.19 | $162.31 | | | 78481 | - | - | $130.86 | $33.90 | $96.95 | | | 78483 | - | - | $176.07 | $50.45 | $125.61 | | | 78491 | - | - | - | $51.85 | $1,177.09 | | | 78492 | - | - | - | $61.88 | $1,177.09 | | | 78494 | - | - | $168.41 | $40.92 | $127.49 | | | 78496 | - | - | $32.13 | $17.20 | $14.93 | | | 78499 | - | - | I.C. | - | - | | | 78579 | - | - | $139.89 | $16.95 | $122.93 | | | 78580 | - | - | $175.07 | $25.61 | $149.45 | | | 78582 | - | - | $245.02 | $36.64 | $208.38 | | | 78597 | - | - | $148.53 | $25.06 | $123.47 | | | 78598 | - | - | $223.56 | $28.84 | $194.72 | | | 78599 | - | - | I.C. | - | - | | | 78600 | - | - | $135.18 | $15.19 | $119.99 | | | 78601 | - | - | $161.00 | $17.44 | $143.56 | | | 78605 | - | - | $149.84 | $18.87 | $130.97 | | | 78606 | - | - | $242.26 | $22.09 | $220.16 | | | 78608 | - | - | - | $50.78 | $1,177.09 | | | 78609 | - | - | $53.06 | $53.06 | - | | | 78610 | - | - | $131.28 | $10.49 | $120.79 | | | 78630 | - | - | $249.66 | $23.61 | $226.05 | | | 78635 | - | - | $250.36 | $21.63 | $228.73 | | | 78645 | - | - | $239.07 | $19.18 | $219.89 | | | 78650 | - | - | $200.75 | $17.81 | $182.93 | | | 78660 | - | - | $113.88 | $15.59 | $98.29 | | | 78699 | - | - | I.C. | - | - | | | 78700 | - | - | $127.39 | $15.44 | $111.95 | | | 78701 | - | - | $167.74 | $17.22 | $150.52 | | | 78707 | - | - | $172.42 | $32.61 | $139.81 | | | 78708 | - | - | $135.95 | $41.14 | $94.81 | | | 78709 | - | - | $272.89 | $48.31 | $224.58 | | | 78725 | - | - | $89.32 | $12.99 | $76.33 | | | 78730 | - | - | $54.23 | $5.28 | $48.95 | | | 78740 | - | - | $161.66 | $19.18 | $142.49 | | | 78761 | - | - | $158.26 | $25.15 | $133.11 | | | 78799 | - | - | I.C. | - | - | | | 78800 | - | - | $186.81 | $22.36 | $164.45 | | | 78801 | - | - | $202.68 | $25.10 | $177.57 | | | 78802 | - | - | $229.03 | $27.35 | $201.68 | | | 78803 | - | - | $281.66 | $36.86 | $244.80 | | | 78804 | - | - | $479.78 | $34.37 | $445.41 | | | 78808 | - | - | $31.06 | - | - | | | 78811 | - | - | - | $51.76 | $1,049.06 | | | 78812 | - | - | - | $66.40 | $1,177.09 | | | 78813 | - | - | - | $66.91 | $1,177.09 | | | 78814 | - | - | - | $75.42 | $1,177.09 | | | 78815 | - | - | - | $83.64 | $1,177.09 | | | 78816 | - | - | - | $84.10 | $1,177.09 | | | 78830 | - | - | $354.40 | $49.74 | $304.66 | | | 78831 | - | - | $524.38 | $61.97 | $462.42 | | | 78832 | - | - | $672.47 | $71.59 | $600.89 | | | 78835 | - | - | $72.91 | $15.66 | $57.25 | | | 78999 | - | - | I.C. | - | - | | | 79005 | - | - | $102.92 | $62.08 | $40.84 | | | 79101 | - | - | $112.20 | $69.48 | $42.72 | | | 79200 | - | - | $100.15 | $57.97 | $42.18 | | | 79300 | - | - | - | $46.54 | - | | | 79403 | - | - | $153.38 | $78.65 | $74.72 | | | 79440 | - | - | $89.70 | $57.97 | $31.74 | | | 79445 | - | - | - | $80.31 | - | | | 79999 | - | - | I.C. | - | - | | | A4641 | - | - | I.C. | - | - | | | A9500 | - | - | I.C. | - | - | | | A9502 | - | - | I.C. | - | - | | | A9503 | - | - | I.C. | - | - | | | A9505 | - | - | I.C. | - | - | | | A9512 | - | - | I.C. | - | - | | | A9537 | - | - | I.C. | - | - | | | A9552 | - | - | I.C. | - | - | | | A9586 | - | - | I.C. | - | - | | | A9587 | - | - | I.C. | - | - | | | A9588 | - | - | I.C. | - | - | | | A9591 | - | - | I.C. | - | - | | | G0279 | - | - | $40.67 | $21.38 | $19.28 | | | G6001 | - | - | $142.83 | $23.71 | $119.12 | | | G6002 | - | - | $58.63 | $15.31 | $43.32 | | | G6003 | - | - | $122.33 | - | - | | | G6004 | - | - | $103.32 | - | - | | | G6005 | - | - | $103.59 | - | - | | | G6006 | - | - | $103.05 | - | - | | | G6007 | - | - | $190.63 | - | - | | | G6008 | - | - | $142.62 | - | - | | | G6009 | - | - | $142.09 | - | - | | | G6010 | - | - | $141.28 | - | - | | | G6011 | - | - | $190.30 | - | - | | | G6012 | - | - | $188.16 | - | - | | | G6013 | - | - | $188.69 | - | - | | | G6014 | - | - | $187.62 | - | - | | | G6015 | - | - | $288.19 | - | - | | | G6016 | - | - | $287.59 | - | - | | | R0075 | - | - | I.C. | - | - | |

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

101 CMR, § 318.05 Severability

The provisions of 101 CMR 318.00 are severable. If any provision of 101 CMR 318.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 318.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue S1345, eff. 8/11/2017.

Rates for Doula Services Rates for Doula Services

101 CMR, § 319.01 General Provisions

(1) Scope and Purpose. 101 CMR 319.00 governs the rates of payments used by all governmental units in making payments to eligible doula providers for doula services rendered to publicly aided individuals.

(2) Applicable Dates of Service. Rates contained in 101 CMR 319.00 are effective for dates of service provided on and after December 8, 2023, unless otherwise indicated.

(3) Coverage. The rates of payment contained in 101 CMR 319.00, or determined in accordance with the provisions of 101 CMR 319.00, are full compensation for doula services rendered to publicly aided individuals as well as for any related administrative or supervisory duties in connection with the provision of services, without regard to where these services are rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 319.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 319.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided individuals.

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT). The publication of such updates and corrections will list

(b) codes for which the code number remains the same, but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, to clarify its policy on and understanding of substantive provisions of 101 CMR 319.00, and as otherwise specified in 101 CMR 319.00.

History

Adopted by Mass Register Issue 1510, eff. 12/8/2023.

101 CMR, § 319.02 Definitions

Terms used in 101 CMR 319.00 have the meanings set forth in 101 CMR 319.02. The descriptions and five-digit codes included in 101 CMR 319.00 utilize the Healthcare Common Procedure Code System (HCPCS) for Level I and Level II coding. Level 1 CPT-4 codes are obtained from the Physicians' 2023 Current Procedural Terminology® by the American Medical Association (AMA), unless otherwise specified. Level II codes are obtained from 2023 HCPCS maintained jointly by the Centers for Medicare & Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and the Health Insurance Association of America. HCPCS is a listing of descriptive terms and identifying codes and modifiers for reporting medical services and procedures performed by physicians and other healthcare professionals, as well as associated non-physician services. 101 CMR 319.00 includes only HCPCS numeric and alpha-numeric identifying codes and modifiers for reporting medical services and procedures that were selected by EOHHS. Any use of CPT outside the fee schedule should refer to the Physicians' 2023 Current Procedural Terminology®.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Doula. A qualified professional who provides non-medical emotional, informational, and physical support to individuals and families during pregnancy, delivery, and the post-pregnancy period.

Eligible Doula Provider.

(1) A provider of doula services who meets the conditions of participation of a governmental unit purchasing such services.

(2) MassHealth providers of doula services must satisfy the provider eligibility requirements set forth in 130 CMR 463.000: Doula Services and 130 CMR 450.000: Administrative and Billing Regulations .

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

Individual Consideration (I.C.). Doula services that are authorized but not listed in 101 CMR 319.00, doula services performed in unusual circumstances, and services whose fees are designated by the letters "I.C." are individually considered items. The governmental unit or purchaser analyzes the eligible provider's operative report, which must contain a diagnosis, a pertinent medical history, a description of the services rendered, and the length of time spent with the patient. In making the determination of whether the service is appropriately classified as an individually considered item the following criteria are used:

(1) policies, procedures, and practices of other third-party purchasers of care, both governmental and private;

(2) the severity and complexity of the patient's disorder or disability;

(3) prevailing provider ethics and accepted practice; and

(4) time, degree of skill, and cost including equipment cost required to perform the procedure(s).

Labor and Delivery. Childbirth or delivery of a fetus following pregnancy, inclusive of all pregnancy outcomes.

Modifiers. Listed services may be modified under certain circumstances. When applicable, the modifying circumstances must be identified by the addition of the appropriate two-digit number or letters.

Perinatal. The period encompassing pregnancy and labor and delivery, through 12 months following delivery, inclusive of all pregnancy outcomes.

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

History

Adopted by Mass Register Issue 1510, eff. 12/8/2023.

101 CMR, § 319.03 General Rate Provisions and Payment

(1) Individual Consideration and Nonlisted Procedures. Rates of payment for doula services that are authorized but not listed in 101 CMR 319.00, services performed in unusual circumstances, and services whose fees are designated by the letters "I.C." are determined on an individual consideration basis.

(2) Fee Schedule. Certain doula services are not associated with CPT codes that have a service-specific description, and therefore must be billed for by using a CPT code that represents unlisted services (Unlisted Service Code) in accordance with the fee schedule below. For such doula services, the doula service associated with each Unlisted Service Code is identified in the parenthetical description of the code description section of the fee schedule below.

| Code | Rate | Code Description | | --- | --- | --- | | 99600 | $100 | Unlisted home visit service or procedure. (Perinatal visit up to 60 minutes.) | | 99600 TF | $150 | Unlisted home visit service or procedure. (Perinatal visit from 61 minutes up to 90 minutes. This service must be identified by adding the modifier TF to the parent service code.) | | 99199 | $900 | Unlisted special service, procedure or report. (Labor and delivery support.) |

(3) Perinatal Visit Payments. For MassHealth providers of doula services, the payment for perinatal visits will not exceed $800 per perinatal period per member, with the exception of payment for additional perinatal visits for which a provider receives prior authorization in accordance with 130 CMR 463.000: Doula Services .

History

Adopted by Mass Register Issue 1510, eff. 12/8/2023.

101 CMR, § 319.04 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1510, eff. 12/8/2023.

101 CMR, § 319.05 Severability

The provisions of 101 CMR 319.00 are severable. If any provision of 101 CMR 319.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 319.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1510, eff. 12/8/2023.

Rates for Clinical Laboratory Services Rates for Clinical Laboratory Services

101 CMR, § 320.01 General Provisions

(1) Scope and Purpose. 101 CMR 320.00 governs the payment rates for clinical laboratory services rendered to publicly aided individuals. The rates set forth in 101 CMR 320.00 do not apply to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act). Rates for services rendered to such individuals are set forth in 114.3 CMR 40.00: Rates for Services under M.G.L. c. 152, Workers' Compensation Act .

(2) Applicable Dates of Service. Rates contained in 101 CMR 320.00 apply for dates of service provided on or after September 1, 2024.

(3) Coverage. The payment rates in 101 CMR 320.00 are full compensation for clinical laboratory services rendered to publicly aided individuals.

(4) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT). The publication of such updates and corrections lists

(a) codes for which only the code numbers changed, with the corresponding cross-references between existing and new codes;

(b) deleted codes for which there are no corresponding new codes; and

(c) codes for entirely new services that require pricing. EOHHS may list and price these codes according to the rate methodology used in setting clinical laboratory rates when Medicare fees are available (including, for codes relating to Coronavirus Disease 2019 (COVID-19), at 100% of Medicare fees). When Medicare fees are not available, EOHHS may apply individual consideration (I.C.) in reimbursing for these codes until appropriate rates can be developed.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to:

(a) clarify its policy on and understanding of substantive provisions of 101 CMR 320.00;

(b) specify any clinical laboratory services subject to selective, volume purchase, preferred supplier, or preferred provider contract(s) between a vendor or provider and governmental unit(s), the governmental unit(s) and eligible vendor(s) or provider(s) subject to the contract; the duration of the contract, the prices at which such clinical laboratory services will be available to eligible providers (as defined by the contract, if applicable), the rates which eligible providers (as defined by the contract) will be paid by the relevant governmental unit(s) for such clinical laboratory services, and any other information deemed necessary by EOHHS;

(c) specify any clinical laboratory services subject to rebate agreement(s) between a manufacturer and governmental unit(s), the governmental unit(s) and eligible providers subject to the agreement, the duration of the rebate agreement, the rates which will be paid to eligible providers (as defined by the applicable rebate agreement) by the relevant governmental unit(s) for the specified clinical laboratory services, and any other information deemed necessary by EOHHS.

(6) Disclaimer of Authorization of Services. 101 CMR 320.00 is neither authorization for nor approval of the substantive services for which rates are determined pursuant to 101 CMR 320.00. governmental units that purchase care are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals.

History

Adopted by Mass Register Issue 1266, eff. 8/1/2014.

101 CMR, § 320.02 Definitions

As used in 101 CMR 320.00, terms have the meanings ascribed in 101 CMR 320.02.

Allowable Fee. The amount of reimbursement that is paid by all governmental units for a laboratory service, as set forth in 101 CMR 320.04 and 101 CMR 320.05.

Bulk Purchase. A single purchase of a laboratory service (one or more tests) to be uniformly and concurrently performed on a minimum of 40 specimens of the same type. A single purchase of various, non-uniform laboratory services, such as by a physician, is not considered a bulk purchase, regardless of the number of specimens presented by such a purchaser to the laboratory.

Charge. The price of a laboratory service as determined by the clinical laboratory performing the service.

Clinical Laboratory. A laboratory where microbiological, chemical, hematological, biophysical, cytological, immuno-hematological, or pathological examinations are performed on materials derived from the human body to provide information for the diagnosis, prevention, or treatment of a disease or assessment of a medical condition.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Eligible Provider of Laboratory Services. A person licensed by an appropriate Board of Registration to perform clinical laboratory services, such registration being in accordance with the provisions of M.G.L. c. 112; or an independent laboratory. Such persons and laboratories must meet all conditions of participation that have been or may be adopted by a governmental unit that purchases laboratory services. For purposes of 101 CMR 320.00, eligible providers of laboratory services do not include hospital laboratories.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Fee Schedule. (Description of Service and HCPCS/CPT Procedure Code). The Healthcare Common Procedure Coding System (HCPCS), which is based upon the American Medical Association (AMA) Current Procedural Terminology (CPT), is the basis by which all procedures are performed. The CPT handbook is updated by the AMA annually. All non-physician codes and terminology is defined by the Centers for Medicare & Medicaid Services (CMS) and set forth in the HCPCS file.

Governmental Unit. The Commonwealth, any department, division, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth.

Independent Clinical Laboratory. A clinical laboratory that is operated independently from a hospital or from an attending or consulting physician's office. If the laboratory is operated or directed by one or more licensed physicians, it must offer its services to other physicians to qualify as an independent clinical laboratory. In cases where two or more distinct, physically separated laboratory facilities operate under the same name and the same director, each facility that performs clinical laboratory services is treated as a separate independent clinical laboratory.

Profile (or Panel) Tests. Any group of tests, whether performed manually, automated, or semi-automated, that is ordered for a specific patient on a specified day, and has at least one of the following characteristics.

(a) The group of tests is designated as a profile or panel by the clinical laboratory performing the tests.

(b) The group of tests is performed by the clinical laboratory and the customary charge is less than the sum of that clinical laboratory's usual and customary charges for the individual tests in that group.

Publicly Aided Individual. A person who receives medical care and services for which a governmental unit is liable, in whole or in part, under a statutory program of public assistance.

Rate. The lesser of the charge or the allowable fee, as defined in 101 CMR 320.02.

Usual and Customary Charge. The lowest fee charged by an independent clinical laboratory for any laboratory service (including individual and profile tests) specified by 101 CMR 320.00 or by such independent clinical laboratory, which fee is in effect at the time such laboratory service is performed, other than a fee offered for a bulk purchase, as defined in 101 CMR 320.02.

History

Adopted by Mass Register Issue 1266, eff. 8/1/2014.

101 CMR, § 320.03 Covered and Excluded Billing Situations

(1) Covered Billing Situations. Except as provided in 101 CMR 320.03(2), the method of determining rates of payment contained in 101 CMR 320.00 apply to clinical laboratory services provided to publicly aided individuals, with the following conditions.

(a) If clinical laboratory services are performed by an independent clinical laboratory, then the independent clinical laboratory must bill the governmental unit directly. The independent clinical laboratory may not bill indirectly by having a physician or dentist bill either the payer or the patient for services performed by the independent clinical laboratory.

(b) If clinical laboratory services are performed by a registered physician or dentist, or by an agent under his or her direct supervision, in his or her private medical office or clinic, then the registered physician or dentist must bill the governmental unit directly.

(2) Excluded Billing Situations. 101 CMR 320.00 and the rates of payment contained in 101 CMR 320.00 do not govern the rates of payment for clinical laboratory services if

(a) the service is provided in state institutions by a state-employed physician, dentist, or dentist consultant;

(b) the service is provided by a physician or dentist whose salary from a hospital or affiliated medical school includes compensation for professional services rendered to patients; or

(c) the physician, dentist, or independent laboratory does not customarily bill private patients without health insurance under comparable circumstances.

(3) Professional and Technical Component Services. Some laboratory services have both professional and technical components. The professional component is set forth in 101 CMR 316.00: Rates for Surgery and Anesthesia Services , while the technical component is set forth in 101 CMR 320.00.

(a) The relevant codes for laboratory services containing both professional and technical components are 83020, 84165, 84166, 84181, 84182, 85390, 85576, 86255, 86256, 86320, 86325,86327, 86334, 86335, 87164, 87207, and 89060.

(b) Surgical pathology services are excluded from 101 CMR 320.00 and instead included in 101 CMR 316.00: Rates for Surgery and Anesthesia Services . Surgical pathology services include codes 80503, 80504, 80505, 80506, 85060, 85097, 85396, 86077, 86078, 86079, 86153, 86486, 86490, 86510, 86580, 88104, 88106, 88108, 88112, 88120, 88121, 88125, 88141, 88160, 88161, 88162, 88172, 88173, 88177, 88182, 88184, 88185, 88187, 88188, 88189, 88199, 88291, 88299, 88300, 88302, 88304, 88305, 88307, 88309, 88311, 88312, 88313, 88314, 88319, 88321, 88323, 88325, 88329, 88331, 88332, 88333, 88334, 88341, 88344, 88346, 88348,88350,88355,88356,88358,88360,88361, 88362, 88363, 88365, 88366, 88367, 88368, 88369, 88374, 88375, 88377, 88380, 88381, 88387, 88388, 88399, 89049, 89060, 89220, 89230, and 89240.

History

Adopted by Mass Register Issue 1266, eff. 8/1/2014.

101 CMR, § 320.04 General Rate Provisions and Maximum Fees

(1) Rate Determination. Payment rates are the lowest of

(a) the eligible provider's usual and customary charge to patients other than publicly aided individuals or industrial accident patients;

(b) the applicable listing from the schedule of allowable fees listed in 101 CMR 320.05; or

(2) Individual Consideration (I.C.). Unlisted procedures and laboratory tests designated I.C. are individually considered items. The eligible provider's bill for such a test must be accompanied by a brief report of the procedure or test performed and the eligible provider's usual and customary charge for that procedure or test. Determination of appropriate payments for procedures and tests designated I.C. are in accordance with the following standards and criteria:

(a) time required to perform the procedure;

(b) degree of skill required in the procedure performed;

(d) policies, procedures, and practices of other third-party purchasers of care;

(e) prevailing medical-laboratory ethics and accepted custom of the medical-laboratory community; and

(f) such other standards and criteria as may be adopted by EOHHS. In no event may an eligible provider bill or be paid in excess of the usual and customary charge for the service.

(3) Administrative and Supervisory Duties. The rates of payment under 101 CMR 320.00 are full compensation for clinical laboratory services rendered to publicly aided individuals, as well as any related administrative or supervisory duties in connection with clinical laboratory services, without regard to where the service is rendered.

(4) Profile (or Panel) Tests. In no event may an eligible provider bill or be paid separately for each of the tests included within a profile test when a profile test has either been performed by the provider or requested by an authorized person.

(5) Limitations on Payment for Panel Tests.

(a) Any combination of the following tests when performed on a single patient on a single date of service is regarded as a single panel test:

| 80047 | Basic Metabolic Panel -calcium, ionized (Consists of 82330, 82374, 82435, 82565, 82947, 84132, 84295, 84520): eight individual tests | | --- | --- | | 80048 | Basic Metabolic Panel -calcium, total (Consists of 82310, 82374, 82435, 82565, 82947, 84132, 84295, 84520): eight individual tests | | 80051 | Electrolyte Panel (Consists of 82374, 82435, 84132, 84295): four individual tests | | 80053 | Comprehensive Metabolic Panel (Consists of 82040, 82247, 82310, 82374, 82435, 82565, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520): 14 individual tests | | 80061 | Lipid Panel (Consists of 82465, 83718, 84478): three individual tests | | 80069 | Renal Function Panel (Consists of 82040, 82310, 82374, 82435, 82565, 82947, 84100, 84132, 84295, 84520): ten individual tests | | 80076 | Hepatic Function Panel (Consists of 82040, 82247, 82248, 84075, 84155, 84460, 84450): seven individual tests | | 82040 | Albumin; serum | | 82247 | Bilirubin; total | | 82248 | Bilirubin; direct | | 82310 | Calcium; total | | 82374 | Carbon dioxide (bicarbonate) | | 82435 | Chloride; blood | | 82465 | Cholesterol, serum or whole blood, total | | 82550 | Creatine kinase (CK), (CPK); total | | 82565 | Creatinine; blood | | 82947 | Glucose; quantitative | | 82977 | Glutamyltransferase, gamma (GGT) | | 83615 | Lactate dehydrogenase (LD), (LDH) | | 84075 | Phosphatase, alkaline | | 84100 | Phosphorus, inorganic (phosphate) | | 84132 | Potassium; serum, plasma or whole blood | | 84155 | Protein; total, except refractometry | | 84295 | Sodium; serum, plasma or whole blood | | 84450 | Transferase; aspatrate amino (AST), (SGOT) | | 84460 | Transferase; alanine amino (ALT), (SGPT) | | 84478 | Triglycerides | | 84520 | Urea nitrogen; quantitative | | 84550 | Uric acid; blood |

(b) Panel tests are reimbursed according to the following schedule.

| Code | Rate | Description | | --- | --- | --- | | ATP02 | $5.60 | Auto Test Panel Pricing Code, 1-2 Tests | | ATP03 | $7.14 | Auto Test Panel Pricing Code, 3 Tests | | ATP04 | $7.54 | Auto Test Panel Pricing Code, 4 Tests | | ATP05 | $8.39 | Auto Test Panel Pricing Code, 5 Tests | | ATP06 | $8.41 | Auto Test Panel Pricing Code, 6 Tests | | ATP07 | $8.78 | Auto Test Panel Pricing Code, 7 Tests | | ATP08 | $9.09 | Auto Test Panel Pricing Code, 8 Tests | | ATP09 | $9.34 | Auto Test Panel Pricing Code, 9 Tests | | ATP10 | $9.34 | Auto Test Panel Pricing Code, 10 Tests | | ATP11 | $9.49 | Auto Test Panel Pricing Code, 11 Tests | | ATP12 | $9.69 | Auto Test Panel Pricing Code, 12 Tests | | ATP13 | $11.34 | Auto Test Panel Pricing Code, 13 Tests | | ATP14 | $11.34 | Auto Test Panel Pricing Code, 14 Tests | | ATP15 | $11.34 | Auto Test Panel Pricing Code, 15 Tests | | ATP16 | $11.34 | Auto Test Panel Pricing Code, 16 Tests | | ATP17 | $11.42 | Auto Test Panel Pricing Code, 17 Tests | | ATP18 | $11.42 | Auto Test Panel Pricing Code, 18 Tests | | ATP19 | $11.89 | Auto Test Panel Pricing Code, 19 Tests | | ATP20 | $12.28 | Auto Test Panel Pricing Code, 20 Tests | | ATP21 | $12.66 | Auto Test Panel Pricing Code, 21 Tests | | ATP22 | $13.04 | Auto Test Panel Pricing Code, 22 Tests | | ATP23 | $13.04 | Auto Test Panel Pricing Code, 23 or more Tests |

History

Adopted by Mass Register Issue 1266, eff. 8/1/2014.

101 CMR, § 320.05 Allowable Fees

| Code | Rate | Description | | --- | --- | --- | | | | Organ and Disease Oriented Panels | | 80047 | $12.11 | Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520) | | 80048 | $7.46 | Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | | 80050 | $17.65 | General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443) | | 80051 | $6.18 | Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295) | | 80053 | $9.31 | Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN) (84520) | | 80055 | $42.16 | Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901) | | 80061 | $11.81 | Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) | | 80069 | $7.65 | Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | | 80074 | $42.00 | Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) | | 80076 | $7.20 | Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) | | 80081 | $66.02 | Obstetric panel (includes HIV testing) | | | | Drug Testing and Therapeutic Assays | | 80143 | $16.44 | Acetaminophen | | 80145 | $34.01 | Adalimumab | | 80150 | $13.30 | Amikacin | | 80151 | $16.44 | Amiodarone | | 80155 | $34.01 | Caffeine | | 80156 | $12.85 | Carbamazepine; total | | 80157 | $11.68 | Carbamazepine; free | | 80158 | $15.92 | Cyclosporine | | 80159 | $17.77 | Clozapine | | 80161 | $16.44 | Carbamazepine; -10,11-epoxide | | 80162 | $11.71 | Digoxin; total | | 80163 | $11.71 | Digoxin; free | | 80164 | $11.94 | Valproic acid (dipropylacetic acid); total | | 80165 | $11.94 | Valproic acid (dipropylacetic acid); free | | 80167 | $16.44 | Felbamate | | 80168 | $14.41 | Ethosuximide | | 80169 | $12.11 | Everolimus | | 80170 | $14.45 | Gentamicin | | 80171 | $19.11 | Gabapentin, whole blood, serum, or plasma | | 80173 | $13.92 | Haloperidol | | 80175 | $11.68 | Lamotrigine | | 80176 | $12.95 | Lidocaine | | 80177 | $11.68 | Levetiracetam | | 80178 | $5.83 | Lithium | | 80179 | $16.44 | Salicylate | | 80180 | $15.92 | Mycophenolate (mycophenolic acid) | | 80181 | $16.44 | Flecainide | | 80183 | $11.68 | Oxcarbazepine | | 80184 | $13.49 | Phenobarbital | | 80185 | $11.68 | Phenytoin; total | | 80186 | $12.13 | Phenytoin; free | | 80187 | $23.91 | Posaconazole | | 80188 | $14.63 | Primidone | | 80189 | $23.91 | Itraconazole | | 80190 | $52.91 | Procainamide; | | 80192 | $14.77 | Procainamide; with metabolites (eg, n-acetyl procainamide) | | 80193 | $34.01 | Leflunomide | | 80194 | $12.88 | Quinidine | | 80195 | $12.11 | Sirolimus | | 80197 | $12.11 | Tacrolimus | | 80198 | $12.47 | Theophylline | | 80199 | $23.91 | Tiagabine | | 80200 | $14.22 | Tobramycin | | 80201 | $10.51 | Topiramate | | 80202 | $11.94 | Vancomycin | | 80203 | $11.68 | Zonisamide | | 80204 | $34.01 | Methotrexate | | 80210 | $23.91 | Rufinamide | | 80220 | $16.44 | Hydroxychloroquine | | 80230 | $34.01 | Infliximab | | 80235 | $23.91 | Lacosamide | | 80280 | $34.01 | Vedolizumab | | 80285 | $23.91 | Voriconazole | | | | Evocative Suppression Testing | | 80299 | $16.44 | Quantitation of therapeutic drug, not elsewhere specified | | 80305 | $8.92 | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service | | 80306 | $11.89 | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; read by instrument assisted direct optical observation (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service | | 80307 | $47.55 | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service | | 80400 | $28.77 | ACTH stimulation panel; for adrenal insufficiency This panel must include the following: Cortisol (82533 x 2) | | 80402 | $76.69 | ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2) | | 80406 | $69.02 | ACTH stimulation panel; for 3 beta-hydroxydehydrogenase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2) | | 80408 | $110.68 | Aldosterone suppression evaluation panel (eg, saline infusion) This panel must include the following: Aldosterone (82088 x 2) Renin (84244 x 2) | | 80410 | $70.88 | Calcitonin stimulation panel (eg, calcium, pentagastrin) This panel must include the following: Calcitonin (82308 x 3) | | 80412 | $706.93 | Corticotropic releasing hormone (CRH) stimulation panel This panel must include the following: Cortisol (82533 x 6) Adrenocorticotropic hormone (ACTH) (82024 x 6) | | 80414 | $45.54 | Chorionic gonadotropin stimulation panel; testosterone response This panel must include the following: Testosterone (84403 x 2 on 3 pooled blood samples) | | 80415 | $49.29 | Chorionic gonadotropin stimulation panel; estradiol response This panel must include the following: Estradiol, total (82670 x 2 on 3 pooled blood samples) | | 80416 | $184.59 | Renal vein renin stimulation panel (eg, captopril) This panel must include the following: Renin (84244 x 6) | | 80417 | $38.79 | Peripheral vein renin stimulation panel (eg, captopril) This panel must include the following: Renin (84244 x 2) | | 80418 | $511.03 | Combined rapid anterior pituitary evaluation panel This panel must include the following: Adrenocorticotropic hormone (ACTH) (82024 x 4) Luteinizing hormone (LH) (83002 x 4) Follicle stimulating hormone (FSH) (83001 x 4) Prolactin (84146 x 4) Human growth hormone (HGH) (83003 x 4) Cortisol (82533 x 4) Thyroid stimulating hormone (TSH) (84443 x 4) | | 80420 | $142.76 | Dexamethasone suppression panel, 48 hour This panel must include the following: Free cortisol, urine (82530 x 2) Cortisol (82533 x 2) Volume measurement for timed collection (81050 x 2) | | 80422 | $40.63 | Glucagon tolerance panel; for insulinoma This panel must include the following: Glucose (82947 x 3) Insulin (83525 x 3) | | 80424 | $44.53 | Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2) | | 80426 | $130.88 | Gonadotropin releasing hormone stimulation panel This panel must include the following: Follicle stimulating hormone (FSH) (83001 x 4) Luteinizing hormone (LH) (83002 x 4) | | 80428 | $58.82 | Growth hormone stimulation panel (eg, arginine infusion, l-dopa administration) This panel must include the following: Human growth hormone (HGH) (83003 x 4) | | 80430 | $114.05 | Growth hormone suppression panel (glucose administration) This panel must include the following: Glucose (82947 x 3) Human growth hormone (HGH) (83003 x 4) | | 80432 | $146.05 | Insulin-induced C-peptide suppression panel This panel must include the following: Insulin (83525) C-peptide (84681 x 5) Glucose (82947 x 5) | | 80434 | $251.36 | Insulin tolerance panel; for ACTH insufficiency This panel must include the following: Cortisol (82533 x 5) Glucose (82947 x 5) | | 80435 | $90.83 | Insulin tolerance panel; for growth hormone deficiency This panel must include the following: Glucose (82947 x 5) Human growth hormone (HGH) (83003 x 5) | | 80436 | $80.39 | Metyrapone panel This panel must include the following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2) | | 80438 | $44.46 | Thyrotropin releasing hormone (TRH) stimulation panel; one hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 3) | | 80439 | $59.27 | Thyrotropin releasing hormone (TRH) stimulation panel; two hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 4) | | | | Urinalysis | | 81000 | $3.55 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy | | 81001 | $2.80 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy | | 81002 | $3.07 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy | | 81003 | $1.98 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy | | 81005 | $1.91 | Urinalysis; qualitative or semiquantitative, except immunoassays | | 81007 | $26.44 | Urinalysis; bacteriuria screen, except by culture or dipstick | | 81015 | $2.69 | Urinalysis; microscopic only | | 81020 | $4.14 | Urinalysis; two or three glass test | | 81025 | $7.59 | Urine pregnancy test, by visual color comparison methods | | 81050 | $3.21 | Volume measurement for timed collection, each | | 81099 | I.C. | Unlisted urinalysis procedure | | | | Chemistry | | 82009 | $3.99 | Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative | | 82010 | $7.20 | Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative | | 82013 | $10.84 | Acetylcholinesterase | | 82016 | $14.54 | Acylcarnitines; qualitative, each specimen | | 82017 | $14.88 | Acylcarnitines; quantitative, each specimen | | 82024 | $34.06 | Adrenocorticotropic hormone (ACTH) | | 82030 | $22.75 | Adenosine, 5-monophosphate, cyclic (cyclic AMP) | | 82040 | $4.37 | Albumin; serum, plasma or whole blood | | 82042 | $6.86 | Albumin; other source, quantitative, each specimen | | 82043 | $5.10 | Albumin; urine (eg, microalbumin), quantitative | | 82044 | $5.49 | Albumin; urine (eg, microalbumin), semiquantitative (eg, reagent strip assay) | | 82045 | $29.93 | Albumin; ischemia modified | | 82075 | $26.46 | Alcohol (ethanol); breath | | 82077 | $15.23 | Alcohol (ethanol); any specimen except urine and breath, immunoassay (eg, IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase) | | 82085 | $8.56 | Aldolase | | 82088 | $35.94 | Aldosterone | | 82103 | $11.85 | Alpha-1-antitrypsin; total | | 82104 | $12.75 | Alpha-1-antitrypsin; phenotype | | 82105 | $14.79 | Alpha-fetoprotein (AFP); serum | | 82106 | $14.99 | Alpha-fetoprotein (AFP); amniotic fluid | | 82107 | $56.80 | Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and total AFP (including ratio) | | 82108 | $22.47 | Aluminum | | 82120 | $5.28 | Amines, vaginal fluid, qualitative | | 82127 | $12.50 | Amino acids; single, qualitative, each specimen | | 82128 | $12.23 | Amino acids; multiple, qualitative, each specimen | | 82131 | $20.27 | Amino acids; single, quantitative, each specimen | | 82135 | $14.51 | Aminolevulinic acid, delta (ALA) | | 82136 | $17.29 | Amino acids, two to five amino acids, quantitative, each specimen | | 82139 | $14.88 | Amino acids, six or more amino acids, quantitative, each specimen | | 82140 | $12.85 | Ammonia | | 82143 | $8.25 | Amniotic fluid scan (spectrophotometric) | | 82150 | $5.71 | Amylase | | 82154 | $25.42 | Androstanediol glucuronide | | 82157 | $25.82 | Androstenedione | | 82160 | $22.53 | Androsterone | | 82163 | $18.10 | Angiotensin II | | 82164 | $12.88 | Angiotensin I - converting enzyme (ACE) | | 82166 | $34.06 | Anti-mullerian hormone (AMH) | | 82172 | $18.60 | Apolipoprotein, each | | 82175 | $16.73 | Arsenic | | 82180 | $8.72 | Ascorbic acid (Vitamin C), blood | | 82190 | $14.02 | Atomic absorption spectroscopy, each analyte | | 82232 | $14.27 | Beta-2 microglobulin | | 82239 | $15.10 | Bile acids; total | | 82240 | $23.44 | Bile acids; cholylglycine | | 82247 | $4.43 | Bilirubin; total | | 82248 | $4.43 | Bilirubin; direct | | 82252 | $4.02 | Bilirubin; feces, qualitative | | 82261 | $14.88 | Biotinidase, each specimen | | 82270 | $3.86 | Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided three cards or single triple card for consecutive collection) | | 82271 | $4.69 | Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources | | 82272 | $3.73 | Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening | | 82274 | $14.04 | Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations | | 82286 | $4.55 | Bradykinin | | 82300 | $20.85 | Cadmium | | 82306 | $26.10 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | | 82308 | $23.63 | Calcitonin | | 82310 | $4.55 | Calcium; total | | 82330 | $12.06 | Calcium; ionized | | 82331 | $11.76 | Calcium; after calcium infusion test | | 82340 | $5.32 | Calcium; urine quantitative, timed specimen | | 82355 | $10.21 | Calculus; qualitative analysis | | 82360 | $11.35 | Calculus; quantitative analysis, chemical | | 82365 | $11.38 | Calculus; infrared spectroscopy | | 82370 | $11.04 | Calculus; X-ray diffraction | | 82373 | $15.93 | Carbohydrate deficient transferrin | | 82374 | $4.30 | Carbon dioxide (bicarbonate) | | 82375 | $10.86 | Carboxyhemoglobin; quantitative | | 82376 | $12.41 | Carboxyhemoglobin; qualitative | | 82378 | $16.72 | Carcinoembryonic antigen (CEA) | | 82379 | $14.88 | Carnitine (total and free), quantitative, each specimen | | 82380 | $8.13 | Carotene | | 82382 | $24.08 | Catecholamines; total urine | | 82383 | $25.64 | Catecholamines; blood | | 82384 | $22.27 | Catecholamines; fractionated | | 82387 | $15.93 | Cathepsin-D | | 82390 | $9.47 | Ceruloplasmin | | 82397 | $12.45 | Chemiluminescent assay | | 82415 | $11.17 | Chloramphenicol | | 82435 | $4.06 | Chloride; blood | | 82436 | $5.07 | Chloride; urine | | 82438 | $4.41 | Chloride; other source | | 82441 | $5.30 | Chlorinated hydrocarbons, screen | | 82465 | $3.84 | Cholesterol, serum or whole blood, total | | 82480 | $6.94 | Cholinesterase; serum | | 82482 | $8.65 | Cholinesterase; RBC | | 82485 | $18.21 | Chondroitin B sulfate, quantitative | | 82495 | $17.88 | Chromium | | 82507 | $24.52 | Citrate | | 82523 | $16.47 | Collagen cross links, any method | | 82525 | $10.94 | Copper | | 82528 | $19.86 | Corticosterone | | 82530 | $14.74 | Cortisol; free | | 82533 | $14.37 | Cortisol; total | | 82540 | $4.09 | Creatine | | 82542 | $21.24 | Column chromatography, includes mass spectrometry, if performed ( eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen | | 82550 | $5.74 | Creatine kinase (CK), (CPK); total | | 82552 | $11.81 | Creatine kinase (CK), (CPK); isoenzymes | | 82553 | $10.19 | Creatine kinase (CK), (CPK); MB fraction only | | 82554 | $10.47 | Creatine kinase (CK), (CPK); isoforms | | 82565 | $4.52 | Creatinine; blood | | 82570 | $4.57 | Creatinine; other source | | 82575 | $8.34 | Creatinine; clearance | | 82585 | $12.47 | Cryofibrinogen | | 82595 | $5.71 | Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit) | | 82600 | $17.11 | Cyanide | | 82607 | $13.30 | Cyanocobalamin (Vitamin B-12); | | 82608 | $12.63 | Cyanocobalamin (Vitamin B-12); unsaturated binding capacity | | 82610 | $16.33 | Cystatin C | | 82615 | $8.42 | Cystine and homocystine, urine, qualitative | | 82626 | $22.28 | Dehydroepiandrosterone (DHEA) | | 82627 | $19.60 | Dehydroepiandrosterone-sulfate (DHEA-S) | | 82633 | $27.32 | Desoxycorticosterone, 11- | | 82634 | $25.82 | Deoxycortisol, 11- | | 82638 | $10.80 | Dibucaine number | | 82642 | $25.82 | Dihydrotestosterone (DHT) | | 82652 | $33.95 | Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed | | 82653 | $20.26 | Elastase, pancreatic (EL-1), fecal; quantitative | | 82656 | $10.17 | Elastase, pancreatic (EL-1), fecal; qualitative or semi-quantitative | | 82657 | $19.55 | Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen | | 82658 | $38.83 | Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; radioactive substrate, each specimen | | 82664 | $54.24 | Electrophoretic technique, not elsewhere specified | | 82668 | $16.57 | Erythropoietin | | 82670 | $24.64 | Estradiol; total | | 82671 | $28.48 | Estrogens; fractionated | | 82672 | $19.14 | Estrogens; total | | 82677 | $21.32 | Estriol | | 82679 | $22.00 | Estrone | | 82681 | $24.64 | Estradiol; free, direct measurement (eg, equilibrium dialysis) | | 82693 | $13.14 | Ethylene glycol | | 82696 | $23.14 | Etiocholanolone | | 82705 | $4.50 | Fat or lipids, feces; qualitative | | 82710 | $14.82 | Fat or lipids, feces; quantitative | | 82715 | $20.26 | Fat differential, feces, quantitative | | 82725 | $16.55 | Fatty acids, nonesterified | | 82726 | $17.42 | Very long chain fatty acids | | 82728 | $12.02 | Ferritin | | 82731 | $56.80 | Fetal fibronectin, cervicovaginal secretions, semi-quantitative | | 82735 | $16.35 | Fluoride | | 82746 | $12.96 | Folic acid; serum | | 82747 | $15.57 | Folic acid; RBC | | 82757 | $15.29 | Fructose, semen | | 82759 | $18.94 | Galactokinase, RBC | | 82760 | $9.88 | Galactose | | 82775 | $18.58 | Galactose-1-phosphate uridyl transferase; quantitative | | 82776 | $10.35 | Galactose-1-phosphate uridyl transferase; screen | | 82777 | $39.02 | Galectin-3 | | 82784 | $8.20 | Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each | | 82785 | $14.52 | Gammaglobulin (immunoglobulin); IgE | | 82787 | $7.07 | Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each | | 82800 | $9.70 | Gases, blood, pH only | | 82803 | $22.99 | Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); | | 82805 | $69.47 | Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry | | 82810 | $8.62 | Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry | | 82820 | $11.76 | Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen) | | 82930 | $5.92 | Gastric acid analysis, includes pH if performed, each specimen | | 82938 | $15.60 | Gastrin after secretin stimulation | | 82941 | $15.55 | Gastrin | | 82943 | $12.60 | Glucagon | | 82945 | $3.47 | Glucose, body fluid, other than blood | | 82946 | $15.67 | Glucagon tolerance test | | 82947 | $3.47 | Glucose; quantitative, blood (except reagent strip) | | 82948 | $4.44 | Glucose; blood, reagent strip | | 82950 | $4.19 | Glucose; post glucose dose (includes glucose) | | 82951 | $11.35 | Glucose; tolerance test (GTT), three specimens (includes glucose) | | 82952 | $3.46 | Glucose; tolerance test, each additional beyond three specimens (List separately in addition to code for primary procedure) | | 82955 | $8.55 | Glucose-6-phosphate dehydrogenase (G6PD); quantitative | | 82960 | $5.34 | Glucose-6-phosphate dehydrogenase (G6PD); screen | | 82962 | $2.89 | Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use | | 82963 | $18.94 | Glucosidase, beta | | 82965 | $11.60 | Glutamate dehydrogenase | | 82977 | $6.35 | Glutamyltransferase, gamma (GGT) | | 82978 | $13.62 | Glutathione | | 82979 | $8.32 | Glutathione reductase, RBC | | 82985 | $14.78 | Glycated protein | | 83001 | $16.39 | Gonadotropin; follicle stimulating hormone (FSH) | | 83002 | $16.33 | Gonadotropin; luteinizing hormone (LH) | | 83003 | $14.70 | Growth hormone, human (HGH) (somatotropin) | | 83006 | $66.67 | Growth stimulation expressed gene 2 (ST2, Interleukin 1 receptor like-1) | | 83009 | $59.40 | Helicobacter pylori, blood test analysis for urease activity, non-radioactive isotope (eg, C-13) | | 83010 | $11.09 | Haptoglobin; quantitative | | 83012 | $23.71 | Haptoglobin; phenotypes | | 83013 | $59.40 | Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13) | | 83014 | $6.93 | Helicobacter pylori; drug administration | | 83015 | $18.47 | Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); qualitative, any number of analytes | | 83018 | $19.37 | Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); quantitative, each, not elsewhere specified | | 83020 | $11.35 | Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) | | 83021 | $15.93 | Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F) | | 83026 | $3.54 | Hemoglobin; by copper sulfate method, non-automated | | 83030 | $9.47 | Hemoglobin; F (fetal), chemical | | 83033 | $7.06 | Hemoglobin; F (fetal), qualitative | | 83036 | $8.56 | Hemoglobin; glycosylated (A1C) | | 83037 | $8.56 | Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use | | 83045 | $5.72 | Hemoglobin; methemoglobin, qualitative | | 83050 | $7.23 | Hemoglobin; methemoglobin, quantitative | | 83051 | $6.45 | Hemoglobin; plasma | | 83060 | $7.76 | Hemoglobin; sulfhemoglobin, quantitative | | 83065 | $7.94 | Hemoglobin; thermolabile | | 83068 | $8.35 | Hemoglobin; unstable, screen | | 83069 | $3.48 | Hemoglobin; urine | | 83070 | $4.19 | Hemosiderin, qualitative | | 83080 | $14.88 | b-Hexosaminidase, each assay | | 83088 | $26.04 | Histamine | | 83090 | $15.80 | Homocysteine | | 83150 | $19.76 | Homovanillic acid (HVA) | | 83491 | $15.79 | Hydroxycorticosteroids, 17- (17-OHCS) | | 83497 | $11.38 | Hydroxyindolacetic acid, 5-(HIAA) | | 83498 | $23.96 | Hydroxyprogesterone, 17-d | | 83500 | $19.97 | Hydroxyproline; free | | 83505 | $21.43 | Hydroxyproline; total | | 83516 | $10.17 | Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method | | 83518 | $8.50 | Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, single step method (eg, reagent strip) | | 83519 | $16.23 | Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA) | | 83520 | $15.23 | Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified | | 83521 | $15.23 | Immunoglobulin light chains (ie, kappa, lambda), free, each | | 83525 | $10.08 | Insulin; total | | 83527 | $11.42 | Insulin; free | | 83528 | $17.48 | Intrinsic factor | | 83529 | $15.23 | Interleukin-6 (IL-6) | | 83540 | $5.71 | Iron | | 83550 | $7.71 | Iron binding capacity | | 83570 | $7.80 | Isocitric dehydrogenase (IDH) | | 83582 | $13.64 | Ketogenic steroids, fractionation | | 83586 | $11.29 | Ketosteroids, 17- (17-KS); total | | 83593 | $25.13 | Ketosteroids, 17- (17-KS); fractionation | | 83605 | $10.20 | Lactate (lactic acid) | | 83615 | $5.33 | Lactate dehydrogenase (LD), (LDH); | | 83625 | $11.28 | Lactate dehydrogenase (LD), (LDH); isoenzymes, separation and quantitation | | 83630 | $17.37 | Lactoferrin, fecal; qualitative | | 83631 | $17.31 | Lactoferrin, fecal; quantitative | | 83632 | $17.83 | Lactogen, human placental (HPL) human chorionic somatomammotropin | | 83633 | $9.92 | Lactose, urine, qualitative | | 83655 | $10.68 | Lead | | 83661 | $19.39 | Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio | | 83662 | $16.68 | Fetal lung maturity assessment; foam stability test | | 83663 | $16.68 | Fetal lung maturity assessment; fluorescence polarization | | 83664 | $17.04 | Fetal lung maturity assessment; lamellar body density | | 83670 | $8.65 | Leucine aminopeptidase (LAP) | | 83690 | $6.08 | Lipase | | 83695 | $12.63 | Lipoprotein (a) | | 83698 | $40.84 | Lipoprotein-associated phospholipase A2 (Lp-PLA2) | | 83700 | $9.93 | Lipoprotein, blood; electrophoretic separation and quantitation | | 83701 | $29.86 | Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation) | | 83704 | $30.15 | Lipoprotein, blood; quantitation of lipoprotein particle number(s) (eg, by nuclear magnetic resonance spectroscopy), includes lipoprotein particle subclass(es), when performed | | 83718 | $7.22 | Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) | | 83719 | $11.24 | Lipoprotein, direct measurement; VLDL cholesterol | | 83721 | $9.26 | Lipoprotein, direct measurement; LDL cholesterol | | 83722 | $30.15 | Lipoprotein, direct measurement; small dense LDL cholesterol | | 83727 | $15.16 | Luteinizing releasing factor (LRH) | | 83735 | $5.91 | Magnesium | | 83775 | $6.50 | Malate dehydrogenase | | 83785 | $23.50 | Manganese | | 83789 | $21.26 | Mass spectrometry and tandem mass spectrometry (eg, MS, MS/MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen | | 83825 | $14.34 | Mercury, quantitative | | 83835 | $14.94 | Metanephrines | | 83857 | $9.47 | Methemalbumin | | 83861 | $19.82 | Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity | | 83864 | $25.13 | Mucopolysaccharides, acid, quantitative | | 83872 | $5.17 | Mucin, synovial fluid (Ropes test) | | 83873 | $15.17 | Myelin basic protein, cerebrospinal fluid | | 83874 | $11.39 | Myoglobin | | 83876 | $44.85 | Myeloperoxidase (MPO) | | 83880 | $34.62 | Natriuretic peptide | | 83883 | $11.99 | Nephelometry, each analyte not elsewhere specified | | 83885 | $21.61 | Nickel | | 83915 | $9.83 | Nucleotidase 5'- | | 83916 | $24.15 | Oligoclonal immune (oligoclonal bands) | | 83918 | $20.81 | Organic acids; total, quantitative, each specimen | | 83919 | $14.51 | Organic acids; qualitative, each specimen | | 83921 | $18.70 | Organic acid, single, quantitative | | 83930 | $5.83 | Osmolality; blood | | 83935 | $6.01 | Osmolality; urine | | 83937 | $26.32 | Osteocalcin (bone g1a protein) | | 83945 | $12.74 | Oxalate | | 83950 | $56.80 | Oncoprotein; HER-2/neu | | 83951 | $56.80 | Oncoprotein; des-gamma-carboxy-prothrombin (DCP) | | 83970 | $36.40 | Parathormone (parathyroid hormone) | | 83986 | $3.16 | pH; body fluid, not otherwise specified | | 83987 | $3.16 | pH; exhaled breath condensate | | 83992 | $15.79 | Phencyclidine (PCP) | | 83993 | $17.31 | Calprotectin, fecal | | 84030 | $4.85 | Phenylalanine (PKU), blood | | 84035 | $3.51 | Phenylketones, qualitative | | 84060 | $6.74 | Phosphatase, acid; total | | 84066 | $8.52 | Phosphatase, acid; prostatic | | 84075 | $4.57 | Phosphatase, alkaline; | | 84078 | $7.28 | Phosphatase, alkaline; heat stable (total not included) | | 84080 | $13.03 | Phosphatase, alkaline; isoenzymes | | 84081 | $14.57 | Phosphatidylglycerol | | 84085 | $8.32 | Phosphogluconate, 6-, dehydrogenase, RBC | | 84087 | $9.46 | Phosphohexose isomerase | | 84100 | $4.18 | Phosphorus inorganic (phosphate); | | 84105 | $5.10 | Phosphorus inorganic (phosphate); urine | | 84106 | $5.13 | Porphobilinogen, urine; qualitative | | 84110 | $7.44 | Porphobilinogen, urine; quantitative | | 84112 | $86.52 | Evaluation of cervicovaginal fluid for specific amniotic fluid protein(s) (eg, placental alpha microglobulin-1 [PAMG-1], placental protein 12 [PP12], alphafetoprotein), qualitative, each specimen | | 84119 | $11.78 | Porphyrins, urine; qualitative | | 84120 | $12.97 | Porphyrins, urine; quantitation and fractionation | | 84126 | $34.49 | Porphyrins, feces, quantitative | | 84132 | $4.20 | Potassium; serum, plasma or whole blood | | 84133 | $4.17 | Potassium; urine | | 84134 | $12.87 | Prealbumin | | 84135 | $18.76 | Pregnanediol | | 84138 | $18.56 | Pregnanetriol | | 84140 | $18.23 | Pregnenolone | | 84143 | $20.12 | 17-hydroxypregnenolone | | 84144 | $18.40 | Progesterone | | 84145 | $24.00 | Procalcitonin (PCT) | | 84146 | $17.09 | Prolactin | | 84150 | $36.84 | Prostaglandin, each | | 84152 | $16.22 | Prostate specific antigen (PSA); complexed (direct measurement) | | 84153 | $16.22 | Prostate specific antigen (PSA); total | | 84154 | $16.22 | Prostate specific antigen (PSA); free | | 84155 | $3.24 | Protein, total, except by refractometry; serum, plasma or whole blood | | 84156 | $3.24 | Protein, total, except by refractometry; urine | | 84157 | $3.53 | Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid) | | 84160 | $4.95 | Protein, total, by refractometry, any source | | 84163 | $13.27 | Pregnancy-associated plasma protein-A (PAPP-A) | | 84165 | $9.47 | Protein; electrophoretic fractionation and quantitation, serum | | 84166 | $15.72 | Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF) | | 84181 | $15.02 | Protein; Western Blot, with interpretation and report, blood or other body fluid | | 84182 | $25.76 | Protein; Western Blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each | | 84202 | $12.65 | Protoporphyrin, RBC; quantitative | | 84203 | $8.59 | Protoporphyrin, RBC; screen | | 84206 | $23.54 | Proinsulin | | 84207 | $24.78 | Pyridoxal phosphate (Vitamin B-6) | | 84210 | $12.77 | Pyruvate | | 84220 | $8.32 | Pyruvate kinase | | 84228 | $10.26 | Quinine | | 84233 | $77.50 | Receptor assay; estrogen | | 84234 | $57.22 | Receptor assay; progesterone | | 84235 | $62.82 | Receptor assay; endocrine, other than estrogen or progesterone (specify hormone) | | 84238 | $32.25 | Receptor assay; non-endocrine (specify receptor) | | 84244 | $19.39 | Renin | | 84252 | $17.85 | Riboflavin (Vitamin B-2) | | 84255 | $22.51 | Selenium | | 84260 | $27.32 | Serotonin | | 84270 | $19.16 | Sex hormone binding globulin (SHBG) | | 84275 | $11.85 | Sialic acid | | 84285 | $22.23 | Silica | | 84295 | $4.24 | Sodium; serum, plasma or whole blood | | 84300 | $4.46 | Sodium; urine | | 84302 | $4.29 | Sodium; other source | | 84305 | $18.75 | Somatomedin | | 84307 | $16.12 | Somatostatin | | 84311 | $7.14 | Spectrophotometry, analyte not elsewhere specified | | 84315 | $2.89 | Specific gravity (except urine) | | 84375 | $34.39 | Sugars, chromatographic, TLC or paper chromatography | | 84376 | $4.85 | Sugars (mono-, di-, and oligosaccharides); single qualitative, each specimen | | 84377 | $4.85 | Sugars (mono-, di-, and oligosaccharides); multiple qualitative, each specimen | | 84378 | $10.17 | Sugars (mono-, di-, and oligosaccharides); single quantitative, each specimen | | 84379 | $10.17 | Sugars (mono-, di-, and oligosaccharides); multiple quantitative, each specimen | | 84392 | $4.84 | Sulfate, urine | | 84402 | $22.46 | Testosterone; free | | 84403 | $22.76 | Testosterone; total | | 84410 | $45.22 | Testosterone; bioavailable, direct measurement (eg, differential precipitation) | | 84425 | $18.72 | Thiamine (Vitamin B-1) | | 84430 | $10.26 | Thiocyanate | | 84431 | $30.96 | Thromboxane metabolite(s), including thromboxane if performed, urine | | 84432 | $14.16 | Thyroglobulin | | 84433 | $19.55 | Thiopurine S-methyltransferase (TPMT) | | 84436 | $6.06 | Thyroxine; total | | 84437 | $5.71 | Thyroxine; requiring elution (eg, neonatal) | | 84439 | $7.95 | Thyroxine; free | | 84442 | $13.03 | Thyroxine binding globulin (TBG) | | 84443 | $14.82 | Thyroid stimulating hormone (TSH) | | 84445 | $44.85 | Thyroid stimulating immune globulins (TSI) | | 84446 | $12.50 | Tocopherol alpha (Vitamin E) | | 84449 | $15.87 | Transcortin (cortisol binding globulin) | | 84450 | $4.57 | Transferase; aspartate amino (AST) (SGOT) | | 84460 | $4.67 | Transferase; alanine amino (ALT) (SGPT) | | 84466 | $11.25 | Transferrin | | 84478 | $5.06 | Triglycerides | | 84479 | $5.71 | Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) | | 84480 | $12.50 | Triiodothyronine T3; total (TT-3) | | 84481 | $14.94 | Triiodothyronine T3; free | | 84482 | $13.90 | Triiodothyronine T3; reverse | | 84484 | $11.00 | Troponin, quantitative | | 84485 | $6.35 | Trypsin; duodenal fluid | | 84488 | $6.44 | Trypsin; feces, qualitative | | 84490 | $8.76 | Trypsin; feces, quantitative, 24-hour collection | | 84510 | $9.37 | Tyrosine | | 84512 | $8.90 | Troponin, qualitative | | 84520 | $3.48 | Urea nitrogen; quantitative | | 84525 | $4.52 | Urea nitrogen; semiquantitative (eg, reagent strip test) | | 84540 | $4.90 | Urea nitrogen, urine | | 84545 | $6.35 | Urea nitrogen, clearance | | 84550 | $3.99 | Uric acid; blood | | 84560 | $4.48 | Uric acid; other source | | 84577 | $14.82 | Urobilinogen, feces, quantitative | | 84578 | $3.94 | Urobilinogen, urine; qualitative | | 84580 | $8.42 | Urobilinogen, urine; quantitative, timed specimen | | 84583 | $5.34 | Urobilinogen, urine; semiquantitative | | 84585 | $13.67 | Vanillylmandelic acid (VMA), urine | | 84586 | $31.16 | Vasoactive intestinal peptide (VIP) | | 84588 | $29.93 | Vasopressin (antidiuretic hormone, ADH) | | 84590 | $10.24 | Vitamin A | | 84591 | $15.04 | Vitamin, not otherwise specified | | 84597 | $12.10 | Vitamin K | | 84600 | $15.09 | Volatiles (eg, acetic anhydride, diethylether) | | 84620 | $11.39 | Xylose absorption test, blood and/or urine | | 84630 | $10.04 | Zinc | | 84681 | $18.35 | C-peptide | | 84702 | $13.27 | Gonadotropin, chorionic (hCG); quantitative | | 84703 | $6.63 | Gonadotropin, chorionic (hCG); qualitative | | 84704 | $13.48 | Gonadotropin, chorionic (hCG); free beta chain | | 84830 | $11.20 | Ovulation tests, by visual color comparison methods for human luteinizing hormone | | 84999 | $4.46 | Unlisted chemistry procedure | | | | Hematology and Coagulation | | 85002 | $4.25 | Bleeding time | | 85004 | $5.71 | Blood count; automated differential WBC count | | 85007 | $3.35 | Blood count; blood smear, microscopic examination with manual differential WBC count | | 85008 | $3.02 | Blood count; blood smear, microscopic examination without manual differential WBC count | | 85009 | $4.47 | Blood count; manual differential WBC count, buffy coat | | 85013 | $6.17 | Blood count; spun microhematocrit | | 85014 | $2.09 | Blood count; hematocrit (Hct) | | 85018 | $2.09 | Blood count; hemoglobin (Hgb) | | 85025 | $6.85 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | | 85027 | $5.71 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) | | 85032 | $3.80 | Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each | | 85041 | $2.66 | Blood count; red blood cell (RBC), automated | | 85044 | $3.80 | Blood count; reticulocyte, manual | | 85045 | $3.52 | Blood count; reticulocyte, automated | | 85046 | $4.91 | Blood count; reticulocytes, automated, including one or more cellular parameters (eg, reticulocyte hemoglobin content [CHr], immature reticulocyte fraction [IRF], reticulocyte volume [MRV], RNA content), direct measurement | | 85048 | $2.24 | Blood count; leukocyte (WBC), automated | | 85049 | $3.95 | Blood count; platelet, automated | | 85055 | $31.52 | Reticulated platelet assay | | 85130 | $10.49 | Chromogenic substrate assay | | 85170 | $14.37 | Clot retraction | | 85175 | $17.96 | Clot lysis time, whole blood dilution | | 85210 | $11.45 | Clotting; factor II, prothrombin, specific | | 85220 | $15.57 | Clotting; factor V (AcG or proaccelerin), labile factor | | 85230 | $15.79 | Clotting; factor VII (proconvertin, stable factor) | | 85240 | $15.79 | Clotting; factor VIII (AHG), one-stage | | 85244 | $18.01 | Clotting; factor VIII related antigen | | 85245 | $20.23 | Clotting; factor VIII, VW factor, ristocetin cofactor | | 85246 | $20.23 | Clotting; factor VIII, VW factor antigen | | 85247 | $20.23 | Clotting; factor VIII, von Willebrand factor, multimetric analysis | | 85250 | $16.79 | Clotting; factor IX (PTC or Christmas) | | 85260 | $15.79 | Clotting; factor X (Stuart-Prower) | | 85270 | $15.79 | Clotting; factor XI (PTA) | | 85280 | $17.06 | Clotting; factor XII (Hageman) | | 85290 | $14.41 | Clotting; factor XIII (fibrin stabilizing) | | 85291 | $8.03 | Clotting; factor XIII (fibrin stabilizing), screen solubility | | 85292 | $16.69 | Clotting; prekallikrein assay (Fletcher factor assay) | | 85293 | $16.69 | Clotting; high molecular weight kininogen assay (Fitzgerald factor assay) | | 85300 | $10.45 | Clotting inhibitors or anticoagulants; antithrombin III, activity | | 85301 | $9.53 | Clotting inhibitors or anticoagulants; antithrombin III, antigen assay | | 85302 | $10.59 | Clotting inhibitors or anticoagulants; protein C, antigen | | 85303 | $12.21 | Clotting inhibitors or anticoagulants; protein C, activity | | 85305 | $10.24 | Clotting inhibitors or anticoagulants; protein S, total | | 85306 | $13.51 | Clotting inhibitors or anticoagulants; protein S, free | | 85307 | $13.51 | Activated Protein C (APC) resistance assay | | 85335 | $11.35 | Factor inhibitor test | | 85337 | $15.23 | Thrombomodulin | | 85345 | $4.14 | Coagulation time; Lee and White | | 85347 | $3.77 | Coagulation time; activated | | 85348 | $3.96 | Coagulation time; other methods | | 85360 | $7.42 | Euglobulin lysis | | 85362 | $6.08 | Fibrin(ogen) degradation (split) products (FDP) (FSP); agglutination slide, semiquantitative | | 85366 | $70.96 | Fibrin(ogen) degradation (split) products (FDP) (FSP); paracoagulation | | 85370 | $10.96 | Fibrin(ogen) degradation (split) products (FDP) (FSP); quantitative | | 85378 | $8.57 | Fibrin degradation products, D-dimer; qualitative or semiquantitative | | 85379 | $8.98 | Fibrin degradation products, D-dimer; quantitative | | 85380 | $8.98 | Fibrin degradation products, D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative | | 85384 | $8.57 | Fibrinogen; activity | | 85385 | $12.75 | Fibrinogen; antigen | | 85390 | $13.65 | Fibrinolysins or coagulopathy screen, interpretation and report | | 85397 | $27.21 | Coagulation and fibrinolysis, functional activity, not otherwise specified (eg, ADAMTS-13), each analyte | | 85400 | $6.80 | Fibrinolytic factors and inhibitors; plasmin | | 85410 | $6.80 | Fibrinolytic factors and inhibitors; alpha-2 antiplasmin | | 85415 | $15.16 | Fibrinolytic factors and inhibitors; plasminogen activator | | 85420 | $5.76 | Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay | | 85421 | $8.98 | Fibrinolytic factors and inhibitors; plasminogen, antigenic assay | | 85441 | $3.70 | Heinz bodies; direct | | 85445 | $6.01 | Heinz bodies; induced, acetyl phenylhydrazine | | 85460 | $6.82 | Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis (Kleihauer-Betke) | | 85461 | $8.25 | Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; rosette | | 85475 | $7.82 | Hemolysin, acid | | 85520 | $11.54 | Heparin assay | | 85525 | $10.44 | Heparin neutralization | | 85530 | $11.54 | Heparin-protamine tolerance test | | 85536 | $6.07 | Iron stain, peripheral blood | | 85540 | $7.58 | Leukocyte alkaline phosphatase with count | | 85547 | $7.58 | Mechanical fragility, RBC | | 85549 | $16.54 | Muramidase | | 85555 | $6.59 | Osmotic fragility, RBC; unincubated | | 85557 | $11.78 | Osmotic fragility, RBC; incubated | | 85576 | $21.97 | Platelet, aggregation (in vitro), each agent | | 85597 | $15.86 | Phospholipid neutralization; platelet | | 85598 | $15.86 | Phospholipid neutralization; hexagonal phospholipid | | 85610 | $3.78 | Prothrombin time; | | 85611 | $3.47 | Prothrombin time; substitution, plasma fractions, each | | 85612 | $15.42 | Russell viper venom time (includes venom); undiluted | | 85613 | $8.45 | Russell viper venom time (includes venom); diluted | | 85635 | $8.69 | Reptilase test | | 85651 | $3.77 | Sedimentation rate, erythrocyte; non-automated | | 85652 | $2.38 | Sedimentation rate, erythrocyte; automated | | 85660 | $4.86 | Sickling of RBC, reduction | | 85670 | $5.09 | Thrombin time; plasma | | 85675 | $6.04 | Thrombin time; titer | | 85705 | $8.49 | Thromboplastin inhibition, tissue | | 85730 | $5.30 | Thromboplastin time, partial (PTT); plasma or whole blood | | 85732 | $5.71 | Thromboplastin time, partial (PTT); substitution, plasma fractions, each | | 85810 | $10.29 | Viscosity | | 85999 | I.C. | Unlisted hematology and coagulation procedure | | | | Immunology | | 86000 | $6.16 | Agglutinins, febrile (eg, Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus), each antigen | | 86001 | $6.90 | Allergen specific IgG quantitative or semiquantitative, each allergen | | 86003 | $4.60 | Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | | 86005 | $7.03 | Allergen specific IgE; qualitative, multiallergen screen (eg, disk, sponge, card) | | 86008 | $15.81 | Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each | | 86015 | $10.63 | Actin (smooth muscle) antibody (ASMA), each | | 86021 | $13.27 | Antibody identification; leukocyte antibodies | | 86022 | $16.20 | Antibody identification; platelet antibodies | | 86023 | $10.99 | Antibody identification; platelet associated immunoglobulin assay | | 86036 | $10.63 | Antineutrophil cytoplasmic antibody (ANCA); screen, each antibody | | 86037 | $10.63 | Antineutrophil cytoplasmic antibody (ANCA); titer, each antibody | | 86038 | $10.66 | Antinuclear antibodies (ANA); | | 86039 | $9.84 | Antinuclear antibodies (ANA); titer | | 86041 | $16.23 | Acetylcholine receptor (AChR); binding antibody | | 86042 | $16.23 | Acetylcholine receptor (AChR); blocking antibody | | 86043 | $10.63 | Acetylcholine receptor (AChR); modulating antibody | | 86051 | $10.17 | Aquaporin-4 (neuromyelitis optica [NMO]) antibody; enzyme-linked immunosorbent immunoassay (ELISA) | | 86052 | $10.63 | Aquaporin-4 (neuromyelitis optica [NMO]) antibody; cell-based immunofluorescence assay (CBA), each | | 86053 | $33.27 | Aquaporin-4 (neuromyelitis optica [NMO]) antibody; flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each | | 86060 | $6.44 | Antistreptolysin 0; titer | | 86063 | $5.09 | Antistreptolysin 0; screen | | 86140 | $4.57 | C-reactive protein; | | 86141 | $11.42 | C-reactive protein; high sensitivity (hsCRP) | | 86146 | $22.44 | Beta 2 Glycoprotein I antibody, each | | 86147 | $22.44 | Cardiolipin (phospholipid) antibody, each Ig class | | 86148 | $14.17 | Anti-phosphatidylserine (phospholipid) antibody | | 86152 | $221.16 | Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); | | 86155 | $14.10 | Chemotaxis assay, specify method | | 86156 | $7.12 | Cold agglutinin; screen | | 86157 | $7.11 | Cold agglutinin; titer | | 86160 | $10.58 | Complement; antigen, each component | | 86161 | $10.58 | Complement; functional activity, each component | | 86162 | $17.92 | Complement; total hemolytic (CH50) | | 86171 | $8.83 | Complement fixation tests, each antigen | | 86200 | $11.42 | Cyclic citrullinated peptide (CCP), antibody | | 86215 | $11.68 | Deoxyribonuclease, antibody | | 86225 | $12.12 | Deoxyribonucleic acid (DNA) antibody; native or double stranded | | 86226 | $10.68 | Deoxyribonucleic acid (DNA) antibody; single stranded | | 86231 | $10.66 | Endomysial antibody (EMA), each immunoglobulin (Ig) class | | 86235 | $15.81 | Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody | | 86255 | $10.63 | Fluorescent noninfectious agent antibody; screen, each antibody | | 86256 | $10.63 | Fluorescent noninfectious agent antibody; titer, each antibody | | 86258 | $10.63 | Gliadin (deamidated) (DGP) antibody, each immunoglobulin (Ig) class | | 86277 | $13.88 | Growth hormone, human (HGH), antibody | | 86280 | $7.22 | Hemagglutination inhibition test (HAI) | | 86294 | $22.55 | Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen) | | 86300 | $18.35 | Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29) | | 86301 | $18.35 | Immunoassay for tumor antigen, quantitative; CA 19-9 | | 86304 | $18.35 | Immunoassay for tumor antigen, quantitative; CA 125 | | 86305 | $18.35 | Human epididymis protein four (HE4) | | 86308 | $4.57 | Heterophile antibodies; screening | | 86309 | $5.71 | Heterophile antibodies; titer | | 86310 | $6.50 | Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney | | 86316 | $18.35 | Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each | | 86317 | $13.22 | Immunoassay for infectious agent antibody, quantitative, not otherwise specified | | 86318 | $15.95 | Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); | | 86320 | $26.39 | Immunoelectrophoresis; serum | | 86325 | $20.40 | Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration | | 86327 | $26.39 | Immunoelectrophoresis; crossed (two-dimensional assay) | | 86328 | $45.28 | Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) | | 86329 | $12.39 | Immunodiffusion; not elsewhere specified | | 86331 | $10.56 | Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody | | 86332 | $21.49 | Immune complex assay | | 86334 | $19.70 | Immunofixation electrophoresis; serum | | 86335 | $25.88 | Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF) | | 86336 | $13.75 | Inhibin A | | 86337 | $18.88 | Insulin antibodies | | 86340 | $13.30 | Intrinsic factor antibodies | | 86341 | $20.79 | Islet cell antibody | | 86343 | $10.99 | Leukocyte histamine release test (LHR) | | 86344 | $9.16 | Leukocyte phagocytosis | | 86352 | $119.81 | Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP) | | 86353 | $43.24 | Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis | | 86355 | $33.27 | B cells, total count | | 86356 | $23.62 | Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen | | 86357 | $33.27 | Natural killer (NK) cells, total count | | 86359 | $33.27 | T cells; total count | | 86360 | $41.43 | T cells; absolute CD4 and CD8 count, including ratio | | 86361 | $23.62 | T cells; absolute CD4 count | | 86362 | $10.63 | Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; cell-based immunofluorescence assay (CBA), each | | 86363 | $33.27 | Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each | | 86364 | $10.17 | Tissue transglutaminase, each immunoglobulin (Ig) class | | 86366 | $16.23 | Muscle-specific kinase (MuSK) antibody | | 86367 | $68.59 | Stem cells (ie, CD34), total count | | 86376 | $12.83 | Microsomal antibodies (eg, thyroid or liver-kidney), each | | 86381 | $22.44 | Mitochondrial antibody (eg, M2), each | | 86382 | $14.91 | Neutralization test, viral | | 86384 | $12.00 | Nitroblue tetrazolium dye test (NTD) | | 86386 | $19.21 | Nuclear Matrix Protein 22 (NMP22), qualitative | | 86403 | $10.18 | Particle agglutination; screen, each antibody | | 86406 | $9.38 | Particle agglutination; titer, each antibody | | 86408 | $42.13 | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]); screen | | 86409 | $105.33 | Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]); titer | | 86413 | $51.43 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) antibody, quantitative | | 86430 | $5.41 | Rheumatoid factor; qualitative | | 86431 | $5.00 | Rheumatoid factor; quantitative | | 86480 | $54.66 | Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon | | 86481 | $88.19 | Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension | | 86485 | $25.15 | Skin test; candida | | 86590 | $11.16 | Streptokinase, antibody | | 86592 | $3.77 | Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) | | 86593 | $3.88 | Syphilis test, non-treponemal antibody; quantitative | | 86596 | $10.63 | Voltage-gated calcium channel antibody, each | | 86602 | $8.98 | Antibody; actinomyces | | 86603 | $11.35 | Antibody; adenovirus | | 86606 | $13.27 | Antibody; Aspergillus | | 86609 | $11.36 | Antibody; bacterium, not elsewhere specified | | 86611 | $8.98 | Antibody; Bartonella | | 86612 | $11.38 | Antibody; Blastomyces | | 86615 | $11.63 | Antibody; Bordetella | | 86617 | $13.66 | Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot) | | 86618 | $15.02 | Antibody; Borrelia burgdorferi (Lyme disease) | | 86619 | $11.80 | Antibody; Borrelia (relapsing fever) | | 86622 | $7.88 | Antibody; Brucella | | 86625 | $11.57 | Antibody; Campylobacter | | 86628 | $10.59 | Antibody; Candida | | 86631 | $10.42 | Antibody; Chlamydia | | 86632 | $11.18 | Antibody; Chlamydia, IgM | | 86635 | $10.12 | Antibody; Coccidioides | | 86638 | $10.69 | Antibody; Coxiella burnetii (Q fever) | | 86641 | $12.71 | Antibody; Cryptococcus | | 86644 | $12.69 | Antibody; cytomegalovirus (CMV) | | 86645 | $14.86 | Antibody; cytomegalovirus (CMV), IgM | | 86648 | $13.41 | Antibody; Diphtheria | | 86651 | $11.63 | Antibody; encephalitis, California (La Crosse) | | 86652 | $11.63 | Antibody; encephalitis, Eastern equine | | 86653 | $11.63 | Antibody; encephalitis, St. Louis | | 86654 | $11.63 | Antibody; encephalitis, Western equine | | 86658 | $11.49 | Antibody; enterovirus (eg, coxsackie, echo, polio) | | 86663 | $11.57 | Antibody; Epstein-Barr (EB) virus, early antigen (EA) | | 86664 | $13.48 | Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA) | | 86665 | $16.00 | Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) | | 86666 | $8.98 | Antibody; Ehrlichia | | 86668 | $12.49 | Antibody; Francisella tularensis | | 86671 | $10.80 | Antibody; fungus, not elsewhere specified | | 86674 | $12.98 | Antibody; Giardia lamblia | | 86677 | $14.86 | Antibody; Helicobacter pylori | | 86682 | $11.47 | Antibody; helminth, not elsewhere specified | | 86684 | $13.97 | Antibody; Haemophilus influenza | | 86687 | $8.02 | Antibody; HTLV-I | | 86688 | $12.35 | Antibody; HTLV-II | | 86689 | $17.06 | Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot) | | 86692 | $15.13 | Antibody; hepatitis, delta agent | | 86694 | $12.69 | Antibody; herpes simplex, non-specific type test | | 86695 | $11.63 | Antibody; herpes simplex, type 1 | | 86696 | $17.06 | Antibody; herpes simplex, type 2 | | 86698 | $12.16 | Antibody; histoplasma | | 86701 | $7.84 | Antibody; HIV-1 | | 86702 | $11.92 | Antibody; HIV-2 | | 86703 | $12.09 | Antibody; HIV-1 and HIV-2, single result | | 86704 | $10.63 | Hepatitis B core antibody (HBcAb); total | | 86705 | $10.38 | Hepatitis B core antibody (HBcAb); IgM antibody | | 86706 | $9.47 | Hepatitis B surface antibody (HBsAb) | | 86707 | $10.20 | Hepatitis Be antibody (HBeAb) | | 86708 | $10.93 | Hepatitis A antibody (HAAb) | | 86709 | $9.93 | Hepatitis A antibody (HAAb), IgM antibody | | 86710 | $11.95 | Antibody; influenza virus | | 86711 | $14.89 | Antibody; JC (John Cunningham) virus | | 86713 | $13.49 | Antibody; Legionella | | 86717 | $10.80 | Antibody; Leishmania | | 86720 | $14.29 | Antibody; Leptospira | | 86723 | $11.63 | Antibody; Listeria monocytogenes | | 86727 | $11.35 | Antibody; lymphocytic choriomeningitis | | 86732 | $13.23 | Antibody; mucormycosis | | 86735 | $11.51 | Antibody; mumps | | 86738 | $11.68 | Antibody; mycoplasma | | 86741 | $11.63 | Antibody; Neisseria meningitidis | | 86744 | $14.10 | Antibody; Nocardia | | 86747 | $13.25 | Antibody; parvovirus | | 86750 | $11.63 | Antibody; Plasmodium (malaria) | | 86753 | $10.93 | Antibody; protozoa, not elsewhere specified | | 86756 | $14.01 | Antibody; respiratory syncytial virus | | 86757 | $17.06 | Antibody; Rickettsia | | 86759 | $16.08 | Antibody; rotavirus | | 86762 | $12.69 | Antibody; rubella | | 86765 | $11.36 | Antibody; rubeola | | 86768 | $11.63 | Antibody; Salmonella | | 86769 | $42.13 | Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) | | 86771 | $21.59 | Antibody; Shigella | | 86774 | $13.05 | Antibody; tetanus | | 86777 | $12.69 | Antibody; Toxoplasma | | 86778 | $12.71 | Antibody; Toxoplasma, IgM | | 86780 | $11.68 | Antibody; Treponema pallidum | | 86784 | $11.08 | Antibody; Trichinella | | 86787 | $11.36 | Antibody; varicella-zoster | | 86788 | $14.86 | Antibody; West Nile virus, IgM | | 86789 | $12.69 | Antibody; West Nile virus | | 86790 | $11.36 | Antibody; virus, not elsewhere specified | | 86793 | $11.63 | Antibody; Yersinia | | 86794 | $14.86 | Antibody; Zika virus, IgM | | 86800 | $14.03 | Thyroglobulin antibody | | 86803 | $12.58 | Hepatitis C antibody; | | 86804 | $13.66 | Hepatitis C antibody; confirmatory test (eg, immunoblot) | | 86805 | $167.12 | Lymphocytotoxicity assay, visual crossmatch; with titration | | 86806 | $41.97 | Lymphocytotoxicity assay, visual crossmatch; without titration | | 86807 | $69.36 | Serum screening for cytotoxic percent reactive antibody (PRA); standard method | | 86808 | $26.17 | Serum screening for cytotoxic percent reactive antibody (PRA); quick method | | 86812 | $22.76 | HLA typing; A, B, or C (eg, A10, B7, B27), single antigen | | 86813 | $51.15 | HLA typing; A, B, or C, multiple antigens | | 86816 | $26.61 | HLA typing; DR/DQ, single antigen | | 86817 | $93.60 | HLA typing; DR/DQ, multiple antigens | | 86821 | $32.24 | HLA typing; lymphocyte culture, mixed (MLC) | | 86825 | $96.56 | Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution | | 86826 | $32.21 | Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure) | | 86828 | $56.61 | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA Class I and Class II HLA antigens | | 86829 | $56.61 | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA Class I or Class II HLA antigens | | 86830 | $84.24 | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class I | | 86831 | $72.21 | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class II | | 86832 | $285.51 | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA Class I | | 86833 | $287.31 | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA Class II | | 86834 | $315.32 | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (eg, titer), HLA Class I | | 86835 | $284.81 | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (eg, titer), HLA Class II | | 86849 | I.C. | Unlisted immunology procedure | | | | Transformation | | 86850 | $8.62 | Antibody screen, RBC, each serum technique | | 86860 | I.C. | Antibody elution (RBC), each elution | | 86870 | I.C. | Antibody identification, RBC antibodies, each panel for each serum technique | | 86880 | $4.75 | Antihuman globulin test (Coombs test); direct, each antiserum | | 86885 | $5.04 | Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell | | 86886 | $4.57 | Antihuman globulin test (Coombs test); indirect, each antibody titer | | 86890 | I.C. | Autologous blood or component, collection processing and storage; predeposited | | 86891 | I.C. | Autologous blood or component, collection processing and storage; intra- or postoperative salvage | | 86900 | $2.64 | Blood typing, serologic; ABO | | 86901 | $2.64 | Blood typing, serologic; Rh (D) | | 86902 | $5.60 | Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test | | 86904 | $14.41 | Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened | | 86905 | $3.38 | Blood typing, serologic; RBC antigens, other than ABO or Rh (D), each | | 86906 | $6.83 | Blood typing, serologic; Rh phenotyping, complete | | 86920 | I.C. | Compatibility test each unit; immediate spin technique | | 86921 | I.C. | Compatibility test each unit; incubation technique | | 86922 | I.C. | Compatibility test each unit; antiglobulin technique | | 86923 | I.C. | Compatibility test each unit; electronic | | 86927 | I.C. | Fresh frozen plasma, thawing, each unit | | 86930 | I.C. | Frozen blood, each unit; freezing (includes preparation) | | 86931 | I.C. | Frozen blood, each unit; thawing | | 86932 | I.C. | Frozen blood, each unit; freezing (includes preparation) and thawing | | 86940 | $7.73 | Hemolysins and agglutinins; auto, screen, each | | 86941 | $10.68 | Hemolysins and agglutinins; incubated | | 86945 | $24.12 | Irradiation of blood product, each unit | | 86960 | I.C. | Volume reduction of blood or blood product (eg, red blood cells or platelets), each unit | | 86965 | $24.12 | Pooling of platelets or other blood products | | 86970 | $19.27 | Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with chemical agents or drugs, each | | 86971 | $19.27 | Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with enzymes, each | | 86976 | $19.27 | Pretreatment of serum for use in RBC antibody identification; by dilution | | 86977 | $19.27 | Pretreatment of serum for use in RBC antibody identification; incubation with inhibitors, each | | 86978 | $19.27 | Pretreatment of serum for use in RBC antibody identification; by differential red cell absorption using patient RBCs or RBCs of known phenotype, each absorption | | 86985 | I.C. | Splitting of blood or blood products, each unit | | 86999 | I.C. | Unlisted transfusion medicine procedure | | | | Microbiology | | 87003 | $14.85 | Animal inoculation, small animal, with observation and dissection | | 87015 | $5.89 | Concentration (any type), for infectious agents | | 87040 | $9.10 | Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) | | 87045 | $8.32 | Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species | | 87046 | $8.32 | Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate | | 87070 | $7.60 | Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates | | 87071 | $8.72 | Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool | | 87073 | $8.52 | Culture, bacterial; quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool | | 87075 | $8.35 | Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates | | 87076 | $7.13 | Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate | | 87077 | $7.13 | Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate | | 87081 | $5.85 | Culture, presumptive, pathogenic organisms, screening only; | | 87084 | $23.87 | Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart | | 87086 | $7.12 | Culture, bacterial; quantitative colony count, urine | | 87088 | $7.13 | Culture, bacterial; with isolation and presumptive identification of each isolate, urine | | 87101 | $6.80 | Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail | | 87102 | $7.42 | Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood) | | 87103 | $18.04 | Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood | | 87106 | $9.10 | Culture, fungi, definitive identification, each organism; yeast | | 87107 | $9.10 | Culture, fungi, definitive identification, each organism; mold | | 87109 | $13.57 | Culture, mycoplasma, any source | | 87110 | $17.28 | Culture, chlamydia, any source | | 87116 | $9.52 | Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates | | 87118 | $12.88 | Culture, mycobacterial, definitive identification, each isolate | | 87140 | $4.91 | Culture, typing; immunofluorescent method, each antiserum | | 87143 | $11.04 | Culture, typing; gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method | | 87147 | $4.57 | Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum | | 87149 | $17.68 | Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed | | 87150 | $30.94 | Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed | | 87152 | $6.83 | Culture, typing; identification by pulse field gel typing | | 87153 | $101.73 | Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene) | | 87154 | $192.30 | Culture, typing; identification of blood pathogen and resistance typing, when performed, by nucleic acid (DNA or RNA) probe, multiplexed amplified probe technique including multiplex reverse transcription, when performed, per culture or isolate, six or more targets | | 87158 | $6.83 | Culture, typing; other methods | | 87164 | $9.47 | Dark field examination, any source (eg, penile, vaginal, oral, skin); includes specimen collection | | 87166 | $9.97 | Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection | | 87168 | $3.77 | Macroscopic examination; arthropod | | 87169 | $3.80 | Macroscopic examination; parasite | | 87172 | $3.77 | Pinworm exam (eg, cellophane tape prep) | | 87176 | $5.19 | Homogenization, tissue, for culture | | 87177 | $7.85 | Ova and parasites, direct smears, concentration and identification | | 87181 | $4.19 | Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip) | | 87184 | $6.60 | Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) | | 87185 | $4.19 | Susceptibility studies, antimicrobial agent; enzyme detection (eg, beta lactamase), per enzyme | | 87186 | $7.63 | Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate | | 87187 | $35.42 | Susceptibility studies, antimicrobial agent; microdilution or agar dilution, minimum lethal concentration (MLC), each plate (List separately in addition to code for primary procedure) | | 87188 | $5.86 | Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent | | 87190 | $6.45 | Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each agent | | 87197 | $13.25 | Serum bactericidal titer (Schlichter test) | | 87205 | $3.77 | Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types | | 87206 | $4.75 | Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types | | 87207 | $5.28 | Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses) | | 87209 | $15.86 | Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites | | 87210 | $5.13 | Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps) | | 87220 | $3.77 | Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies) | | 87230 | $17.41 | Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile toxin) | | 87250 | $17.25 | Virus isolation; inoculation of embryonated eggs, or small animal, includes observation and dissection | | 87252 | $22.99 | Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect | | 87253 | $17.81 | Virus isolation; tissue culture, additional studies or definitive identification (eg, hemabsorption, neutralization, immunofluorescence stain), each isolate | | 87254 | $17.25 | Virus isolation; centrifuge enhanced (shell vial) technique, includes identification with immunofluorescence stain, each virus | | 87255 | $29.86 | Virus isolation; including identification by non-immunologic method, other than by cytopathic effect (eg, virus specific enzymatic activity) | | 87260 | $12.73 | Infectious agent antigen detection by immunofluorescent technique; adenovirus | | 87265 | $10.56 | Infectious agent antigen detection by immunofluorescent technique; Bordetella pertussis/parapertussis | | 87267 | $11.83 | Infectious agent antigen detection by immunofluorescent technique; Enterovirus, direct fluorescent antibody (DFA) | | 87269 | $12.00 | Infectious agent antigen detection by immunofluorescent technique; giardia | | 87270 | $10.56 | Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis | | 87271 | $11.83 | Infectious agent antigen detection by immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody (DFA) | | 87272 | $10.56 | Infectious agent antigen detection by immunofluorescent technique; cryptosporidium | | 87273 | $10.56 | Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 2 | | 87274 | $10.56 | Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 1 | | 87275 | $10.80 | Infectious agent antigen detection by immunofluorescent technique; influenza B virus | | 87276 | $14.17 | Infectious agent antigen detection by immunofluorescent technique; influenza A virus | | 87278 | $13.76 | Infectious agent antigen detection by immunofluorescent technique; Legionella pneumophila | | 87279 | $14.49 | Infectious agent antigen detection by immunofluorescent technique; Parainfluenza virus, each type | | 87280 | $11.83 | Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus | | 87281 | $10.56 | Infectious agent antigen detection by immunofluorescent technique; Pneumocystis carinii | | 87283 | $53.62 | Infectious agent antigen detection by immunofluorescent technique; Rubeola | | 87285 | $10.74 | Infectious agent antigen detection by immunofluorescent technique; Treponema pallidum | | 87290 | $11.83 | Infectious agent antigen detection by immunofluorescent technique; Varicella zoster virus | | 87299 | $14.20 | Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism | | 87300 | $10.56 | Infectious agent antigen detection by immunofluorescent technique, polyvalent for multiple organisms, each polyvalent antiserum | | 87301 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; adenovirus enteric types 40/41 | | 87305 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Aspergillus | | 87320 | $13.23 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Chlamydia trachomatis | | 87324 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Clostridium difficile toxin(s) | | 87327 | $11.83 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Cryptococcus neoformans | | 87328 | $12.19 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; cryptosporidium | | 87329 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; giardia | | 87332 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; cytomegalovirus | | 87335 | $11.16 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Escherichia coli 0157 | | 87336 | $14.11 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Entamoeba histolytica dispar group | | 87337 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Entamoeba histolytica group | | 87338 | $12.68 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Helicobacter pylori, stool | | 87339 | $14.11 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Helicobacter pylori | | 87340 | $9.11 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) | | 87341 | $9.11 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) neutralization | | 87350 | $10.17 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis Be antigen (HBeAg) | | 87380 | $16.19 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis, delta agent | | 87385 | $11.68 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Histoplasma capsulatum | | 87389 | $21.24 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result | | 87390 | $21.22 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 | | 87391 | $19.31 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-2 | | 87400 | $12.46 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Influenza, A or B, each | | 87420 | $12.27 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; respiratory syncytial virus | | 87425 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; rotavirus | | 87426 | $35.33 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) | | 87427 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Shiga-like toxin | | 87428 | $63.59 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B | | 87430 | $14.82 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Streptococcus, group A | | 87449 | $10.56 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; not otherwise specified, each organism | | 87451 | $9.27 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; polyvalent for multiple organisms, each polyvalent antiserum | | 87467 | $13.27 | Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg), quantitative | | 87468 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Anaplasma phagocytophilum, amplified probe technique | | 87469 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Babesia microti, amplified probe technique | | 87471 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique | | 87472 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, quantification | | 87475 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, direct probe technique | | 87476 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique | | 87478 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Borrelia miyamotoi, amplified probe technique | | 87480 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct probe technique | | 87481 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique | | 87482 | $49.16 | Infectious agent detection by nucleic acid (DNA or RNA); Candida species, quantification | | 87483 | $367.55 | Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (eg, Neisseria meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenzae, E. coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster virus, Cryptococcus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets | | 87484 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Ehrlichia chaffeensis, amplified probe technique | | 87485 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, direct probe technique | | 87486 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique | | 87487 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, quantification | | 87490 | $20.06 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique | | 87491 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique | | 87492 | $47.15 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification | | 87493 | $32.87 | Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique | | 87495 | $26.48 | Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, direct probe technique | | 87496 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique | | 87497 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification | | 87498 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, amplified probe technique, includes reverse transcription when performed | | 87500 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique | | 87501 | $45.25 | Infectious agent detection by nucleic acid (dNa or RNA); influenza virus, includes reverse transcription, when performed, and amplified probe technique, each type or subtype | | 87502 | $84.48 | Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first two types or sub-types | | 87503 | $25.77 | Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, each additional influenza virus type or sub-type beyond two (List separately in addition to code for primary procedure) | | 87505 | $113.14 | Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, three - five targets | | 87506 | $231.92 | Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, six - 11 targets | | 87507 | $367.55 | Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets | | 87510 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, direct probe technique | | 87511 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique | | 87512 | $36.83 | Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, quantification | | 87516 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, amplified probe technique | | 87517 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification | | 87520 | $27.53 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique | | 87521 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed | | 87522 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed | | 87523 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis D (delta), quantification, including reverse transcription, when performed | | 87525 | $26.28 | Infectious agent detection by nucleic acid (DNA or rNa); hepatitis G, direct probe technique | | 87526 | $34.62 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, amplified probe technique | | 87527 | $36.83 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, quantification | | 87528 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, direct probe technique | | 87529 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique | | 87530 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, quantification | | 87531 | $51.15 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, direct probe technique | | 87532 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, amplified probe technique | | 87533 | $36.83 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, quantification | | 87534 | $19.33 | Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique | | 87535 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, includes reverse transcription when performed | | 87536 | $75.05 | Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed | | 87537 | $19.33 | Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, direct probe technique | | 87538 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe technique, includes reverse transcription when performed | | 87539 | $51.70 | Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, quantification, includes reverse transcription when performed | | 87540 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, direct probe technique | | 87541 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique | | 87542 | $36.83 | Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, quantification | | 87550 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, direct probe technique | | 87551 | $42.54 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, amplified probe technique | | 87552 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species, quantification | | 87555 | $23.70 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, direct probe technique | | 87556 | $36.76 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, amplified probe technique | | 87557 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, quantification | | 87560 | $24.07 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, direct probe technique | | 87561 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique | | 87562 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, quantification | | 87563 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma genitalium, amplified probe technique | | 87580 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, direct probe technique | | 87581 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique | | 87582 | $266.87 | Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, quantification | | 87590 | $23.70 | Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique | | 87591 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique | | 87592 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, quantification | | 87593 | $30.95 | Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each | | 87623 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, six, 11, 42, 43, 44) | | 87624 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) | | 87625 | $35.76 | Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed | | 87631 | $125.78 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, three - five targets | | 87632 | $192.30 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, six - 11 targets | | 87633 | $367.55 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets | | 87634 | $61.91 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe technique | | 87635 | $51.31 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique | | 87636 | $142.63 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique | | 87637 | $142.63 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique | | 87640 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique | | 87641 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique | | 87650 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, direct probe technique | | 87651 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique | | 87652 | $36.83 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, quantification | | 87653 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique | | 87660 | $17.68 | Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, direct probe technique | | 87661 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique | | 87662 | $45.25 | Infectious agent detection by nucleic acid (DNA or RNA); Zika virus, amplified probe technique | | 87797 | $26.48 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism | | 87798 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism | | 87799 | $37.78 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, each organism | | 87800 | $38.51 | Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique | | 87801 | $61.91 | Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique | | 87802 | $11.23 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group B | | 87803 | $14.11 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Clostridium difficile toxin A | | 87804 | $14.60 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza | | 87806 | $28.90 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies | | 87807 | $11.55 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; respiratory syncytial virus | | 87808 | $13.48 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Trichomonas vaginalis | | 87809 | $19.19 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; adenovirus | | 87810 | $31.12 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Chlamydia trachomatis | | 87811 | $41.38 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) | | 87850 | $21.66 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Neisseria gonorrhoeae | | 87880 | $14.58 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A | | 87899 | $14.17 | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified | | 87900 | $114.95 | Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics | | 87901 | $227.04 | Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions | | 87902 | $227.04 | Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus | | 87903 | $430.94 | Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested | | 87904 | $22.99 | Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary procedure) | | 87905 | $10.78 | Infectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid) | | 87906 | $113.52 | Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (eg, integrase, fusion) | | 87910 | $227.04 | Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus | | 87912 | $227.04 | Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis B virus | | 87913 | $257.45 | Infectious agent genotype analysis by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mutation identification in targeted region(s) | | 87999 | I.C. | Unlisted microbiology procedure | | | | Anatomic Pathology | | 88000 | I.C. | Necropsy (autopsy), gross examination only; without CNS | | 88005 | I.C. | Necropsy (autopsy), gross examination only; with brain | | 88007 | I.C. | Necropsy (autopsy), gross examination only; with brain and spinal cord | | 88012 | I.C. | Necropsy (autopsy), gross examination only; infant with brain | | 88014 | I.C. | Necropsy (autopsy), gross examination only; stillborn or newborn with brain | | 88016 | I.C. | Necropsy (autopsy), gross examination only; macerated stillborn | | 88020 | I.C. | Necropsy (autopsy), gross and microscopic; without CNS | | 88025 | I.C. | Necropsy (autopsy), gross and microscopic; with brain | | 88027 | I.C. | Necropsy (autopsy), gross and microscopic; with brain and spinal cord | | 88028 | I.C. | Necropsy (autopsy), gross and microscopic; infant with brain | | 88029 | I.C. | Necropsy (autopsy), gross and microscopic; stillborn or newborn with brain | | 88036 | I.C. | Necropsy (autopsy), limited, gross and/or microscopic; regional | | 88037 | I.C. | Necropsy (autopsy), limited, gross and/or microscopic; single organ | | 88040 | I.C. | Necropsy (autopsy); forensic examination | | 88045 | I.C. | Necropsy (autopsy); coroner's call | | 88099 | I.C. | Unlisted necropsy (autopsy) procedure | | | | Cytopathology | | 88130 | $15.86 | Sex chromatin identification; Barr bodies | | 88140 | $7.05 | Sex chromatin identification; peripheral blood smear, polymorphonuclear drumsticks | | 88142 | $17.87 | Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision | | 88143 | $20.32 | Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision | | 88147 | $44.59 | Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision | | 88148 | $15.27 | Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision | | 88150 | $15.27 | Cytopathology, slides, cervical or vaginal; manual screening under physician supervision | | 88152 | $24.38 | Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision | | 88153 | $21.19 | Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision | | 88155 | $12.92 | Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code[s] for other technical and interpretation services) | | 88164 | $15.27 | Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision | | 88165 | $37.23 | Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision | | 88166 | $15.27 | Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening under physician supervision | | 88167 | $15.27 | Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening using cell selection and review under physician supervision | | 88174 | $22.37 | Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision | | 88175 | $23.47 | Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision | | | | Cytogenic Studies | | 88230 | $102.73 | Tissue culture for non-neoplastic disorders; lymphocyte | | 88233 | $124.11 | Tissue culture for non-neoplastic disorders; skin or other solid tissue biopsy | | 88235 | $132.55 | Tissue culture for non-neoplastic disorders; amniotic fluid or chorionic villus cells | | 88237 | $126.77 | Tissue culture for neoplastic disorders; bone marrow, blood cells | | 88239 | $130.09 | Tissue culture for neoplastic disorders; solid tumor | | 88240 | $11.53 | Cryopreservation, freezing and storage of cells, each cell line | | 88241 | $10.66 | Thawing and expansion of frozen cells, each aliquot | | 88245 | $152.71 | Chromosome analysis for breakage syndromes; baseline Sister Chromatid Exchange (SCE), 20-25 cells | | 88248 | $152.71 | Chromosome analysis for breakage syndromes; baseline breakage, score 50-100 cells, count 20 cells, 2 karyotypes (eg, for ataxia telangiectasia, Fanconi anemia, fragile X) | | 88249 | $152.71 | Chromosome analysis for breakage syndromes; score 100 cells, clastogen stress (eg, diepoxybutane, mitomycin C, ionizing radiation, UV radiation) | | 88261 | $233.11 | Chromosome analysis; count five cells, one karyotype, with banding | | 88262 | $110.67 | Chromosome analysis; count 15-20 cells, two karyotypes, with banding | | 88263 | $132.54 | Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding | | 88264 | $127.53 | Chromosome analysis; analyze 20-25 cells | | 88267 | $166.30 | Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, one karyotype, with banding | | 88269 | $153.15 | Chromosome analysis, in situ for amniotic fluid cells, count cells from six-12 colonies, one karyotype, with banding | | 88271 | $18.89 | Molecular cytogenetics; DNA probe, each (eg, FISH) | | 88272 | $35.89 | Molecular cytogenetics; chromosomal in situ hybridization, analyze three-five cells (eg, for derivatives and markers) | | 88273 | $30.70 | Molecular cytogenetics; chromosomal in situ hybridization, analyze ten-30 cells (eg, for microdeletions) | | 88274 | $37.37 | Molecular cytogenetics; interphase in situ hybridization, analyze 25-99 cells | | 88275 | $45.14 | Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells | | 88280 | $29.52 | Chromosome analysis; additional karyotypes, each study | | 88283 | $60.50 | Chromosome analysis; additional specialized banding technique (eg, NOR, C-banding) | | 88285 | $23.73 | Chromosome analysis; additional cells counted, each study | | 88289 | $30.36 | Chromosome analysis; additional high resolution study | | 88371 | $19.60 | Protein analysis of tissue by Western Blot, with interpretation and report; | | 88372 | $23.12 | Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each | | | | In vivo, (e.g., Transcutaneous) Laboratory Procedures | | 88720 | $4.43 | Bilirubin, total, transcutaneous | | 88738 | $4.43 | Hemoglobin (Hgb), quantitative, transcutaneous | | 88740 | $8.26 | Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin | | 88741 | $8.26 | Hemoglobin, quantitative, transcutaneous, per day; methemoglobin | | | | Other Procedures | | 89050 | $4.16 | Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; | | 89051 | $4.94 | Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count | | 89055 | $3.77 | Leukocyte assessment, fecal, qualitative or semiquantitative | | 89060 | $6.46 | Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine) | | 89125 | $5.19 | Fat stain, feces, urine, or respiratory secretions | | 89160 | $4.28 | Meat fibers, feces | | 89190 | $5.11 | Nasal smear for eosinophils | | | | Reproductive Medicine Procedures | | 89250 | I.C. | Culture of oocyte(s)/embryo(s), less than four days; | | 89251 | I.C. | Culture of oocyte(s)/embryo(s), less than four days; with co-culture of oocyte(s)/embryos | | 89253 | I.C. | Assisted embryo hatching, microtechniques (any method) | | 89254 | I.C. | Oocyte identification from follicular fluid | | 89255 | I.C. | Preparation of embryo for transfer (any method) | | 89257 | I.C. | Sperm identification from aspiration (other than seminal fluid) | | 89258 | I.C. | Cryopreservation; embryo(s) | | 89259 | I.C. | Cryopreservation; sperm | | 89264 | I.C. | Sperm identification from testis tissue, fresh or cryopreserved | | 89268 | I.C. | Insemination of oocytes | | 89272 | I.C. | Extended culture of oocyte(s)/embryo(s), four-seven days | | 89280 | I.C. | Assisted oocyte fertilization, microtechnique; less than or equal to ten oocytes | | 89281 | I.C. | Assisted oocyte fertilization, microtechnique; greater than ten oocytes | | 89290 | I.C. | Biopsy, oocyte polar body or embryo blastomere, microtechnique (for preimplantation genetic diagnosis); less than or equal to five embryos | | 89291 | I.C. | Biopsy, oocyte polar body or embryo blastomere, microtechnique (for preimplantation genetic diagnosis); greater than five embryos | | 89300 | $8.68 | Semen analysis; presence and/or motility of sperm including Huhner test (post coital) | | 89310 | $7.59 | Semen analysis; motility and count (not including Huhner test) | | 89320 | $10.86 | Semen analysis; volume, count, motility, and differential | | 89321 | $10.63 | Semen analysis; sperm presence and motility of sperm, if performed | | 89322 | $13.67 | Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, Kruger) | | 89325 | $9.41 | Sperm antibodies | | 89329 | $17.28 | Sperm evaluation; hamster penetration test | | 89330 | $9.15 | Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test | | 89331 | $17.28 | Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated) | | 89335 | I.C. | Cryopreservation, reproductive tissue, testicular | | 89342 | I.C. | Storage (per year); embryo(s) | | 89343 | I.C. | Storage (per year); sperm/semen | | 89344 | I.C. | Storage (per year); reproductive tissue, testicular/ovarian | | 89346 | I.C. | Storage (per year); oocyte(s) | | 89352 | I.C. | Thawing of cryopreserved; embryo(s) | | 89353 | I.C. | Thawing of cryopreserved; sperm/semen, each aliquot | | 89354 | I.C. | Thawing of cryopreserved; reproductive tissue, testicular/ovarian | | 89356 | I.C. | Thawing of cryopreserved; oocytes, each aliquot | | 89398 | I.C. | Unlisted reproductive medicine laboratory procedure | | | | Other Pathology and Laboratory | | 36415 | $7.56 | Collection of venous blood by venipuncture | | 78267 | $9.75 | Urea breath test, C-14 (isotopic); acquisition for analysis | | 78268 | $83.26 | Urea breath test, C-14 (isotopic); analysis | | 81105 | $107.78 | Human Platelet Antigen 1 genotyping (HPA-1), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-1a/b (L33P) | | 81106 | $107.78 | Human Platelet Antigen 2 genotyping (HPA-2), GP1BA (glycoprotein Ib [platelet], alpha polypeptide [GPIba]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-2a/b (T145M) | | 81107 | $107.78 | Human Platelet Antigen 3 genotyping (HPA-3), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex], antigen CD41 [GPIIb]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-3a/b (I843S) | | 81108 | $107.78 | Human Platelet Antigen 4 genotyping (HPA-4), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa], antigen CD61 [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-4a/b (R143Q) | | 81109 | $107.78 | Human Platelet Antigen 5 genotyping (HPA-5), ITGA2 (integrin, alpha 2 [CD49B, alpha 2 subunit of VLA-2 receptor] [GPIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant (eg, HPA-5a/b (K505E)) | | 81110 | $107.78 | Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3 (integrin, beta 3 [platelet glycoprotein IIIa, antigen CD61] [GPIIIa]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-6a/b (R489Q) | | 81111 | $107.78 | Human Platelet Antigen 9 genotyping (HPA-9w), ITGA2B (integrin, alpha 2b [platelet glycoprotein IIb of IIb/IIIa complex, antigen CD41] [GPIIb]) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-9a/b (V837M) | | 81112 | $107.78 | Human Platelet Antigen 15 genotyping (HPA-15), CD109 (CD109 molecule) (eg, neonatal alloimmune thrombocytopenia [NAIT], post-transfusion purpura), gene analysis, common variant, HPA-15a/b (S682Y) | | 81120 | $170.42 | IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg, glioma), common variants (eg, R132H, R132C) | | 81121 | $260.85 | IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (eg, glioma), common variants (eg, R140W, R172M) | | 81161 | $246.04 | DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed | | 81162 | $1,609.32 | BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements) | | 81163 | $412.72 | BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis | | 81164 | $515.22 | BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) | | 81165 | $249.46 | BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis | | 81166 | $265.75 | BRCA 1 (BRCA 1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) | | 81167 | $249.46 | BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements) | | 81168 | $182.82 | CCND1/IGH (t(11;14)) (eg, mantle cell lymphoma) translocation analysis, major breakpoint, qualitative and quantitative, if performed | | 81170 | $264.56 | ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain | | 81171 | $120.82 | AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg, fragile X intellectual disability 2 [FRAXE]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles | | 81172 | $242.37 | AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg, fragile X intellectual disability 2 [FRAXE]) gene analysis; characterization of alleles (eg, expanded size and methylation status) | | 81173 | $265.75 | AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; full gene sequence | | 81174 | $163.32 | AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; known familial variant | | 81175 | $596.59 | ASXL1 (additional sex combs like one, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; full gene sequence | | 81176 | $213.33 | ASXL1 (additional sex combs like one, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; targeted sequence analysis (eg, exon 12) | | 81177 | $120.82 | ATN1 (atrophin 1) (eg, dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81178 | $120.82 | ATXN1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81179 | $120.82 | ATXN2 (ataxin 2) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81180 | $120.82 | ATXN3 (ataxin 3) (eg, spinocerebellar ataxia, Machado-Joseph disease) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81181 | $120.82 | ATXN7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81182 | $120.82 | ATXN8OS (ATXN8 opposite strand [non-protein coding]) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81183 | $120.82 | ATXN10 (ataxin 10) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81184 | $120.82 | CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; evaluation to detect abnormal (eg, expanded) alleles | | 81185 | $746.30 | CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; full gene sequence | | 81186 | $163.32 | CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; known familial variant | | 81187 | $120.82 | CNBP (CCHC-type zinc finger nucleic acid binding protein) (eg, myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81188 | $120.82 | CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles | | 81189 | $242.37 | CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; full gene sequence | | 81190 | $163.32 | CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; known familial variant(s) | | 81191 | $182.82 | NTRK1 (neurotrophic receptor tyrosine kinase 1) (eg, solid tumors) translocation analysis | | 81192 | $182.82 | NTRK2 (neurotrophic receptor tyrosine kinase 2) (eg, solid tumors) translocation analysis | | 81193 | $182.82 | NTRK3 (neurotrophic receptor tyrosine kinase 3) (eg, solid tumors) translocation analysis | | 81194 | $457.06 | NTRK (neurotrophic receptor tyrosine kinase 1, 2, and 3) (eg, solid tumors) translocation analysis | | 81200 | $41.67 | ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg, E285A, Y231X) | | 81201 | $687.86 | APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence | | 81202 | $246.93 | APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants | | 81203 | $176.38 | APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion variants | | 81204 | $120.82 | AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; characterization of alleles (eg, expanded size or methylation status) | | 81205 | $83.77 | BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, maple syrup urine disease) gene analysis, common variants (eg, R183P, G278S, E422X) | | 81206 | $144.59 | BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative | | 81207 | $127.73 | BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative | | 81208 | $189.27 | BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; other breakpoint, qualitative or quantitative | | 81209 | $34.67 | BLM (Bloom syndrome, RecQ helicase-like) (eg, Bloom syndrome) gene analysis, 2281del6ins7 variant | | 81210 | $154.68 | BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600 variant(s) | | 81212 | $388.03 | BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; 185delAG, 5385insC, 6174delT variants | | 81215 | $330.92 | BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant | | 81216 | $163.25 | BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis | | 81217 | $330.92 | BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant | | 81218 | $213.33 | CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute myeloid leukemia), gene analysis, full gene sequence | | 81219 | $107.26 | CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis, common variants in exon nine | | 81220 | $490.85 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; common variants (eg, ACMG/ACOG guidelines) | | 81221 | $85.74 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; known familial variants | | 81222 | $383.68 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; duplication/deletion variants | | 81223 | $440.06 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; full gene sequence | | 81224 | $148.82 | CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; intron 8 poly-T analysis (eg, male infertility) | | 81225 | $256.94 | CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17) | | 81226 | $397.65 | CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN) | | 81227 | $154.16 | CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *5, *6) | | 81228 | $793.69 | Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number variants, comparative genomic hybridization [CGH] microarray analysis | | 81229 | $1,022.98 | Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants, comparative genomic hybridization (CGH) microarray analysis | | 81230 | $154.16 | CYP3A4 (cytochrome P450 family three subfamily A member four) (eg, drug metabolism), gene analysis, common variant(s) (eg, *2, *22) | | 81231 | $154.16 | CYP3A5 (cytochrome P450 family three subfamily A member five) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7) | | 81232 | $154.16 | DPYD (dihydropyrimidine dehydrogenase) (eg, 5-fluorouracil/5-FU and capecitabine drug metabolism), gene analysis, common variant(s) (eg, *2A, *4, *5, *6) | | 81233 | $154.68 | BTK (Bruton's tyrosine kinase) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, C481S, C481R, C481F) | | 81234 | $120.82 | DMPK (DM1 protein kinase) (eg, myotonic dystrophy type one) gene analysis; evaluation to detect abnormal (expanded) alleles | | 81235 | $286.24 | EGFR (epidermal growth factor receptor) (eg, non-small cell lung cancer) gene analysis, common variants (eg, exon 19 LREA deletion, L858R, T790M, G719A, G719S, L861Q) | | 81236 | $249.46 | EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, myelodysplastic syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence | | 81237 | $154.68 | EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, diffuse large B-cell lymphoma) gene analysis, common variant(s) (eg, codon 646) | | 81238 | $529.13 | F9 (coagulation factor IX) (eg, hemophilia B), full gene sequence | | 81239 | $242.37 | DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; characterization of alleles (eg, expanded size) | | 81240 | $57.93 | F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene analysis, 20210G>A variant | | 81241 | $64.70 | F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene analysis, Leiden variant | | 81242 | $32.29 | FANCC (Fanconi anemia, complementation group C) (eg, Fanconi anemia, type C) gene analysis, common variant (eg, IVS4+4A>T) | | 81243 | $50.30 | FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability [XLID]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles | | 81244 | $39.59 | FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability [XLID]) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status) | | 81245 | $145.96 | FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; internal tandem duplication (ITD) variants (ie, exons 14, 15) | | 81246 | $73.20 | FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; tyrosine kinase domain (TKD) variants (eg, D835, I836) | | 81247 | $154.16 | G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; common variant(s) (eg, A, A-) | | 81248 | $330.92 | G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; known familial variant(s) | | 81249 | $529.13 | G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; full gene sequence | | 81250 | $51.58 | G6PC (glucose-6-phosphatase, catalytic subunit) (eg, Glycogen storage disease, type 1a, von Gierke disease) gene analysis, common variants (eg, R83C, Q347X) | | 81251 | $41.67 | GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene analysis, common variants (eg, N370S, 84GG, L444P, IVS2+1G>A) | | 81252 | $89.18 | GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; full gene sequence | | 81253 | $54.25 | GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; known familial variants | | 81254 | $30.87 | GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (eg, nonsyndromic hearing loss) gene analysis, common variants (eg, 309kb [del(GJB6-D13S1830)] and 232kb [del(GJB6-D13S1854)]) | | 81255 | $45.37 | HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay-Sachs disease) gene analysis, common variants (eg, 1278insTATC, 1421+1G>C, G269S) | | 81256 | $57.64 | HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis, common variants (eg, C282Y, H63D) | | 81257 | $90.18 | HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring) | | 81258 | $330.92 | HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; known familial variant | | 81259 | $529.13 | HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; full gene sequence | | 81260 | $34.67 | IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein) (eg, familial dysautonomia) gene analysis, common variants (eg, 2507+6T>C, R696P) | | 81261 | $174.60 | IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (eg, polymerase chain reaction) | | 81262 | $60.45 | IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); direct probe methodology (eg, Southern blot) | | 81263 | $259.73 | IGH@ (Immunoglobulin heavy chain locus) (eg, leukemia and lymphoma, B-cell), variable region somatic mutation analysis | | 81264 | $152.33 | IGK@ (Immunoglobulin kappa light chain locus) (eg, leukemia and lymphoma, B-cell), gene rearrangement analysis, evaluation to detect abnormal clonal population(s) | | 81265 | $205.54 | Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (eg, pre-transplant recipient and donor germline testing, posttransplant non-hematopoietic recipient germline [eg, buccal swab or other germline tissue sample] and donor testing, twin zygosity testing, or maternal cell contamination of fetal cells) | | 81266 | $268.80 | Comparative analysis using Short Tandem Repeat (STR) markers; each additional specimen (eg, additional cord blood donor, additional fetal samples from different cultures, or additional zygosity in multiple birth pregnancies) (List separately in addition to code for primary procedure) | | 81267 | $182.95 | Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; without cell selection | | 81268 | $229.98 | Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; with cell selection (eg, CD3, CD33), each cell type | | 81269 | $178.49 | HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; duplication/deletion variants | | 81270 | $80.83 | JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.Val617Phe (V617F) variant | | 81271 | $120.82 | HTT (huntingtin) (eg, Huntington disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles | | 81272 | $290.59 | KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor [GIST], acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons eight, 11, 13, 17, 18) | | 81273 | $110.12 | KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, mastocytosis), gene analysis, D816 variant(s) | | 81274 | $242.37 | HTT (huntingtin) (eg, Huntington disease) gene analysis; characterization of alleles (eg, expanded size) | | 81275 | $170.42 | KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; variants in exon 2 (eg, codons 12 and 13) | | 81276 | $170.42 | KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146) | | 81277 | $1,022.98 | Cytogenomic neoplasia (genome-wide) microarray analysis, interrogation of genomic regions for copy number and loss-of-heterozygosity variants for chromosomal abnormalities | | 81278 | $182.82 | IGH@/BCL2 (t(14;18)) (eg, follicular lymphoma) translocation analysis, major breakpoint region (MBR) and minor cluster region (mcr) breakpoints, qualitative or quantitative | | 81279 | $163.32 | JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) targeted sequence analysis (eg, exons 12 and 13) | | 81283 | $64.70 | IFNL3 (interferon, lambda 3) (eg, drug response), gene analysis, rs12979860 variant | | 81284 | $120.82 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles | | 81285 | $242.37 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; characterization of alleles (eg, expanded size) | | 81286 | $242.37 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; full gene sequence | | 81287 | $109.92 | MGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme) promoter methylation analysis | | 81288 | $169.60 | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis | | 81289 | $163.32 | FXN (frataxin) (eg, Friedreich ataxia) gene analysis; known familial variant(s) | | 81290 | $34.67 | MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene analysis, common variants (eg, IVS3-2A>G, del6.4kb) | | 81291 | $57.62 | MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C) | | 81292 | $595.62 | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis | | 81293 | $291.90 | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants | | 81294 | $178.49 | MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants | | 81295 | $336.61 | MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis | | 81296 | $297.84 | MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants | | 81297 | $188.10 | MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants | | 81298 | $566.03 | MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis | | 81299 | $271.62 | MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants | | 81300 | $209.89 | MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants | | 81301 | $307.39 | Microsatellite instability analysis (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) of markers for mismatch repair deficiency (eg, BAT25, BAT26), includes comparison of neoplastic and normal tissue, if performed | | 81302 | $465.52 | MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; full sequence analysis | | 81303 | $105.83 | MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; known familial variant | | 81304 | $132.28 | MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; duplication/deletion variants | | 81305 | $154.68 | MYD88 (myeloid differentiation primary response 88) (eg, Waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant | | 81306 | $256.94 | NUDT15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common variant(s) (eg, *2, *3, *4, *5, *6) | | 81307 | $596.59 | PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; full gene sequence | | 81308 | $265.75 | PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; known familial variant | | 81309 | $242.37 | PIK3CA (phosphatidylinositol-4, 5-biphosphate 3-kinase, catalytic subunit alpha) (eg, colorectal and breast cancer) gene analysis, targeted sequence analysis (eg, exons 7, 9, 20) | | 81310 | $217.40 | NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis, exon 12 variants | | 81311 | $260.85 | NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, variants in exon 2 (eg, codons 12 and 13) and exon 3 (eg, codon 61) | | 81312 | $120.82 | PABPN1 (poly[A] binding protein nuclear 1) (eg, oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81313 | $224.92 | PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related peptidase 3 [prostate specific antigen]) ratio (eg, prostate cancer) | | 81314 | $290.59 | PDGFRA (platelet-derived growth factor receptor, alpha polypeptide) (eg, gastrointestinal stromal tumor [GIST]), gene analysis, targeted sequence analysis (eg, exons 12, 18) | | 81315 | $182.82 | PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; common breakpoints (eg, intron 3 and intron 6), qualitative or quantitative | | 81316 | $182.82 | PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; single breakpoint (eg, intron 3, intron 6 or exon 6), qualitative or quantitative | | 81317 | $596.59 | PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis | | 81318 | $291.90 | PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants | | 81319 | $179.46 | PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg, hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants | | 81320 | $256.94 | PLCG2 (phospholipase C gamma 2) (eg, chronic lymphocytic leukemia) gene analysis, common variants (eg, R665W, S707F, L845F) | | 81321 | $529.13 | PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; full sequence analysis | | 81322 | $41.10 | PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; known familial variant | | 81323 | $264.56 | PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; duplication/deletion variant | | 81324 | $668.78 | PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; duplication/deletion analysis | | 81325 | $678.67 | PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; full sequence analysis | | 81326 | $41.10 | PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; known familial variant | | 81327 | $169.32 | SEPT9 (Septin9) (eg, colorectal cancer) promoter methylation analysis | | 81328 | $154.16 | SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5) | | 81329 | $120.82 | SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; dosage/deletion analysis (eg, carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed | | 81330 | $41.45 | SMPD1(sphingomyelin phosphodiesterase 1, acid lysosomal) (eg, Niemann-Pick disease, Type A) gene analysis, common variants (eg, R496L, L302P, fsP330) | | 81331 | $45.04 | SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A) (eg, Prader-Willi syndrome and/or Angelman syndrome), methylation analysis | | 81332 | $38.49 | SERPINA1 (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1) (eg, alpha-1-antitrypsin deficiency), gene analysis, common variants (eg, *S and *Z) | | 81333 | $120.82 | TGFBI (transforming growth factor beta-induced) (eg, corneal dystrophy) gene analysis, common variants (eg, R124H, R124C, R124L, R555W, R555Q) | | 81334 | $290.59 | RUNX1 (runt related transcription factor 1) (eg, acute myeloid leukemia, familial platelet disorder with associated myeloid malignancy), gene analysis, targeted sequence analysis (eg, exons 3-8) | | 81335 | $154.16 | TPMT (thiopurine S-methyltransferase) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3) | | 81336 | $265.75 | SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; full gene sequence | | 81337 | $163.32 | SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; known familial sequence variant(s) | | 81338 | $132.57 | MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R) | | 81339 | $163.32 | MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; sequence analysis, exon 10 | | 81340 | $184.24 | TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using amplification methodology (eg, polymerase chain reaction) | | 81341 | $43.73 | TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using direct probe methodology (eg, Southern blot) | | 81342 | $177.70 | TRG@ (T cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population(s) | | 81343 | $120.82 | PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81344 | $120.82 | TBP (TATA box binding protein) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles | | 81345 | $163.32 | TERT (telomerase reverse transcriptase) (eg, thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (eg, promoter region) | | 81346 | $154.16 | TYMS (thymidylate synthetase) (eg, 5-fluorouracil/5-FU drug metabolism), gene analysis, common variant(s) (eg, tandem repeat variant) | | 81347 | $170.42 | SF3B1 (splicing factor [3b] subunit B1) (eg, myelodysplastic syndrome/acute myeloid leukemia) gene analysis, common variants (eg, A672T, E622D, L833F, R625C, R625L) | | 81348 | $154.68 | SRSF2 (serine and arginine-rich splicing factor 2) (eg, myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variants (eg, P95H, P95L) | | 81349 | $1,022.98 | Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and loss-of-heterozygosity variants, low-pass sequencing analysis | | 81350 | $206.36 | UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, drug metabolism, hereditary unconjugated hyperbilirubinemia [Gilbert syndrome]) gene analysis, common variants (eg, 28, 36, 37) | | 81351 | $566.03 | TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence | | 81352 | $290.59 | TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; targeted sequence analysis (eg, 4 oncology) | | 81353 | $271.62 | TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; known familial variant | | 81355 | $77.78 | VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, -1639G>A, c.173+1000C>T) | | 81357 | $170.42 | U2AF1 (U2 small nuclear RNA auxiliary factor one) (eg, myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variants (eg, S34F, S34Y, Q157R, Q157P) | | 81360 | $170.42 | ZRSR2 (zinc finger CCCH-type, RNA binding motif and serine/arginine-rich 2) (eg, myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variant(s) (eg, E65fs, E122fs, R448fs) | | 81361 | $154.16 | HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE) | | 81362 | $330.92 | HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); known familial variant(s) | | 81363 | $178.49 | HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); duplication/deletion variant(s) | | 81364 | $286.24 | HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); full gene sequence | | 81370 | $354.62 | HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, -C, -DRB1/3/4/5, and -DQB1 | | 81371 | $356.74 | HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and -DRB1 (eg, verification typing) | | 81372 | $355.92 | HLA Class I typing, low resolution (eg, antigen equivalents); complete (ie, HLA-A, -B, and -C) | | 81373 | $112.38 | HLA Class I typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-A, -B, or -C), each | | 81374 | $65.55 | HLA Class I typing, low resolution (eg, antigen equivalents); one antigen equivalent (eg, B27), each | | 81375 | $194.67 | HLA Class II typing, low resolution (eg, antigen equivalents); HLA-DRB1/3/4/5 and -DQB1 | | 81376 | $107.78 | HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each | | 81377 | $83.55 | HLA Class II typing, low resolution (eg, antigen equivalents); one antigen equivalent, each | | 81378 | $304.75 | HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C, and -DRB1 | | 81379 | $295.76 | HLA Class I typing, high resolution (ie, alleles or allele groups); complete (ie, HLA-A, -B, and -C) | | 81380 | $156.31 | HLA Class I typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA-A, -B, or -C), each | | 81381 | $149.83 | HLA Class I typing, high resolution (ie, alleles or allele groups); one allele or allele group (eg, B57:01P), each | | 81382 | $109.07 | HLA Class II typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each | | 81383 | $96.24 | HLA Class II typing, high resolution (ie, alleles or allele groups); one allele or allele group (eg, HLA-DQB106:02P), each | | 81400 | $56.40 | Molecular pathology procedure, Level one (eg, identification of single germline variant [eg, SNP] by techniques such as restriction enzyme digestion or melt curve analysis) | | 81401 | $120.82 | Molecular pathology procedure, Level two (eg, 2-10 SNPs, one methylated variant, or one somatic variant [typically using nonsequencing target variant analysis], or detection of a dynamic mutation disorder/triplet repeat) | | 81402 | $132.57 | Molecular pathology procedure, Level three (eg, >10 SNPs, 2-10 methylated variants, or 2-10 somatic variants [typically using non-sequencing target variant | | | | analysis], immunoglobulin and T-cell receptor gene rearrangements, duplication/deletion variants of 1 exon, loss of heterozygosity [LOH], uniparental disomy [UPD]) | | 81403 | $163.32 | Molecular pathology procedure, Level four (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in two or more independent reactions, mutation scanning or duplication/deletion variants of two-five exons) | | 81404 | $242.37 | Molecular pathology procedure, Level five (eg, analysis of two-five exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis) | | 81405 | $265.75 | Molecular pathology procedure, Level six (eg, analysis of six-ten exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 11-25 exons, regionally targeted cytogenomic array analysis) | | 81406 | $249.46 | Molecular pathology procedure, Level seven (eg, analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons) | | 81407 | $746.30 | Molecular pathology procedure, Level eight (eg, analysis of 26-50 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of >50 exons, sequence analysis of multiple genes on one platform) | | 81408 | $1,763.75 | Molecular pathology procedure, Level nine (eg, analysis of >50 exons in a single gene by DNA sequence analysis) | | 81410 | $444.47 | Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK | | 81411 | $1,190.70 | Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1 | | 81412 | $2,159.32 | Ashkenazi Jewish associated disorders (eg, Bloom syndrome, Canavan disease, cystic fibrosis, familial dysautonomia, Fanconi anemia group C, Gaucher disease, Tay-Sachs disease), genomic sequence analysis panel, must include sequencing of at least 9 genes, including ASPA, BLM, CFTR, FANCC, GBA, HEXA, IKBKAP, MCOLN1, and SMPD1 | | 81413 | $515.81 | Cardiac ion channelopathies (eg, Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia); genomic sequence analysis panel, must include sequencing of at least ten genes, including ANK2, CASQ2, CAV3, KCNE1, KCNE2, KCNH2, KCNJ2, KCNQ1, RYR2, and SCN5A | | 81414 | $515.81 | Cardiac ion channelopathies (eg, Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia); duplication/deletion gene analysis panel, must include analysis of at least two genes, including KCNH2 and KCNQ1 | | 81415 | $4,215.36 | Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis | | 81416 | $10,582.50 | i Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) (List separately in addition to code for primary procedure) | | 81417 | $282.20 | Exome (eg, unexplained constitutional or heritable disorder or syndrome); reevaluation of previously obtained exome sequence (eg, updated knowledge or unrelated condition/syndrome) | | 81418 | $0.00 | Drug metabolism (eg, pharmacogenomics) genomic sequence analysis panel, must include testing of at least six genes, including CYP2C19, CYP2D6, and CYP2D6 duplication/deletion analysis | | 81419 | $2,159.32 | Epilepsy genomic sequence analysis panel, must include analyses for ALDH7A1, CACNA1A, CDKL5, CHD2, GABRG2, GRIN2A, KCNQ2, MECP2, PCDH19, POLG, PRRT2, SCN1A, SCN1B, SCN2A, SCN8A, SLC2A1, SLC9A6, STXBP1, SYNGAP1, TCF4, TPP1, TSC1, TSC2, and ZEB2 | | 81420 | $669.39 | Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 | | 81422 | $669.39 | Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood | | 81425 | $4,436.89 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis | | 81426 | $2,389.84 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome (eg, parents, siblings) (List separately in addition to code for primary procedure) | | 81427 | $2,061.52 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); reevaluation of previously obtained genome sequence (eg, updated knowledge or unrelated condition/syndrome) | | 81430 | $1,433.05 | Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); genomic sequence analysis panel, must include sequencing of at least 60 genes, including CDH23, CLRN1, GJB2, GPR98, MTRNR1, MYO7A, MYO15A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS1 | | 81431 | $599.30 | Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); duplication/deletion analysis panel, must include copy number analyses for STRC and DFNB1 deletions in GJB2 and GJB6 genes | | 81432 | $598.84 | Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least ten genes, always including BRCA1, BRCA2, CDH1, MLH1, MSH2, MSH6, PALB2, PTEN, STK11, and TP53 | | 81433 | $387.08 | Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11 | | 81434 | $527.28 | Hereditary retinal disorders (eg, retinitis pigmentosa, Leber congenital amaurosis, cone-rod dystrophy), genomic sequence analysis panel, must include sequencing of at least 15 genes, including ABCA4, CNGA1, CRB1, EYS, PDE6A, PDE6B, PRPF31, PRPH2, RDH12, RHO, RP1, RP2, RPE65, RPGR, and USH2A | | 81435 | $515.81 | Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include sequencing of at least ten genes, including APC, BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and STK11 | | 81436 | $515.81 | Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); duplication/deletion analysis panel, must include analysis of at least five genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11 | | 81437 | $387.08 | Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); genomic sequence analysis panel, must include sequencing of at least six genes, including MAX, SDHB, SDHC, SDHD, TMEM127, and VHL | | 81438 | $387.08 | Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD, and VHL | | 81439 | $515.81 | Hereditary cardiomyopathy (eg, hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy), genomic sequence analysis panel, must include sequencing of at least five cardiomyopathy-related genes (eg, DSG2, MYBPC3, MYH7, PKP2, TTN) | | 81440 | $2,931.35 | Nuclear encoded mitochondrial genes (eg, neurologic or myopathic phenotypes), genomic sequence panel, must include analysis of at least 100 genes, including BCS1L, C10orf2, COQ2, COX10, DGUOK, MPV17, OPA1, PDSS2, POLG, POLG2, RRM2B, SCO1, SCO2, SLC25A4, SUCLA2, SUCLG1, TAZ, TK2, and TYMP | | 81441 | $2,159.32 | Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi anemia, dyskeratosis congenita, Diamond-Blackfan anemia, Shwachman-Diamond syndrome, GATA2 deficiency syndrome, congenital amegakaryocytic thrombocytopenia) sequence analysis panel, must include sequencing of at least 30 genes, including BRCA2, BRIP1, DKC1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, GATA1, GATA2, MPL, NHP2, NOP10, PALB2, RAD51C, RPL11, RPL35A, RPL5, RPS10, RPS19, RPS24, RPS26, RPS7, SBDS, TERT, and TINF2 | | 81442 | $1,890.39 | Noonan spectrum disorders (eg, Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence analysis panel, must include sequencing of at least 12 genes, including BRAF, CBL, HRAS, KRAS, MAP2K1, MAP2K2, NRAS, PTPN11, RAF1, RIT1, SHOC2, and SOS1 | | 81443 | $2,159.32 | Genetic testing for severe inherited conditions (eg, cystic fibrosis, Ashkenazi Jewish-associated disorders [eg, Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (eg, ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH) | | 81445 | $527.28 | Solid organ neoplasm, genomic sequence analysis panel, five-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysis | | 81448 | $515.81 | Hereditary peripheral neuropathies (eg, Charcot-Marie-Tooth, spastic paraplegia), genomic sequence analysis panel, must include sequencing of at least five peripheral neuropathy-related genes (eg, BSCL2, GJB1, MFN2, MPZ, REEP1, SPAST, SPG11, SPTLC1) | | 81449 | $527.28 | Solid organ neoplasm, genomic sequence analysis panel, five-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed; RNA analysis | | 81450 | $669.81 | Hematolymphoid neoplasm or disorder, genomic sequence analysis panel, five-50 genes, interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis | | 81451 | $669.81 | Hematolymphoid neoplasm or disorder, genomic sequence analysis panel, five-50 genes, interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis | | 81455 | $2,574.72 | Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic sequence analysis panel, interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis | | 81456 | $2,574.72 | Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic sequence analysis panel, interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; RNA analysis | | 81457 | $0.00 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, microsatellite instability | | 81458 | $0.00 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, copy number variants and microsatellite instability | | 81459 | $0.00 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements | | 81460 | $1,134.97 | Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes [MELAS], myoclonic epilepsy with ragged-red fibers [MERFF], neuropathy, ataxia, and retinitis pigmentosa [NARP], Leber hereditary optic neuropathy [LHON]), genomic sequence, must include sequence analysis of entire mitochondrial genome with heteroplasmy detection | | 81462 | $0.00 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants and rearrangements | | 81463 | $0.00 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis, copy number variants, and microsatellite instability | | 81464 | $0.00 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements | | 81465 | $825.44 | Whole mitochondrial genome large deletion analysis panel (eg, Kearns-Sayre syndrome, chronic progressive external ophthalmoplegia), including heteroplasmy detection, if performed | | 81470 | $806.03 | X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); genomic sequence analysis panel, must include sequencing of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2 | | 81471 | $806.03 | X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); duplication/deletion gene analysis, must include analysis of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2 | | 81479 | I.C. | Unlisted molecular pathology procedure | | 81490 | $741.35 | Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score | | 81493 | $925.97 | Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score | | 81500 | $229.73 | Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score | | 81503 | $791.04 | Oncology (ovarian), biochemical assays of five proteins (CA-125, apolipoprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score | | 81504 | $458.58 | Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores | | 81506 | $60.78 | Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, HbA1c, insulin, hs-CRP, adiponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk score | | 81507 | $701.09 | Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy | | 81508 | $47.89 | Fetal congenital abnormalities, biochemical assays of two proteins (PAPP-A, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score | | 81509 | $1,311.67 | Fetal congenital abnormalities, biochemical assays of three proteins (PAPP-A, hCG [any form], DIA), utilizing maternal serum, algorithm reported as a risk score | | 81510 | $48.98 | Fetal congenital abnormalities, biochemical assays of three analytes (AFP, uE3, hCG [any form]), utilizing maternal serum, algorithm reported as a risk score | | 81511 | $135.37 | Fetal congenital abnormalities, biochemical assays of four analytes (AFP, uE3, hCG [any form], DIA) utilizing maternal serum, algorithm reported as a risk score (may include additional results from previous biochemical testing) | | 81512 | $61.31 | Fetal congenital abnormalities, biochemical assays of five analytes (AFP, uE3, total hCG, hyperglycosylated hCG, DIA) utilizing maternal serum, algorithm reported as a risk score | | 81513 | $125.78 | Infectious disease, bacterial vaginosis, quantitative real-time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species, utilizing vaginal-fluid specimens, algorithm reported as a positive or negative result for bacterial vaginosis | | 81514 | $231.92 | Infectious disease, bacterial vaginosis and vaginitis, quantitative real-time amplification of DNA markers for Gardnerella vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), and Lactobacillus species (L. crispatus and L. jensenii), utilizing vaginal-fluid specimens, algorithm reported as a positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and/or Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata, Candida krusei, when reported | | 81517 | $155.38 | Liver disease, analysis of 3 biomarkers (hyaluronic acid [HA], procollagen III amino terminal peptide [PIIINP], tissue inhibitor of metalloproteinase 1 [TIMP-1]), using immunoassays, utilizing serum, prognostic algorithm reported as a risk score and risk of liver fibrosis and liver-related clinical events within 5 years | | 81518 | $3,415.50 | Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy | | 81519 | $3,415.50 | Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, algorithm reported as recurrence score | | 81520 | $2,213.69 | Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and eight housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence risk score | | 81521 | $3,415.50 | Oncology (breast), mRNA, microarray gene expression profiling of 70 content genes and 465 housekeeping genes, utilizing fresh frozen or formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk of distant metastasis | | 81522 | $3,415.50 | Oncology (breast), mRNA, gene expression profiling by RT-PCR of 12 genes (eight content and four housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk score | | 81523 | $3,415.50 | Oncology (breast), mRNA, next-generation sequencing gene expression profiling of 70 content genes and 31 housekeeping genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as index related to risk to distant metastasis | | 81525 | $2,747.92 | Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (seven content and five housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score | | 81528 | $262.58 | Oncology (colorectal) screening, quantitative real-time target and signal amplification of ten DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result | | 81529 | $6,343.33 | Oncology (cutaneous melanoma), mRNA, gene expression profiling by real-time RT-PCR of 31 genes (28 content and three housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk, including likelihood of sentinel lymph node metastasis | | 81535 | $511.01 | Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combination | | 81536 | $156.59 | Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; each additional single drug or drug combination (List separately in addition to code for primary procedure) | | 81538 | $2,531.86 | Oncology (lung), mass spectrometric 8-protein signature, including amyloid A, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival | | 81539 | $670.23 | Oncology (high-grade prostate cancer), biochemical assay of four proteins (Total PSA, Free PSA, Intact PSA, and human kallikrein-2 [hK2]), utilizing plasma or serum, prognostic algorithm reported as a probability score | | 81540 | $3,307.03 | Oncology (tumor of unknown origin), mRNA, gene expression profiling by realtime RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype | | 81541 | $3,415.50 | Oncology (prostate), mRNA gene expression profiling by real-time RT-PCR of 46 genes (31 content and 15 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a disease-specific mortality risk score | | 81542 | $3,415.50 | Oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as metastasis risk score | | 81546 | $3,174.75 | Oncology (thyroid), mRNA, gene expression analysis of 10,196 genes, utilizing fine needle aspirate, algorithm reported as a categorical result (eg, benign or suspicious) | | 81551 | $1,790.21 | Oncology (prostate), promoter methylation profiling by real-time PCR of three genes (GSTP1, APC, RASSF1), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a likelihood of prostate cancer detection on repeat biopsy | | 81552 | $6,857.46 | Oncology (uveal melanoma), mRNA, gene expression profiling by real-time RTPCR of 15 genes (12 content and three housekeeping), utilizing fine needle aspirate or formalin-fixed paraffin-embedded tissue, algorithm reported as risk of metastasis | | 81554 | $4,867.95 | Pulmonary disease (idiopathic pulmonary fibrosis [IPF]), mRNA, gene expression analysis of 190 genes, utilizing transbronchial biopsies, diagnostic algorithm reported as categorical result (eg, positive or negative for high probability of usual interstitial pneumonia [UIP]) | | 81560 | $565.04 | Transplantation medicine (allograft rejection, pediatric liver and small bowel), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorithm reported as a rejection risk score | | 81595 | $2,857.28 | Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and nine housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score | | 81596 | $63.66 | Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, and haptoglobin) utilizing serum, prognostic algorithm reported as scores for fibrosis and necroinflammatory activity in liver | | 81599 | I.C. | Unlisted multianalyte assay with algorithmic analysis | | G0027 | $5.73 | Semen analysis; presence and/or motility of sperm excluding Huhner | | G0327 | $0.00 | ESRD related services for home dialysis (less than full month), per day; for patients twenty years of age and over | | G0103 | $17.03 | Prostate cancer screening; prostate specific antigen test (PSA) | | G0123 | $17.87 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision | | G0143 | $23.85 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision | | G0144 | $38.78 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision | | G0145 | $23.36 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision | | G0147 | $15.27 | Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision | | G0148 | $28.17 | Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening | | G0306 | $6.85 | Complete CBC, automated (HgB, HCT, RBC, WBC, without platelet count) and automated WBC differential count | | G0307 | $5.71 | Complete CBC, automated (HgB, HCT, RBC, WBC; without platelet count) | | G0328 | $15.92 | Colorectal cancer screening; fecal occult blood test, immunoassay, one to three simultaneous determinations | | G0432 | $17.26 | Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening | | G0433 | $16.13 | Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening | | G0435 | $10.56 | Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening | | G0471 | $9.32 | Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (SNF) or by a laboratory on behalf of a home health agency (HHA) | | G0472 | $40.87 | Hepatitis C antibody screening for individual at high risk and other covered indication(s) | | G0475 | $21.24 | HIV antigen/antibody, combination assay, screening | | G0476 | $30.94 | Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test | | G0480 | $59.69 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; one-seven drug class(es), including metabolite(s) if performed | | G0481 | $91.84 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; eight-14 drug class(es), including metabolite(s) if performed | | G0482 | $123.97 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed | | G0483 | $160.71 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed | | G0499 | $24.93 | Hepatitis B screening in nonpregnant, high-risk individual includes hepatitis B surface antigen (HBSAG), antibodies to HBSAG (anti-HBS) and antibodies to hepatitis B core antigen (anti-HBC), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive HBSAG result | | G0659 | $54.80 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem), excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes CoV-2) (Coronavirus disease [COVID-19]), any specimen source | | G2023 | $23.46 | Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source | | G2023 CG | $44.27 | Specimen collection for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source | | G2024 | $25.46 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source | | G2024 CG | $46.27 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source | | G9143 | $106.46 | Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s) | | P2028 | $4.37 | Cephalin flocculation, blood | | P2029 | $4.37 | Congo red, blood | | P2031 | $4.37 | Hair analysis (excluding arsenic) | | P2033 | $4.37 | Thymol turbidity, blood | | P2038 | $4.37 | Mucoprotein, blood (seromucoid) (medical necessity procedure) | | P3000 | $15.27 | Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision | | P9604 | $4.78 | Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated trip charge | | P9612 | $7.56 | Catheterization for collection of specimen, single patient, all places of service | | P9615 | $7.56 | Catheterization for collection of specimen(s) (multiple patients) | | Q0111 | $15.27 | Wet mounts, including preparations of vaginal, cervical or skin specimens | | Q0112 | $5.14 | All potassium hydroxide (KOH) preparations | | Q0113 | $3.77 | Pinworm examinations | | Q0114 | $8.59 | Fern test | | Q0115 | $22.05 | Postcoital direct, qualitative examinations of vaginal or cervical mucous | | U0001 | $35.92 | CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel | | U0002 | $51.31 | 2019-nCoV coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC | | U0003 | $75.00 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R | | U0004 | $75.00 | 2019-nCoV coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R | | U0005 | $25.00 | Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique, CDC or non-CDC, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either HCPCS code U0003 or U0004) as described by CMS-2020-01-R2 |

History

Adopted by Mass Register Issue 1266, eff. 8/1/2014.

101 CMR, § 320.06 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1266, eff. 8/1/2014.

101 CMR, § 320.07 Severability

The provisions of 101 CMR 323.00 are severable. If any provision of 101 CMR 323.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 323.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1266, eff. 8/1/2014.

Rates for Homeless Medical Respite Services Rates for Homeless Medical Respite Services

101 CMR, § 321.01 General Provision

(1) Scope and Purpose. 101 CMR 321.00 governs the rates for all governmental units and worker's compensation insurers for homeless medical respite services provided by eligible providers.

(2) Applicable Dates of Service. Rates contained in 101 CMR 321.00 apply for dates of service provided on or after January 3, 2025, unless otherwise indicated.

(3) Disclaimer of Authorization of Services. 101 CMR 321.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 321.00. Governmental units that purchase the services described in 101 CMR 321.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 321.00.

History

Adopted by Mass Register Issue 1538, eff. 1/3/2025.

101 CMR, § 321.02 Definitions

As used in 101 CMR 321.00, unless the context requires otherwise, terms have the meanings in 101 CMR 321.02.

Eligible Provider. A medical respite setting that meets the conditions of participation that have been adopted by a governmental unit purchasing medical respite services established under 130 CMR 458.000: Homeless Medical Respite Services .

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, or any department, agency, board, commission, division, or political subdivision of the Commonwealth.

Homeless Medical Respite or Medical Respite. As defined in 130 CMR 458.402: Homeless Medical Respite or Medical Respite .

Medical Leave of Absence (MLOA). As defined in 130 CMR 458.402: Medical Leave of Absence (MLOA) .

Nonmedical Leave of Absence (NMLOA). As defined in 130 CMR 458.402: Nonmedical Leave of Absence (NMLOA) .

Per Diem. A unit of payment that refers to a billable day in which the member is enrolled in the program.

Post-hospitalization Medical Respite. As defined in 130 CMR 458.402: Post-hospitalization Medical Respite .

Pre-procedure Medical Respite. As defined in 130 CMR 458.402: Pre-procedure Medical Respite .

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program.

History

Adopted by Mass Register Issue 1538, eff. 1/3/2025.

101 CMR, § 321.03 Rate Provisions

(1) Rates as Payment in Full. The rates under 101 CMR 321.00 constitute payment in full for homeless medical respite services provided by eligible providers to publicly aided and industrial accident patients, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Payment rates for medical respite program services are set forth in 101 CMR 321.03(2).

| Code | Rate | Service Description | | --- | --- | --- | | H0043-UA | $255.44 | Supported housing, per diem (comprehensive pre-procedure medical respite services, short-term pre procedure housing) | | H0043-UB | $255.44 | Supported housing, per diem (comprehensive post-hospitalization medical respite services, short-term post hospitalization housing) | | H0043-UC | $255.44 | Supported housing, per diem (comprehensive post-hospitalization medical respite services medical leave of absence) | | H0043-UD | $255.44 | Supported housing, per diem (comprehensive post hospitalization medical respite services non-medical leave of absence - planned) | | H0043-U1 | $255.44 | Supported housing, per diem (comprehensive post hospitalization medical respite services non-medical leave of absence - unplanned) |

History

Adopted by Mass Register Issue 1538, eff. 1/3/2025.

101 CMR, § 321.04 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1538, eff. 1/3/2025.

101 CMR, § 321.05 Severability

The provisions of 101 CMR 321.00 are severable. If any provision of 101 CMR 321.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 321.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1538, eff. 1/3/2025.

Rates for Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment Rates for Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment

101 CMR, § 322.01 General Provisions

(1) Scope and Purpose. 101 CMR 322.00 governs the determination of rates of payment to be used by all governmental units in making payment to eligible providers of durable medical equipment and supplies provided to publicly aided individuals. The rates set forth in 101 CMR 322.00 do not apply to individuals covered by the Workers' Compensation Act, M.G.L. c. 152. Rates for services rendered to such individuals are set forth in 114.3 CMR 40.06: Fees .

(2) Applicable Dates of Service. Rates contained in 101 CMR 322.00 apply for dates of service provided on or after October 1, 2024, unless otherwise specified.

(3) Coverage. 101 CMR 322.00 and the rates of payment contained herein apply to the following categories:

(a) the purchase or rental of durable medical equipment;

(b) the purchase of medical and surgical supplies;

(d) the purchase or rental of prescribed oxygen delivery systems and respiratory therapy devices and related supplies;

(e) the purchase or rental of intravenous and enteral therapy, equipment, and related supplies and services;

(f) the repair or modification of the above listed types of equipment.

(4) Exclusions. 101 CMR 322.00 and the rates of payment contained herein do not apply to the following services:

(a) respiratory therapy services rendered by a qualified respiratory therapist;

(b) all services included in the reimbursement to an institutional provider; and

(5) Disclaimer of Authorization of Services. 101 CMR 322.00 is not authorization for nor approval of the procedures for which rates are determined pursuant to 101 CMR 322.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care to publicly aided individuals.

(6) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an Administrative Bulletin. The publication of such updates and corrections will list:

(a) codes for which the code numbers only changed, with the corresponding crosswalk;

(b) codes for which the code numbers remain the same but the description has changed;

(d) for entirely new codes that require new pricing, EOHHS may list these codes and price them at a percentage of the prevailing Medicare fees as described in 101 CMR 322.01(6)(d) and 101 CMR 322.03(16), when Medicare fees are available. When Medicare fees are not available or when otherwise designated by EOHHS as described in 101 CMR 322.03(16), EOHHS may apply individual consideration, adjusted acquisition cost plus a standard markup, or specify a fixed rate as described in 101 CMR 322.01(7)(e) in reimbursing for these new codes until appropriate rates can be developed.

(7) Administrative Bulletins. EOHHS may issue administrative bulletins to:

(a) clarify its policy on substantive provisions of 101 CMR 322.00;

(b) specify any durable medical equipment or medical supplies subject to a preferred supplier contract or contracts between a supplier and a governmental unit or units, the governmental unit(s) and eligible providers subject to the contract; the duration of the preferred supplier contract, the prices at which such durable medical equipment or medical supplies will be available to eligible providers (as defined by the preferred supplier contract), the rates which eligible providers (as defined by the preferred supplier contract) will be paid by the relevant governmental unit(s) for such durable medical equipment or medical supplies, and any other information deemed necessary by EOHHS;

(c) specify any durable medical equipment or medical supplies subject to a rebate agreement or agreements between a manufacturer and a governmental unit or units, the governmental unit(s) and eligible providers subject to the agreement, the duration of the rebate agreement, the rates which will be paid to eligible providers (as defined by the applicable rebate agreement) by the relevant governmental unit(s) for the specified durable medical equipment or medical supplies, and any other information deemed necessary by EOHHS;

(d) specify upward adjustments to the standard markup defined at 101 CMR 322.02 for codes when a governmental unit determines that the standard markup requires adjustment to account for increased provider costs and/or a shift in utilization patterns or to maintain access to care;

(e) specify a fixed rate for codes which do not have a Medicare rate or would otherwise be priced at Individual Consideration based on an adjusted acquisition cost when a fixed rate can be determined by using a comparison of industry rates including Medicare crossover payments, other state Medicaid payment rates and Medicaid third-party liability/private insurance rates;

(f) specify upward adjustments to historical fixed rates which do not have a Medicare rate for codes when a governmental unit determines that the historical fixed rate requires adjustment to account for increased provider costs and/or a shift in utilization patterns or to maintain access to care;

(g) specify any durable medical equipment or medical supplies subject to the pricing methodology described at 101 CMR 322.03(20);

(h) describe conditions of payment for an add-on payment for certain mobility system repairs for MassHealth members under 101 CMR 322.05(1); and

(i) describe conditions of payment for supplemental payments for certain patient lift systems or other designated services under 101 CMR 322.05(2) for MassHealth members who are eligible for both Medicare and MassHealth services (dual eligible members).

History

Adopted by Mass Register Issue 1359, eff. 3/1/2018.

101 CMR, § 322.02 General Definitions

Meaning of Terms. Terms used in 101 CMR 322.00 have the following meanings:

Accessories. Products that are used primarily and customarily to modify or enhance the usefulness or functional capability of durable medical equipment and that are generally not useful in the absence of durable medical equipment.

Adjusted Acquisition Cost (AAC). The price paid to a supplier by an eligible provider for durable medical equipment, medical and surgical supplies, customized equipment, oxygen and respiratory therapy systems or devices and related supplies, enteral and intravenous therapy, equipment, and related supplies excluding all associated costs such as, but not limited to, shipping, handling, sales tax, and insurance costs. The adjusted acquisition cost must reflect all discounts, including but not limited to manufacturer, dealer, trade, and volume discounts, including rebates, in whatever form, extended to the provider for the purchase of the covered item. The only discount that does not have to be passed on to the governmental unit is the amount allowed to the provider that is attributable to a timely payment to the manufacturer or supplier, not to exceed 5% of the AAC. The methodology for pricing at AAC is set forth in 101 CMR 322.03(17).

Advertised Price. The price of a product or service as displayed or announced in a print, radio, television, or online advertisement.

Assistive Technology Professional (ATP). An individual with experience in assistive/ rehabilitation technology and certification by the Rehabilitation Engineering and Assistive Technology Society of North America who analyzes the equipment needs of persons with disabilities, assists in the selection of equipment, and trains the person with a disability on how to use the specific equipment. This equipment may include manual and power wheelchairs, seating and alternative positioning, ambulation assistance, environmental control, alternate computer access, augmentative and alternative communication devices, and products of daily living.

Capped Rentals. Capped rental items are designated with the modifiers KH, KI, and KJ in the "code" column of 101 CMR 322.06 and are rented for a maximum period of 13 months, at which point the provider stops billing and turns over ownership and all warranty information to the consumer. The provider may bill for repairs as needed to maintain the proper working condition of the equipment for the consumer's use after ownership turns over to the consumer.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Cross-walk. A cross-reference in which a code is deleted and replaced with another code.

Customized Equipment. Durable medical equipment that:

(a) is uniquely constructed, adapted or modified solely for the full-time use of the patient for whom it is purchased;

(b) is made to order or adapted to meet the specific needs of the patient; and

(c) the unique construction, adaptation or modification of which permanently precludes the use of such equipment by another individual.

Durable Medical Equipment (DME). Equipment that:

(a) is used primarily and customarily to serve a medical purpose;

(b) is generally not useful in the absence of disability, illness and injury;

(d) is appropriate for home use (any setting in which normal life activities take place).

Eligible Provider. Any person, partnership, corporation, or other entity that is authorized by the Commonwealth of Massachusetts to engage in the business of furnishing durable medical equipment, medical and surgical supplies, customized equipment, oxygen or respiratory therapy equipment, mobility systems, intravenous and enteral therapy equipment, and related supplies and services and who meets such conditions of participation as may be adopted by a governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Home Infusion Therapy (HIT) Services. The administration of medications to a patient in a home setting using delivery devices through intravenous, subcutaneous, or epidural routes. Drug therapies commonly administered include antibiotics, chemotherapy, pain management, parenteral nutrition, and immunoglobulin.

Individual Consideration (I.C.). Items for which there is no specified rate or when otherwise designated by EOHHS are individual consideration and are subject to the following procedure. The purchasing governmental unit analyzes the eligible provider's report of services submitted before making a determination. Providers must keep adequate records to substantiate their I.C. claims and must provide these documents, including a copy of the current invoice, to the purchasing agency. The methodology for pricing at I.C. is set forth in 101 CMR 322.03(19).

Liquid Oxygen System. Respiratory therapy equipment utilizing liquid oxygen.

Medical Supplies. Consumable or disposable supplies or devices for home use, necessary for the treatment of a specific illness, injury, disease, or disability including, but not limited to, test strips, syringes, ostomy products, and surgical items that are:

(a) required to address an individual medical disability, illness, or injury;

(b) cannot withstand repeated use by more than on individual;

(d) consumable or disposable; and

(e) appropriate for use in any setting in which normal life activities take place.

Mobility System. A manual or power wheelchair or other wheeled device, such as a scooter, including a base, a seating system, its components, accessories, and modifications.

Oxygen. Gaseous or liquid medical grade oxygen that conforms to United States Pharmacopeia Reference Standards.

Oxygen Delivery Systems. A comprehensive oxygen service that includes, but is not limited to: the gaseous/liquid oxygen, oxygen generating device and related delivery systems container or cylinder, manifold systems whenever high volume oxygen is used, stand, cart, walker/stroller, supply reservoir, contents indicator, regulator with flow gauge, humidification devices, cannulas, masks, and special oxygen administration device, tubing and refill adapter.

Oxygen Generating Device. Any device suitable for domiciliary use that produces oxygen by any chemical or physical means such as, but not limited to, oxygen concentrators, and oxygen enrichers, and that conforms to such standards as may be required by federal and state governmental units.

Patient Lift System. A hoist, jack hoist, or hydraulic lift which may be either a sling lift (or Hoyer Lift, a brand name, used for patients whose mobility is limited) or sit-to-stand lift, which may be mobile (floor) lifts or overhead lifts (suspended from ceiling-mounted or overhead tracks).

Positioning System. Equipment prescribed to meet a medical need and intended to provide an alternative position to the seated wheelchair position.

Preferred Supplier Contract. A contract between a supplier of durable medical equipment or medical supplies and EOHHS or another governmental unit under which the supplier agrees to supply specified durable medical equipment or medical supplies at specified rates to certain eligible providers defined by the contract.

Prescribing Provider. The member's physician, nurse practitioner, clinical nurse specialist, or physician's assistant who prescribes and writes the prescription.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory public program.

Rate. See 101 CMR 322.03 and 322.06.

Rebate Agreement. An agreement by which a manufacturer of durable medical equipment or medical supplies agrees to pay EOHHS or another governmental unit a rebate related to payments for specified durable medical equipment or medical supplies by the relevant government unit or units to certain eligible providers defined in the agreement.

Recall. An action taken by the manufacturer to retrieve, replace, or repair dangerous or defective DME, whether or not such action is taken at the direction of the Food and Drug Administration (FDA).

Request for Prior Authorization. A request by a provider, as required by the governmental unit, that the government unit determine the medical necessity of specified equipment or supplies for a particular individual. The provider must submit any such request to the governmental unit in accordance with all applicable laws, regulations and policies.

Respiratory Therapy Devices and Supplies. Those modalities and necessary ancillary equipment used in the care and treatment of pulmonary insufficiencies from whatever cause as may be ordered by the prescribing provider for their therapeutic and remedial effect, and that meet such standards as may be required by federal or state governmental units. Respiratory therapy devices include, but are not limited to, the complete device and related delivery system accessories, including, regulator with flow gauge, humidification and heating units, filters, cannulas, masks, and special administration device tubing and adapters.

Retail Price. The total price charged for a product sold to a customer, which includes the manufacturer's cost plus a retail markup.

Sale Price. The price at which something sells or is sold after its price has been reduced.

Seating Systems. A seated positioning system, including its components, accessories and modifications, which may be attached to a base wheelchair and is designed to meet the individualized medical needs of the patient.

Shelf Price. The sign or tag placed by an authorized person at each point of display which clearly sets forth the retail price of the consumer item.

Standard Markup. Except where otherwise indicated in an applicable section of101 CMR 322.03, the standard markup for durable medical equipment, medical and surgical supplies, and oxygen and respiratory equipment that is applied to the AAC, net of any discounts as specified in the definition of AAC at 101 CMR 322.02, and paid to a supplier by an eligible provider cannot exceed:

(a) the applicable standard markup set forth below for items for which the eligible provider received a timely payment discount less than or equal to 5% will be applied to the AAC, net of costs and discounts to be excluded under the definition of AAC at 101 CMR 322.02:

20% for medical and surgical supplies and disposable items;
25% for enteral and parenteral solutions;
35% for wheeled mobility system equipment and accessories, as defined in 101 CMR 322.02, and for certain patient lift systems; and
30% for all other equipment, customized tracheostomy supplies, and certain diabetic equipment and supplies.

(b) the applicable standard markup set forth below for items for which the eligible provider received a timely payment discount greater than 5%, will be applied to the AAC net of costs and discounts to be excluded under the definition of AAC at 101 CMR 322.02:

25% for medical and surgical supplies and disposable items;
30% for enteral and parenteral solutions;
40% for wheeled mobility system equipment and accessories, as defined in 101 CMR 322.02; and
35% for all other equipment, customized tracheostomy supplies, and certain diabetic equipment and supplies.

Used Equipment. Any item that has been previously purchased or rented, including equipment that was:

(a) used by a patient for a trial period;

(b) used by the supplier as a demonstrator; or

Usual and Customary Charge. The lowest price that an eligible provider charges to any payer in Massachusetts other than for publicly aided individuals for the same equipment or item including, but not limited to, the shelf price, sale price, or advertised price.

History

Adopted by Mass Register Issue 1359, eff. 3/1/2018.

101 CMR, § 322.03 General Rate Provisions

(1) Purchase or Rental of Durable Medical Equipment, Medical and Surgical Supplies. Payment to an eligible provider for the purchase of the above services will be the lowest of:

(a) the eligible provider's usual and customary charge;

(b) the preferred supplier rate published in an administrative bulletin pursuant to 101 CMR 322.01(7) plus an additional percentage handling fee if applicable;

(d) such schedule of allowable fees set forth in 101 CMR 322.06.

(2) Direct Service Component (RE Units). Payment to an eligible DME provider for the initial evaluation of customized seating, positioning, mobility systems, installation of customized movable and fixed patient lift systems, and assembly of the pre-approved levels of time and complexity as defined below:

(a) RE 1-5 - Specialized (1-5 hours).

(b) RE 6-10 - Intermediate

More time and complexity with multiple trials of equipment, custom fabrication of some parts (6-10 hours).

(c) RE 11-15 - More time and complexity with multiple trials of equipment, high level of complexity in custom fabrication of some parts and may involve use of components from one or more manufactures (11-15 hours).

(d) RE 16-23 - Complex - More time and complexity with multiple trials of equipment, very high level of complexity and may involve extensive time for trials of multiple products, extended amount of custom fabrication, or interactions with several professionals-physicians, therapist, teachers. (16-23 hours).

(e) RE units will be billed using the K0739-U5 code and modifier combination.

(3) Rental of Oxygen Delivery Systems.

(a) The monthly rate of reimbursement for comprehensive oxygen services includes, but is not limited to, the following services:

the gaseous/liquid oxygen, oxygen generating device and related delivery system container or cylinder, manifold systems whenever high volume oxygen is used, stand, cart, walker/stroller, supply reservoir, contents indicator, regulator with flow gauge, humidification devices, cannulas, masks, and/or special oxygen administration device, tubing and refill adapter;
the complete device, cleaned and sterilized when appropriate, in proper working condition, and any maintenance, service and repair of unit as needed including replacement of defective parts. The routine replacement of parts, including disposable parts, occurs as needed or according to manufacturer's specifications;
delivery of the gaseous oxygen inclusive of 24-hour service costs;

back-up gaseous oxygen and related equipment and supplies; and

demonstration and instruction of safe usage of equipment, delivery and set-up.

(b) Payment to an eligible provider for the rental of oxygen generating devices and oxygen delivery systems shall be the lower of:

the eligible provider's usual and customary charge; or
such schedule of allowable fees set forth in 101 CMR 322.06

(c) Payment to an eligible provider for the rental of oxygen delivery systems provided to publicly aided individuals in a nursing facility shall be the lower of:

the eligible provider's usual and customary charge; or
90% of the schedule of allowable fees set for in 101 CMR 322.06.

(4) Purchase and Rental of Respiratory Therapy Devices.

(a) Respiratory Therapy Devices (Purchase).

The purchased respiratory therapy device includes, but is not limited to, the following services:

a. the complete device, new at the time of purchase, and in proper working condition;

b. service and repair of the unit as needed including replacement of defective parts. The routine replacement of parts, including disposable parts, occurs as needed or according to manufacturer's specifications; these can be billed for purchased devices unless otherwise specified under warranty;

c. the device and related delivery system accessories including, regulator with flow gauge, humidification and heating units, cannulas, masks, or special administration device, tubing and adapters;

d. delivery of the device inclusive of 24-hour service costs;

e. demonstration and instruction of safe usage of equipment, delivery and set-up.

Payment to an eligible provider for the purchase of respiratory therapy devices shall be the lower of:

a. the eligible provider's usual and customary charge; or

b. such schedule of allowable fees set forth in 101 CMR 322.06.

(b) Respiratory Therapy Devices (Rental).

The monthly rental of respiratory therapy devices includes, but is not limited to:

a. the complete device, cleaned and sterilized when appropriate, in proper working condition, and any maintenance, service and repair of unit as needed including replacement of defective parts. The routine replacement of parts, including disposable parts, occurs as needed or according to manufacturer's specifications;

b. the device and related delivery system accessories including, regulator with flow gauge, humidification and heating units, filters, cannulas, masks, and special administration device, tubing and adapters;

c. delivery of the device inclusive of 24-hour service costs;

d. monthly cleaning and check of unit;

e. back-up respiratory therapy equipment; and

f. demonstration and instruction of safe usage of equipment, delivery, and set-up.

Payment to an eligible provider for the rental of the above services shall be the lower of:

a. the eligible provider's usual and customary rental fees and terms; or

b. the fees set forth in 101 CMR 322.06.

Payment to an eligible provider for the rental of respiratory therapy devices provided to publicly-aided individuals in a nursing facility shall be the lower of:

a. the eligible provider's usual and customary rental fees and terms; or

b. 90% of the schedule of allowable fees set forth in101 CMR 322.06.

(5) General Rate Provisions for the Purchase of Home Infusion Therapy Services.

(a) Payment to an eligible provider for home infusion therapy services shall be the lower of

the eligible provider's usual and customary charge; or
such schedule of allowable fees set forth in 101 CMR 322.06.

(b) For services designated I.C., the adjusted acquisition costs to the eligible provider for items consumed per day plus a 20% markup plus $8.00 for professional service.

(c) Included in the per diem fees are all necessary supplies, equipment and administrative services. Payment for Pharmacy items and services shall be determined under the provisions of 101 CMR 331.00: Prescribed Drugs . Payment for nursing services shall be determined according to purchaser specifications under the provisions of 101 CMR 350.00: Home Health Services . Parenteral and enteral nutrition formula shall be billed separately.

(6) Option to Purchase. Governmental units may reserve the right to purchase, at their option, durable medical equipment and respiratory therapy equipment that is being supplied on a monthly rental basis to publicly-aided individuals.

(a) If covered, items can be purchased new or used; however, total payments cannot exceed the fee for purchase as new.

(b) If covered, items can be purchased at 100% of the fee.

(c) If covered, items that are usually purchased and fall into the inexpensive and frequently purchased item category can be rented for 10% of the purchase price, not to exceed ten months of rental and the fee for purchase as new.

(d) If covered, used equipment can be rented at 10% of 75% of the fee for purchase as new.

(e) If covered, used equipment can be purchased at 75% of the fee for purchase as new.

(f) Capped rental items that are purchased prior to the end of the 13-month capped rental period are purchased at an amount not to exceed 13 months of rental.

(7) Condition of Rental Equipment upon Delivery. All equipment that is rented on a monthly basis must be clean and in proper working condition when delivered. Respiratory therapy equipment provided on a rental basis must be in proper working condition and be free from contaminating agents. Tubing and masks shall be new or unused, in proper working condition and free from contaminating agents.

(8) Condition of Purchased Equipment upon Delivery. All equipment that is purchased must be new and unused, clean, in proper working condition, free from defects, and meet all implied and expressed warranties. In the case of rental items purchased under 101 CMR 322.03(6), Option to Purchase, the equipment shall be in proper working condition and be free from contaminating agents. Tubing and masks shall be new or unused, in proper working condition and free from contaminating agents. ( See 101 CMR 322.03(7): Condition of Rental Equipment Upon Delivery .)

(9) Rental Services. Unless otherwise authorized under 101 CMR 322.00, rental rates include the cost of servicing, repairs and maintenance including replacements of defective parts and disposable items.

(10) Delivery, Installation and Patient Instructional Time. Unless otherwise authorized under 101 CMR 322.00, the maximum allowable fee for purchase or rental of durable medical equipment shall include the following where required and appropriate:

(a) cost of the provider's delivery to the inside of the recipient's residence and, when appropriate, to the room in which the equipment will be used; including allowance of the delivery via UPS or a similar delivery service with a copy of the proof of delivery slip signed by the recipient or recipient's caregiver, or noted by the company driver when a signature is unobtainable, and/or a copy of the delivery service company log (route) sheet.

(b) installation and set up of the equipment

(11) Terms and Warranties. Other terms and warranties included under 101 CMR 322.00 's rate provisions notwithstanding, all terms, express and implied warranties, warranties of repair and service, or any other warranties, which are extended to a specific recipient or customarily extended to any payor shall apply to purchases, or rentals made under authority of 101 CMR 322.00.

(12) Repairs, Maintenance Service, Replacement Parts, and Professional Services. All rates for repair and maintenance services to purchased equipment that require repair, replacement parts and/or the use of technical components (services) can be found within 101 CMR 322.06.

(13) Modifiers. The following list of letter modifiers must be added, where appropriate, to HCPCS procedure codes to determine the percent fee to be paid on claims. Refer to purchasers' manuals for specific coding instructions.

(a) Capped rental coding modifiers are as follows:

KH-Initial claim, either rent (first month) or purchase

KI-Second or third month rental

KJ-Rental months four to 13

(b) Additional modifiers are as follows:

A1-Dressing for one wound
A2 -Dressing for two wounds
A3-Dressing for three wounds
A4-Dressing for four wounds
A5-Dressing for five wounds
A6-Dressing for six wounds
A7-Dressing for seven wounds
A8-Dressing for eight wounds
A9-Dressing for nine or more wounds
AU-Item furnished in conjunction with a urological, ostomy, or tracheostomy supply
AV-Items furnished in conjunction with prosthetic/orthotic
AW-Item furnished in conjunction with a surgical dressing
AX-Item furnished in conjunction with dialysis services
AY-Item or service furnished to an ESRD patient that is not for the treatment of ESRD
BA-Item furnished in conjunction with parenteral enteral nutrition (PEN) services
BO-Orally administered nutrition, not by feeding tube
CS-Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico including, but not limited to, subsequent clean-up activities
GA-Waiver of liability statement issued as required by payer policy, individual case
GS-Dosage of epo or darbepoietin alfa has been reduced 25% of preceding month's dosage
GU-Waiver of liability statement issued as required by payer policy, routine notice
GX-Notice of liability issued, voluntary under payer policy

JB-Subcutaneous administration

KC-Replacement of special power wheelchair interface (applicable to codes E2320-E2330)

KF-item designated by FDA as class III device
KK- DMEPOS item subject to DMEPOS competitive bidding program number 2
KL-DMEPOS item delivered via mail
KO-Single drug unit dose formulation
KP-First drug of a multiple unit dose formulation

KQ-Second or subsequent drug of a multiple drug unit dose formulation

KR-Rental item for a partial month
KS-Glucose monitor supply for diabetic beneficiary not treated with insulin
KX-Specific required documentation on file (member treated with insulin)
KU-DMEPOS item subject to DMEPOS competitive bidding program number 3
LL-Lease/rental with option to purchase
LT-Left side (used to identify procedures performed on the left side of the body)
MS- Six-month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
NU-New equipment
QF-Prescribed amount of oxygen exceeds 4 liters per minute (LPM) and portable oxygen is prescribed
QG-Prescribed amount of oxygen is greater than 4 liters per minute (LPM)

RA-Replacement of a DME item (for use only with K0108 for direct service component for customization purposes, MassHealth only)

RB-Replacement of a part of a DME furnished as part of a repair

RR-Rental of durable medical equipment and oxygen/respiratory therapy equipment

RT-Right side (used to identify procedures performed on the right side of the body)
SC-Medically necessary service or supply
SD-Services provided by registered nurse with specialized, highly technical home infusion training
TW when used in conjunction with code A4210: Back-up equipment; when used with codes for alternative and augmentative communication devices: MassHealth only--non-dedicated alternative and augmentative communication devices
U1-Medicaid level of care 1 (used only for nonstandard power wheelchair trays and patient lift systems)
U2-Medicaid level of care 2 (first six months of rental, volume/pressure ventilator)
U3-Medicaid level of care 3 (used for supplies for maintenance of insulin infusion catheter for MassHealth or to identify a Corrective Mobility Repair add-on payment when used in conjunction with HCPCS code K0739).

U4-Medicaid level of care 3 (used only for supplies for maintenance of insulin infusion catheter for MassHealth)

U5-direct service components for customized mobility services requiring ATP RE-1 through RE-23, for installation of patient lift systems RE-1 through RE-23, and setup of safety beds RE-1 through RE-5.
U6-used when requesting premium incontinent products
UA-Medicaid level of care 10 (used for adults for safety beds and customized tracheostomy supplies)
UB-Medicaid level of care 11 (repair, RTS providers only)
UC-Medicaid level of care 12 (used for pediatric specialized equipment only)
UD-Medicaid level of care 13 (bariatric equipment)
UE-Used durable medical equipment.

(14) Shop Repair of Purchased Equipment and Rental Equipment.

(a) Whenever a repair service for purchased equipment that is unusable or requires removing the equipment from the residential setting to the shop, the eligible provider must supply a substitute unit in proper working condition and comparable in all respects to the unit to be serviced. The provision of the substitute equipment will be on a rental basis: the rental rate will be established utilizing the one-month KJ fee on file for the primary HCPCS code being repaired on a one-time per repair basis.

(b) No payment for rental of substitute equipment shall exceed the one month rental fee, per repair.

(c) Whenever a repair service for rental equipment requires the removal of the equipment from the residential setting, the eligible provider must supply a substitute unit in proper working condition and comparable in all aspects to unit to be repaired. No extra rental charge will be allowed for this substituted equipment.

(15) Recall Provisions. Whenever purchased or rental equipment is subject to recall, the provider will fully address the recall as specified in the manufacturer's recall instructions. For recalls of potentially dangerous or defective DME that predictably could cause serious health problems or death, the DME provider shall provide the member with a copy of the Recall Notice and fully address the Recall as specified in the Recall instructions no later than five business days from the date the DME provider receives the Recall Notice. Any costs not covered by the manufacturer or other third party for activity associated with amelioration, repair or replacement of recalled equipment is included in the general rate provisions for each category of equipment in 101 CMR 322.03.

(16) General Rate Provisions for Pricing of New Codes

As described in 101 CMR 322.01(6), EOHHS may publish new procedure codes in the form of an Administrative Bulletin and set fees as follows:

(a) when Medicare fees are available, except as otherwise specified in 101 CMR 322.03(16)

100% of Medicare for

a. specialized wheeled mobility equipment and accessories

b. first six months' rental for volume ventilators

c. certain diabetic equipment and supplies

d. certain patient lifts and accessories

e. elevating leg rests

85% of Medicare for all other items, including speech generating devices and certain oxygen equipment and supplies

(b) when Medicare fees are not available and for certain durable medical equipment or medical supplies, apply individual consideration at adjusted acquisition cost plus the standard markup as defined in 101 CMR 322.02. MassHealth may specify a fixed rate determined by using a comparison of industry rates including Medicare crossover payments, other state Medicaid payment rates and Medicaid third-party liability/private insurance rates.

(17) AAC Methodology and Documentation.

(a) The eligible provider must accurately indicate the amount of any discounts set forth at 101 CMR 322.02 and the order in which any discounts were applied. The provider must maintain documentation evidencing the amount and application of discounts.

(b) Current Catalogue Price. The AAC to the eligible provider shall not exceed the manufacturer's current catalogue price. Eligible providers must maintain documentation of the current catalogue price or submit documentation of the current catalogue price with a claim or invoice for any item priced using the AAC methodology.

(c) Documentation of the Purchase Price and Timely Payment Discount for Items Not Subject to Prior Authorization (PA). For items not subject to PA and purchased in advance of filing a claim, the AAC must be evidenced by the purchase price to the provider from the manufacturer for the equipment listed on a copy of a current receipted invoice from the manufacturer. The invoice and supporting documentation submitted with claims to the applicable governmental unit must indicate:

the date of the timely payment; and
the amount and percentage of the timely payment discount.

Providers must maintain documentation evidencing the percentage of the AAC that the provider's supplier allows as a timely payment discount, and how the supplier defines "timely payment" for any such discount.

(d) Documentation of Amount and Percentage of Timely Payment Discount for Items Subject to PA. For items subject to PA and not purchased in advance of filing a claim, the eligible provider must include the following with the PA request:

a copy of the quote from the manufacturer;

supporting documentation of cost and discounts;

documentation of the amount and percentage of the timely payment discount. The claim must reflect the actual purchase price to the provider from the manufacturer if less than the quote submitted for prior authorization. Manufacturers enrolled as DME providers must submit documentation that demonstrates the retail/catalogue/list price along with all discounts that would be passed on to a provider; and
Providers are required to submit invoices on initial claims but are not required to submit invoices on subsequent claims during a PA period if the price established on the PA has not changed.

(18) The Methodology for Pricing Capped Rentals. Purchase rates for items, including power wheelchairs, otherwise designated in 101 CMR 322.06 with the capped rental modifiers KH, KI, KJ are indicated with the modifiers NU and UE. The NU rates are established as a percentage of Medicare's rates, pursuant to 101 CMR 322.01(5) and 101 CMR 322.03(16). The purchase of capped rental items, including power wheelchairs, otherwise designated with the modifiers KH, KI, KJ for capped rental, will be no more than the sum of the capped rental methodology applied for 13 months. See 101 CMR 322.03(14).

(a) The methodology for capped rental payment of items other than power wheelchairs designated with the modifiers KH, KI, and KJ is as follows:

for months one through three of rental (KH, KI), 10% of the new purchase fee;
for months four through 13 of rental (KJ), payment at 75% of the amount for months one through three;
no further monthly payments after the 13^th month.

(b) The methodology for payment of power wheelchairs designated with the modifiers KH, KI, KJ is as follows:

for the first three months of rental (KH, KI), 15% of the new purchase fee;
for months four through 13 (KJ), payment at 40% of the amount for months one through three;
no further monthly payments after the 13^th month

(19) Except where otherwise stipulated in 101 CMR 322.03, payment to an eligible provider for individual consideration will be the lower of:

(a) the eligible provider's usual and customary charge; or

(b) the following rate, as applicable

for purchases of supplies and disposable items, the adjusted acquisition cost to the eligible provider plus the applicable standard markup of 20% or 25%, as defined in 101 CMR 322.02;
for purchases of enteral and parenteral solutions, the adjusted acquisition cost to the eligible provider plus the applicable standard markup of 25% or 30%, as defined in 101 CMR 322.02;
for purchases of wheeled mobility system equipment and related accessories, and for certain patient lift systems, the adjusted acquisition cost to the eligible provider plus the applicable standard markup of 35% or 40%, as defined in 101 CMR 322.02;
for purchases of other new equipment or customized tracheostomy supplies or certain diabetic equipment and supplies, the adjusted acquisition cost to the eligible provider plus the applicable standard markup of 30% or 35%, as defined in 101 CMR 322.02;
for rental items, one-tenth of the fee paid for the item if purchased new;
for capped rental items, refer to the methodology within the definition of "capped rental" in 101 CMR 322.02;
for used items, 75% of the fee paid for the item if purchased new.
for covered drugs, the adjusted acquisition cost, as defined in 101 CMR 322.02;
for home infusion therapy, the adjusted acquisition cost to the eligible provider for items consumed per day plus a 20% markup plus $8.00 for professional services, as indicated in 101 CMR 322.03 (5)(b).

(20) Methodology for Certain Durable Medical Equipment or Medical Supplies Purchased at Pharmacies. Payments to pharmacies billing through the pharmacy online processing system for designated durable medical equipment or medical supplies will be the lower of wholesale acquisition cost and usual and customary charge, as defined in 101 CMR 331.00: Prescribed Drugs (with any references to "prescription drugs" changed, for purposes of 101 CMR 322.03 (20), to "durable medical equipment" or "medical supplies", as applicable). EOHHS will designate durable medical equipment or medical supplies subject to this pricing methodology in an administrative bulletin or other appropriate written issuance.

History

Adopted by Mass Register Issue 1359, eff. 3/1/2018.

101 CMR, § 322.04 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements . In addition, each eligible provider that receives an add-on or supplemental payment pursuant to 101 CMR 322.05 must file or make available all records and information necessary to demonstrate compliance with conditions of payment upon EOHHS request, including documentation of the uses of such payments.

History

Adopted by Mass Register Issue 1359, eff. 3/1/2018.

101 CMR, § 322.05 Add-on and Supplemental Payment Provisions

(1) Providers Eligible for Add-on Payment.

(a) To be eligible for Corrective Mobility System Repair add-on payments, as defined in 130 CMR 409.402, a provider must be:

a MassHealth enrolled DME provider; and
in compliance with the conditions of payment set forth in 101 CMR 322.05(1)(b).

(b) Conditions of Payment. Add-on payments will be made only

for Corrective Mobility System Repairs. For purposes of 101 CMR 322.05, Maintenance Repairs, as defined in 130 CMR 409.402, are not Corrective Mobility System Repairs and would not qualify for an add-on payment;
under federally approved payment methods and consistent with federal funding requirements and all federal payment limits as determined by the Secretary of Health and Human Services;
to providers that meet service standards as defined by EOHHS via administrative bulletin or other written issuance, including standards related to timely service and turnaround times;
to providers that demonstrate compliance with other conditions of payment as described by EOHHS via administrative bulletin or other written issuance; and
to providers that comply with all applicable requirements of 130 CMR 409.000: Durable Medical Equipment Services .

EOHHS may audit compliance with conditions of payment.
EOHHS may, via administrative bulletin or other written issuance, establish standards governing various conditions of payment including, but not limited to, attestations, reporting requirements, compliance with payment conditions, penalties for noncompliance, and recovery.

(d) Timing of Payment. Add-on payments will be made at the same time as payment for the billable code is made pursuant to 101 CMR 322.06.

(e) Corrective Mobility System Repair Add-on Payment Documentation.

MassHealth will pay DME providers an add-on payment of $1,000.00 per eligible mobility system repair when the mobility system repair is performed within the time period established by EOHHS via administrative bulletin or other written issuance to providers for qualifying mobility system repairs.
The mobility system must be thoroughly evaluated using a safety and performance evaluation or industry equivalent evaluation, and any qualifying repair must include any additional items that may not have been identified by the member at the time of the intake for the repair. The completed evaluation must be kept in the member's file.
To receive an add-on payment, providers must comply with pre-payment and post-payment reporting requirements established by EOHHS, in addition to compliance with any administrative bulletin or other written issuance described in 101 CMR 322.05(1)(b)3.

(f) Add-on Payment Reinvestment. 80% of the add-on payment must be reinvested to improve the provider's timeliness of mobility system repairs.

(2) Supplemental Payments for Services Provided to Dual Eligible Members. Supplemental payments apply to certain patient lift systems (HCPCS codes E0639 and E0640) or other designated services for MassHealth members who are eligible for both Medicare and MassHealth services (dual eligible members).

(a) Provider Eligibility. To be eligible to receive a supplemental payment for certain patient lift systems (HCPCS E0640 and E0639) or other designated services, a provider must be:

a MassHealth enrolled DME provider; and
in compliance with the conditions of payment set forth in 101 CMR 322.05(2)(b).

(b) Conditions of Payment. Supplemental payments will be made only under federally approved payment methods and consistent with federal funding requirements and all federal payment limits as determined by the Secretary of Health and Human Services, for providers that:

comply with other conditions of payment as described by EOHHS via administrative bulletin or other written issuance, including reconciliation of the total Medicare and total MassHealth payments; and
comply with all applicable requirements of 130 CMR 409.000: Durable Medical Equipment Services .

EOHHS may audit compliance with conditions of payment.
EOHHS may, via administrative bulletin or other written issuance, establish standards governing various conditions of payment including, but not limited to, attestations, reporting requirements, compliance with payment conditions, penalties for noncompliance, and recovery.

(d) Payment Methodology. The supplemental payment is calculated based on the MassHealth allowed amount (AAC+ the applicable markup defined in 101 CMR 322.02) minus the total Medicare allowed amount for the full rental period.

History

Adopted by Mass Register Issue 1532, eff. 10/1/2024 (EMERGENCY).

101 CMR, § 322.06 Allowable Fees and Rate Schedule

| Code | Rate | Description | | --- | --- | --- | | Medical and Surgical Supplies A4000-A9999 | | | | Injection Supplies | | | | A4206 | 0.22 | Syringe with needle, sterile 1cc, each | | A4207 | 0.43 | Syringe with needle, sterile 2cc, each | | A4208 | 0.28 | Syringe with needle, sterile 3cc, each | | A4209 | 0.45 | Syringe with needle, sterile 5cc or greater, each | | A4210 | AAC+20% | Needle-free injection device, each | | A4210TW | 4.98 | Needle-free injection device, each (for use for billing nasal adaptor/mucosacal atomization device/nasal adaptor purchased as part of nasal naloxone rescue kit, each, two maximum per kit) | | A4211 | AAC+20% | Supplies for self-administered injections | | A4212 | 0.13 | Non-coring needle or stylet with or without catheter | | A4213 | 0.76 | Syringe, sterile, 20 cc or greater, each | | A4215KX | 0.23 | Needle, sterile, any size, each (specific required documentation on file, member treated with insulin) | | A4215NU | 0.10 | Needle, sterile, any size, each | | A4216 | 0.42 | Sterile water, saline and/or dextrose diluent/flush, 10 ml | | A4217AU | 2.51 | Sterile water/saline 500 ml (items furnished in conjunction with urological, ostomy, or tracheostomy supplies) | | A4217NU | 2.51 | Sterile water/saline 500 ml | | A4218 | AAC+20% | Sterile saline or water, metered dose dispenser, 10 ml | | A4220 | AAC+20% | Refill kit for implantable infusion pump | | A4221 | 18.88 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drug separately) | | A4222 | 37.60I | nfusion supplies for external drug infusion pump, per cassette or bag (list drug separately) | | A4223 | AAC+20% | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) | | A4224 | 16.49 | Supplies for maintenance of insulin infusion catheter, per week | | A4225 | 2.21 | Supplies for external insulin infusion pump, syringe type cartridge, sterile, each | | A4226 | I.C. | Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week | | Batteries | | | | A4233NU | 0.58 | Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each | | A4233NUKL | 0.77 | Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each (DMEPOS item delivered via mail) | | A4234NU | 2.50 | Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each | | A4234NUKL | 3.47 | Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each | | A4235NU | 1.06 | Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each | | A4235NUKL | 2.23 | Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each | | A4236NU | 1.19 | Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each | | A4236NUKL | 1.60 | Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each | | Other Supplies | | | | A4244 | 1.27 | Alcohol or peroxide, per pint | | A4245 | 3.61 | Alcohol wipes, per box | | A4246 | 4.73 | Betadine or phisohex solution, per pint | | A4247 | 3.56 | Betadine or iodine swabs/wipes, per box | | A4248 | AAC+20% | Chlorhexidine containing antiseptic, 1 ml | | A4250 | 18.88 | Urine test or reagent strips or tablets (100 tablets or strips) | | A4253NU | 8.32 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips | | A4253NUKL | 8.32 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips (DMEPOS item delivered via mail) | | A4255 | 4.32 | Platforms for home blood glucose monitor, 50 per box | | A4256 | 4.00 | Normal, low and high calibrator solution / chips | | A4256KL | 10.90 | Normal, low and high calibrator solution / chips (DMEPOS delivered via mail) | | A4257 | 14.10 | Replacement lens shield cartridge for use with laser skin piercing device, each | | A4258 | 2.52 | Spring-powered device for lancet, each | | A4258KL | 17.20 | Spring-powered device for lancet, each (DMEPOS delivered via mail) | | A4259 | 1.65 | Lancets, per box of 100 | | A4259KL | 10.31 | Lancets, per box of 100 (DMEPOS delivered via mail) | | A4264 | AAC+20% | Permanent implantable contraceptive intratubal occlusion device(s) and delivery system | | A4265 | 3.20 | Paraffin, per pound | | A4281 | 19.18 | Tubing for breast pump, replacement | | A4282 | 28.35 | Adapter for breast pump, replacement | | A4283 | 1.00 | Cap for breast pump bottle, replacement | | A4284 | 18.45 | Breast shield and splash protector for use with breast pump, replacement | | A4285 | 7.73 | Polycarbonate bottle for use with breast pump, replacement | | A4286 | AAC+20% | Locking ring for breast pump, replacement | | Vascular Catheters and Drug Delivery Systems | | | | A4305 | AAC+20% | Disposable drug delivery system, flow rate of 50 ml or greater per hour | | A4306 | AAC+20% | Disposable drug delivery system, flow rate of less than 50 ml per hour | | Incontinence Appliances and Care Supplies | | | | A4310 | 7.26 | Insertion tray without drainage bag and without catheter (accessories only) | | A4311 | 13.13 | Insertion tray without drainage bag with indwelling catheter, Foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc .) | | A4312 | 14.41 | Insertion tray without drainage bag with indwelling catheter, Foley type, two-way, all silicone | | A4313 | 14.80 | Insertion tray without drainage bag with indwelling catheter, Foley type, three-way, for continuous irrigation | | A4314 | 20.20 | Insertion tray with drainage bag with indwelling catheter, Foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) | | A4315 | 21.07 | Insertion tray with drainage bag with indwelling catheter, Foley type, two-way, all silicone | | A4316 | 26.68 | Insertion tray with drainage bag with indwelling catheter, Foley type, three-way, for continuous irrigation | | A4320 | 5.02 | Irrigation tray with bulb or piston syringe, any purpose | | A4321 | AAC+20% | Therapeutic agent for urinary catheter irrigation | | A4322 | 2.86 | Irrigation syringe, bulb or piston, each | | A4326 | 9.74 | Male external catheter with integral collection chamber, any type, each | | A4327 | 39.71 | Female external urinary collection device; metal cup, each | | A4328 | 8.34 | Female external urinary collection device; pouch, each | | A4330 | 6.72 | Perianal fecal collection pouch with adhesive, each | | A4331 | 2.99 | Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each | | A4332 | 0.11 | Lubricant, individual sterile packet, each | | A4333 | 2.07 | Urinary catheter anchoring device, adhesive skin attachment, each | | A4334 | 4.62 | Urinary catheter anchoring device, leg strap, each | | A4335 | AAC+20% | Incontinence supply; miscellaneous | | A4336 | 1.35 | Incontinence supply, urethral insert, any type, each | | A4337 | AAC+20% | Incontinence supply, rectal insert, any type, each | | A4338 | 11.53 | Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc .), each | | A4340 | 29.84 | Indwelling catheter; specialty type, eg ; coude, mushroom, wing, etc .), each | | A4344 | 14.27 | Indwelling catheter, foley type, two-way, all silicone, each | | A4346 | 18.40 | Indwelling catheter; foley type, three way for continuous irrigation, each | | A4349 | 1.90 | Male external catheter, with or without adhesive, disposable, each | | A4351 | 1.71 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc .), each | | A4352 | 6.04 | Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each | | A4353 | 6.57 | Intermittent urinary catheter, with insertion supplies | | A4354 | 11.09 | Insertion tray with drainage bag but without catheter | | A4355 | 7.12 | Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each | | A4356 | 36.44 | External urethral clamp or compression device (not to be used for catheter clamp), each | | A4357 | 7.75 | Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each | | A4358 each | 6.23 | Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each | | A4360 | 0.39 | Disposable external urethral clamp or compression device, with pad and/or pouch, each | | Ostomy Supplies | | | | A4361 | 16.75 | Ostomy faceplate, each | | A4362 | 2.77 | Skin barrier; solid, 4 x 4 or equivalent; each | | A4363 | 2.23 | Ostomy clamp, any type, replacement only, each | | A4364 | 2.71 | Adhesive, liquid or equal, any type, per oz | | A4366 | 1.22 | Ostomy vent, any type, each | | A4367 | 6.22 | Ostomy belt, each | | A4368 | 0.24 | Ostomy filter, any type, each | | A4369 | 2.28 | Ostomy skin barrier, liquid (spray, brush, etc), per oz | | A4371 | 3.43 | Ostomy skin barrier, powder, per oz | | A4372 | 3.94 | Ostomy skin barrier, solid 4x4 or equivalent, standard wear, with built-in convexity, each | | A4373 | 5.89 | Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each | | A4375 | 16.14 | Ostomy pouch, drainable, with faceplate attached, plastic, each | | A4376 | 44.72 | Ostomy pouch, drainable, with faceplate attached, rubber, each | | A4377 | 4.04 | Ostomy pouch, drainable, for use on faceplate, plastic, each | | A4378 | 28.88 | Ostomy pouch, drainable, for use on faceplate, rubber, each | | A4379 | 14.11 | Ostomy pouch, urinary, with faceplate attached, plastic, each | | A4380 | 35.07 | Ostomy pouch, urinary, with faceplate attached, rubber, each | | A4381 | 4.34 | Ostomy pouch, urinary, for use on faceplate, plastic, each | | A4382 | 23.13 | Ostomy pouch, urinary, for use on faceplate, heavy plastic, each | | A4383 | 26.49 | Ostomy pouch, urinary, for use on faceplate, rubber, each | | A4384 | 9.04 | Ostomy faceplate equivalent, silicone ring, each | | A4385 | 4.79 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each | | A4387 | 2.11 | Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each | | A4388 | 4.11 | Ostomy pouch, drainable, with extended wear barrier attached, (one piece), each | | A4389 | 5.84 | Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each | | A4390 | 9.03 | Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each | | A4391 | 6.65 | Ostomy pouch, urinary, with extended wear barrier attached (one piece), each | | A4392 | 7.68 | Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (one piece), each | | A4393 | 8.50 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (one piece), each | | A4394 | 2.43 | Ostomy deodorant, with or without lubricant, for use in ostomy pouch, liquid, per fluid ounce | | A4395 | 0.04 | Ostomy deodorant for use in ostomy pouch, solid, per tablet | | A4396 | 38.04 | Ostomy belt with peristomal hernia support | | A4398 | 12.75 | Ostomy irrigation supply; bag, each | | A4399 | 11.53 | Ostomy irrigation supply; cone/catheter, with or without brush | | A4400 | 45.92 | Ostomy irrigation set | | A4402 | 1.28 | Lubricant, per ounce | | A4404 | 1.58 | Ostomy ring, each | | A4405 | 3.20 | Ostomy skin barrier, non-pectin based, paste, per ounce | | A4406 | 5.38 | Ostomy skin barrier, pectin-based, paste, per ounce | | A4407 | 8.23 | Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each | | A4408 | 9.27 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each | | A4409 | 5.84 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each | | A4410 | 8.50 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each | | A4411 | 4.79 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each | | A4412 | 2.54 | Ostomy pouch, drainable, high output, for use on a barrier with flange (two piece system), without filter, each | | A4413 | 5.18 | Ostomy pouch, drainable, high output, for use on a barrier with flange (two piece system), with filter, each | | A4414 | 4.62 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each | | A4415 | 5.63 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each | | A4416 | 2.59 | Ostomy pouch, closed, with barrier attached, with filter (one piece), each | | A4417 | 3.49 | Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each | | A4418 | 1.71 | Ostomy pouch, closed; without barrier attached, with filter (one piece), each | | A4419 | 1.63 | Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (two piece), each | | A4420 | AAC+20% | Ostomy pouch, closed, for use on barrier with locking flange (two piece), each | | A4421 | AAC+20% | Ostomy supply; miscellaneous | | A4422 | 0.11 | Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each | | A4423 | 1.75 | Ostomy pouch, closed; for use on barrier with locking flange, with filter (two piece), each | | A4424 | 4.47 | Ostomy pouch, drainable, with barrier attached, with filter (one piece), each | | A4425 | 3.37 | Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (two piece system), each | | A4426 | 2.57 | Ostomy pouch, drainable; for use on barrier with locking flange (two piece system), each | | A4427 | 2.62 | Ostomy pouch, drainable; for use on barrier with locking flange, with filter (two piece system), each | | A4428 | 6.12 | Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each | | A4429 | 7.75 | Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (one piece), each | | A4430 | 8.00 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (one piece), each | | A4431 | 5.84 | Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (one piece), each | | A4432 | 3.37 | Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (two piece), each | | A4433 | 3.15 | Ostomy pouch, urinary; for use on barrier with locking flange (two piece), each | | A4434 | 3.53 | Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (two piece), each | | A4435 | 5.42 | Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each | | A4436 | 16.95 | Irrigation supply: sleeve, reusable, per month | | A4437 | 16.95 | Irrigation supply: sleeve disposable, per month | | Miscellaneous Supplies | | | | A4450AU | 0.08 | Tape, non-waterproof, per 18 square inches | | A4450AV | 0.08 | Tape, non-waterproof, per 18 square inches | | A4450AW | 0.10 | Tape, non-waterproof, per 18 square inches | | A4452AU | 0.34 | Tape, waterproof, per 18 square inches | | A4452AV | 0.34 | Tape, waterproof, per 18 square inches | | A4452AW | 0.37 | Tape, waterproof, per 18 square inches | | A4455 | 1.34 | Adhesive remover or solvent (for tape, cement or other adhesive), per ounce | | A4456 | 0.23 | Adhesive remover, wipes, any type, each | | A4458 | AAC+20% | Enema bag with tubing, reusable | | A4459 | AAC+20% | Manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type | | A4461 | 3.09 | Surgical dressing holder, non-reusable, each | | A4463 | 12.51 | Surgical dressing holder, reusable, each | | A4465 | 11.52 | Non-elastic binder for extremity | | A4467 | AAC+20% | Belt, strap, sleeve, garment, or covering, any type | | A4470 | AAC+20% | Gravlee jet washer | | A4480 | AAC+20% | Vabra aspirator | | A4481 | 0.35 | Tracheostoma filter, any type, any size, each | | A4483 | 69.60 | Moisture exchanger, disposable, for use with invasive mechanical ventilation | | A4490 | 7.26 | Surgical stockings above knee length, each | | A4495 | 28.85 | Surgical stockings thigh length, each | | A4500 | 8.22 | Surgical stockings below knee length, each | | A4510 | 11.61 | Surgical stockings full length, each | | A4520 | AAC+20% | Incontinence garment, any type ( e.g. , brief, diaper), each | | A4550 | 1.52 | Surgical trays | | A4553 | AAC+20% | Non-disposable underpads, all sizes | | A4554 | 0.29 | Disposable underpads, all sizes, ( e.g. , Chux's) | | A4555 | AAC+20% | Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only | | A4556 | 9.71 | Electrodes, ( e.g. , apnea monitor), per pair | | A4557 | 16.65 | Lead wires, ( e.g. , apnea monitor), per pair | | A4558 | 4.36 | Conductive gel or paste, for use with electrical device ( e.g. , TENS, NMES), per oz | | A4559 | 0.09 | Coupling gel or paste, for use with ultrasound device, per oz | | A4561 | 18.75 | Pessary, rubber, any type | | A4562 | 46.68 | Pessary, non rubber, any type | | A4565 | 7.23 | Slings | | A4566 | AAC+20% | Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment | | A4570 | AAC+20% | Splint | | A4575 | AAC+20% | Topical hyperbaric oxygen chamber, disposable | | A4580 | AAC+20% | Cast supplies ( e.g. plaster) | | A4590 | AAC+20% | Special casting material ( e.g. fiberglass) | | A4595 | 20.65 | Electrical stimulator supplies, two lead, per month, ( e.g. TENS, NMES) | | A4600 | AAC+20% | Sleeve for intermittent limb compression device, replacement only, each | | A4601 | AAC+20% | Lithium ion battery, rechargeable, for non-prosthetic use, replacement | | A4602 | 3.49 | Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each | | A4604NU | 46.16 | Tubing with integrated heating element for use with positive airway pressure device | | A4605NU | 15.41 | Tracheal suction catheter, closed system, each | | A4606 | AAC+20% | Oxygen probe for use with oximeter device, replacement | | A4608 | 47.10 | Transtracheal oxygen catheter, each | | Supplies for Oxygen and Related Respiratory Equipment | | | | A4611NU | 175.33 | Battery, heavy duty; replacement for patient owned ventilator (new equipment) | | A4611RR | 18.18 | Battery, heavy duty; replacement for patient owned ventilator (rental) | | A4611UE | 131.50 | Battery, heavy duty; replacement for patient owned ventilator (used durable medical equipment) | | A4612NU | 71.34 | Battery cables; replacement for patient-owned ventilator (new equipment) | | A4612RR | 7.27 | Battery cables; replacement for patient-owned ventilator (rental) | | A4612UE | 54.40 | Battery cables; replacement for patient-owned ventilator (used durable medical equipment) | | A4613NU | 109.40 | Battery charger; replacement for patient-owned ventilator (new equipment) | | A4613RR | 10.95 | Battery charger; replacement for patient-owned ventilator (rental) | | A4613UE | 79.12 | Battery charger; replacement for patient-owned ventilator (used durable medical equipment) | | A4614 | 22.35 | Peak expiratory flow rate meter, hand held | | A4615 | 0.68 | Cannula, nasal | | A4616 | 0.06 | Tubing (oxygen), per foot | | A4617 | 2.92 | Mouth piece | | A4618NU | 8.36 | Breathing circuits | | A4618RR | 0.97 | Breathing circuits | | A4618UE | 6.26 | Breathing circuits | | A4619NU | 1.68 | Face tent | | A4620 | 0.56 | Variable concentration mask | | A4623 | 6.15 | Tracheostomy, inner cannula | | A4623UA | AAC+30% | Tracheostomy, inner cannula (customized nonstandard size for adults for MassHealth members only) | | A4623UC | AAC+30% | Tracheostomy, inner cannula (customized nonstandard size for children for MassHealth members only) | | A4624NU | 2.10 | Tracheal suction catheter, any type other than closed system, each | | A4625 | 5.53 | Tracheostomy care kit for new tracheostomy | | A4626 | 3.00 | Tracheostomy cleaning brush, each | | A4627 | 13.28 | Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler | | A4628NU | 3.51 | Oropharyngeal suction catheter, each | | A4629 | 4.36 | Tracheostomy care kit for established tracheostomy | | Supplies for Other Durable Medical Equipment | | | | A4630NU | 5.87 | Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient | | A4633NU | 38.56 | Replacement bulb/lamp for ultraviolet light therapy system, each | | A4634 | AAC+20% | Replacement bulb for therapeutic light box, tabletop model | | A4635NU | 4.81 | Underarm pad, crutch, replacement, each (new equipment) | | A4635RR | 0.65 | Underarm pad, crutch, replacement, each (rental) | | A4635UE | 3.20 | Underarm pad, crutch, replacement, each (used durable medical equipment) | | A4636NU | 2.95 | Replacement, handgrip, cane, crutch, or walker, each (new equipment) | | A4636RR | 0.30 | Replacement, handgrip, cane, crutch, or walker, each (rental) | | A4636UE | 2.18 | Replacement, handgrip, cane, crutch, or walker, each (used durable medical equipment) | | A4637NU | 1.56 | Replacement, tip, cane, crutch, walker, each (new equipment) | | A4637RR | 0.19 | Replacement, tip, cane, crutch, walker, each (rental) | | A4637UE | 1.17 | Replacement, tip, cane, crutch, walker, each (used durable medical equipment) | | A4638NU | AAC+20% | Replacement battery for patient-owned ear pulse generator, each (new equipment) | | A4638RR | I.C. | Replacement battery for patient-owned ear pulse generator, each (rental) | | A4638UE | I.C. | Replacement battery for patient-owned ear pulse generator, each (used durable medical equipment) | | A4639KH | 27.00 | Replacement pad for infrared heating pad system, each (capped rental) | | A4639KI | 27.00 | Replacement pad for infrared heating pad system, each (capped rental) | | A4639KJ | 20.25 | Replacement pad for infrared heating pad system, each (capped rental) | | A4639NU | 269.96 | Replacement pad for infrared heating pad system, each (new equipment) | | A4639UE | 202.47 | Replacement pad for infrared heating pad system, each (used durable medical equipment) | | A4640NU | 50.46 | Replacement pad for use with medically necessary alternating pressure pad owned by patient (new equipment) | | A4640RR | 5.10 | Replacement pad for use with medically necessary alternating pressure pad owned by patient (rental) | | A4640UE | 36.61 | Replacement pad for use with medically necessary alternating pressure pad owned by patient (used durable medical equipment) | | A4649 | AAC+20% | Surgical supplies, miscellaneous | | Dialysis Supplies | | | | A4651 | AAC+20% | Calibrated microcapillary tube, each | | A4652 | AAC+20% | Microcapillary tube sealant | | A4653 | AAC+20% | Peritoneal dialysis catheter anchoring device, belt, each | | A4657 | AAC+20% | Syringe, with or without needle, each | | A4660 | 44.52 | Sphygmomanometer/blood pressure apparatus with cuff and stethoscope | | A4663 | 30.08 | Blood pressure cuff only | | A4670 | 63.57 | Automatic blood pressure monitor | | A4671 | AAC+20% | Disposable cycler set used with cycler dialysis machine, each | | A4672 | AAC+20% | Drainage extension line, sterile, for dialysis, each | | A4673 | AAC+20% | Extension line with easy lock connectors, used with dialysis | | A4674 | AAC+20% | Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz | | A4680 | AAC+20% | Activated carbon filter for hemodialysis, each | | A4690 | AAC+20% | Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each | | A4706 | AAC+20% | Bicarbonate concentrate, solution, for hemodialysis, per gallon | | A4707 | AAC+20% | Bicarbonate concentrate, powder, for hemodialysis, per packet | | A4708 | AAC+20% | Acetate concentrate solution, for hemodialysis, per gallon | | A4709 | AAC+20% | Acid concentrate, solution, for hemodialysis, per gallon | | A4714 | AAC+20% | Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon | | A4719 | AAC+20% | Y set tubing for peritoneal dialysis | | A4720 | AAC+20% | Dialysate solution, any concentration of dextrose, fluid volume greater than 249cc, but less than or equal to 999cc, for peritoneal dialysis | | A4721 | AAC+20% | Dialysate solution, any concentration of dextrose, fluid volume greater than 999cc but less than or equal to 1999cc, for peritoneal dialysis | | A4722 | AAC+20% | Dialysate solution, any concentration of dextrose, fluid volume greater than 1999cc but less than or equal to 2999cc, for peritoneal dialysis | | A4723 | AAC+20% | Dialysate solution, any concentration of dextrose, fluid volume greater than 2999cc but less than or equal to 3999cc, for peritoneal dialysis | | A4724 | AAC+20% | Dialysate solution, any concentration of dextrose, fluid volume greater than 3999cc but less than or equal to 4999cc, for peritoneal dialysis | | A4725 | AAC+20% | Dialysate solution, any concentration of dextrose, fluid volume greater than 4999cc but less than or equal to 5999cc, for peritoneal dialysis | | A4726 | AAC+20% | Dialysate solution, any concentration of dextrose, fluid volume greater than 5999cc, for peritoneal dialysis | | A4728 | AAC+20% | Dialysate solution, non-dextrose containing, 500 ml | | A4730 | AAC+20% | Fistula cannulation set for hemodialysis, each | | A4736 | AAC+20% | Topical anesthetic, for dialysis, per gram | | A4737 | AAC+20% | Injectable anesthetic, for dialysis, per 10 ml | | A4740 | AAC+20% | Shunt accessory, for hemodialysis, any type, each | | A4750 | AAC+20% | Blood tubing, arterial or venous, for hemodialysis, each | | A4755 | AAC+20% | Blood tubing, arterial and venous combined, for hemodialysis, each | | A4760 | AAC+20% | Dialysate solution test kit, for peritoneal dialysis, any type, each | | A4765 | AAC+20% | Dialysate concentrate, powder, additive for peritoneal dialysis, per packet | | A4766 | AAC+20% | Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml | | A4770 | AAC+20% | Blood collection tube, vacuum, for dialysis, per 50 | | A4771 | AAC+20% | Serum clotting time tube, for dialysis, per 50 | | A4773 | AAC+20% | Occult blood test strips, for dialysis, per 50 | | A4774 | AAC+20% | Ammonia test strips, for dialysis, per 50 | | A4802 | AAC+20% | Protamine sulfate, for hemodialysis, per 50 mg | | A4860 | AAC+20% | Disposable catheter tips for peritoneal dialysis, per 10 | | A4870 | AAC+20% | Plumbing and/or electrical work for home hemodialysis equipment | | A4890 | AAC+20% | Contracts, repair and maintenance, for hemodialysis equipment | | A4911 | AAC+20% | Drain bag/bottle, for dialysis, each | | A4913 | AAC+20% | Miscellaneous dialysis supplies, not otherwise specified | | A4918 | AAC+20% | Venous pressure clamp, for hemodialysis, each | | A4927 | 7.89 | Gloves, non-sterile, per 100 | | A4930 | 0.36 | Gloves, sterile, per pair | | A4931 | AAC+20% | Oral thermometer, reusable, any type, each | | A4932 | AAC+20% | Rectal thermometer, reusable, any type, each | | Ostomy Pouches and Supplies | | | | A5051 | 1.94 | Ostomy pouch, closed; with barrier attached (one piece), each | | A5052 | 1.39 | Ostomy pouch, closed; without barrier attached (one piece), each | | A5053 | 1.39 | Ostomy pouch, closed; for use on faceplate, each | | A5054 | 1.69 | Ostomy pouch, closed; for use on barrier with flange (two piece), each | | A5055 | 1.35 | Stoma cap | | A5056 | 4.39 | Ostomy pouch, drainable, with extended wear barrier attached, with filter, (one piece), each | | A5057 | 9.03 | Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (one piece), each | | A5061 | 3.32 | Ostomy pouch, drainable; with barrier attached, (one piece), each | | A5062 | 2.09 | Ostomy pouch, drainable; without barrier attached (one piece), each | | A5063 | 2.54 | Ostomy pouch, drainable; for use on barrier with flange (two piece system), each | | A5071 | 5.64 | Ostomy pouch, urinary; with barrier attached (one piece), each | | A5072 | 3.32 | Ostomy pouch, urinary; without barrier attached (one piece), each | | A5073 | 2.99 | Ostomy pouch, urinary; for use on barrier with flange (two piece), each | | A5081 | 3.11 | Stoma plug or seal, any type | | A5082 | 11.18 | Continent device; catheter for continent stoma | | A5083 | 0.60 | Continent device, stoma absorptive cover for continent stoma | | A5093 | 1.84 | Ostomy accessory; convex insert | | Incontinence Supplies | | | | A5102 | 21.06 | Bedside drainage bottle with or without tubing, rigid or expandable, each | | A5105 | 32.56 | Urinary suspensory; with or without leg bag, with or without tube, each | | A5112 | 28.13 | Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each | | A5113 | 4.20 | Leg strap; latex, replacement only, per set | | A5114 | 7.16 | Leg strap; foam or fabric, replacement only, per set | | A5120AU | 0.23 | Skin barrier, wipes or swabs, each | | A5120AV | 0.26 | Skin barrier, wipes or swabs, each | | A5121 | 6.94 | Skin barrier; solid, 6 x 6 or equivalent, each | | A5122 | 10.26 | Skin barrier; solid, 8 x 8 or equivalent, each | | A5126 | 1.23 | Adhesive or non-adhesive; disk or foam pad | | A5131 | 14.90 | Appliance cleaner, incontinence and ostomy appliances, per 16 oz. | | A5200 | 10.63 | Percutaneous catheter/tube anchoring device, adhesive skin attachment | | Dressings | | | | A6000 | AAC+20% | Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card | | A6010 | 29.10 | Collagen based wound filler, dry form, sterile, per gram of collagen | | A6011 | 2.14 | Collagen based wound filler, gel/paste, per gram of collagen | | A6021 | 19.75 | Collagen dressing, sterile, size 16 sq. in. or less, each | | A6022 | 19.75 | Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each | | A6023 | 178.83 | Collagen dressing, sterile, size more than 48 sq. in., each | | A6024 | 5.81 | Collagen dressing wound filler, sterile, per 6 inches | | A6025 | AAC+20% | Gel sheet for dermal or epidermal application, ( e.g. , silicone, hydrogel, other), each | | A6154 | 13.52 | Wound pouch, each | | A6196 | 6.91 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing | | A6197 | 15.44 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | | A6198 | AAC+20% | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing | | A6199 | 4.97 | Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches | | A6203 | 3.16 | Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | | A6204 | 5.85 | Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | | A6205 | 14.64 | Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | | A6206 | AAC+20% | Contact layer, sterile, 16 sq. in. or less, each dressing | | A6207 | 6.89 | Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | | A6208 | AAC+20% | Contact layer, sterile, more than 48 sq. in., each dressing | | A6209 | 7.02 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6210 | 18.73 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | | A6211 | 27.60 | Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | | A6212 | 9.12 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | | A6213 | 9.25 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | | A6214 | 9.66 | Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | | A6215 | AAC+20% | Foam dressing, wound filler, sterile, per gram | | A6216 | 0.04 | Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6217 | 0.18 | Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | | A6218 | 0.57 | Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing | | A6219 | 0.90 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | | A6220 | 2.43 | Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | | A6221 | AAC+20% | Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | | A6222 | 2.00 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6223 | 2.28 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 square inches, but less than or equal to 48 square inches, without adhesive border, each dressing | | A6224 | 3.39 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 square inches, without adhesive border, each dressing | | A6228 | AAC+20% | Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6229 | 3.39 | Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | | A6230 | AAC+20% | Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | | A6231 | 4.39 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing | | A6232 | 6.45 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing | | A6233 | 18.02 | Gauze, impregnated, hydrogel for direct wound contact, sterile, pad size more than 48 sq. in., each dressing | | A6234 | 6.15 | Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6235 | 15.80 | Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | | A6236 | 25.61 | Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | | A6237 | 7.44 | Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | | A6238 | 21.42 | Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | | A6239 | 20.53 | Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | | A6240 | 11.51 | Hydrocolloid dressing, wound filler, paste, sterile, per fluid ounce | | A6241 | 2.41 | Hydrocolloid dressing, wound filler, dry form, sterile, per gram | | A6242 | 5.70 | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6243 | 11.58 | Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | | A6244 | 36.92 | Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | | A6245 | 6.83 | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | | A6246 | 9.33 | Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | | A6247 | 22.35 | Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | | A6248 | 15.27 | Hydrogel dressing, wound filler, gel, per fluid ounce | | A6250 | 9.21 | Skin sealants, protectants, moisturizers, ointments, any type, any size | | A6251 | 1.87 | Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6252 | 3.06 | Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | | A6253 | 5.95 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | | A6254 | 5.95 | Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | | A6255 | 1.13 | Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | | A6256 | 1.38 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | | A6257 | 1.45 | Transparent film, sterile, 16 sq. in. or less, each dressing | | A6258 | 4.05 | Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | | A6259 | 10.29 | Transparent film, sterile, more than 48 sq. in., each dressing | | A6260 | 11.23 | Wound cleansers, any type, any size | | A6261 | AAC+20% | Wound filler, gel/paste, per fluid ounce, not otherwise specified | | A6262 | 0.97 | Wound filler, dry form, per gram, not otherwise specified | | A6266 | 1.81 | Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard | | A6402 | 0.11 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6403 | 0.40 | Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing | | A6404 | 0.64 | Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | | A6407 | 1.77 | Packing strips, non-impregnated, sterile, up to 2 inch in width, per linear yard | | A6410 | 0.37 | Eye pad, sterile, each | | A6411 | AAC+20% | Eye pad, non-sterile, each | | A6412 | AAC+20% | Eye patch, occlusive, each | | A6413 | AAC+20% | Adhesive bandage, first-aid type, any size, each | | A6441 | 0.64 | Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard | | A6442 | 0.15 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard | | A6443 | 0.26 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard | | A6444 | 0.53 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than five inches, per yard | | A6445 | 0.31 | Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard | | A6446 | 0.38 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard | | A6447 | 0.64 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard | | A6448 | 1.09 | Light compression bandage, elastic, knitted/woven, width less than three inches, per yard | | A6449 | 1.65 | Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | | A6450 | AAC+20% | Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard | | A6451 | AAC+20% | Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches or less than five inches, per yard | | A6452 | 5.55 | High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches or less than five inches, per yard | | A6453 | 0.59 | Self-adherent bandage, elastic, non-knitted/non-woven, less than three inches, per yard | | A6454 | 0.73 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard | | A6455 | 1.31 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard | | A6456 | 1.19 | Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | | A6457 | 1.07 | Tubular dressing with or without elastic, any width, per linear yard | | A6460 | AAC+20% | Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | | A6461 | AAC+20% | Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | | Compression Garments | | | | A6501 | AAC+20% | Compression burn garment, bodysuit (head to foot), custom fabricated | | A6502 | AAC+20% | Compression burn garment, chin strap, custom fabricated | | A6503 | AAC+20% | Compression burn garment, facial hood, custom fabricated | | A6504 | AAC+20% | Compression burn garment, glove to wrist, custom fabricated | | A6505 | AAC+20% | Compression burn garment, glove to elbow, custom fabricated | | A6506 | AAC+20% | Compression burn garment, glove to axilla, custom fabricated | | A6507 | AAC+20% | Compression burn garment, foot to knee length, custom fabricated | | A6508 | AAC+20% | Compression burn garment, foot to thigh length, custom fabricated | | A6509 | AAC+20% | Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated | | A6510 | AAC+20% | Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated | | A6511 | AAC+20% | Compression burn garment, lower trunk including leg openings (panty), custom fabricated | | A6512 | AAC+20% | Compression burn garment, not otherwise classified | | A6513 | AAC+20% | Compression burn mask, face/neck | | A6550 | 21.28 | Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories | | Respiratory Supplies | | | | A7000NU | 6.73 | Canister, disposable, used with suction pump, each (new equipment) | | A7001NU | 29.42 | Canister, non-disposable, used with suction pump, each | | A7002NU | 3.41 | Tubing, used with suction pump, each | | A7003NU | 2.13 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | | A7004NU | 1.32 | Small volume nonfiltered pneumatic nebulizer, disposable | | A7005NU | 22.88 | Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable | | A7006NU | 8.02 | Administration set, with small volume filtered pneumatic nebulizer | | A7007NU | 3.85 | Large volume nebulizer, disposable, unfilled, used with aerosol compressor | | A7008NU | 10.34 | Large volume nebulizer, disposable, prefilled, used with aerosol compressor | | A7009NU | 37.38 | Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer | | A7010NU | 19.69 | Corrugated tubing, disposable, used with large volume nebulizer, 100 feet | | A7012NU | 3.30 | Water collection device, used with large volume nebulizer | | A7013NU | 0.67 | Filter, disposable, used with aerosol compressor or ultrasonic generator | | A7014NU | 3.80 | Filter, nondisposable, used with aerosol compressor or ultrasonic generator | | A7015NU | 1.56 | Aerosol mask, used with DME nebulizer | | A7016NU | 6.43 | Dome and mouthpiece, used with small volume ultrasonic nebulizer | | A7017NU | 125.19 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen (new equipment) | | A7017RR | 12.52 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen (rental) | | A7017UE | 93.89 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen (used durable medical equipment) | | A7018 | 0.33 | Water, distilled, used with large volume nebulizer, 1000 ml | | A7020 | 13.11 | Interface for cough stimulating device, includes all components, replacement only | | A7025KH | 40.88 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each (capped rental) | | A7025KI | 40.88 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each (capped rental) | | A7025KJ | 30.66 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each (capped rental) | | A7025NU | 408.77 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each (new equipment) | | A7025UE | 306.58 | High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each (used durable medical equipment) | | A7026NU | 27.01 | High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each | | A7027NU | 138.24 | Combination oral/nasal mask, used with continuous positive airway pressure device, each | | A7028NU | 40.71 | Oral cushion for combination oral/nasal mask, replacement only, each | | A7029NU | 16.71 | Nasal pillows for combination oral/nasal mask, replacement only, pair | | A7030NU | 122.43 | Full face mask used with positive airway pressure device, each | | A7031NU | 46.07 | Face mask interface, replacement for full face mask, each | | A7032NU | 26.11 | Cushion for use on nasal mask interface, replacement only, each | | A7033NU | 18.77 | Pillow for use on nasal cannula type interface, replacement only, pair | | A7034NU | 75.89 | Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap | | A7035NU | 24.17 | Headgear used with positive airway pressure device | | A7036NU | 12.44 | Chinstrap used with positive airway pressure device | | A7037NU | 23.47 | Tubing used with positive airway pressure device | | A7038NU | 2.90 | Filter, disposable, used with positive airway pressure device | | A7039NU | 9.48 | Filter, non disposable, used with positive airway pressure device | | A7040 | 37.09 | One way chest drain valve | | A7041 | 69.72 | Water seal drainage container and tubing for use with implanted chest tube | | A7042 | 164.90 | Implanted pleural catheter, each | | A7043 | 26.13 | Vacuum drainage bottle and tubing for use with implanted catheter | | A7044NU | 84.39 | Oral interface used with positive airway pressure device, each | | A7045NU | 13.43 | Exhalation port with or without swivel used with accessories for positive airway devices, replacement only (new equipment) | | A7045RR | 1.34 | Exhalation port with or without swivel used with accessories for positive airway devices, replacement only (rental) | | A7045UE | 10.08 | Exhalation port with or without swivel used with accessories for positive airway devices, replacement only (used durable medical equipment) | | A7046NU | 13.88 | Replacement water chamber for humidifier, used with positive pressure device, each | | A7047 | 113.61 | Oral interface used with respiratory suction pump, each | | A7048 | 46.48 | Vacuum drainage collection and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each | | Tracheostomy Supplies | | | | A7501 | 98.69 | Tracheostoma valve, including diaphragm, each | | A7502 | 46.91 | Replacement diaphragm/faceplate for tracheostoma valve, each | | A7503 | 10.66 | Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each | | A7504 | 0.64 | Filter for use in a tracheostoma heat and moisture exchange system, each | | A7505 | 4.40 | Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each | | A7506 | 0.31 | Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each | | A7507 | 2.34 | Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each | | A7508 | 2.69 | Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each | | A7509 | 1.33 | Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each | | A7520NU | 44.62 | Tracheostomy/laryngectomy tube, non-cuffed, polyvinyalchloride (PVC), silicone or equal, each | | A7520UA | AAC+30% | Tracheostomy/laryngectomy tube, non-cuffed, polyvinyalchloride (PVC), silicone or equal, each (customized nonstandard size for adults for MassHealth members only) | | A7520UC | AAC+30% | Tracheostomy/laryngectomy tube, non-cuffed, polyvinyalchloride (PVC), silicone or equal, each (customized nonstandards for children for MassHealth members only) | | A7521NU | 44.20 | Tracheostomy/laryngectomy tube, cuffed, polyvinyalchloride (PVC), silicone or equal, each | | A7521UA | AAC+30% | Tracheostomy/laryngectomy tube, cuffed, polyvinyalchloride (PVC), silicone or equal, each (customized nonstandard size for adults for MassHealth members only) | | A7521UC | AAC+30% | Tracheostomy/laryngectomy tube, cuffed, polyvinyalchloride (PVC), silicone or equal, each (customized nonstandard size for children for MassHealth members only) | | A7522NU | 42.44 | Tracheostomy/laryngectomy tube, stainless steel [sterilizable and reusable], each | | A7522UC | AAC+20% | Tracheostomy/laryngectomy tube, stainless steel [sterilizable and reusable], each (pediatric specialized rehabilitation equipment) | | A7523 | AAC+20% | Tracheostomy shower protector, each | | A7524 | 72.74 | Tracheostoma stent/stud/button, each | | A7525 | 1.94 | Tracheostomy mask, each | | A7526 | 3.18 | Tracheostomy tube collar/holder, each | | A7527 | 3.37 | Tracheostomy/laryngectomy tube plug, each | | Protective Helmet | | | | A8000NU | 144.11 | Helmet, protective, soft, prefabricated, includes all components and accessories (new equipment) | | A8000RR | 14.41 | Helmet, protective, soft, prefabricated, includes all components and accessories (rental) | | A8000UE | 108.10 | Helmet, protective, soft, prefabricated, includes all components and accessories (used durable medical equipment) | | A8001NU | 144.11 | Helmet, protective, hard, prefabricated, includes all components and accessories (new equipment) | | A8001RR | 14.41 | Helmet, protective, hard, prefabricated, includes all components and accessories (rental) | | A8001UE | 108.10 | Helmet, protective, hard, prefabricated, includes all components and accessories (used durable medical equipment) | | A8002NU | AAC+30% | Helmet, protective, soft, custom fabricated, includes all components and accessories (new equipment) | | A8002RR | I.C. | Helmet, protective, soft, custom fabricated, includes all components and accessories (rental) | | A8002UE | I.C. | Helmet, protective, soft, custom fabricated, includes all components and accessories (used durable medical equipment) | | A8003NU | AAC+30% | Helmet, protective, hard, custom fabricated, includes all components and accessories (new equipment) | | A8003RR | I.C. | Helmet, protective, hard, custom fabricated, includes all components and accessories (rental) | | A8003UE | I.C. | Helmet, protective, hard, custom fabricated, includes all components and accessories (used durable medical equipment) | | A8004NU | AAC+30% | Soft interface for helmet, replacement only (new equipment) | | A8004RR | I.C. | Soft interface for helmet, replacement only (rental) | | A8004UE | I.C. | Soft interface for helmet, replacement only (used durable medical equipment) | | Other Supplies and Devices | | | | A9272 | AAC+20% | Wound suction, disposable, includes dressing, all accessories and components, any type, each | | A9273 | AAC+20% | Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type | | A9274 | AAC+30% | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories | | A9275 | AAC+30% | Home glucose disposable monitor, includes test strips | | A9276 | AAC+30% | Sensor, invasive ( e.g. , subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, 1 unit + 1 day supply | | A9277 | AAC+30% | Transmitter; external, for use with interstitial continuous glucose monitoring system | | A9278 | AAC+30% | Receiver (monitor); external, for use with interstitial continuous glucose monitoring system | | A9279 | AAC+30% | Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified | | A9280 | AAC+30% | Alarm or alarm device, not otherwise classified | | A9281 | AAC+20% | Reaching/grabbing device, any type, any length, each | | A9282 | AAC+20% | Wig, any type, each | | A9284 | AAC+20% | Spirometer, non-electronic, includes all accessories | | A9286 | AAC+20% | Hygienic item or device, disposable or non-disposable, any type, each | | A9300 | AAC+30% | Exercise equipment | | A9900 | AAC+20% | Miscellaneous DME supply, accessory, and/or service component of another HCPCS code | | A9999 | AAC+20% | Miscellaneous DME supply or accessory, not otherwise specified | | Enteral and Parenteral Therapy B4000-B9999 | | | | Enteral Formulae and Enteral Medical Supplies | | | | B4034 | 4.01 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | | B4035 | 7.57 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | | B4036 | 5.34 | Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | | B4081 | 15.61 | Nasogastric tubing with stylet | | B4082 | 11.49 | Nasogastric tubing without stylet | | B4083 | 1.78 | Stomach tube - Levine type | | B4087NU | 25.80 | Gastrostomy/jejunostomy tube, standard, any material, any type, each | | B4087UC | 144.00 | Gastrostomy/jejunostomy tube, standard, any material, any type, each (mickey tube) | | B4088NU | 27.96 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | | B4088UC | 144.00 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each (mickey tube) | | B4100 | AAC+25% | Food thickener, administered orally, per ounce | | B4102 | AAC+25% | Enteral formula, for adults, used to replace fluids and electrolytes ( e.g. , clear liquids), 500 ML = 1 unit | | B4103 | AAC+25% | Enteral formula, for pediatrics, used to replace fluids and electrolytes ( e.g. , clear liquids), 500 ML = 1 unit | | B4104 | AAC+25% | Additive for enteral formula ( e.g. , fiber) | | B4105 | AAC + 20% | In-Line cartridge containing digestive enzyme(s) for enteral feeding, each | | B4149BA | 1.11 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4149BO | AAC+25% | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4150BA | 0.47 | Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4150BO | 1.82 | Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4152BA | 0.38 | Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4152BO | 1.67 | Enteral formula, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4153BA | 1.34 | Enteral formula, hydrolyzed nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4153BO | 10.24 | Enteral formula,hydrolyzed nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4154BA | 0.84 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease or metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4154BO | AAC+25% | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease or metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4155BA | 0.71 | Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates ( e.g. , glucose polymers), proteins/amino acids ( e.g. , glutamine, arginine), fat ( e.g. , medium chain tryglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4155BO | AAC+25% | Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates ( e.g. , glucose polymers), proteins/amino acids ( e.g. , glutamine, arginine), fat ( e.g. , medium chain tryglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4157BA | AAC+25% | Enteral formula, nutritionally complete for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4157BO | AAC+25% | Enteral formula, nutritionally complete for special metabolic neds for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4158BA | AAC+25% | Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4158BO | AAC+25% | Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4159BA | AAC+25% | Enteral formula for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit | | B4159BO | AAC+25% | Enteral formula for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4160BA | AAC+25% | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minterals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4160BO | AAC+25% | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minterals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4161BA | AAC+25% | Enter formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4161BO | AAC+25% | Enter formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | B4162BA | AAC+25% | Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (item furnished in conjunction with PEN services) | | B4162BO | AAC+25% | Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit (orally administered, 1 can = 1 unit) | | Parenteral Nutrition Solutions and Supplies | | | | B4164 | 16.58 | Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - homemix | | B4168 | 24.17 | Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - homemix | | B4172 | AAC+25% | Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - homemix | | B4176 | 46.78 | Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - homemix | | B4178 | 56.14 | Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - homemix | | B4180 | 23.80 | Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml=1 unit) - home mix | | B4185 | 10.97 | Parenteral nutrition solution, not otherwise specified, 10 grams lipids | | B4187 | I.C. | Omegaven, 10 grams lipids | | B4189 | 173.45 | Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix | | B4193 | 224.12 | Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix | | B4197 | 272.86 | Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix | | B4199 | 311.79 | Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix | | B4216 | 7.53 | Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes) homemix per day | | B4220 | 7.81 | Parenteral nutrition supply kit; premix, per day | | B4222 | 9.63 | Parenteral nutrition supply kit; home mix, per day | | B4224 | 24.40 | Parenteral nutrition administration kit, per day | | B5000 | 11.60 | Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal - Aminosyn RF, NephrAmine, RenAmine - premix | | B5100 | 4.53 | Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, hepatic - f, HepatAmine - premix | | B5200 | AAC+25% | Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress-branch chain amino acids - FreAmine-HBC - premix | | Enteral and Parenteral Pumps | | | | B9002MS | 41.90 | Enteral nutrition infusion pump, any type (six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty) | | B9002NU | 801.69 | Enteral nutrition infusion pump, any type(new equipment) | | B9002RR | 78.49 | Enteral nutrition infusion pump, any type (rental) | | B9002UE | 601.26 | Enteral nutrition infusion pump, any type (used durable medical equipment) | | B9004MS | 194.88 | Parenteral nutrition infusion pump, portable (six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty) | | B9004NU | 2,462.07 | Parenteral nutrition infusion pump, portable (new equipment) | | B9004RR | 389.75 | Parenteral nutrition infusion pump, portable (rental) | | B9004UE | 1,846.55 | Parenteral nutrition infusion pump, portable (used durable medical equipment) | | B9006MS | 194.88 | Parenteral nutrition infusion pump, stationary (six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty) | | B9006NU | 2,462.07 | Parenteral nutrition infusion pump, stationary (new equipment) | | B9006RR | 389.75 | Parenteral nutrition infusion pump, stationary (rental) | | B9006UE | 1,846.55 | Parenteral nutrition infusion pump, stationary (used durable medical equipment) | | B9998 | AAC+20% | NOC for enteral supplies | | B9999 | AAC+20% | NOC for parenteral supplies | | Durable Medical Equipment E0100-E9999 | | | | Canes | | | | E0100NU | 19.06 | Cane, includes canes of all materials, adjustable or fixed, with tip (new equipment) | | E0100RR | 5.00 | Cane, includes canes of all materials, adjustable or fixed, with tip (rental) | | E0100UE | 14.27 | Cane, includes canes of all materials, adjustable or fixed, with tip (used durable medical equipment) | | E0105NU | 45.53 | Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips (new equipment) | | E0105RR | 7.08 | Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips (rental) | | E0105UD | AAC+30% | Cane, quad or three-prong, includes canes of all materials, adjustable or fixed, with tips (bariatric equipment) | | E0105UE | 34.16 | Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips (used durable medical equipment) | | Crutches | | | | E0110NU | 72.91 | Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips (new equipment) | | E0110RR | 15.02 | Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips (rental) | | E0110UD | AAC+30% | Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips (bariatric equipment) | | E0110UE | 54.66 | Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips (used durable medical equipment) | | E0111NU | 50.04 | Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips (new equipment) | | E0111RR | 7.91 | Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips (rental) | | E0111UD | AAC+30% | Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips (bariatric equipment) | | E0111UE | 38.62 | Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips (used durable medical equipment) | | E0112NU | 29.55 | Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips (new equipment) | | E0112RR | 7.94 | Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips (rental) | | E0112UD | AAC+30% | Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips (bariatric equipment) | | E0112UE | 22.54 | Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips (used durable medical equipment) | | E0113NU | 19.86 | Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip (new equipment) | | E0113RR | 4.84 | Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip (rental) | | E0113UD | AAC+30% | Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip (bariatric equipment) | | E0113UE | 14.90 | Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip (used durable medical equipment) | | E0114NU | 37.69 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips (new equipment) | | E0114RR | 6.84 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips (rental) | | E0114UD | AAC+30% | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips (bariatric equipment) | | E0114UE | 28.49 | Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips (used durable medical equipment) | | E0116NU | 26.08 | Crutch underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each (new equipment) | | E0116RR | 4.32 | Crutch underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each (rental) | | E0116UD | AAC+30% | Crutch underarm, other than wood, adjustable or fixed, each, with pad, tip and handgrip (bariatric equipment) | | E0116UE | 19.63 | Crutch underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each (used durable medical equipment) | | E0117KH | 18.10 | Crutch, underarm, articulating, spring assisted, each (capped rental) | | E0117KI | 18.10 | Crutch, underarm, articulating, spring assisted, each (capped rental) | | E0117KJ | 13.57 | Crutch, underarm, articulating, spring assisted, each (capped rental) | | E0117NU | 180.97 | Crutch, underarm, articulating, spring assisted, each (new equipment) | | E0117UD | AAC+30% | Crutch, underarm, articulating, spring assisted, each (bariatric equipment) | | E0117UE | 135.73 | Crutch, underarm, articulating, spring assisted, each (used durable medical equipment) | | E0118NU | AAC+30% | Crutch substitute, lower leg platform, with or without wheels, each (new equipment) | | E0118RR | I.C. | Crutch substitute, lower leg platform, with or without wheels, each (rental) | | E0118UE | I.C. | Crutch substitute, lower leg platform, with or without wheels, each (used durable medical equipment) | | Walkers | | | | E0130NU | 45.33 | Walker, rigid (pickup), adjustable or fixed height (new equipment) | | E0130RR | 7.70 | Walker, rigid (pickup), adjustable or fixed height (rental) | | E0130UD | AAC+30% | Walker, rigid (pickup), adjustable or fixed height (bariatric equipment) | | E0130UE | 34.01 | Walker, rigid (pickup), adjustable or fixed height (used durable medical equipment) | | E0135NU | 52.16 | Walker, folding (pickup), adjustable or fixed height (new equipment) | | E0135RR | 7.76 | Walker, folding (pickup), adjustable or fixed height (rental) | | E0135UD | AAC+30% | Walker, folding (pickup), adjustable or fixed height (bariatric equipment) | | E0135UE | 39.71 | Walker, folding (pickup), adjustable or fixed height (used durable medical equipment) | | E0140KH | 26.10 | Walker with trunk support, adjustable or fixed height, any type (capped rental) | | E0140KI | 26.10 | Walker with trunk support, adjustable or fixed height, any type (capped rental) | | E0140KJ | 19.58 | Walker with trunk support, adjustable or fixed height, any type (capped rental) | | E0140NU | 260.87 | Walker with trunk support, adjustable or fixed height, any type (new equipment) | | E0140UC | AAC+30% | Walker with trunk support, adjustable or fixed height, any type (pediatric specialized rehabilitation equipment) | | E0140UD | AAC+30% | Walker with trunk support, adjustable or fixed height, any type (bariatric equipment) | | E0140UE | 195.65 | Walker with trunk support, adjustable or fixed height, any type (used durable medical equipment) | | E0141NU | 76.41 | Walker, rigid, wheeled, adjustable or fixed height (new equipment) | | E0141RR | 10.73 | Walker, rigid, wheeled, adjustable or fixed height (rental) | | E0141UC | AAC+30% | Walker, rigid, wheeled, adjustable or fixed height (pediatric specialized rehabilitation equipment) | | E0141UD | AAC+30% | Walker, rigid, wheeled, adjustable or fixed height (bariatric equipment) | | E0141UE | 57.31 | Walker, rigid, wheeled, adjustable or fixed height (used durable medical equipment) | | E0143NU | 71.87 | Walker, folding, wheeled, adjustable or fixed height (new equipment) | | E0143RR | 9.75 | Walker, folding, wheeled, adjustable or fixed height (rental) | | E0143UC | AAC+30% | Walker, folding, wheeled, adjustable or fixed height (pediatric specialized rehabilitation equipment) | | E0143UD | AAC+30% | Walker, folding, wheeled, adjustable or fixed height (bariatric equipment) | | E0143UE | 53.82 | Walker, folding, wheeled, adjustable or fixed height (used durable medical equipment) | | E0144KH | 23.70 | Walker enclosed, four sided framed, rigid or folding, wheeled, with posterior seat (capped rental) | | E0144KI | 23.70 | Walker enclosed, four sided framed, rigid or folding, wheeled, with posterior seat (capped rental) | | E0144KJ | 17.77 | Walker enclosed, four sided framed, rigid or folding, wheeled, with posterior seat (capped rental) | | E0144NU | 236.98 | Walker, enclosed, four sided framed, rigid or folding, wheeled, with posterior seat (new equipment) | | E0144UC | AAC+30% | Walker enclosed, four sided framed, rigid or folding, wheeled, with posterior seat (pediatric specialized rehabilitation equipment) | | E0144UD | AAC+30% | Walker enclosed, four sided framed, rigid or folding, wheeled, with posterior seat (bariatric equipment) | | E0144UE | 177.74 | Walker enclosed, four sided framed, rigid or folding, wheeled, with posterior seat (used durable medical equipment) | | E0147NU | 392.85 | Walker, heavy duty, multiple breaking system, variable wheel resistance (new equipment) | | E0147RR | 39.29 | Walker, heavy duty, multiple breaking system, variable wheel resistance walker (rental) | | E0147UD | AAC+30% | Walker, heavy duty, multiple breaking system, variable wheel resistance walker (bariatric equipment) | | E0147UE | 294.64 | Walker, heavy duty, multiple breaking system, variable wheel resistance walker (used durable medical equipment) | | E0148NU | 85.87 | Walker, heavy duty, without wheels, rigid or folding, any type, each (new equipment) | | E0148RR | 8.59 | Walker, heavy duty, without wheels, rigid or folding, any type, each (rental) | | E0148UD | AAC+30% | Walker, heavy duty, without wheels, rigid or folding, any type, each (bariatric equipment) | | E0148UE | 64.40 | Walker, heavy duty, without wheels, rigid or folding, any type, each (used durable medical equipment) | | E0149KH | 13.97 | Walker, heavy duty, wheeled, rigid or folding, any type (capped rental) | | E0149KI | 13.97 | Walker, heavy duty, wheeled, rigid or folding, any type (capped rental) | | E0149KJ | 10.47 | Walker, heavy duty, wheeled, rigid or folding, any type (capped rental) | | E0149NU | 139.62 | Walker, heavy duty, wheeled, rigid or folding, any type (new equipment) | | E0149UD | AAC+30% | Walker, heavy duty, wheeled, rigid or folding, any type (bariatric equipment) | | E0149UE | 104.71 | Walker, heavy duty, wheeled, rigid or folding, any type (used durable medical equipment) | | Attachments | | | | E0153NU | 55.42 | Platform attachment, forearm crutch, each (new equipment) | | E0153RR | 6.26 | Platform attachment, forearm crutch, each (rental) | | E0153UC | AAC+30% | Platform attachment, forearm crutch, each (pediatric specialized rehabilitation equipment) | | E0153UD | AAC+30% | Platform attachment, forearm crutch, each | | E0153UE | 41.56 | Platform attachment, forearm crutch, each (used durable medical equipment) | | E0154NU | 44.47 | Platform attachment, walker, each (new equipment) | | E0154RR | 4.74 | Platform attachment, walker, each (rental) | | E0154UC | AAC+30% | Platform attachment, walker, each (pediatric specialized rehabilitation equipment) | | E0154UD | AAC+30% | Platform attachment, walker, each (bariatric equipment) | | E0154UE | 33.35 | Platform attachment, walker, each (used durable medical equipment) | | E0155NU | 20.60 | Wheel attachment, rigid pick-up walker, per pair (new equipment) | | E0155RR | 2.34 | Wheel attachment, rigid pick-up walker, per pair (rental) | | E0155UD | AAC+30% | Wheel attachment, rigid pick-up walker, per pair (bariatric equipment) | | E0155UE | 15.61 | Wheel attachment, rigid pick-up walker, per pair (used durable medical equipment) | | E0156NU | 17.03 | Seat attachment, walker (new equipment) | | E0156RR | 2.01 | Seat attachment, walker (rental) | | E0156UD | AAC+30% | Seat attachment, walker (bariatric equipment) | | E0156UE | 12.78 | Seat attachment, walker (used durable medical equipment) | | E0157NU | 57.04 | Crutch attachment, walker, each (new equipment) | | E0157RR | 6.03 | Crutch attachment, walker, each (rental) | | E0157UE | 42.78 | Crutch attachment, walker, each (used durable medical equipment) | | E0158NU | 21.43 | Leg extensions for walker, per set of four (4) (new equipment) | | E0158RR | 2.28 | Leg extensions for walker, per set of four (4) (rental) | | E0158UD | AAC+30% | Leg extensions for walker, per set of four (4) (bariatric equipment) | | E0158UE | 16.07 | Leg extensions for walker, per set of four (4) (used durable medical equipment) | | E0159NU | 12.72 | Brake attachment for wheeled walker, replacement, each (new equipment) | | E0159RR | 1.28 | Brake attachment for wheeled walker, replacement, each (rental) | | E0159UD | AAC+30% | Brake attachment for wheeled walker, replacement, each (bariatric equipment) | | E0159UE | 9.55 | Brake attachment for wheeled walker, replacement, each (used durable medical equipment) | | Commodes | | | | E0160NU | 27.36 | Sitz type bath or equipment, portable, used with or without commode (new equipment) | | E0160RR | 3.04 | Sitz type bath or equipment, portable, used with or without commode (rental) | | E0160UE | 20.51 | Sitz type bath or equipment, portable, used with or without commode (used durable medical equipment) | | E0161NU | 20.94 | Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s (new equipment) | | E0161RR | 2.76 | Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s (rental) | | E0161UE | 15.68 | Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s (used durable medical equipment) | | E0162NU | 136.92 | Sitz bath chair (new equipment) | | E0162RR | 14.36 | Sitz bath chair (rental) | | E0162UE | 106.17 | Sitz bath chair (used durable medical equipment) | | E0163NU | 77.89 | Commode chair, mobile or stationary, with fixed arms (new equipment) | | E0163RR | 12.74 | Commode chair, mobile or stationary, with fixed arms (rental) | | E0163UD | AAC+30% | Commode chair, mobile or stationary, with fixed arms (bariatric equipment) | | E0163UE | 58.41 | Commode chair, mobile or stationary, with fixed arms (used durable medical equipment) | | E0165KH | 13.34 | 4 Commode chair, mobile or stationary, with detachable arms (capped rental) | | E0165KI | 13.34 | 4 Commode chair, mobile or stationary, with detachable arms (capped rental) | | E0165KJ | 10.00 | Commode chair, mobile or stationary, with detachable arms (capped rental) | | E0165NU | 133.37 | Commode chair, mobile or stationary, with detachable arms (new equipment purchase) | | E0165UD | AAC+30% | Commode chair, mobile or stationary, with detachable arms (bariatric equipment) | | E0165UE | 100.02 | Commode chair, mobile or stationary, with detachable arms (used durable medical equipment purchase) | | E0167NU | 10.20 | Pail or pan for use with commode chair, replacement only (new equipment) | | E0167RR | 0.95 | Pail or pan for use with commode chair, replacement only (rental) | | E0167UD | AAC+30% | Pail or pan for use with commode chair, replacement only (bariatric equipment) | | E0167UE | 7.68 | Pail or pan for use with commode chair, replacement only (used durable medical equipment) | | E0168NU | 129.25 | Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each (new equipment) | | E0168RR | 12.95 | Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each (rental) | | E0168UE | 96.93 | Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each (used durable medical equipment) | | E0170KH | 147.71 | Commode chair with integrated seat lift mechanism, electric, any type (capped rental) | | E0170KI | 147.71 | Commode chair with integrated seat lift mechanism, electric, any type (capped rental) | | E0170KJ | 110.78 | Commode chair with integrated seat lift mechanism, electric, any type (capped rental) | | E0170NU | 1,477.13 | Commode chair with integrated seat lift mechanism, electric, any type (new equipment purchase) | | E0170UD | AAC+30% | Commode chair with integrated seat lift mechanism, electric, any type (bariatric equipment) | | E0170UE | 1,107.85 | Commode chair with integrated seat lift mechanism, electric, any type | | E0171KH | 26.48 | Commode chair with integrated seat lift mechanism, non-electric, any type (capped rental) | | E0171KI | 26.48 | Commode chair with integrated seat lift mechanism, non-electric, any type (capped rental) | | E0171KJ | 19.86 | Commode chair with integrated seat lift mechanism, non-electric, any type (capped rental) | | E0171NU | 264.78 | Commode chair with integrated seat lift mechanism, non-electric, any type (new equipment purchase) | | E0171UD | AAC+30% | Commode chair with integrated seat lift mechanism, non-electric, any type (bariatric equipment) | | E0171UE | 198.58 | Commode chair with integrated seat lift mechanism, non-electric, any type (used durable medical equipment) | | E0172 | AAC+30% | Seat lift mechanism placed over or on top of toilet, any type | | E0175NU | 61.06 | Foot rest, for use with commode chair, each (new equipment) | | E0175RR | 6.12 | Foot rest, for use with commode chair, each (rental) | | E0175UE | 45.81 | Foot rest, for use with commode chair, each (used durable medical equipment) | | Decubitis Care Equipment | | | | E0181KH | 20.81 | Powered pressure reducing mattress overlay/pad, alternating with pump, includes heavy duty (capped rental) | | E0181KI | 20.81 | Powered pressure reducing mattress overlay/pad, alternating with pump, includes heavy duty (capped rental) | | E0181KJ | 15.61 | Powered pressure reducing mattress overlay/pad, alternating with pump, includes heavy duty (capped rental) | | E0181NU | 208.08 | Powered pressure reducing mattress overlay/pad, alternating with pump, includes heavy duty (new equipment purchase) | | E0181UE | 156.06 | Powered pressure reducing mattress overlay/pad, alternating with pump, includes heavy duty (used durable medical equipment purchase) | | E0182KH | 18.79 | Pump for alternating pressure pad, for replacement only (capped rental) | | E0182KI | 18.79 | Pump for alternating pressure pad, for replacement only (capped rental) | | E0182KJ | 14.10 | Pump for alternating pressure pad, for replacement only (capped rental) | | E0182NU | 187.94 | Pump for alternating pressure pad, for replacement only (new equipment purchase) | | E0182UE | 140.95 | Pump for alternating pressure pad, for replacement only (used durable medical equipment purchase) | | E0184NU | 165.32 | Dry pressure mattress (new equipment) | | E0184RR | 18.56 | Dry pressure mattress (rental) | | E0184UE | 125.54 | Dry pressure mattress (used durable medical equipment) | | E0185NU | 238.83 | Gel or gel-like pressure pad for mattress, standard mattress length and width | | E0185RR | 29.97 | Gel or gel-like pressure pad for mattress, standard mattress length and width | | E0185UE | 181.76 | Gel or gel-like pressure pad for mattress, standard mattress length and width | | E0186KH | 16.21 | Air pressure mattress (capped rental) | | E0186KI | 16.21 | Air pressure mattress (capped rental) | | E0186KJ | 12.16 | Air pressure mattress (capped rental) | | E0186NU | 162.10 | Air pressure mattress (new equipment purchase) | | E0186UE | 121.57 | Air pressure mattress (used durable medical equipment) | | E0187KH | 18.03 | Water pressure mattress (capped rental) | | E0187KI | 18.03 | Water pressure mattress (capped rental) | | E0187KJ | 13.52 | Water pressure mattress (capped rental) | | E0187NU | 180.29 | Water pressure mattress (new equipment purchase) | | E0187UE | 135.21 | Water pressure mattress (used durable medical equipment purchase) | | E0188NU | 21.07 | Synthetic sheepskin pad (new equipment) | | E0188RR | 2.30 | Synthetic sheepskin pad (rental) | | E0188UE | 15.81 | Synthetic sheepskin pad (used durable medical equipment) | | E0189NU | 45.24 | Lambswool sheepskin pad, any size (new equipment) | | E0189RR | 4.58 | Lambswool sheepskin pad, any size (rental) | | E0189UE | 33.93 | Lambswool sheepskin pad, any size (used durable medical equipment) | | E0190NU | AAC+30% | Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories (new equipment) | | E0190RR | I.C. | Positioning cushion/pillow/wedge, any shape or size includes all components and accessories (rental) | | E0190UE | I.C. | Positioning cushion/pillow/wedge, any shape or size includes all components and accessories (used durable medical equipment) | | E0191NU | 9.39 | Heel or elbow protector, each (new equipment) | | E0191RR | 0.97 | Heel or elbow protector, each (rental) | | E0191UE | 7.00 | Heel or elbow protector, each (used durable medical equipment) | | E0193KH | 625.46 | Powered air flotation bed (low air loss therapy) (capped rental) | | E0193KI | 625.46 | Powered air flotation bed (low air loss therapy) (capped rental) | | E0193KJ | 469.09 | Powered air flotation bed (low air loss therapy) (capped rental) | | E0194KH | 3,058.05 | Air fluidized bed (capped rental) | | E0194KI | 3,058.05 | Air fluidized bed (capped rental) | | E0194KJ | 2,293.53 | Air fluidized bed (capped rental) | | E0196KH | 25.95 | Gel pressure mattress (capped rental) | | E0196KI | 25.95 | Gel pressure mattress (capped rental) | | E0196KJ | 19.46 | Gel pressure mattress (capped rental) | | E0196NU | 259.51 | Gel pressure mattress (new equipment purchase) | | E0196UE | 194.63 | Gel pressure mattress (used durable medical equipment purchase) | | E0197KH | 19.78 | Air pressure pad for mattress, standard mattress length and width (capped rental) | | E0197KI | 19.78 | Air pressure pad for mattress, standard mattress length and width (capped rental) | | E0197KJ | 14.83 | Air pressure pad for mattress, standard mattress length and width (capped rental) | | E0197NU | 164.20 | Air pressure pad for mattress, standard mattress length and width (new equipment) | | E0197UE | 134.52 | Air pressure pad for mattress, standard mattress length and width (used durable medical equipment) | | E0198KH | 17.71 | Water pressure pad for mattress, standard mattress length and width (capped rental) | | E0198KI | 17.71 | Water pressure pad for mattress, standard mattress length and width (capped rental) | | E0198KJ | 13.28 | Water pressure pad for mattress, standard mattress length and width (capped rental) | | E0198NU | 177.06 | Water pressure pad for mattress, standard mattress length and width | | E0198UE | 132.80 | Water pressure pad for mattress, standard mattress length and width | | E0199NU | 25.67 | Dry pressure pad for mattress, standard mattress length and width | | E0199RR | 2.57 | Dry pressure pad for mattress, standard mattress length and width | | E0199UE | 19.24 | Dry pressure pad for mattress, standard mattress length and width | | Heat/Cold Application | | | | E0200NU | 63.33 | Heat lamp, without stand (table model), includes bulb, or infrared element | | E0200RR | 8.60 | Heat lamp, without stand (table model), includes bulb, or infrared element | | E0200UE | 47.52 | Heat lamp, without stand (table model), includes bulb, or infrared element | | E0202RR | 125.00 | Phototherapy (bilirubin) light with photometer (per episode) | | E0203 | AAC+30% | Therapeutic lightbox, minimum 10,000 lux, table top model | | E0205NU | 155.01 | Heat lamp, with stand, includes bulb, or infrared element (new equipment) | | E0205RR | 17.05 | Heat lamp, with stand, includes bulb, or infrared element (rental) | | E0205UE | 116.25 | Heat lamp, with stand, includes bulb, or infrared element (used durable medical equipment) | | E0210NU | 30.68 | Electric heat pad, standard (new equipment) | | E0210RR | 2.50 | Electric heat pad, standard (rental) | | E0210UE | 23.00 | Electric heat pad, standard (used durable medical equipment) | | E0215NU | 56.58 | Electric heat pad, moist (new equipment) | | E0215RR | 5.92 | Electric heat pad, moist (rental) | | E0215UE | 42.45 | Electric heat pad, moist (used durable medical equipment) | | E0217NU | 466.53 | Water circulating heat pad with pump (new equipment) | | E0217RR | 51.94 | Water circulating heat pad with pump (rental) | | E0217UE | 349.87 | Water circulating heat pad with pump (used durable medical equipment) | | E0218 | AAC+30% | Fluid circulating cold pad with pump, any type | | E0221 | 1,690.77 | Infrared heating pad system | | E0225NU | 310.42 | Hydrocollator unit, includes pads (new equipment) | | E0225RR | 30.60 | Hydrocollator unit, includes pads (rental) | | E0225UE | 232.82 | Hydrocollator unit, includes pads (used durable medical equipment) | | E0231 | AAC+30% | Non-contact wound warming device (temperature control unit, AC adapter and power cord) for use with warming card and wound cover | | E0232 | AAC+30% | Warming card for use with the non contact wound warming device and non contact wound warming wound cover | | E0235KH | 14.82 | Paraffin bath unit, portable (see medical supply code A4265 for paraffin) (capped rental) | | E0235KI | 14.82 | Paraffin bath unit, portable (see medical supply code A4265 for paraffin) (capped rental) | | E0235KJ | 11.11 | Paraffin bath unit, portable (see medical supply code A4265 for paraffin) (capped rental) | | E0235NU | 148.16 | Paraffin bath unit, portable (see medical supply code A4265 for paraffin) (new equipment purchase) | | E0235UE | 111.12 | Paraffin bath unit, portable (see medical supply code A4265 for paraffin) (used durable medical equipment) | | E0236KH | 41.57 | Pump for water circulating pad (capped rental) | | E0236KI | 41.57 | Pump for water circulating pad (capped rental) | | E0236KJ | 31.18 | Pump for water circulating pad (capped rental) | | E0236NU | 415.74 | Pump for water circulating pad (new equipment purchase) | | E0236UE | 311.80 | Pump for water circulating pad (used durable medical equipment purchase) | | E0239NU | 422.70 | Hydrocollator unit, portable (new equipment) | | E0239RR | 42.28 | Hydrocollator unit, portable (rental) | | E0239UE | 317.03 | Hydrocollator unit, portable (used durable medical equipment) | | Bath and Toilet Aids | | | | E0240NU | AAC+30% | Bath/shower chair, with or without wheels, any size (new equipment) | | E0240RR | I.C. | Bath/shower chair, with or without wheels, any size (rental) | | E0240UE | I.C. | Bath/shower chair, with or without wheels, any size (used durable medical equipment) | | E0241 | 32.36 | Bath tub wall rail, each | | E0242 | 69.79 | Bath tub rail, floor base | | E0243 | 38.14 | Toilet rail, each | | E0244 | 60.76 | Raised toilet seat | | E0244UD | AAC+30% | Raised toilet seat (bariatric equipment) | | E0245 | 42.37 | Tub stool or bench | | E0245UD | AAC+30% | Tub stool or bench (bariatric equipment) | | E0246 | 99.65 | Transfer tub rail attachment | | E0247NU | AAC+30% | Transfer bench, for tub or toilet with or without commode opening (new equipment) | | E0247RR | I.C. | Transfer bench, for tub or toilet with or without commode opening (rental) | | E0247UE | I.C. | Transfer bench, for tub or toilet with or without commode opening (used durable medical equipment) | | E0248NU | AAC+30% | Transfer bench, heavy duty, for tub or toilet with or without commode opening (new equipment) | | E0248RR | I.C. | Transfer bench, heavy duty, for tub or toilet with or without commode opening (rental) | | E0248UE | I.C. | Transfer bench, heavy duty, for tub or toilet with or without commode opening (used durable medical equipment) | | E0249NU | 93.60 | Pad for water circulating heat unit (new equipment) | | E0249RR | 10.29 | Pad for water circulating heat unit (rental) | | E0249UE | 70.20 | Pad for water circulating heat unit (used durable medical equipment) | | Hospital Beds and Accessories | | | | E0250KH | 67.97 | Hospital bed, fixed height, with any type side rails, with mattress (capped rental) | | E0250KI | 67.97 | Hospital bed, fixed height, with any type side rails, with mattress (capped rental) | | E0250KJ | 50.97 | Hospital bed, fixed height, with any type side rails, with mattress (capped rental) | | E0250NU | 679.66 | Hospital bed, fixed height, with any type side rails, with mattress (new equipment purchase) | | E0250RB | AAC+30% | Hospital bed, fixed height, with any type side rails, with mattress (replacement of a part of DME furnished as part of a repair) | | E0250UE | 509.75 | Hospital bed, fixed height, with any type side rails, with mattress (used durable medical equipment purchase) | | E0251KH | 52.92 | Hospital bed, fixed height, with any type side rails, without mattress (capped rental) | | E0251KI | 52.92 | Hospital bed, fixed height, with any type side rails, without mattress (capped rental) | | E0251KJ | 39.69 | Hospital bed, fixed height, with any type side rails, without mattress (capped rental) | | E0251NU | 529.21 | Hospital bed, fixed height, with any type side rails, without mattress (new equipment purchase) | | E0251RB | AAC+30% | Hospital bed, fixed height, with any type side rails, without mattress (replacement of a part of DME furnished as part of a repair) | | E0251UE | 396.91 | Hospital bed, fixed height, with any type side rails, without mattress (used durable medical equipment purchase) | | E0255KH | 79.03 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress (capped rental) | | E0255KI | 79.03 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress (capped rental) | | E0255KJ | 59.27 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress (capped rental) | | E0255NU | 790.33 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress (new equipment purchase) | | E0255RB | AAC+30% | Hospital bed, variable height, hi-lo, with any type side rails, with mattress (replacement of a part of DME furnished as part of a repair) | | E0255UE | 592.75 | Hospital bed, variable height, hi-lo, with any type side rails, with mattress (used durable medical equipment purchase) | | E0256KH | 66.78 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress (capped rental) | | E0256KI | 66.78 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress (capped rental) | | E0256KJ | 50.08 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress (capped rental) | | E0256NU | 585.31 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress (new equipment purchase) | | E0256RB | AAC+30% | Hospital bed, variable height, hi-lo, with any type side rails, without mattress (replacement of a part of a DME furnished as part of a repair) | | E0256UE | 438.98 | Hospital bed, variable height, hi-lo, with any type side rails, without mattress (used durable medical equipment purchase) | | E0260KH | 89.03 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (capped rental) | | E0260KI | 89.03 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (capped rental) | | E0260KJ | 66.77 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (capped rental) | | E0260NU | 890.29 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (new equipment purchase) | | E0260RB | AAC+30% | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (replacement of a part of a DME furnished as part of a repair) | | E0260UE | 667.72 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress (used durable medical equipment purchase) | | E0261KH | 87.11 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress (capped rental) | | E0261KI | 87.11 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress (capped rental) | | E0261KJ | 65.33 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress (capped rental) | | E0261NU | 871.08 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress (new equipment purchase) | | E0261RB | AAC+30% | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress | | E0261UE | 653.31 | Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress (used durable medical equipment purchase) | | E0265KH | 138.78 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress (capped rental) | | E0265KI | 138.78 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress (capped rental) | | E0265KJ | 104.08 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress (capped rental) | | E0265NU | 1,387.80 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress (new equipment purchase) | | E0265RB | AAC+30% | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress (replacement of a part of a DME furnished as part of a repair) | | E0265UE | 1,040.85 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress (used durable medical equipment purchase) | | E0266KH | 122.24 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress (capped rental) | | E0266KI | 122.24 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress (capped rental) | | E0266KJ | 91.68 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress (capped rental) | | E0266NU | 1,222.39 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress (new equipment purchase) | | E0266RB | AAC+30% | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress (replacement of a part of a DME furnished as part of a repair) | | E0266UE | 916.79 | Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress (used durable medical equipment) | | E0270 | AAC+30% | Hospital bed, institutional type includes: oscillating, circulating and Stryker frame, with mattress | | E0271NU | 142.77 | Mattress, innerspring (new equipment) | | E0271RR | 14.63 | Mattress, innerspring (rental) | | E0271UE | 109.88 | Mattress, innerspring (used durable medical equipment) | | E0272NU | 140.42 | Mattress, foam rubber (new equipment) | | E0272RR | 14.41 | Mattress, foam rubber (rental) | | E0272UE | 105.03 | Mattress, foam rubber (used durable medical equipment) | | E0273 | 44.73 | Bed board | | E0274NU | 60.99 | Over-bed table (new equipment) | | E0274RR | 6.10 | Over-bed table (rental) | | E0274UE | 45.74 | Over-bed table (used durable medical equipment) | | E0275NU | 13.06 | Bed pan, standard, metal or plastic (new equipment) | | E0275RR | 1.31 | Bed pan, standard, metal or plastic (rental) | | E0275UE | 9.81 | Bed pan, standard, metal or plastic (used durable medical equipment) | | E0276NU | 10.57 | Bed pan, fracture, metal or plastic (new equipment) | | E0276RR | 1.24 | Bed pan, fracture, metal or plastic (rental) | | E0276UE | 8.14 | Bed pan, fracture, metal or plastic (used durable medical equipment) | | E0277KH | 391.46 | Powered pressure-reducing air mattress (capped rental) | | E0277KI | 391.46 | Powered pressure-reducing air mattress (capped rental) | | E0277KJ | 293.59 | Powered pressure-reducing air mattress (capped rental) | | E0277NU | 3,914.59 | Powered pressure-reducing air mattress (new equipment purchase) | | E0277UE | 2,935.94 | Powered pressure-reducing air mattress (used durable medical equipment purchase) | | E0280NU | 26.72 | Bed cradle, any type (new equipment) | | E0280RR | 2.67 | Bed cradle, any type (rental) | | E0280UE | 20.04 | Bed cradle, any type (used durable medical equipment) | | E0290KH | 53.72 | Hospital bed, fixed height, without side rails, with mattress (capped rental) | | E0290KI | 53.72 | Hospital bed, fixed height, without side rails, with mattress (capped rental) | | E0290KJ | 40.29 | Hospital bed, fixed height, without side rails, with mattress (capped rental) | | E0290NU | 537.20 | Hospital bed, fixed height, without side rails, with mattress (new equipment purchase) | | E0290RB | AAC+30% | Hospital bed, fixed height, without side rails, with mattress (replacement of a part of a DME furnished as part of a repair) | | E0290UE | 402.90 | Hospital bed, fixed height, without side rails, with mattress (used durable medical equipment purchase) | | E0291KH | 39.20 | Hospital bed, fixed height, without side rails, without mattress (capped rental) | | E0291KI | 39.20 | Hospital bed, fixed height, without side rails, without mattress (capped rental) | | E0291KJ | 29.40 | Hospital bed, fixed height, without side rails, without mattress (capped rental) | | E0291NU | 392.02 | Hospital bed, fixed height, without side rails, without mattress (new equipment purchase) | | E0291RB | AAC+30% | Hospital bed, fixed height, without side rails, without mattress (replacement of a part of a DME furnished as part of a repair) | | E0291UE | 294.02 | Hospital bed, fixed height, without side rails, without mattress (used durable medical equipment purchase) | | E0292KH | 60.36 | Hospital bed, variable height, hi-lo, without side rails, with mattress (capped rental) | | E0292KI | 60.36 | Hospital bed, variable height, hi-lo, without side rails, with mattress (capped rental) | | E0292KJ | 45.27 | Hospital bed, variable height, hi-lo, without side rails, with mattress (capped rental) | | E0292NU | 603.59 | Hospital bed, variable height, hi-lo, without side rails, with mattress (new equipment purchase) | | E0292RB | AAC+30% | Hospital bed, variable height, hi-lo, without side rails, with mattress (replacement of a part of a DME furnished as part of a repair) | | E0292UE | 452.69 | Hospital bed, variable height, hi-lo, without side rails, with mattress (used durable medical equipment purchase) | | E0293 | AAC+30% | Hospital bed, variable height, hi-lo, without side rails, without mattress (replacement of a part of a DME furnished as part of a repair) | | E0293KH | 51.37 | Hospital bed, variable height, hi-lo, without side rails, without mattress (capped rental) | | E0293KI | 51.37 | Hospital bed, variable height, hi-lo, without side rails, without mattress (capped rental) | | E0293KJ | 38.52 | Hospital bed, variable height, hi-lo, without side rails, without mattress (capped rental) | | E0293NU | 513.66 | Hospital bed, variable height, hi-lo, without side rails, without mattress (new equipment purchase) | | E0293UE | 385.24 | Hospital bed, variable height, hi-lo, without side rails, without mattress (used durable medical equipment purchase) | | E0294KH | 86.05 | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress (capped rental) | | E0294KI | 86.05 | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress (capped rental) | | E0294KJ | 64.53 | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress (capped rental) | | E0294NU | 860.46 | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress (new equipment purchase) | | E0294RB | AAC+30% | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress (replacement of a part of a DME furnished as part of a repair) | | E0294UE | 645.34 | Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress (used durable medical equipment purchase) | | E0295KH | 83.79 | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress (capped rental) | | E0295KI | 83.79 | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress (capped rental) | | E0295KJ | 62.84 | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress (capped rental) | | E0295NU | 837.93 | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress (new equipment purchase) | | E0295RB | AAC+30% | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress (replacement of a part of a DME furnished as part of a repair) | | E0295UE | 628.45 | Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress (used durable medical equipment purchase) | | E0296KH | 132.98 | Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress (capped rental) | | E0296KI | 132.98 | Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress (capped rental) | | E0296KJ | 99.74 | Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress (capped rental) | | E0296NU | 1,329.83 | Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress (new equipment purchase) | | E0296RB | AAC+30% | Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress (replacement of a part of a DME furnished as part of a repair) | | E0296UE | 997.37 | Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress (used durable medical equipment purchase) | | E0297KH | 96.78 | Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress (capped rental) | | E0297KI | 96.78 | Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress (capped rental) | | E0297KJ | 72.59 | Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress (capped rental) | | E0297NU | 967.81 | Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress (new equipment purchase) | | E0297RB | AAC+30% | Hospital bed, total electric (head, foot and height adjustments), without side rails, without (replacement of a part of a DME furnished as part of a repair) | | E0297UE | 725.86 | Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress (used durable medical equipment purchase) | | E0300KH | I.C. | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure (capped rental) | | E0300KI | I.C. | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure (capped rental) | | E0300KJ | I.C. | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure (capped rental) | | E0300NU | AAC+30% | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure (new equipment) | | E0300RB | AAC+30% | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure (replacement of a part of a DME furnished as part of a repair) | | E0300UE | I.C. | Pediatric crib, hospital grade, fully enclosed, with or without top enclosure (used durable medical equipment) | | E0301KH | 185.10 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress (capped rental) | | E0301KI | 186.10 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress (capped rental) | | E0301KJ | 138.82 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress (capped rental) | | E0301NU | 1,850.96 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress (new equipment purchase) | | E0301RB | AAC+30% | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress (replacement of a part of a DME furnished as part of a repair) | | E0301UE | 1,388.22 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, without mattress (used durable medical equipment) | | E0302KH | 499.90 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress (capped rental) | | E0302KI | 499.90 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress (capped rental) | | E0302KJ | 374.93 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress (capped rental) | | E0302NU | 4,999.02 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress (new equipment purchase) | | E0302RB | AAC+30% | Hospital bed, heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress (replacement of a part of a DME furnished as part of a repair) | | E0302UE | 3,749.27 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress (used durable medical equipment) | | E0303KH | 204.80 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress (capped rental) | | E0303KI | 204.80 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress (capped rental) | | E0303KJ | 153.60 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress (capped rental) | | E0303NU | 2,047.99 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress (new equipment purchase) | | E0303RB | AAC+30% | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress (replacement of a part of a DME furnished as part of a repair) | | E0303UE | 1,535.99 | Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress (used durable medical equipment purchase) | | E0304KH | 535.17 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress (capped rental) | | E0304KI | 536.17 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress (capped rental) | | E0304KJ | 401.38 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress (capped rental) | | E0304NU | 5,351.69 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress (new equipment purchase) | | E0304RB | AAC+30% | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress (replacement of a part of a DME furnished as part of a repair) | | E0304UE | 4,013.76 | Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress (used durable medical equipment purchase) (used durable medical equipment purchase) | | E0305KH | 12.27 | Bed side rails, half length (capped rental) | | E0305KI | 12.27 | Bed side rails, half length (capped rental) | | E0305KJ | 9.20 | Bed side rails, half length (capped rental) | | E0305NU | 122.66 | Bed side rails, half length (new equipment purchase) | | E0305UE | 91.99 | Bed side rails, half length (used durable medical equipment purchase) | | E0310NU | 128.61 | Bed side rails, full length (new equipment) | | E0310RR | 14.59 | Bed side rails, full length (rental) | | E0310UE | 96.46 | Bed side rails, full length (used durable medical equipment) | | E0315NU | 74.32 | Bed accessory: board, table, or support device, any type (new equipment) | | E0315RR | 7.43 | Bed accessory: board, table, or support device, any type (rental) | | E0315UE | 55.74 | Bed accessory: board, table, or support device, any type (used durable medical equipment) | | E0316KH | 157.89 | Safety enclosure frame/canopy for use with hospital bed, any type (capped rental) | | E0316KI | 157.89 | Safety enclosure frame/canopy for use with hospital bed, any type (capped rental) | | E0316KJ | 118.42 | Safety enclosure frame/canopy for use with hospital bed, any type (capped rental) | | E0316NU | 1,578.88 | Safety enclosure frame/canopy for use with hospital bed, any type (new equipment purchase) | | E0316UE | 1,184.16 | Safety enclosure frame/canopy for use with hospital bed, any type (used durable medical equipment purchase) | | E0325NU | 8.69 | Urinal; male, jug-type, any material (new equipment) | | E0325RR | 1.11 | Urinal; male, jug-type, any material (rental) | | E0325UE | 6.09 | Urinal; male, jug-type, any material (used durable medical equipment) | | E0326NU | 9.17 | Urinal; female, jug-type, any material (new equipment) | | E0326RR | 0.99 | Urinal; female, jug-type, any material (rental) | | E0326UE | 6.89 | Urinal; female, jug-type, any material (used durable medical equipment) | | E0328 | AAC+30% | Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress | | E0328UA | AAC+30% | Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress (Medicaid level of care ten, use for adults for safety beds) | | E0329 | AAC+30% | Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress | | E0329UA | AAC+30% | Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress (Medicaid level of care ten, use for adults for safety beds) | | E0350 | AAC+30% | Control unit for electronic bowel irrigation/evacuation system | | E0352 | AAC+20% | Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system | | E0370 | AAC+20% | Air pressure elevator for heel | | E0371KH | 286.02 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width (capped rental) | | E0371KI | 286.02 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width (capped rental) | | E0371KJ | 214.51 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width (capped rental) | | E0371NU | 2,860.17 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width (new equipment purchase) | | E0371UE | 2,145.12 | Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width (used durable medical equipment purchase) | | E0372KH | 315.53 | Powered air overlay for mattress, standard mattress length and width (capped rental) | | E0372KI | 315.53 | Powered air overlay for mattress, standard mattress length and width (capped rental) | | E0372KJ | 236.65 | Powered air overlay for mattress, standard mattress length and width (capped rental) | | E0372NU | 3,155.29 | Powered air overlay for mattress, standard mattress length and width (new equipment purchase) | | E0372UE | 2,366.46 | Powered air overlay for mattress, standard mattress length and width (used durable medical equipment purchase) | | E0373KH | 376.82 | Nonpowered advanced pressure reducing mattress (capped rental) | | E0373KI | 376.82 | Nonpowered advanced pressure reducing mattress (capped rental) | | E0373KJ | 282.62 | Nonpowered advanced pressure reducing mattress (capped rental) | | E0373NU | 3,768.22 | Nonpowered advanced pressure reducing mattress (new equipment purchase) | | E0373UE | 2,826.17 | Nonpowered advanced pressure reducing mattress (used durable medical equipment purchase) | | Oxygen and Related Respiratory Equipment | | | | E0424RR | 119.48 | Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing (rental) | | E0425 | AAC+30% | Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing | | E0430 | AAC+30% | Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing | | E0431RR | 21.34 | Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (rental) | | E0433RR | 40.26 | Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge | | E0434RR | 21.34 | Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing (rental) | | E0435 | AAC+30% | Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor | | E0439QF | 119.48 | Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing (rental) (prescribed amount of oxygen exceeds 4 LPM and portable oxygen is prescribed) | | E0439QG | 119.48 | Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing (rental) (prescribed amount of oxygen is greater than 4 LPM) | | E0439RR | 119.48 | Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing (rental) | | E0440 | AAC+30% | Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing | | E0441 | 58.57 | Oxygen contents, gaseous (for use with owned gaseous stationary systems or when both a stationary and portable gaseous system are owned), one month's supply = 1 unit | | E0442 | 58.57 | Oxygen contents, liquid (for use with owned liquid stationary systems or when both a stationary and portable liquid system are owned), one month's supply = 1 unit | | E0443RR | 57.33 | Portable oxygen contents, gaseous (for use only with portable gaseous systems when no stationary gas or liquid system is used), one month's supply = 1 unit (rental) | | E0444RR | 57.33 | Portable oxygen contents, liquid (for use only with portable liquid systems when no stationary gas or liquid system is used), one month's supply = 1 unit (rental) | | E0445NU | 856.30 | Oximeter device for measuring blood oxygen levels non-invasively (new equipment) | | E0445RR | 85.63 | Oximeter device for measuring blood oxygen levels non-invasively (rental) | | E0445UE | 642.23 | Oximeter device for measuring blood oxygen levels non-invasively (used durable medical equipment) | | E0446 | AAC+30% | Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories | | E0447 | 56.94 | Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (LPM) | | E0455 | AAC+20% | Oxygen tent, excluding croup or pediatric tents | | E0457NU | 548.45 | Chest shell (cuirass) (new equipment) | | E0457RR | 54.84 | Chest shell (cuirass) (rental) | | E0457UE | 411.31 | Chest shell (cuirass) (used durable medical equipment) | | E0459KH | 45.42 | Chest wrap (capped rental) | | E0459KI | 45.42 | Chest wrap (capped rental) | | E0459KJ | 34.06 | Chest wrap (capped rental) | | E0459NU | 476.86 | Chest wrap (new equipment purchase) | | E0459UE | 357.65 | Chest wrap (used durable medical equipment purchase) | | E0462KH | 232.76 | Rocking bed with or without side rails (capped rental) | | E0462KI | 232.76 | Rocking bed with or without side rails (capped rental) | | E0462KJ | 174.57 | Rocking bed with or without side rails (capped rental) | | E0462NU | 2,327.56 | Rocking bed with or without side rails (new equipment purchase) | | E0462UE | 1,745.67 | Rocking bed with or without side rails (used durable medical equipment purchase) | | E0465RR | 896.95 | Home ventilator, any type, used with invasive interface ( e.g. , tracheostomy tube) (rental, months seven and beyond) | | E0465U2 | 1,055.23 | Home ventilator, any type, used with invasive interface ( e.g. , tracheostomy tube) (rental, first six months) | | E0466RR | 896.95 | Home ventilator, any type, used with non-invasive interface ( e.g. , mask, chest shell) (rental, months seven and beyond) | | E0466U2 | 1,055.23 | Home ventilator, any type, used with non-invasive interface ( e.g. , mask, chest shell) (rental, first six months) | | E0467RR | 1,091.46 | Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions (rental, months seven and beyond) | | E0467U2 | 1,284.07 | Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions (rental, first six months) | | E0470KH | 146.83 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0470KI | 146.83 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0470KJ | 110.12 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0470NU | 1,468.29 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (new equipment) (humidifier not included) | | E0470UE | 1,101.22 | Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (used durable medical equipment purchase) (humidifier not included) | | E0471KH | 392.40 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0471KI | 392.40 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0471KJ | 294.30 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0471NU | 3,924.03 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (new equipment purchase) (humidifier not included) | | E0471UE | 2,943.02 | Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g. , nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (used durable medical equipment purchase) (humidifier not included) | | E0472KH | 431.07 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g. , tracheostomy tube (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0472KI | 431.07 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g. , tracheostomy tube (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0472KJ | 323.30 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g. , tracheostomy tube (intermittent assist device with continuous positive airway pressure device) (capped rental) (humidifier not included) | | E0472NU | 4,310.69 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g. , tracheostomy tube (intermittent assist device with continuous positive airway pressure device) (new equipment purchase) (humidifier not included) | | E0472UE | 3,233.02 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g. , tracheostomy tube (intermittent assist device with continuous positive airway pressure device) (used durable medical equipment purchase) (humidifier not included) | | E0480KH | 41.29 | Percussor, electric or pneumatic, home model (capped rental) | | E0480KI | 41.29 | Percussor, electric or pneumatic, home model (capped rental) | | E0480KJ | 30.97 | Percussor, electric or pneumatic, home model (capped rental) | | E0480NU | 412.93 | Percussor, electric or pneumatic, home model (new equipment purchase) | | E0480UE | 309.70 | Percussor, electric or pneumatic, home model (used durable medical equipment purchase) | | E0481 | AAC+30% | Intrapulmonary percussive ventilation system and related accessories | | E0482KH | 404.09 | Cough stimulating device, alternating positive and negative airway pressure (capped rental) | | E0482KI | 404.09 | Cough stimulating device, alternating positive and negative airway pressure (capped rental) | | E0482KJ | 303.07 | Cough stimulating device, alternating positive and negative airway pressure (capped rental) | | E0482NU | 4,040.90 | Cough stimulating device, alternating positive and negative airway pressure (new equipment purchase) | | E0482UE | 3,030.68 | Cough stimulating device, alternating positive and negative airway pressure (used durable medical equipment purchase) | | E0483KH | 999.01 | High frequency chest wall oscillation air-pulse generator system, includes all accessories and supplies, each (capped rental) | | E0483KI | 999.01 | High frequency chest wall oscillation air-pulse generator system, includes all accessories and supplies, each (capped rental) | | E0483KJ | 749.25 | High frequency chest wall oscillation air-pulse generator system, includes all accessories and supplies, each (capped rental) | | E0483NU | 9,990.05 | High frequency chest wall oscillation air-pulse generator system, includes all accessories and supplies, each (new equipment) | | E0483UE | 7,492.54 | High frequency chest wall oscillation air-pulse generator system, includes all accessories and supplies, each (used durable medical equipment) | | E0484NU | 34.71 | Oscillatory positive expiratory pressure device, non-electric, any type, each (new equipment) | | E0484RR | 3.46 | Oscillatory positive expiratory pressure device, non-electric, any type, each (rental) | | E0484UE | 26.04 | Oscillatory positive expiratory pressure device, non-electric, any type, each (used durable medical equipment) | | E0485NU | AAC+30% | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment (new equipment) | | E0485RR | I.C. | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment (rental) | | E0485UE | I.C. | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment (used durable medical equipment) | | E0486NU | $1881.22 | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment (new equipment) | | E0487 | AAC+30% | Spirometer, electronic, includes all accessories | | IPPB Machines | | | | E0500RR | 103.14 | IPPB machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source (rental) | | Humidifiers/Compressors/Nebulizers | | | | E0550KH | 40.04 | Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery (capped rental) | | E0550KI | 40.04 | Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery (capped rental) | | E0550KJ | 30.03 | Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery (capped rental) | | E0550NU | 400.44 | Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery (new equipment purchase) | | E0550UE | 300.33 | Humidifier, durable for extensive supplemental humidification during IPPB treatments or oxygen delivery (used durable medical equipment purchase) | | E0555 | AAC+30% | Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter | | E0560NU | 138.91 | Humidifier, durable for supplemental humidification during IPPB treatment or oxygen delivery (new equipment) | | E0560RR | 16.28 | Humidifier, durable for supplemental humidification during IPPB treatment or oxygen delivery (rental) | | E0560UE | 104.18 | Humidifier, durable for supplemental humidification during IPPB treatment or oxygen delivery (used durable medical equipment) | | E0561NU | 73.66 | Humidifier, non-heated, used with positive airway pressure device (new equipment) | | E0561RR | 7.36 | Humidifier, non-heated, used with positive airway pressure device (rental) | | E0561UE | 55.24 | Humidifier, non-heated, used with positive airway pressure device (used durable medical equipment) | | E0562NU | 189.83 | Humidifier, heated, used with positive airway pressure device (new equipment) | | E0562RR | 18.97 | Humidifier, heated, used with positive airway pressure device (rental) | | E0562UE | 142.37 | Humidifier, heated, used with positive airway pressure device (used durable medical equipment) | | E0565KH | 50.84 | Compressor, air power source for equipment which is not selfcontained or cylinder driven (capped rental) | | E0565KI | 50.84 | Compressor, air power source for equipment which is not selfcontained or cylinder driven (capped rental) | | E0565KJ | 38.13 | Compressor, air power source for equipment which is not self- contained or cylinder driven (capped rental) | | E0565NU | 508.39 | Compressor, air power source for equipment which is not self- contained or cylinder driven (new equipment purchase) | | E0565UE | 381.29 | Compressor, air power source for equipment which is not self- contained or cylinder driven (used durable medical equipment | | E0570KH | 12.32 | Nebulizer, with compressor (capped rental) | | E0570KI | 12.32 | Nebulizer, with compressor (capped rental) | | E0570KJ | 9.24 | Nebulizer, with compressor (capped rental) | | E0570NU | 123.17 | Nebulizer, with compressor (new equipment purchase) | | E0570UE | 92.37 | Nebulizer, with compressor (used durable medical equipment purchase) | | E0572KH | 34.83 | Aerosol compressor, adjustable pressure, light duty for intermittent use (capped rental) | | E0572KI | 34.83 | Aerosol compressor, adjustable pressure, light duty for intermittent use (capped rental) | | E0572KJ | 26.12 | Aerosol compressor, adjustable pressure, light duty for intermittent use (capped rental) | | E0572NU | 348.33 | Aerosol compressor, adjustable pressure, light duty for intermittent use (new equipment purchase) | | E0572UE | 261.25 | Aerosol compressor, adjustable pressure, light duty for intermittent use (used durable medical equipment purchase) | | E0574KH | 37.83 | Ultrasonic/electronic aerosol generator with small volume nebulizer (capped rental) | | E0574KI | 37.83 | Ultrasonic/electronic aerosol generator with small volume nebulizer (capped rental) | | E0574KJ | 28.38 | Ultrasonic/electronic aerosol generator with small volume nebulizer (capped rental) | | E0574NU | 378.34 | Ultrasonic/electronic aerosol generator with small volume nebulizer (new equipment purchase) | | E0574UE | 283.75 | Ultrasonic/electronic aerosol generator with small volume nebulizer (used durable medical equipment purchase) | | E0575KH | 96.58 | Nebulizer, ultrasonic, large volume (capped rental rental) | | E0575KI | 96.58 | Nebulizer, ultrasonic, large volume (capped rental rental) | | E0575KJ | 72.43 | Nebulizer, ultrasonic, large volume (capped rental rental) | | E0575NU | 965.77 | Nebulizer, ultrasonic, large volume (new equipment purchase) | | E0575UE | 724.33 | Nebulizer, ultrasonic, large volume (used durable medical equipment purchase) | | E0580NU | 107.29 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter (new equipment) | | E0580RR | 10.74 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter (rental) | | E0580UE | 80.46 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter (used durable medical equipment) | | E0585KH | 28.01 | Nebulizer, with compressor and heater (capped rental) | | E0585KI | 28.01 | Nebulizer, with compressor and heater (capped rental) | | E0585KJ | 21.01 | Nebulizer, with compressor and heater (capped rental) | | E0585NU | 280.08 | Nebulizer, with compressor and heater (new equipment purchase) | | E0585UE | 210.06 | Nebulizer, with compressor and heater (used durable medical equipment purchase) | | Pumps and Vaporizers | | | | E0600KH | 43.03 | Respiratory suction pump, home model, portable or stationary, electric (capped rental) | | E0600KI | 43.03 | Respiratory suction pump, home model, portable or stationary, electric (capped rental) | | E0600KJ | 32.27 | Respiratory suction pump, home model, portable or stationary, electric (capped rental) | | E0600NU | 430.27 | Respiratory suction pump, home model, portable or stationary, electric (new equipment purchase) | | E0600UE | 322.70 | Respiratory suction pump, home model, portable or stationary, electric (used durable medical equipment) | | E0601KH | 60.50 | Continuous positive airway pressure (CPAP) device (capped rental) (humidifier not included) | | E0601KI | 60.50 | Continuous positive airway pressure (CPAP) device (capped rental) (humidifier not included) | | E0601KJ | 45.38 | Continuous positive airway pressure (CPAP) device (capped rental) (humidifier not included) | | E0601NU | 605.03 | Continuous positive airway pressure (CPAP) device (new equipment purchase) (humidifier not included) | | E0601UE | 453.77 | Continuous positive airway pressure (CPAP) device (used durable medical equipment purchase) (humidifier not included) | | E0602NU | 27.74 | Breast pump, manual, any type (new equipment) | | E0602RR | 2.79 | Breast pump, manual, any type (rental) | | E0602UE | 20.81 | Breast pump, manual, any type (used durable medical equipment) | | E0603NU | 213.20 | Breast pump, electric (AC and/or DC), any type | | E0604RR | 70.00 | Breast pump, hospital grade, electric (AC and /or DC), any type (rental) | | E0605NU | 24.84 | Vaporizer, room type (new equipment) | | E0605RR | 2.50 | Vaporizer, room type (rental) | | E0605UE | 18.65 | Vaporizer, room type (used durable medical equipment) | | E0606KH | 21.57 | Postural drainage board (capped rental) | | E0606KI | 21.57 | Postural drainage board (capped rental) | | E0606KJ | 16.18 | Postural drainage board (capped rental) | | E0606NU | 215.73 | Postural drainage board (new equipment purchase) | | E0606UE | 161.80 | Postural drainage board (used durable medical equipment purchase) | | Monitoring Devices | | | | E0607NU | 62.78 | Home blood glucose monitor (new equipment) | | E0607RR | 6.27 | Home blood glucose monitor (rental) | | E0607UE | 47.08 | Home blood glucose monitor (used durable medical equipment) | | E0610NU | 189.98 | Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) (new equipment) | | E0610RR | 20.03 | Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) (rental) | | E0610UE | 142.50 | Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) (used durable medical equipment) | | E0615NU | 449.92 | Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems (new equipment) | | E0615RR | 54.97 | Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems (rental) | | E0615UE | 337.47 | Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems (used durable medical equipment) | | E0616 | AAC+30% | Implantable cardiac event recorder with memory, activator and programmer | | E0617KH | 285.70 | External defibrillator with integrated electrocardiogram analysis (capped rental) | | E0617KHKF | 317.22 | External defibrillator with integrated electrocardiogram analysis (capped rental) (FDA class III device) | | E0617KI | 285.70 | External defibrillator with integrated electrocardiogram analysis (capped rental) | | E0617KIKF | 317.22 | External defibrillator with integrated electrocardiogram analysis (capped rental) (FDA class III device) | | E0617KJ | 214.28 | External defibrillator with integrated electrocardiogram analysis (capped rental) | | E0617KJKF | 237.92 | External defibrillator with integrated electrocardiogram analysis (capped rental) (FDA class III device) | | E0617NU | 2,857.02 | External defibrillator with integrated electrocardiogram analysis (new equipment purchase) | | E0617NUKF | 3,172.20 | External defibrillator with integrated electrocardiogram analysis (new equipment purchase) (FDA class III device) | | E0617UE | 2,142.77 | External defibrillator with integrated electrocardiogram analysis (used durable medical equipment purchase) | | E0617UEKF | 2,379.15 | External defibrillator with integrated electrocardiogram analysis (used durable medical equipment purchase) (FDA class III device) | | E0618KH | 263.46 | Apnea monitor, without recording feature (capped rental) | | E0618KI | 263.46 | Apnea monitor, without recording feature (capped rental) | | E0618KJ | 195.45 | Apnea monitor, without recording feature (capped rental) | | E0619KH | 224.28 | Apnea monitor, with recording feature (capped rental) | | E0619KI | 224.28 | Apnea monitor, with recording feature (capped rental) | | E0619KJ | 168.21 | Apnea monitor, with recording feature (capped rental) | | E0620KH | 81.27 | Skin piercing device for collection of capillary blood, laser, each (capped rental) | | E0620KI | 81.27 | Skin piercing device for collection of capillary blood, laser, each (capped rental) | | E0620KJ | 60.95 | Skin piercing device for collection of capillary blood, laser, each (capped rental) | | E0620NU | 821.53 | Skin piercing device for collection of capillary blood, laser, each (new equipment) | | E0620UE | 616.15 | Skin piercing device for collection of capillary blood, laser, each (used durable medical equipment) | | Patient Lifts | | | | E0621NU | 80.25 | Sling or seat, patient lift, canvas or nylon (new equipment) | | E0621RR | 7.85 | Sling or seat, patient lift, canvas or nylon (rental) | | E0621UE | 60.36 | Sling or seat, patient lift, canvas or nylon (used durable medical equipment) | | E0625NU | AAC+30% | Patient lift, bathroom or toilet, not otherwise classified (new equipment) | | E0625RR | I.C. | Patient lift, bathroom or toilet, not otherwise classified (rental) | | E0625UE | I.C. | Patient lift, bathroom or toilet, not otherwise classified (used durable medical equipment) | | E0627NU | 278.85 | Seat lift mechanism, electric, any type (new equipment) | | E0627RR | 27.89 | Seat lift mechanism, electric, any type (rental) | | E0627UE | 209.14 | Seat lift mechanism, electric, any type (used durable medical equipment) | | E0629NU | 279.55 | Seat lift mechanism, non-electric, any type (new equipment) | | E0629RR | 27.96 | Seat lift mechanism, non-electric, any type (rental) | | E0629UE | 209.65 | Seat lift mechanism, non-electric, any type (used durable medical equipment) | | E0630KH | 77.45 | Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) (capped rental) | | E0630KI | 77.45 | Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) (capped rental) | | E0630KJ | 58.09 | Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) (capped rental) | | E0630NU | 774.52 | Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) (new equipment purchase) | | E0630RB | AAC+30% | Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) (replacement of a part of a DME furnished as part of a repair) | | E0630UE | 580.89 | Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) (used durable medical equipment purchase) | | E0635KH | 106.66 | Patient lift, electric with seat or sling (capped rental) | | E0635KI | 106.66 | Patient lift, electric with seat or sling (capped rental) | | E0635KJ | 79.99 | Patient lift, electric with seat or sling (capped rental) | | E0635NU | 1,066.58 | Patient lift, electric with seat or sling (new equipment purchase) | | E0635RB | AAC+30% | Patient lift, electric with seat or sling (replacement of a part of a DME furnished as part of a repair) | | E0635U1 | AAC+35% | Patient lift, electric with seat or sling (nonstandard lift involving customization, special orders, or special sizing requirements) | | E0635UE | 799.94 | Patient lift, electric with seat or sling (used durable medical equipment purchase) | | E0636KH | 1,107.26 | Multipositional patient support system, with integrated lift, patient accessible controls (capped rental) | | E0636KI | 1,107.26 | Multipositional patient support system, with integrated lift, patient accessible controls (capped rental) | | E0636KJ | 830.45 | Multipositional patient support system, with integrated lift, patient accessible controls (capped rental) | | E0636NU | 11,072.60 | Multipositional patient support system, with integrated lift, patient accessible controls (new equipment purchase) | | E0636RB | AAC+30% | Multipositional patient support system, with integrated lift, patient accessible controls (replacement of a part of a DME furnished as part of a repair) | | E0636UE | 8,304.45 | Multipositional patient support system, with integrated lift, patient accessible controls (used durable medical equipment purchase) | | E0637NU | 2,104.97 | Combination sit to stand system, any size including pediatric, with seat lift feature, with or without wheels (new equipment) | | E0637RR | 210.51 | Combination sit to stand system, any size including pediatric, with seat lift feature, with or without wheels (rental) | | E0637UE | 1,578.72 | Combination sit to stand system, any size including pediatric, with seat lift feature, with or without wheels (used durable medical equipment) | | E0638NU | 853.57 | Standing frame system, one position ( e.g. , upright, supine or prone stander), any size including pediatric, with or without wheels (new equipment) | | E0638RR | 85.36 | Standing frame system, one position ( e.g. , upright, supine or prone stander), any size, with or without wheels (rental) | | E0638UE | 640.18 | Standing frame system, one position ( e.g. , upright, supine or prone stander), any size including pediatric, with or without wheels (used durable medical equipment) | | E0639KH | 123.32 | Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories) (capped rental) | | E0639KI | 123.32 | Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories) (capped rental) | | E0639KJ | 92.49 | Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories) (capped rental) | | E0639NU | AAC+35% | Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories) (new equipment) | | E0639RB | AAC+35% | Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories (replacement of a part of DME furnished as part of a repair) | | E0639UE | 924.90 | Patient lift, moveable from room to room with disassembly and reassembly, includes all components/accessories) (used durable medical equipment purchase) | | E0640KH | 123.32 | Patient lift, fixed system, includes all components/accessories (capped rental) | | E0640KI | 123.32 | Patient lift, fixed system, includes all components/accessories (capped rental) | | E0640KJ | 92.49 | Patient lift, fixed system, includes all components/accessories (capped rental) | | E0640NU | AAC+35% | Patient lift, fixed system, includes all components/accessories (new equipment) | | E0640RB | AAC+35% | Patient lift, fixed system, includes all components/accessories (replacement of a part of DME furnished as part of a repair) | | E0640UE | 924.90 | Patient lift, fixed system, includes all components/accessories (used durable medical equipment purchase) | | E0641 | AAC+30% | Standing frame system, multi-position ( e.g. three-way stander), any size including pediatric, with or without wheels | | E0642 | AAC+30% | Standing frame system, mobile (dynamic stander), any size including pediatric | | Compression Devices | | | | E0650NU | 676.77 | Pneumatic compressor, non-segmental home model (new equipment) | | E0650RR | 83.51 | Pneumatic compressor, non-segmental home model (rental) | | E0650UE | 507.58 | Pneumatic compressor, non-segmental home model (used durable medical equipment) | | E0651NU | 733.56 | Pneumatic compressor, segmental home model without calibrated gradient pressure (new equipment purchase) | | E0651RR | 86.90 | Pneumatic compressor, segmental home model without calibrated gradient pressure (rental) | | E0651UE | 550.19 | Pneumatic compressor, segmental home model without calibrated gradient pressure (used durable medical equipment) | | E0652NU | 4,981.67 | Pneumatic compressor, segmental home model with calibrated gradient pressure (new equipment) | | E0652RR | 418.49 | Pneumatic compressor, segmental home model with calibrated gradient pressure (rental) | | E0652UE | 3,732.92 | Pneumatic compressor, segmental home model with calibrated gradient pressure (used durable medical equipment) | | E0655NU | 95.61 | Non-segmental pneumatic appliance for use with pneumatic compressor, half arm (new equipment) | | E0655RR | 10.13 | Non-segmental pneumatic appliance for use with pneumatic compressor, half arm (rental) | | E0655UE | 71.71 | Non-segmental pneumatic appliance for use with pneumatic compressor, half arm (used durable medical equipment) | | E0656KH | 54.30 | Segmental pneumatic appliance for use with pneumatic compressor, trunk (rental) | | E0656KI | 54.30 | Segmental pneumatic appliance for use with pneumatic compressor, trunk (rental) | | E0656KJ | 40.72 | Segmental pneumatic appliance for use with pneumatic compressor, trunk (rental) | | E0656NU | 542.98 | Segmental pneumatic appliance for use with pneumatic compressor, trunk (new equipment) | | E0656UE | 407.24 | Segmental pneumatic appliance for use with pneumatic compressor, trunk (used durable medical equipment) | | E0657KH | 51.01 | Segmental pneumatic appliance for use with pneumatic compressor, chest (capped rental) | | E0657KI | 51.01 | Segmental pneumatic appliance for use with pneumatic compressor, chest (capped rental) | | E0657KJ | 38.26 | Segmental pneumatic appliance for use with pneumatic compressor, chest (capped rental) | | E0657NU | 510.09 | Segmental pneumatic appliance for use with pneumatic compressor, chest (new equipment) | | E0657UE | 382.57 | Segmental pneumatic appliance for use with pneumatic compressor, chest (used durable medical equipment) | | E0660NU | 148.69 | Non-segmental pneumatic appliance for use with pneumatic compressor, full leg (new equipment) | | E0660RR | 13.28 | Non-segmental pneumatic appliance for use with pneumatic compressor, full leg (rental) | | E0660UE | 111.53 | Non-segmental pneumatic appliance for use with pneumatic compressor, full leg (used durable medical equipment) | | E0665NU | 128.73 | Non-segmental pneumatic appliance for use with pneumatic compressor, full arm (new equipment) | | E0665RR | 12.42 | Non-segmental pneumatic appliance for use with pneumatic compressor, full arm (rental) | | E0665UE | 96.66 | Non-segmental pneumatic appliance for use with pneumatic compressor, full arm (used durable medical equipment) | | E0666NU | 129.77 | Non-segmental pneumatic appliance for use with pneumatic compressor, half leg (new equipment) | | E0666RR | 13.37 | Non-segmental pneumatic appliance for use with pneumatic compressor, half leg (rental) | | E0666UE | 97.34 | Non-segmental pneumatic appliance for use with pneumatic compressor, half leg (used durable medical equipment) | | E0667NU | 258.60 | Segmental pneumatic appliance for use with pneumatic compressor, full leg | | E0667RR | 34.36 | Segmental pneumatic appliance for use with pneumatic compressor, full leg | | E0667UE | 193.95 | Segmental pneumatic appliance for use with pneumatic compressor, full leg | | E0668NU | 415.23 | Segmental pneumatic appliance for use with pneumatic compressor, full arm (new equipment) | | E0668RR | 40.98 | Segmental pneumatic appliance for use with pneumatic compressor, full arm (rental) | | E0668UE | 311.43 | Segmental pneumatic appliance for use with pneumatic compressor, full arm (used durable rental equipment) | | E0669NU | 163.57 | Segmental pneumatic appliance for use with pneumatic compressor, half leg (new equipment) | | E0669RR | 16.36 | Segmental pneumatic appliance for use with pneumatic compressor, half leg (rental) | | E0669UE | 122.68 | Segmental pneumatic appliance for use with pneumatic compressor, half leg (used durable rental equipment) | | E0670NU | 1,004.05 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, two full legs and trunk (new equipment purchase) | | E0670RR | 126.45 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, two full legs and trunk (rental) | | E0670UE | 753.00 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, two full legs and trunk (used durable medical equipment purchase) | | E0671NU | 390.30 | Segmental gradient pressure pneumatic appliance, full leg (new equipment) | | E0671RR | 39.05 | Segmental gradient pressure pneumatic appliance, full leg (rental) | | E0671UE | 292.71 | Segmental gradient pressure pneumatic appliance, full leg (used durable rental equipment) | | E0672NU | 303.25 | Segmental gradient pressure pneumatic appliance, full arm (new equipment) | | E0672RR | 30.34 | Segmental gradient pressure pneumatic appliance, full arm (rental) | | E0672UE | 227.46 | Segmental gradient pressure pneumatic appliance, full arm (used durable medical equipment) | | E0673NU | 251.99 | Segmental gradient pressure pneumatic appliance, half leg (new equipment) | | E0673RR | 25.20 | Segmental gradient pressure pneumatic appliance, half leg (rental) | | E0673UE | 189.02 | Segmental gradient pressure pneumatic appliance, half leg (used durable medical equipment) | | E0675KH | 361.35 | Pneumatic compression device, high pressure, rapid inflation/ deflation cycle, for arterial insufficiency (unilateral or bilateral system) (capped rental) | | E0675KI | 361.35 | Pneumatic compression device, high pressure, rapid inflation/ deflation cycle, for arterial insufficiency (unilateral or bilateral system) (capped rental) | | E0675KJ | 271.01 | Pneumatic compression device, high pressure, rapid inflation/ | | E0675NU | 3,613.52 | Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system) (new equipment purchase) | | E0675UE | 2,710.14 | Pneumatic compression device, high pressure, rapid inflation/deflation cycle, for arterial insufficiency (unilateral or bilateral system) (used durable medical equipment purchase) | | E0676 | AAC+30% | Intermittent limb compression device (includes all accessories), not otherwise specified | | Ultraviolet Light | | | | E0691NU | 844.39 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection; treatment area two square feet or less (new equipment) | | E0691RR | 84.43 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection; treatment area two square feet or less (rental) | | E0691UE | 633.29 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection; treatment area two square feet or less (used durable medical equipment purchase) | | E0692NU | 1,060.32 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, four foot panel (new equipment) | | E0692RR | 106.02 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, four foot panel (rental) | | E0692UE | 795.23 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, four foot panel (used durable medical equipment) | | E0693NU | 1,307.08 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, six foot panel (new equipment) | | E0693RR | 130.71 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, six foot panel (rental) | | E0693UE | 980.31 | Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye protection, six foot panel (used durable medical equipment) | | E0694NU | 4,160.29 | Ultraviolet multidirectional light therapy system in six foot cabinet, includes bulbs/lamps, timer and eye protection (new equipment) | | E0694RR | 416.02 | Ultraviolet multidirectional light therapy system in six foot cabinet, includes bulbs/lamps, timer and eye protection (rental) | | E0694UE | 3,120.24 | Ultraviolet multidirectional light therapy system in six foot cabinet, includes bulbs/lamps, timer and eye protection (used durable medical equipment) | | Safety Equipment | | | | E0700 | AAC+30% | Safety equipment ( e.g. , belt, harness or vest) | | E0705NU | 45.79 | Transfer device, any type, each (new equipment) | | E0705NUKU | 61.76 | Transfer device, any type, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0705RR | 4.63 | Transfer device, any type, each (rental) | | E0705RRKU | 6.31 | Transfer device, any type, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0705UE | 33.97 | Transfer device, any type, each (used durable medical equipment) | | E0705UEKU | 45.43 | Transfer device, any type, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | Restraints | | | | E0710 | AAC+20% | Restraints, any type (body, chest, wrist or ankle) | | Nerve Stimulators and Devices | | | | E0720NU | 268.58 | Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation (new equipment) | | E0730NU | 251.77 | Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation (new equipment) | | E0731NU | 245.57 | Form fitting conductive garment for delivery of TENS or NMES (with conductive fibers separated from the patient's skin by layers of fabric) (new equipment) | | E0740KH | 49.15 | Non-implanted, pelvic floor stimulator, monitor, sensor and/or trainer (capped rental) | | E0740KI | 49.15 | Non-implanted, pelvic floor stimulator, monitor, sensor and/or trainer (capped rental) | | E0740KJ | 36.86 | Non-implanted pelvic floor stimulator, monitor, sensor and/or trainer capped rental) | | E0740NU | 491.47 | Non-implanted pelvic floor stimulator, complete system (new equipment) | | E0740UE | 368.60 | Non-implanted pelvic floor stimulator, complete system (used durable medical equipment) | | E0744KH | 86.05 | Neuromuscular stimulator for scoliosis (capped rental) | | E0744KI | 86.05 | Neuromuscular stimulator for scoliosis (capped rental) | | E0744KJ | 64.53 | Neuromuscular stimulator for scoliosis (capped rental) | | E0744NU | 860.46 | Neuromuscular stimulator for scoliosis (new equipment purchase) | | E0744UE | 645.35 | Neuromuscular stimulator for scoliosis (new equipment purchase) | | E0745KH | 84.12 | Neuromuscular stimulator, electronic shock unit (capped rental) | | E0745KI | 84.12 | Neuromuscular stimulator, electronic shock unit (capped rental) | | E0745KJ | 63.09 | Neuromuscular stimulator, electronic shock unit (capped rental) | | E0745NU | 841.16 | Neuromuscular stimulator, electronic shock unit (new equipment purchase) | | E0745UE | 630.87 | Neuromuscular stimulator, electronic shock unit (used durable medical equipment purchase) | | E0746 | AAC+30% | Electromyography (EMG), biofeedback device | | E0747NUKF | 3,127.88 | Osteogenesis stimulator, electrical, non-invasive, other than spinal applications (new equipment) (FDA class III device) | | E0747RRKF | 310.82 | Osteogenesis stimulator, electrical, non-invasive, other than spinal applications (rental) (FDA class III device) | | E0747UEKF | 2,323.96 | Osteogenesis stimulator, electrical, non-invasive, other than spinal applications (used durable medical equipment) (FDA class III device) | | E0748NUKF | 3,656.03 | Osteogenesis stimulator, electrical, non-invasive, spinal applications (new equipment) (FDA class III device) | | E0748RRKF | 365.59 | Osteogenesis stimulator, electrical, non-invasive, spinal applications (rental) (FDA class III device) | | E0748UEKF | 2,742.02 | Osteogenesis stimulator, electrical, non-invasive, spinal applications (used durable medical equipment) (FDA class III device) | | E0749KHKF | 267.21 | Osteogenesis stimulator, electrical, surgically implanted (capped rental) (FDA class III device) | | E0749KIKF | 267.21 | Osteogenesis stimulator, electrical, surgically implanted (capped rental) (FDA class III device) | | E0749KJKF | 200.41 | Osteogenesis stimulator, electrical, surgically implanted (capped rental) (FDA class III device) | | E0749NUKF | 2,672.15 | Osteogenesis stimulator, electrical, surgically implanted (new equipment purchase) (FDA class III device) | | E0749UEKF | 2,004.11 | Osteogenesis stimulator, electrical, surgically implanted (used durable medical equipment purchase) (FDA class III device) | | E0755 | AAC+30% | Electronic salivary reflex stimulator (intra-oral/non-invasive) | | E0760NUKF | 3,038.10 | Ostogenesis stimulator, low intensity ultrasound, non-invasive (new equipment) (FDA class III device) | | E0760RRKF | 303.82 | Ostogenesis stimulator, low intensity ultrasound, non-invasive (rental) (FDA class III device) | | E0760UEKF | 2,278.55 | Ostogenesis stimulator, low intensity ultrasound, non-invasive (used durable medical equipment) (FDA class III device) | | E0761 | AAC+30% | Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic energy treatment device | | E0762KH | 87.82 | Transcutaneous electrical joint stimulation device system, includes all accessories (capped rental) | | E0762KI | 87.82 | Transcutaneous electrical joint stimulation device system, includes all accessories (capped rental) | | E0762KJ | 65.87 | Transcutaneous electrical joint stimulation device system, includes all accessories (capped rental) | | E0762NU | 878.22 | Transcutaneous electrical joint stimulation device system, includes all accessories (new equipment) | | E0762UE | 658.67 | Transcutaneous electrical joint stimulation device system, includes all accessories (used durable medical equipment) | | E0764KHKF | 1,039.92 | Functional neuromuscular stimulator, transcutaneous stimulation of muscles of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program (capped rental) (FDA class III device) | | E0764KIKF | 1,039.92 | Functional neuromuscular stimulator, transcutaneous stimulation of muscles of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program (capped rental) (FDA class III device) | | E0764KJKF | 779.93 | Functional neuromuscular stimulator, transcutaneous stimulation of muscles of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program (capped rental) (FDA class III device) | | E0764NUKF | 10,399.16 | Functional neuromuscular stimulator, transcutaneous stimulation of muscles of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program (new equipment) (FDA class III device) | | E0764UEKF | 7,799.37 | Functional neuromuscular stimulator, transcutaneous stimulation of muscles of ambulation with computer control, used for walking by spinal cord injured, entire system, after completion of training program (used durable medical equipment) (FDA class III device) | | E0765NU | 79.06 | FDA approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting (new equipment) | | E0765RR | 7.91 | FDA approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting (rental) | | E0765UE | 59.31 | FDA approved nerve stimulator, with replaceable batteries, for treatment of nausea and vomiting (used durable medical equipment) | | E0766RRKF | 11,643.37 | Electrical stimulation device used for cancer treatment, includes all accessories, any type (rental) (FDA Class III device) | | E0769 | AAC+30% | Electrical stimulation or electromagnetic wound treatment device, not otherwise classified | | E0770NU | AAC+30% | Functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system, not otherwise specified (new equipment) | | Infusion Supplies | | | | E0776NU | 125.81 | IV pole (new equipment) | | E0776NUBA | 68.49 | IV pole (new equipment) (item furnished in conjunction with parenteral enteral nutrition (PEN) services) | | E0776RR | 14.62 | IV pole (rental) | | E0776RRBA | 13.62 | IV pole (rental) (item furnished in conjunction with parenteral enteral nutrition (PEN) services) | | E0776UE | 93.41 | IV pole (used durable medical equipment) | | E0776UEBA | 51.37 | IV pole (used durable medical equipment) (item furnished in conjunction with parenteral enteral nutrition (PEN) services) | | E0779KH | 15.45 | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater (capped rental) | | E0779KI | 15.45 | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater (capped rental) | | E0779KJ | 11.59 | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater (capped rental) | | E0779NU | 154.53 | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater (new equipment purchase) | | E0779UE | 115.90 | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater (used durable medical equipment) | | E0780NU | 9.70 | Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours (new equipment) | | E0781KH | 204.36 | Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient (capped rental) | | E0781KI | 204.36 | Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient (capped rental) | | E0781KJ | 153.27 | Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient (capped rental) | | E0781NU | 2,043.57 | Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient (new equipment purchase) | | E0781UE | 1,532.68 | Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient | | E0782NUKF | 3,429.28 | Infusion pump, implantable, non-programmable (includes all components, e.g. , pump, catheter, connectors, etc.) (new equipment) (FDA class III device) | | E0782RRKF | 342.94 | Infusion pump, implantable, non-programmable (includes all components, e.g. , pump, catheter, connectors, etc.) (rental) (FDA class III device) | | E0782UEKF | 2,571.96 | Infusion pump, implantable, non-programmable (includes all components, e.g. , pump, catheter, connectors, etc.) (used durable medical equipment) (FDA class III device) | | E0783NUKF | 7,693.09 | Infusion pump system, implantable, programmable (includes all components, e.g. , pump, catheter, connectors, etc.) (new equipment) (FDA class III device) | | E0783RRKF | 769.33 | Infusion pump system, implantable, programmable (includes all components, e.g. , pump, catheter, connectors, etc.) (rental) (FDA class III device) | | E0783UEKF | 5,769.83 | Infusion pump system, implantable, programmable (includes all components, e.g. , pump, catheter, connectors, etc.) (used durable medical equipment) (FDA class III device) | | E0784KH | 418.23 | External ambulatory infusion pump, insulin (capped rental) | | E0784KI | 418.23 | External ambulatory infusion pump, insulin (capped rental) | | E0784KJ | 313.67 | External ambulatory infusion pump, insulin (capped rental) | | E0784NU | AAC+30% | External ambulatory infusion pump, insulin (new equipment purchase, Non-Medicare) | | E0784UE | 3,136.73 | External ambulatory infusion pump, insulin (used durable medical equipment) | | E0785KF | 444.01 | Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement (FDA class III device) | | E0786NUKF | 7,233.30 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) (new equipment) (FDA class III device) | | E0786RRKF | 723.32 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) (rental) (FDA class III device) | | E0786UEKF | 5,425.00 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) (used durable medical equipment) (FDA class III device) | | E0787 | I.C. | External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing | | E0791KH | 265.68 | Parenteral infusion pump, stationary, single or multi-channel (capped rental) | | E0791KI | 266.68 | Parenteral infusion pump, stationary, single or multi-channel (capped rental) | | E0791KJ | 199.26 | Parenteral infusion pump, stationary, single or multi-channel (capped rental) | | E0791NU | 2,656.76 | Parenteral infusion pump, stationary, single or multi-channel (new equipment purchase) | | E0791UE | 1,992.57 | Parenteral infusion pump, stationary, single or multi-channel (used durable medical equipment) | | Traction Equipment | | | | E0830NU | AAC+30% | Ambulatory traction device, all types, each | | E0840NU | 68.84 | Traction frame, attached to headboard, cervical traction (new equipment) | | E0840RR | 13.66 | Traction frame, attached to headboard, cervical traction (rental) | | E0840UE | 51.61 | Traction frame, attached to headboard, cervical traction (used durable medical equipment) | | E0849KH | 48.43 | Traction equipment, cervical, freestanding stand/frame, pneumatic, applying traction force to other than mandible (capped rental) | | E0849KI | 48.43 | Traction equipment, cervical, freestanding stand/frame, pneumatic, applying traction force to other than mandible (capped rental) | | E0849KJ | 36.33 | Traction equipment, cervical, freestanding stand/frame, pneumatic, applying traction force to other than mandible (capped rental) | | E0849NU | 484.33 | Traction equipment, cervical, freestanding stand/frame, pneumatic, applying traction force to other than mandible (new equipment) | | E0849UE | 363.25 | Traction equipment, cervical, freestanding stand/frame, pneumatic, applying traction force to other than mandible (used durable medical equipment) | | E0850NU | 98.71 | Traction stand, free standing, cervical traction (new equipment) | | E0850RR | 11.53 | Traction stand, free standing, cervical traction (rental) | | E0850UE | 74.04 | Traction stand, free standing, cervical traction (used durable medical equipment) | | E0855KH | 47.23 | Cervical traction equipment not requiring additional stand or frame (capped rental) | | E0855KI | 47.23 | Cervical traction equipment not requiring additional stand or frame (capped rental) | | E0855KJ | 35.42 | Cervical traction equipment not requiring additional stand or frame (capped rental) | | E0855NU | 472.26 | Cervical traction equipment not requiring additional stand or frame (new equipment) | | E0855UE | 354.20 | Cervical traction equipment not requiring additional stand or frame (used durable medical equipment) | | E0856KH | 14.46 | Cervical traction device, cervical collar with inflatable air bladder (capped rental) | | E0856KI | 14.46 | Cervical traction device, cervical collar with inflatable air bladder (capped rental) | | E0856KJ | 10.85 | Cervical traction device, cervical collar with inflatable air bladder (capped rental) | | E0856NU | 144.59 | Cervical traction device, with inflatable air bladder(s) (new equipment) | | E0856UE | 108.44 | Cervical traction device, with inflatable air bladder(s) (used durable medical equipment) | | E0860NU | 36.21 | Traction equipment, overdoor, cervical (new equipment) | | E0860RR | 6.12 | Traction equipment, overdoor, cervical (rental) | | E0860UE | 27.73 | Traction equipment, overdoor, cervical (used durable medical equipment) | | E0870NU | 109.30 | Traction frame, attached to footboard, extremity traction, ( e.g. , buck's) (new equipment) | | E0870RR | 12.61 | Traction frame, attached to footboard, extremity traction, ( e.g. , buck's) (rental) | | E0870UE | 82.34 | Traction frame, attached to footboard, extremity traction, ( e.g. , buck's) (used durable medical equipment) | | E0880NU | 117.97 | Traction stand, free standing, extremity traction, ( e.g. , buck's) (new equipment) | | E0880RR | 18.52 | Traction stand, free standing, extremity traction, ( e.g. , buck's) (rental) | | E0880UE | 89.29 | Traction stand, free standing, extremity traction, ( e.g. , buck's) (used durable medical equipment) | | E0890NU | 113.14 | Traction frame, attached to footboard, pelvic traction (new equipment) | | E0890RR | 30.86 | Traction frame, attached to footboard, pelvic traction (rental) | | E0890UE | 91.14 | Traction frame, attached to footboard, pelvic traction (used durable medical equipment) | | E0900NU | 120.40 | Traction stand, free standing, pelvic traction, ( e.g. , buck's) (new equipment) | | E0900RR | 25.96 | Traction stand, free standing, pelvic traction, ( e.g. , buck's) (rental) | | E0900UE | 90.33 | Traction stand, free standing, pelvic traction, ( e.g. , buck's) (used durable medical equipment) | | Orthopedic Devices | | | | E0910KH | 13.30 | Trapeze bars, a/k/a patient helper, attached to bed, with grab bar (capped rental) | | E0910KI | 13.30 | Trapeze bars, a/k/a patient helper, attached to bed, with grab bar (capped rental) | | E0910KJ | 9.98 | Trapeze bars, a/k/a patient helper, attached to bed, with grab bar (capped rental) | | E0910NU | 133.03 | Trapeze bars, a/k/a patient helper, attached to bed, with grab bar (new equipment purchase) | | E0910UE | 99.77 | Trapeze bars, a/k/a patient helper, attached to bed, with grab bar (used durable medical equipment purchase) | | E0911KH | 37.63 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed with grab bar (capped rental) | | E0911KI | 37.63 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed with grab bar (capped rental) | | E0911KJ | 28.22 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed with grab bar (capped rental) | | E0911NU | 376.30 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed with grab bar (new equipment purchase) | | E0911UE | 282.23 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed with grab bar (used durable medical equipment purchase) | | E0912KH | 83.56 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar (capped rental) | | E0912KI | 83.56 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar (capped rental) | | E0912KJ | 62.67 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar (capped rental) | | E0912NU | 835.64 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar (new equipment purchase) | | E0912UE | 626.73 | Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar (used durable medical equipment purchase) | | E0920KH | 43.37 | Fracture frame, attached to bed, includes weights (capped rental) | | E0920KI | 43.37 | Fracture frame, attached to bed, includes weights (capped rental) | | E0920KJ | 32.53 | Fracture frame, attached to bed, includes weights (capped rental) | | E0920NU | 433.67 | Fracture frame, attached to bed, includes weights (new equipment purchase) | | E0920UE | 325.25 | Fracture frame, attached to bed, includes weights (used durable medical equipment purchase) | | E0930KH | 42.93 | Fracture frame, free standing, includes weights (capped rental) | | E0930KI | 42.93 | Fracture frame, free standing, includes weights (capped rental) | | E0930KJ | 32.20 | Fracture frame, free standing, includes weights (capped rental) | | E0930NU | 429.25 | Fracture frame, free standing, includes weights (new equipment purchase) | | E0930UE | 321.94 | Fracture frame, free standing, includes weights (used durable medical equipment) | | E0935RR | 21.37 | Continuous passive motion exercise device for use on knee only (daily rental) | | E0936 | AAC+30% | Continuous passive motion exercise device for use other than knee | | E0940KH | 23.36 | Trapeze bar, free standing, complete with grab bar (capped rental) | | E0940KI | 23.36 | Trapeze bar, free standing, complete with grab bar (capped rental) | | E0940KJ | 17.52 | Trapeze bar, free standing, complete with grab bar (capped rental) | | E0940NU | 233.58 | Trapeze bar, free standing, complete with grab bar (new equipment purchase) | | E0940UE | 175.19 | Trapeze bar, free standing, complete with grab bar (used durable medical equipment purchase) | | E0941KH | 34.29 | Gravity assisted traction device, any type (capped rental) | | E0941KI | 34.29 | Gravity assisted traction device, any type (capped rental) | | E0941KJ | 25.72 | Gravity assisted traction device, any type (capped rental) | | E0941NU | 342.89 | Gravity assisted traction device, any type (new equipment purchase) | | E0941UE | 257.17 | Gravity assisted traction device, any type (used durable medical equipment purchase) | | E0942NU | 18.65 | Cervical head harness/halter (new equipment) | | E0942RR | 1.88 | Cervical head harness/halter (rental) | | E0942UE | 13.97 | Cervical head harness/halter (used durable medical equipment) | | E0944NU | 43.10 | Pelvic belt/harness/boot (new equipment) | | E0944RR | 3.73 | Pelvic belt/harness/boot (rental) | | E0944UE | 32.33 | Pelvic belt/harness/boot (used durable medical equipment) | | E0945NU | 41.65 | Extremity belt/harness (new equipment) | | E0945RR | 3.54 | Extremity belt/harness (rental) | | E0945UE | 32.23 | Extremity belt/harness (used durable medical equipment) | | E0946KH | 55.60 | Fracture, frame, dual with cross bars, attached to bed, ( e.g. , balken, 4 poster) (capped rental) | | E0946KI | 55.60 | Fracture, frame, dual with cross bars, attached to bed, ( e.g. , balken, 4 poster) (capped rental) | | E0946KJ | 41.70 | Fracture, frame, dual with cross bars, attached to bed, ( e.g. , balken, 4 poster) (capped rental) | | E0946NU | 555.99 | Fracture, frame, dual with cross bars, attached to bed, ( e.g. , balken, 4 poster) (new equipment purchase) | | E0946UE | 416.99 | Fracture, frame, dual with cross bars, attached to bed, ( e.g. , balken, 4 poster) (used durable medical equipment purchase) | | E0947NU | 569.88 | Fracture frame, attachments for complex pelvic traction (new equipment) | | E0947RR | 59.08 | Fracture frame, attachments for complex pelvic traction (rental) | | E0947UE | 427.40 | Fracture frame, attachments for complex pelvic traction (used durable medical equipment) | | E0948NU | 551.21 | Fracture frame, attachments for complex cervical traction (new equipment) | | E0948RR | 55.10 | Fracture frame, attachments for complex cervical traction | | E0948UE | 388.76 | Fracture frame, attachments for complex cervical traction (used durable medical equipment) | | Wheelchair Accessories (see also K0001-K0109) | | | | E0950NU | 81.53 | Wheelchair accessory, tray, each (new equipment) (standard tray) | | E0950NUKU | 85.71 | Wheelchair accessory, tray, each (new equipment) (standard tray), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0950RR | 8.16 | Wheelchair accessory, tray, each (rental) | | E0950RRKU | 8.59 | Wheelchair accessory, tray, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0950U1 | AAC+35% | Wheelchair accessory, tray, each (nonstandard tray for customized mobility system) | | E0950UE | 61.15 | Wheelchair accessory, tray, each (used durable medical equipment) | | E0950UEKU | 64.29 | Wheelchair accessory, tray, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0951NU | 14.31 | Heel loop/holder, any type, with or without ankle strap, each (new equipment) | | E0951NUKU | 16.56 | Heel loop/holder, any type, with or without ankle strap, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0951RR | 1.55 | Heel loop/holder, any type, with or without ankle strap, each (rental) | | E0951RRKU | 1.89 | Heel loop/holder, any type, with or without ankle strap, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0951UE | 10.73 | Heel loop/holder, any type, with or without ankle strap, each (used durable medical equipment) | | E0951UEKU | 12.42 | Heel loop/holder, any type, with or without ankle strap, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0952NU | 15.72 | Toe loop/holder, any type, each (new equipment) | | E0952NUKU | 16.40 | Toe loop/holder, any type, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0952RR | 1.70 | Toe loop/holder, any type, each (rental) | | E0952RRKU | 1.89 | Toe loop/holder, any type, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0952UE | 11.78 | Toe loop/holder, any type, each (used durable medical equipment) | | E0952UEKU | 12.27 | Toe loop/holder, any type, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0953NU | 71.22 | Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each (new equipment) | | E0953NUKU | 95.62 | Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each (new equipment) (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0953RR | 7.12 | Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each (rental) | | E0953RRKU | 9.56 | Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each (rental) (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0953UE | 53.42 | Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each (used durable medical equipment) | | E0953UEKU | 71.72 | Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each (used durable medical equipment) (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0954NU | 49.86 | Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot (new equipment) | | E0954NUKU | 56.51 | Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot (new equipment) (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0954RR | 4.98 | Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot (rental) | | E0954RRKU | 5.65 | Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot (rental) (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0954UE | 37.40 | Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot (used durable medical equipment) | | E0954UEKU | 42.38 | Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot (used durable medical equipment) (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0955KH | 16.05 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (capped rental) | | E0955KHKU | 19.62 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0955KI | 16.05 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (capped rental) | | E0955KIKU | 19.62 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0955KJ | 12.04 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (capped rental) | | E0955KJKU | 14.72 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0955NU | 160.42 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (new equipment) | | E0955NUKU | 196.20 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0955UE | 120.31 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (used durable medical equipment) | | E0955UEKU | 147.15 | Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0956NU | 86.78 | Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each (new equipment) | | E0956NUKU | 95.62 | Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0956RR | 8.68 | Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each (rental) | | E0956RRKU | 9.56 | Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0956UE | 65.09 | Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each (used durable medical equipment) | | E0956UEKU | 71.72 | Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0957NU | 122.46 | Wheelchair accessory, medial thigh support, any type, including any type mounting hardware (new equipment) | | E0957NUKU | 133.81 | Wheelchair accessory, medial thigh support, any type, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0957RR | 12.25 | Wheelchair accessory, medial thigh support, any type, including any type mounting hardware (rental) | | E0957RRKU | 13.39 | Wheelchair accessory, medial thigh support, any type, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0957UE | 91.85 | Wheelchair accessory, medial thigh support, any type, including any type mounting hardware (used durable medical equipment) | | E0957UEKU | 100.35 | Wheelchair accessory, medial thigh support, any type, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0958KH | 40.92 | Manual wheelchair accessory, one-arm drive attachment, each (capped rental) | | E0958KHKU | 43.08 | Manual wheelchair accessory, one-arm drive attachment, each | | E0958KI | 40.92 | Manual wheelchair accessory, one-arm drive attachment, each (capped rental) | | E0958KIKU | 43.08 | Manual wheelchair accessory, one-arm drive attachment, each | | E0958KJ | 30.69 | Manual wheelchair accessory, one-arm drive attachment, each (capped rental) | | E0958KJKU | 32.31 | Manual wheelchair accessory, one-arm drive attachment, each | | E0958NU | 409.20 | Manual wheelchair accessory, one-arm drive attachment, each (new equipment purchase) | | E0958NUKU | 430.80 | Manual wheelchair accessory, one-arm drive attachment, each | | E0958UE | 306.90 | Manual wheelchair accessory, one-arm drive attachment, each (used durable medical equipment purchase) | | E0958UEKU | 323.10 | Manual wheelchair accessory, one-arm drive attachment, each | | E0959NU | 45.46 | Manual wheelchair accessory, adapter for amputee, each (new equipment) | | E0959NUKU | 51.35 | Manual wheelchair accessory, adapter for amputee, each | | E0959RR | 4.26 | Manual wheelchair accessory, adapter for amputee, each (rental) | | E0959RRKU | 4.54 | Manual wheelchair accessory, adapter for amputee, each | | E0959UE | 34.26 | Manual wheelchair accessory, adapter for amputee, each (used durable medical equipment) | | E0959UEKU | 38.87 | Manual wheelchair accessory, adapter for amputee, each | | E0960NU | 76.13 | Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware, each (new equipment) | | E0960NUKU | 88.26 | Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0960RR | 7.62 | Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware, each (rental) | | E0960RRKU | 8.85 | Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0960UE | 57.11 | Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware, each (used durable medical equipment) | | E0960UEKU | 66.21 | Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0961NU | 25.17 | Manual wheelchair accessory, wheel lock brake extension (handle), each (new equipment) | | E0961NUKU | 34.56 | Manual wheelchair accessory, wheel lock brake extension (handle), each | | E0961RR | 2.33 | Manual wheelchair accessory, wheel lock brake extension (handle), each (rental) | | E0961RRKU | 3.07 | Manual wheelchair accessory, wheel lock brake extension (handle), each | | E0961UE | 13.53 | Manual wheelchair accessory, wheel lock brake extension (handle), each (used durable medical equipment) | | E0961UEKU | 14.65 | Manual wheelchair accessory, wheel lock brake extension (handle), each | | E0966NU | 72.77 | Manual wheelchair accessory, headrest extension, each (new equipment) | | E0966NUKU | 82.91 | Manual wheelchair accessory, headrest extension, each | | E0966RR | 6.99 | Manual wheelchair accessory, headrest extension, each (rental) | | E0966RRKU | 7.69 | Manual wheelchair accessory, headrest extension, each | | E0966UE | 54.58 | Manual wheelchair accessory, headrest extension, each (used durable medical equipment) | | E0966UEKU | 62.18 | Manual wheelchair accessory, headrest extension, each | | E0967NU | 68.93 | Manual wheelchair accessory, hand rim with projections, any type, replacement only, each (new equipment) | | E0967NUKU | 76.30 | Manual wheelchair accessory, hand rim with projections, any type, replacement only, each | | E0967RR | 6.90 | Manual wheelchair accessory, hand rim with projections, any type, replacement only, each (rental) | | E0967RRKU | 7.64 | Manual wheelchair accessory, hand rim with projections, any type, replacement only, each | | E0967UE | 51.69 | Manual wheelchair accessory, hand rim with projections, any type, replacement only, each (used durable medical equipment) | | E0967UEKU | 57.20 | Manual wheelchair accessory, hand rim with projections, any type, replacement only, each | | E0968KH | 18.73 | Commode seat, wheelchair (capped rental) | | E0968KI | 18.73 | Commode seat, wheelchair (capped rental) | | E0968KJ | 14.05 | Commode seat, wheelchair (capped rental) | | E0968NU | 187.30 | Commode seat, wheelchair (new equipment purchase) | | E0968UE | 140.48 | Commode seat, wheelchair (used durable medical equipment purchase) | | E0969NU | 173.16 | Narrowing device, wheelchair (new equipment) | | E0969RR | 14.61 | Narrowing device, wheelchair (rental) | | E0969UE | 129.88 | Narrowing device, wheelchair (used durable medical equipment) | | E0971NU | 39.76 | Manual wheelchair accessory, anti-tipping device, each (new equipment) | | E0971NUKU | 50.40 | Manual wheelchair accessory, anti-tipping device, each | | E0971RR | 3.98 | Manual wheelchair accessory, anti-tipping device, each (rental) | | E0971RRKU | 5.05 | Manual wheelchair accessory, anti-tipping device, each | | E0971UE | 29.83 | Manual wheelchair accessory, anti-tipping device, each (used durable medical equipment) | | E0971UEKU | 37.83 | Manual wheelchair accessory, anti-tipping device, each | | E0973NU | 79.05 | Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each (new equipment) | | E0973NUKU | 111.53 | Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0973RR | 6.86 | Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each (rental) | | E0973RRKU | 9.03 | Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0973UE | 59.29 | Wheelchair accessory, adjustable height detachable armrest, complete assembly, each (used durable medical equipment) | | E0973UEKU | 83.65 | Wheelchair accessory, adjustable height detachable armrest, complete assembly, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0974NU | 76.25 | Manual wheelchair accessory, anti-rollback device, each (new equipment) | | E0974NUKU | 86.04 | Manual wheelchair accessory, anti-rollback device, each | | E0974RR | 7.44 | Manual wheelchair accessory, anti-rollback device, each (rental) | | E0974RRKU | 8.21 | Manual wheelchair accessory, anti-rollback device, each | | E0974UD | AAC+35% | Manual wheelchair accessory, anti-rollback devise, each (bariatric equipment) | | E0974UE | 57.19 | Manual wheelchair accessory, anti-rollback device, each (used durable medical equipment) | | E0974UEKU | 64.53 | Manual wheelchair accessory, anti-rollback device, each | | E0978NU | 31.42 | Wheelchair accessory, positioning belt/safety belt/pelvic strap, each (new equipment) | | E0978NUKU | 41.42 | Wheelchair accessory, positioning belt/safety belt/pelvic strap, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0978RR | 3.15 | Wheelchair accessory, positioning belt/safety belt/pelvic strap, each (rental) | | E0978RRKU | 4.15 | Wheelchair accessory, positioning belt/safety belt/pelvic strap, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0978UE | 23.39 | Wheelchair accessory, positioning belt/safety belt/pelvic strap, each (used durable medical equipment) | | E0978UEKU | 30.71 | Wheelchair accessory, positioning belt/safety belt/pelvic strap, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0980NU | 36.54 | Safety vest, wheelchair (new equipment) | | E0980RR | 3.66 | Safety vest, wheelchair (rental) | | E0980UE | 27.25 | Safety vest, wheelchair (used durable medical equipment) | | E0981NU | 41.68 | Wheelchair accessory, seat upholstery, replacement only, each (new equipment) | | E0981NUKU | 45.74 | Wheelchair accessory, seat upholstery, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0981RR | 3.86 | Wheelchair accessory, seat upholstery, replacement only, each (rental) | | E0981RRKU | 3.95 | Wheelchair accessory, seat upholstery, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0981UC | AAC+35% | Wheelchair accessory, seat upholstery, replacement only, each (pediatric specialized rehabilitation equipment) | | E0981UE | 31.42 | Wheelchair accessory, seat upholstery, replacement only, each (used durable medical equipment) | | E0981UEKU | 34.62 | Wheelchair accessory, seat upholstery, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0982NU | 45.83 | Wheelchair accessory, back upholstery, replacement only, each (new equipment) (bid under round one of the DMEPOS competitive bidding program for use with noncompetitive bid base equipment) | | E0982NUKU | 49.97 | Wheelchair accessory, back upholstery, replacement only, each (new equipment) (bid under round one of the DMEPOS competitive bidding program for use with noncompetitive bid base equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0982RR | 4.17 | Wheelchair accessory, back upholstery, replacement only, each (rental) | | E0982RRKU | 4.24 | Wheelchair accessory, back upholstery, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0982UE | 34.38 | Wheelchair accessory, back upholstery, replacement only, each (used durable medical equipment) | | E0982UEKU | 37.50 | Wheelchair accessory, back upholstery, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0983KH | 276.31 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control (capped rental) | | E0983KI | 276.31 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control (capped rental) | | E0983KJ | 207.23 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control (capped rental) | | E0983NU | 2,763.10 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control (new equipment purchase) | | E0983UE | 2,072.33 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, joystick control (used durable medical equipment purchase) | | E0984KH | 194.67 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control (capped rental) | | E0984KI | 194.67 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control (capped rental) | | E0984KJ | 146.00 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control (capped rental) | | E0984NU | 1,946.70 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control (new equipment) | | E0984UE | 1,460.03 | Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control (used durable medical equipment) | | E0985KH | 21.40 | Wheelchair accessory, seat lift mechanism (capped rental) | | E0985KHKU | 22.85 | Wheelchair accessory, seat lift mechanism (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0985KI | 21.40 | Wheelchair accessory, seat lift mechanism (capped rental) | | E0985KIKU | 22.85 | Wheelchair accessory, seat lift mechanism (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0985KJ | 18.31 | Wheelchair accessory, seat lift mechanism (capped rental) | | E0985KJKU | 17.14 | Wheelchair accessory, seat lift mechanism (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0985NU | 213.95 | Wheelchair accessory, seat lift mechanism (new equipment) | | E0985NUKU | 228.50 | Wheelchair accessory, seat lift mechanism (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0985UE | 160.46 | Wheelchair accessory, seat lift mechanism (used durable medical equipment) | | E0985UEKU | 171.38 | Wheelchair accessory, seat lift mechanism (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0986KH | 537.76 | Manual wheelchair accessory, push activated power assist, each (capped rental) | | E0986KI | 537.76 | Manual wheelchair accessory, push activated power assist, each (capped rental) | | E0986KJ | 403.32 | Manual wheelchair accessory, push activated power assist, each (capped rental) | | E0986NU | 5,377.60 | Manual wheelchair accessory, push-rim activated power assist system, each (new equipment) | | E0986UE | 4,033.20 | Manual wheelchair accessory, push-rim activated power assist system, each (used durable medical equipment) | | E0988KH | 314.76 | Manual wheelchair accessory, lever-activated, wheel drive, pair (capped rental) | | E0988KI | 314.76 | Manual wheelchair accessory, lever-activated, wheel drive, pair (capped rental) | | E0988KJ | 236.07 | Manual wheelchair accessory, lever-activated, wheel drive, pair (capped rental) | | E0988NU | 3,147.60 | Manual wheelchair accessory, lever-activated, wheel drive, pair (new equipment) | | E0988UE | 2,360.70 | Manual wheelchair accessory, lever-activated, wheel drive, pair (used durable medical equipment) | | E0990NU | 89.61 | Wheelchair accessory, elevating leg rest, complete assembly, each (new equipment) | | E0990NUKU | 113.91 | Wheelchair accessory, elevating leg rest, complete assembly, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0990RR | 9.67 | Wheelchair accessory, elevating leg rest, complete assembly, each (rental) | | E0990RRKU | 12.83 | Wheelchair accessory, elevating leg rest, complete assembly, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0990UE | 68.96 | Wheelchair accessory, elevating leg rest, complete assembly, each (used durable medical equipment) | | E0990UEKU | 89.01 | Wheelchair accessory, elevating leg rest, complete assembly, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0992NU | 88.26 | Manual wheelchair accessory, solid seat insert (new equipment) | | E0992NUKU | 110.56 | Manual wheelchair accessory, solid seat insert | | E0992RR | 7.95 | Manual wheelchair accessory, solid seat insert (rental) | | E0992RRKU | 9.21 | Manual wheelchair accessory, solid seat insert | | E0992UE | 66.20 | Manual wheelchair accessory, solid seat insert (used durable medical equipment) | | E0992UEKU | 82.91 | Manual wheelchair accessory, solid seat insert | | E0994NU | 19.48 | Arm rest, each (new equipment) | | E0994RR | 1.97 | Arm rest, each (rental) | | E0994UE | 14.62 | Arm rest, each (used durable medical equipment) | | E0995NU | 24.62 | Wheelchair accessory, calf rest/pad, replacement only, each (new equipment) | | E0995NUKU | 25.06 | Wheelchair accessory, calf rest/pad, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0995RR | 2.51 | Wheelchair accessory, calf rest/pad, replacement only, each (rental) | | E0995RRKU | 2.59 | Wheelchair accessory, calf rest/pad, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E0995UE | 18.45 | Wheelchair accessory, calf rest/pad, replacement only, each (used durable medical equipment) | | E0995UEKU | 18.78 | Wheelchair accessory, calf rest/pad, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1002KH | 364.46 | Wheelchair accessory, power seating system, tilt only (capped rental) | | E1002KHKU | 393.17 | Wheelchair accessory, power seating system, tilt only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1002KI | 365.46 | Wheelchair accessory, power seating system, tilt only (capped rental) | | E1002KIKU | 393.17 | Wheelchair accessory, power seating system, tilt only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1002KJ | 273.35 | Wheelchair accessory, power seating system, tilt only (capped rental) | | E1002KJKU | 294.88 | Wheelchair accessory, power seating system, tilt only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1002NU | 3,644.60 | Wheelchair accessory, power seating system, tilt only (new equipment) | | E1002NUKU | 3,931.70 | Wheelchair accessory, power seating system, tilt only (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1002UE | 2,733.45 | Wheelchair accessory, power seating system, tilt only (used durable medical equipment) | | E1002UEKU | 2,948.78 | Wheelchair accessory, power seating system, tilt only (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1003KH | 409.80 | Wheelchair accessory, power seating system, recline only, without shear reduction (capped rental) | | E1003KHKU | 425.99 | Wheelchair accessory, power seating system, recline only, without shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1003KI | 409.80 | Wheelchair accessory, power seating system, recline only, without shear reduction (capped rental) | | E1003KIKU | 425.99 | Wheelchair accessory, power seating system, recline only, without shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1003KJ | 307.35 | Wheelchair accessory, power seating system, recline only, without shear reduction (capped rental) | | E1003KJKU | 319.49 | Wheelchair accessory, power seating system, recline only, without shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1003NU | 4,098.00 | Wheelchair accessory, power seating system, recline only, without shear reduction (new equipment) | | E1003NUKU | 4,259.90 | Wheelchair accessory, power seating system, recline only, without shear reduction (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1003UE | 3,073.50 | Wheelchair accessory, power seating system, recline only, without shear reduction (used durable medical equipment) | | E1003UEKU | 3,194.93 | Wheelchair accessory, power seating system, recline only, without shear reduction (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1004KH | 452.43 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (capped rental) | | E1004KHKU | 472.32 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1004KI | 452.43 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (capped rental) | | E1004KIKU | 472.32 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1004KJ | 339.32 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (capped rental) | | E1004KJKU | 354.24 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1004NU | 4,524.30 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (new equipment) | | E1004NUKU | 4,723.20 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1004UE | 3,393.23 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (used durable medical equipment) | | E1004UEKU | 3,542.40 | Wheelchair accessory, power seating system, recline only, with mechanical shear reduction (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1005KH | 492.26 | Wheelchair accessory, power seating system, recline only, with power shear reduction (capped rental) | | E1005KHKU | 511.25 | Wheelchair accessory, power seating system, recline only, with power shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1005KI | 492.26 | Wheelchair accessory, power seating system, recline only, with power shear reduction (capped rental) | | E1005KIKU | 511.25 | Wheelchair accessory, power seating system, recline only, with power shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1005KJ | 369.20 | Wheelchair accessory, power seating system, recline only, with power shear reduction (capped rental) | | E1005KJKU | 383.44 | Wheelchair accessory, power seating system, recline only, with power shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1005NU | 4,922.60 | Wheelchair accessory, power seating system, recline only, with power shear reduction (new equipment) | | E1005NUKU | 5,112.50 | Wheelchair accessory, power seating system, recline only, with power shear reduction (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1005UE | 3,691.95 | Wheelchair accessory, power seating system, recline only, with power shear reduction (used durable medical equipment) | | E1005UEKU | 3,834.38 | Wheelchair accessory, power seating system, recline only, with power shear reduction (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1006KH | 604.91 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (capped rental) | | E1006KHKU | 626.23 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1006KI | 604.91 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (capped rental) | | E1006KIKU | 626.23 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1006KJ | 453.68 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (capped rental) | | E1006KJKU | 469.67 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1006NU | 6,049.10 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (new equipment) | | E1006NUKU | 6,262.30 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1006UE | 4,536.83 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (used durable medical equipment) | | E1006UEKU | 4,696.73 | Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1007KH | 785.57 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (capped rental) | | E1007KHKU | 847.97 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1007KI | 785.57 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (capped rental) | | E1007KIKU | 847.97 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1007KJ | 589.18 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (capped rental) | | E1007KJKU | 635.98 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1007NU | 7,855.70 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (new equipment) | | E1007NUKU | 8,479.70 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1007UE | 5,891.78 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (used durable medical equipment) | | E1007UEKU | 6,359.78 | Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1008KH | 795.09 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (capped rental) | | E1008KHKU | 848.03 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1008KI | 795.09 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (capped rental) | | E1008KIKU | 848.03 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1008KJ | 596.32 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (capped rental) | | E1008KJKU | 636.02 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1008NU | 7,950.90 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (new equipment) | | E1008NUKU | 8,480.30 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1008UE | 5,963.18 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (used durable medical equipment) | | E1008UEKU | 6,360.23 | Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1009NU | AAC+35% | Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and legrest, each (new equipment) | | E1009RR | I.C. | Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and legrest, each (rental) | | E1009UE | I.C. | Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and legrest, each (used durable medical equipment) | | E1010KH | 105.95 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair (capped rental) | | E1010KHKU | 110.96 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1010KI | 105.95 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair (capped rental) | | E1010KIKU | 110.96 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1010KJ | 79.46 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair (capped rental) | | E1010KJKU | 83.22 | Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1010NU | 1,059.50 | Wheelchair accessory, addition to power seating system, power leg elevation system, including legrest, pair (new equipment) | | E1010NUKU | 1,109.60 | Wheelchair accessory, addition to power seating system, power leg elevation system, including legrest, pair (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1010UE | 794.63 | Wheelchair accessory, addition to power seating system, power leg elevation system, including legrest, pair (used durable medical equipment) | | E1010UEKU | 832.20 | Wheelchair accessory, addition to power seating system, power leg elevation system, including legrest, pair (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1011NU | AAC+35% | Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair) (new equipment) | | E1011RR | I.C. | Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair) (rental) | | E1011UE | I.C. | Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair) (used durable medical equipment) | | E1012KH | 94.99 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (capped rental) | | E1012KHKU | 110.96 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1012KI | 94.99 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (capped rental) | | E1012KIKU | 110.96 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1012KJ | 71.24 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (capped rental) | | E1012KJKU | 83.22 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1012NU | 949.90 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (new equipment) | | E1012NUKU | 1,109.60 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1012UE | 712.43 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (used durable medical equipment) | | E1012UEKU | 832.20 | Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1014KH | 40.38 | Reclining back, addition to pediatric size wheelchair (capped rental) | | E1014KI | 40.38 | Reclining back, addition to pediatric size wheelchair (capped rental) | | E1014KJ | 30.29 | Reclining back, addition to pediatric size wheelchair (capped rental) | | E1014NU | 403.80 | Reclining back, addition to pediatric size wheelchair (new equipment) | | E1014UE | 302.85 | Reclining back, addition to pediatric size wheelchair (used durable medical equipment) | | E1015NU | 121.49 | Shock absorber for manual wheelchair, each (new equipment) | | E1015NUKU | 133.26 | Shock absorber for manual wheelchair, each | | E1015RR | 12.14 | Shock absorber for manual wheelchair, each (rental) | | E1015RRKU | 13.32 | Shock absorber for manual wheelchair, each | | E1015UE | 91.11 | Shock absorber for manual wheelchair, each (used durable medical equipment) | | E1015UEKU | 99.94 | Shock absorber for manual wheelchair, each | | E1016NU | 110.79 | Shock absorber for power wheelchair, each (new equipment) | | E1016RR | 11.09 | Shock absorber for power wheelchair, each (rental) | | E1016UE | 83.09 | Shock absorber for power wheelchair, each (used durable medical equipment) | | E1017NU | AAC+35% | Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each (new equipment) | | E1017RR | I.C. | Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each (rental) | | E1017UE | I.C. | Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, each (used durable medical equipment) | | E1018NU | AAC+35% | Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each (new equipment) | | E1018RR | I.C. | Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each (rental) | | E1018UE | I.C. | Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair, each (used durable medical equipment) | | E1020KH | 20.53 | Residual limb support system for wheelchair, any type (capped rental) | | E1020KHKU | 23.60 | Residual limb support system for wheelchair, any type (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1020KI | 20.53 | Residual limb support system for wheelchair, any type (capped rental) | | E1020KIKU | 23.60 | Residual limb support system for wheelchair, any type (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1020KJ | 15.40 | Residual limb support system for wheelchair, any type (capped rental) | | E1020KJKU | 17.70 | Residual limb support system for wheelchair, any type (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1020NU | 205.35 | Residual limb support system for wheelchair, any type (new equipment) | | E1020NUKU | 236.00 | Residual limb support system for wheelchair, any type (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1020UE | 154.01 | Residual limb support system for wheelchair, any type (used durable medical equipment) | | E1020UEKU | 177.00 | Residual limb support system for wheelchair, any type (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1028KH | 16.52 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (capped rental) | | E1028KHKU | 20.03 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1028KI | 16.52 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (capped rental) | | E1028KIKU | 20.03 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1028KJ | 12.39 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (capped rental) | | E1028KJKU | 15.02 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1028NU | 165.19 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (new equipment) | | E1028NUKU | 200.30 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1028UE | 123.90 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (used durable medical equipment) | | E1028UEKU | 150.23 | Wheelchair accessory, manual swingaway, retractable, or removable mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1029KH | 34.93 | Wheelchair accessory, manual ventilator tray, fixed (capped rental) | | E1029KHKU | 35.84 | Wheelchair accessory, manual ventilator tray, fixed (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1029KI | 34.93 | Wheelchair accessory, manual ventilator tray, fixed (capped rental) | | E1029KIKU | 35.84 | Wheelchair accessory, manual ventilator tray, fixed (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1029KJ | 26.20 | Wheelchair accessory, manual ventilator tray, fixed (capped rental) | | E1029KJKU | 26.88 | Wheelchair accessory, manual ventilator tray, fixed (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1029NU | 349.30 | Wheelchair accessory, manual ventilator tray, fixed (new equipment) | | E1029NUKU | 358.40 | Wheelchair accessory, manual ventilator tray, fixed (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1029UE | 261.98 | Wheelchair accessory, manual ventilator tray, fixed (used durable medical equipment) | | E1029UEKU | 268.80 | Wheelchair accessory, manual ventilator tray, fixed (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1030KH | 109.66 | Wheelchair accessory, manual ventilator tray, gimbaled (capped rental) | | E1030KHKU | 113.04 | Wheelchair accessory, manual ventilator tray, gimbaled (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1030KI | 109.66 | Wheelchair accessory, manual ventilator tray, gimbaled (capped rental) | | E1030KIKU | 113.04 | Wheelchair accessory, manual ventilator tray, gimbaled (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1030KJ | 82.25 | Wheelchair accessory, manual ventilator tray, gimbaled (capped rental) | | E1030KJKU | 84.78 | Wheelchair accessory, manual ventilator tray, gimbaled (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1030NU | 1,096.60 | Wheelchair accessory, manual ventilator tray, gimbaled (new equipment) | | E1030NUKU | 1,130.40 | Wheelchair accessory, manual ventilator tray, gimbaled (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1030UE | 822.45 | Wheelchair accessory, manual ventilator tray, gimbaled (used durable medical equipment) | | E1030UEKU | 847.80 | Wheelchair accessory, manual ventilator tray, gimbaled (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E1031KH | 40.21 | Rollabout chair, any and all types with castors 5 inches or greater (capped rental) | | E1031KI | 40.21 | Rollabout chair, any and all types with castors 5 inches or greater (capped rental) | | E1031KJ | 30.16 | Rollabout chair, any and all types with castors 5 inches or greater (capped rental) | | E1031NU | 402.14 | Rollabout chair, any and all types with castors 5 inches or greater (new equipment purchase) | | E1031UE | 301.61 | Rollabout chair, any and all types with castors 5 inches or greater (used durable medical equipment purchase) | | E1035KH | 551.35 | Multi-positional patient transfer system, with integrated seat, operated by care giver (capped rental) | | E1035KI | 551.35 | Multi-positional patient transfer system, with integrated seat, operated by care giver (capped rental) | | E1035KJ | 413.52 | Multi-positional patient transfer system, with integrated seat, operated by care giver (capped rental) | | E1035NU | 5,513.53 | Multi-positional patient transfer system, with integrated seat, operated by care giver (new equipment purchase) | | E1035UE | 4,135.15 | Multi-positional patient transfer system, with integrated seat, operated by care giver (used durable medical equipment purchase) | | E1036KH | 783.48 | Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity great than 300 pounds (capped rental) | | E1036KI | 783.48 | Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity great than 300 pounds (capped rental) | | E1036KJ | 587.61 | Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity great than 300 pounds (capped rental) | | E1036NU | 7,834.79 | Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity great than 300 pounds (new equipment purchase) | | E1036UE | 5,876.09 | Multi-positional patient transfer system, extra-wide, with integrated seat, operated by caregiver, patient weight capacity great than 300 pounds (used durable medical equipment purchase) | | E1037KH | 93.21 | Transport chair, pediatric size (capped rental) | | E1037KI | 93.21 | Transport chair, pediatric size (capped rental) | | E1037KJ | 69.91 | Transport chair, pediatric size (capped rental) | | E1037NU | 932.11 | Transport chair, pediatric size (new equipment purchase) | | E1037UE | 699.08 | Transport chair, pediatric size (used durable medical equipment purchase) | | E1038KH | 14.89 | Transport chair, adult size, patient weight capacity up to and including 300 pounds (capped rental) | | E1038KI | 14.89 | Transport chair, adult size, patient weight capacity up to and including 300 pounds (capped rental) | | E1038KJ | 11.17 | Transport chair, adult size, patient weight capacity up to and including 300 pounds (capped rental) | | E1038NU | 148.92 | Transport chair, adult size, patient weight capacity up to and including 300 pounds (new equipment purchase) | | E1038UE | 111.69 | Transport chair, adult size, patient weight capacity up to and including 300 pounds (used durable medical equipment purchase) | | E1039KH | 29.76 | Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds (capped rental) | | E1039KI | 29.76 | Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds (capped rental) | | E1039KJ | 22.32 | Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds (capped rental) | | E1039NU | 297.59 | Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds (new equipment purchase | | E1039UE | 223.19 | Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds (used durable medical equipment purchase) | | Wheelchairs E1050KH | 81.34 | Fully reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1050KI | 81.34 | Fully reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1050KJ | 61.00 | Fully reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1050NU | 813.37 | Fully reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (new equipment purchase) | | E1050UE | 610.03 | Fully reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (used durable medical equipment purchase) | | E1060KH | 118.46 | Fully reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests (capped rental) | | E1060KI | 118.46 | Fully reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests (capped rental) | | E1060KJ | 88.84 | Fully reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests (capped rental) | | E1060NU | 1,184.56 | Fully reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests (new equipment purchase) | | E1060UE | 888.42 | Fully reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests (used durable medical equipment purchase) | | E1070KH | 102.93 | Fully reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest (capped rental) | | E1070KI | 102.93 | Fully reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest (capped rental) | | E1070KJ | 77.20 | Fully reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest (capped rental) | | E1070NU | 1,029.27 | Fully reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest (new equipment purchase) | | E1070UE | 771.95 | Fully reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest (used durable medical equipment purchase) | | E1083KH | 68.33 | Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest (capped rental) | | E1083KI | 68.33 | Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest (capped rental) | | E1083KJ | 51.25 | Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest (capped rental) | | E1083NU | 683.32 | Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest (new equipment purchase) | | E1083UE | 512.49 | Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg rest (used durable medical equipment purchase) | | E1084KH | 90.75 | Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests (capped rental) | | E1084KI | 90.75 | Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests (capped rental) | | E1084KJ | 68.06 | Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests (capped rental) | | E1084NU | 907.46 | Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests (new equipment purchase) | | E1084UE | 680.60 | Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests (used durable medical equipment) | | E1087KH | 118.90 | High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1087KI | 118.90 | High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1087KJ | 89.17 | High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1087NU | 1,188.98 | High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests (new equipment purchase) | | E1087UE | 891.74 | High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests (used durable medical equipment purchase) | | E1088KH | 141.68 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests (capped rental) | | E1088KI | 141.68 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests (capped rental) | | E1088KJ | 106.26 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests (capped rental) | | E1088NU | 1,416.78 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests (new equipment purchase) | | E1088UE | 1,062.59 | High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable elevating leg rests (used durable medical equipment purchase) | | E1092KH | 102.65 | Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests (capped rental) | | E1092KI | 102.65 | Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests (capped rental) | | E1092KJ | 76.99 | Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests (capped rental) | | E1092NU | 1,026.55 | Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests (new equipment purchase) | | E1092UE | 769.91 | Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests (used durable medical equipment purchase) | | E1093KH | 88.27 | Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests (capped rental) | | E1093KI | 88.27 | Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests (capped rental) | | E1093KJ | 66.20 | Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests (capped rental) | | E1093NU | 882.73 | Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests (new equipment purchase) | | E1093UE | 662.04 | Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests (used durable medical equipment purchase) | | E1100KH | 97.54 | Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1100KI | 97.54 | Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1100KJ | 73.15 | Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (capped rental) | | E1100NU | 975.38 | Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (new equipment purchase) | | E1100UE | 731.53 | Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests (used durable medical equipment) | | E1110KH | 94.49 | Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest (capped rental) | | E1110KI | 94.49 | Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest (capped rental) | | E1110KJ | 70.86 | Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest (capped rental) | | E1110NU | 944.86 | Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest (new equipment purchase) | | E1110UE | 708.65 | Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest (used durable medical equipment purchase) | | E1150KH | 76.65 | Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests (capped rental) | | E1150KI | 76.65 | Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests (capped rental) | | E1150KJ | 57.49 | Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests (capped rental) | | E1150NU | 766.53 | Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests (new equipment purchase) | | E1150UE | 574.90 | Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests (used durable medical equipment purchase) | | E1160KH | 58.74 | Wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1160KI | 58.74 | Wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1160KJ | 44.05 | Wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1160NU | 587.35 | Wheelchair, fixed full length arms, swing away detachable elevating legrests (new equipment purchase) | | E1160UE | 440.51 | Wheelchair, fixed full length arms, swing away detachable elevating legrests (used durable medical equipment purchase) | | E1161KH | 261.57 | Manual adult size wheelchair, includes tilt in space (capped rental) | | E1161KI | 261.57 | Manual adult size wheelchair, includes tilt in space (capped rental) | | E1161KJ | 196.18 | Manual adult size wheelchair, includes tilt in space (capped rental) | | E1161NU | 2,615.70 | Manual adult size wheelchair, includes tilt in space (new equipment) | | E1161UE | 1,961.78 | Manual adult size wheelchair, includes tilt in space (used durable medical equipment) | | E1170KH | 83.03 | Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1170KI | 83.03 | Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1170KJ | 62.27 | Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1170NU | 830.28 | Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests (new equipment purchase) | | E1170UE | 622.71 | Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests (used durable medical equipment purchase) | | E1171KH | 75.32 | Amputee wheelchair, fixed full length arms, without footrests or legrest (capped rental) | | E1171KI | 75.32 | Amputee wheelchair, fixed full length arms, without footrests or legrest (capped rental) | | E1171KJ | 56.49 | Amputee wheelchair, fixed full length arms, without footrests or legrest (capped rental) | | E1171NU | 753.19 | Amputee wheelchair, fixed full length arms, without footrests or legrest (new equipment purchase) | | E1171UE | 564.89 | Amputee wheelchair, fixed full length arms, without footrests or legrest (used durable medical equipment purchase) | | E1172KH | 92.06 | Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest (capped rental) | | E1172KI | 92.06 | Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest (capped rental) | | E1172KJ | 69.05 | Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest (capped rental) | | E1172NU | 920.55 | Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest (new equipment purchase) | | E1172UE | 690.41 | Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest (used durable medical equipment purchase) | | E1180KH | 95.23 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests (capped rental) | | E1180KI | 95.23 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests (capped rental) | | E1180KJ | 71.42 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests (capped rental) | | E1180NU | 952.26 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests (new equipment purchase) | | E1180UE | 714.20 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests (used durable medical equipment purchase) | | E1190KH | 101.42 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests (capped rental) | | E1190KI | 101.42 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests (capped rental) | | E1190KJ | 76.07 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests (capped rental) | | E1190NU | 1,014.22 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests (new equipment purchase) | | E1190UE | 760.67 | Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests (used durable medical equipment purchase) | | E1195KH | 118.05 | Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1195KI | 118.05 | Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1195KJ | 88.54 | Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1195NU | 1,180.48 | Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests (new equipment purchase) | | E1195UE | 885.36 | Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests (used durable medical equipment purchase) | | E1200KH | 81.76 | Amputee wheelchair, fixed full length arms, swing away detachable footrest (capped rental) | | E1200KI | 81.76 | Amputee wheelchair, fixed full length arms, swing away detachable footrest (capped rental) | | E1200KJ | 60.66 | Amputee wheelchair, fixed full length arms, swing away detachable footrest (capped rental) | | E1200NU | 808.78 | Amputee wheelchair, fixed full length arms, swing away detachable footrest (new equipment purchase) | | E1200UE | 606.58 | Amputee wheelchair, fixed full length arms, swing away detachable footrest (used durable medical equipment purchase) | | E1221KH | 44.65 | Wheelchair with fixed arm, footrests (capped rental) | | E1221KI | 44.65 | Wheelchair with fixed arm, footrests (capped rental) | | E1221KJ | 33.49 | Wheelchair with fixed arm, footrests (capped rental) | | E1221NU | 446.51 | Wheelchair with fixed arm, footrests (new equipment purchase) | | E1221UE | 334.88 | Wheelchair with fixed arm, footrests (used durable medical equipment purchase) | | E1222KH | 63.70 | Wheelchair with fixed arm, elevating legrests (capped rental) | | E1222KI | 63.70 | Wheelchair with fixed arm, elevating legrests (capped rental) | | E1222KJ | 47.78 | Wheelchair with fixed arm, elevating legrests (capped rental) | | E1222NU | 636.99 | Wheelchair with fixed arm, elevating legrests (new equipment purchase) | | E1222UE | 477.74 | Wheelchair with fixed arm, elevating legrests (used durable medical equipment) | | E1223KH | 69.55 | Wheelchair with detachable arms, footrests (capped rental) | | E1223KI | 69.55 | Wheelchair with detachable arms, footrests (capped rental) | | E1223KJ | 52.16 | Wheelchair with detachable arms, footrests (capped rental) | | E1223NU | 695.47 | Wheelchair with detachable arms, footrests (new equipment purchase) | | E1223UE | 521.60 | Wheelchair with detachable arms, footrests (used durable medical equipment) | | E1224KH | 76.25 | Wheelchair with detachable arms, elevating legrests (capped rental) | | E1224KI | 76.25 | Wheelchair with detachable arms, elevating legrests (capped rental) | | E1224KJ | 57.19 | Wheelchair with detachable arms, elevating legrests (capped rental) | | E1224NU | 762.54 | Wheelchair with detachable arms, elevating legrests (new equipment purchase) | | E1224UE | 571.91 | Wheelchair with detachable arms, elevating legrests (used durable medical equipment) | | E1225KH | 32.66 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each (capped rental) | | E1225KHKU | 44.63 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each | | E1225KI | 32.66 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each (capped rental) | | E1225KIKU | 44.63 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each | | E1225KJ | 24.50 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each (capped rental) | | E1225KJKU | 33.47 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each | | E1225NU | 326.57 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each (new equipment purchase) | | E1225NUKU | 446.30 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each | | E1225UE | 244.93 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E) (used durable medical equipment) | | E1225UEKU | 334.73 | Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80E), each | | E1226NU | 375.26 | Wheelchair accessory, manual fully reclining back, (recline greater than 80E), each (new equipment) | | E1226NUKU | 538.82 | Wheelchair accessory, manual fully reclining back, (recline greater than 80E), each | | E1226RR | 38.16 | Wheelchair accessory, manual fully reclining back, (recline greater than 80E), each (rental) | | E1226RRKU | 55.45 | Wheelchair accessory, manual fully reclining back, (recline greater than 80E), each | | E1226UE | 281.43 | Wheelchair accessory, manual fully reclining back, (recline greater than 80E), each (used durable medical equipment) | | E1226UEKU | 404.07 | Wheelchair accessory, manual fully reclining back, (recline greater than 80E), each | | E1227NU | 260.76 | Special height arms for wheelchair (new equipment) | | E1227RR | 26.09 | Special height arms for wheelchair (rental) | | E1227UE | 195.59 | Special height arms for wheelchair (used durable medical equipment) | | E1228KH | 30.98 | Special back height for wheelchair (capped rental) | | E1228KI | 30.98 | Special back height for wheelchair (capped rental) | | E1228KJ | 23.24 | Special back height for wheelchair (capped rental) | | E1228NU | 309.80 | Special back height for wheelchair (new equipment purchase) | | E1228UE | 232.35 | Special back height for wheelchair (used durable medical equipment purchase) | | E1229 | AAC+35% | Wheelchair, pediatric size, not otherwise specified | | E1230NU | 2,473.38 | Power operated vehicle (three or four wheel nonhighway) specify brand name and model number (new equipment) | | E1230RR | 243.26 | Power operated vehicle (three or four wheel nonhighway) specify brand name and model number (rental) | | E1230UE | 1,956.14 | Power operated vehicle (three or four wheel nonhighway) specify brand name and model number (used durable medical equipment) | | E1231NU | AAC+35% | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system (new equipment) | | E1231RR | I.C. | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system (rental) | | E1231UE | I.C. | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating system (used durable medical equipment) | | E1232KH | 236.42 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system (capped rental) | | E1232KI | 236.42 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system (capped rental) | | E1232KJ | 177.32 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system (capped rental) | | E1232NU | 2,364.20 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system (new equipment) | | E1232UE | 1,773.15 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system (used durable medical equipment) | | E1233KH | 244.95 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system (capped rental) | | E1233KI | 244.95 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system (capped rental) | | E1233KJ | 183.71 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system (capped rental) | | E1233NU | 2,449.50 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system (new equipment) | | E1233UE | 1,837.13 | Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system (used durable medical equipment) | | E1234KH | 213.26 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system (capped rental) | | E1234KI | 213.26 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system (capped rental) | | E1234KJ | 159.95 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system (capped rental) | | E1234NU | 2,132.60 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system (new equipment) | | E1234UE | 1,599.45 | Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system (used durable medical equipment) | | E1235KH | 205.36 | Wheelchair, pediatric size, rigid, adjustable, with seating system (capped rental) | | E1235KI | 205.36 | Wheelchair, pediatric size, rigid, adjustable, with seating system (capped rental) | | E1235KJ | 154.02 | Wheelchair, pediatric size, rigid, adjustable, with seating system (capped rental) | | E1235NU | 2,053.60 | Wheelchair, pediatric size, rigid, adjustable, with seating system (new equipment) | | E1235UE | 1,540.20 | Wheelchair, pediatric size, rigid, adjustable, with seating system (used durable medical equipment) | | E1236KH | 181.16 | Wheelchair, pediatric size, folding, adjustable, with seating system (capped rental) | | E1236KI | 181.16 | Wheelchair, pediatric size, folding, adjustable, with seating system (capped rental) | | E1236KJ | 135.87 | Wheelchair, pediatric size, folding, adjustable, with seating system (capped rental) | | E1236NU | 1,811.60 | Wheelchair, pediatric size, folding, adjustable, with seating system (new equipment) | | E1236UE | 1,358.70 | Wheelchair, pediatric size, folding, adjustable, with seating system (used durable medical equipment) | | E1237KH | 182.75 | Wheelchair, pediatric size, rigid, adjustable, without seating system (capped rental) | | E1237KI | 182.75 | Wheelchair, pediatric size, rigid, adjustable, without seating system (capped rental) | | E1237KJ | 137.06 | Wheelchair, pediatric size, rigid, adjustable, without seating system (capped rental) | | E1237NU | 1,827.50 | Wheelchair, pediatric size, rigid, adjustable, without seating system (new equipment) | | E1237UE | 1,370.63 | Wheelchair, pediatric size, rigid, adjustable, without seating system (used durable medical equipment) | | E1238KH | 181.16 | Wheelchair, pediatric size, folding, adjustable, without seating system (capped rental) | | E1238KI | 181.16 | Wheelchair, pediatric size, folding, adjustable, without seating system (capped rental) | | E1238KJ | 135.87 | Wheelchair, pediatric size, folding, adjustable, without seating system (capped rental) | | E1238NU | 1,811.60 | Wheelchair, pediatric size, folding, adjustable, without seating system (new equipment) | | E1238UE | 1,358.70 | Wheelchair, pediatric size, folding, adjustable, without seating system (used durable medical equipment) | | E1239 | AAC+35% | Power wheelchair, pediatric size, not otherwise specified | | E1240KH | 96.81 | Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest (capped rental) | | E1240KI | 96.81 | Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest (capped rental) | | E1240KJ | 72.60 | Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest (capped rental) | | E1240NU | 968.07 | Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest (new equipment purchase) | | E1240UE | 726.05 | Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest (used durable medical equipment purchase) | | E1270KH | 74.18 | Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1270KI | 74.18 | Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1270KJ | 55.63 | Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests (capped rental) | | E1270NU | 741.80 | Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests (new equipment purchase) | | E1270UE | 556.35 | Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests (used durable medical equipment) | | E1280KH | 123.34 | Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests (capped rental) | | E1280KI | 123.34 | Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests (capped rental) | | E1280KJ | 92.50 | Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests (capped rental) | | E1280NU | 1,233.35 | Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests (new equipment purchase) | | E1280UE | 925.01 | Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests (used durable medical equipment) | | E1295KH | 114.14 | Heavy duty wheelchair, fixed full length arms, elevating legrest (capped rental) | | E1295KI | 114.14 | Heavy duty wheelchair, fixed full length arms, elevating legrest (capped rental) | | E1295KJ | 85.60 | Heavy duty wheelchair, fixed full length arms, elevating legrest (capped rental) | | E1295NU | 1,141.38 | Heavy duty wheelchair, fixed full length arms, elevating legrest (new equipment purchase) | | E1295UE | 856.04 | Heavy duty wheelchair, fixed full length arms, elevating legrest (used durable medical equipment purchase) | | E1296NU | 543.53 | Special wheelchair seat height from floor (new equipment) | | E1296RR | 55.22 | Special wheelchair seat height from floor (rental) | | E1296UE | 407.65 | Special wheelchair seat height from floor (used durable medical equipment) | | E1297NU | 98.30 | Special wheelchair seat depth, by upholstery (new equipment) | | E1297RR | 10.92 | Special wheelchair seat depth, by upholstery (rental) | | E1297UE | 73.71 | Special wheelchair seat depth, by upholstery (used durable medical equipment) | | E1298NU | 398.11 | Special wheelchair seat depth and/or width, by construction (new equipment) | | E1298RR | 40.73 | Special wheelchair seat depth and/or width, by construction (rental) | | E1298UE | 298.57 | Special wheelchair seat depth and/or width, by construction (used durable medical equipment) | | Whirlpool-Equipment | | | | E1300 | AAC+30% | Whirlpool, portable (overtub type) | | E1310NU | 1,715.19 | Whirlpool, non-portable (built-in type) (new equipment) | | E1310RR | 146.69 | Whirlpool, non-portable (built-in type) (rental) | | E1310UE | 1,286.41 | Whirlpool, non-portable (built-in type) (used durable medical equipment) | | Additional Oxygen Related Equipment | | | | E1352 | AAC+20% | Oxygen accessory, flow regulator capable of positive inspiratory pressure | | E1353 | 26.61 | Regulator | | E1354 | AAC+30% | Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each | | E1355 | 20.05 | Stand/rack | | E1356 | AAC+30% | Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each | | E1357 | AAC+30% | Oxygen accessory, battery charger for portable concentrator, any type, replacement only, each | | E1358 | AAC+30% | Oxygen accessory, dc power adapter for portable concentrator, any type, replacement only, each | | E1372NU | 141.66 | Immersion external heater for nebulizer (new equipment) | | E1372RR | 17.64 | Immersion external heater for nebulizer (rental) | | E1372UE | 105.50 | Immersion external heater for nebulizer (used durable medical equipment) | | E1390RR | 119.48 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (rental) | | E1391RR | 119.48 | Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each (rental) | | E1392RR | 40.26 | Portable oxygen concentrator, rental | | E1399NU | AAC+30% | Durable medical equipment, miscellaneous (new equipment) | | E1399RB | AAC+30% | Durable medical equipment, miscellaneous (replacement of a part of DME furnished as part of a repair) | | E1399U1 | AAC+35% | Durable medical equipment miscellaneous (used only for installation of patient lift systems with RE1-RE23) | | E1399U3 | AAC+30% | Supplies for maintenance of insulin infusion catheter each (used for MassHealth members instead of A4224) Supplies for external insulin infusion pump, syringe type cartridge, sterile each (used for MassHealth members instead of A4225) | | E1399U4 | AAC+30% | Supplies for maintenance of insulin infusion catheter each (used for MassHealth members instead of A4224)Supplies for external insulin infusion pump, syringe type cartridge, sterile each (used for MassHealth members instead of A4225) | | E1399UC | AAC+35% | Durable medical equipment, miscellaneous (used for pediatric specialized rehabilitation equipment only) | | E1405RR | 147.53 | Oxygen and water vapor enriching system with heated delivery (rental) | | E1406RR | 131.89 | Oxygen and water vapor enriching system without heated delivery (rental) | | Artificial Kidney Machines and Accessories | | | | E1500 | AAC+30% | Centrifuge, for dialysis | | E1510 | AAC+30% | Kidney, dialysate delivery system kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, i.v. poles, pressure gauge, concentrate container | | E1520 | AAC+30% | Heparin infusion pump for hemodialysis | | E1530 | AAC+30% | Air bubble detector for hemodialysis, each, replacement | | E1540 | AAC+20% | Pressure alarm for hemodialysis, each, replacement | | E1550 | AAC+20% | Bath conductivity meter for hemodialysis, each | | E1560 | AAC+20% | Blood leak detector for hemodialysis, each, replacement | | E1570 | AAC+30% | Adjustable chair, for esrd patients | | E1575 | AAC+30% | Transducer protectors/fluid barriers, for hemodialysis, any size, per 10 | | E1580 | AAC+20% | Unipuncture control system for hemodialysis | | E1590 | AAC+30% | Hemodialysis machine | | E1592 | AAC+30% | Automatic intermittent peritioneal dialysis system | | E1594 | AAC+30% | Cycler dialysis machine for peritoneal dialysis | | E1610 | AAC+30% | Reverse osmosis water purification system, for hemodialysis | | E1615 | AAC+30% | Deionizer water purification system, for hemodialysis | | E1620 | AAC+30% | Blood pump for hemodialysis, replacement | | E1625 | AAC+30% | Water softening system, for hemodialysis | | E1630 | AAC+30% | Reciprocating peritoneal dialysis system | | E1632 | AAC+30% | Wearable artificial kidney, each | | E1634 | AAC+30% | Peritoneal dialysis clamps, each | | E1635 | AAC+30% | Compact (portable) travel hemodialyzer system | | E1636 | AAC+30% | Sorbent cartridges, for hemodialysis, per 10 | | E1637 | AAC+30% | Hemostats, each | | E1639 | AAC+30% | Scale, each | | E1699 | AAC+30% | Dialysis equipment, not otherwise specified | | Jaw Motion Rehabilitation System and Accessories | | | | E1700KH | 9.74 | Jaw motion rehabilitation system (capped rental) | | E1700KI | 9.74 | Jaw motion rehabilitation system (capped rental) | | E1700KJ | 21.21 | Jaw motion rehabilitation system (capped rental) | | E1700NU | 293.51 | Jaw motion rehabilitation system (new equipment) | | E1700UE | 220.13 | Jaw motion rehabilitation system (used durable medical equipment) | | E1701 | 9.64 | Replacement cushions for jaw motion rehabilitation system, pkg. of 6 | | E1702 | 20.98 | Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200 | | Flexion/Extension Device | | | | E1800KH | 97.85 | Dynamic adjustable elbow extension/flexion device, includes soft interface material (capped rental) | | E1800KI | 97.85 | Dynamic adjustable elbow extension/flexion device, includes soft interface material (capped rental) | | E1800KJ | 73.39 | Dynamic adjustable elbow extension/flexion device, includes soft interface material (capped rental) | | E1800NU | 978.52 | Dynamic adjustable elbow extension/flexion device, includes soft interface material (new equipment purchase) | | E1800UE | 733.89 | Dynamic adjustable elbow extension/flexion device, includes soft interface material (used durable medical equipment) | | E1801KH | 121.23 | Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1801KI | 121.23 | Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1801KJ | 90.92 | Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1801NU | 1,212.27 | Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (new equipment purchase) | | E1801UE | 909.20 | Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (used durable medical equipment) | | E1802KH | 307.10 | Dynamic adjustable forearm pronation/supination device, includes soft interface material (capped rental) | | E1802KI | 307.10 | Dynamic adjustable forearm pronation/supination device, includes soft interface material (capped rental) | | E1802KJ | 230.32 | Dynamic adjustable forearm pronation/supination device, includes soft interface material (capped rental) | | E1802NU | 3,070.97 | Dynamic adjustable forearm pronation/supination device, includes soft interface material (new equipment purchase) | | E1802UE | 2,303.22 | Dynamic adjustable forearm pronation/supination device, includes soft interface material (used durable medical equipment) | | E1805KH | 118.73 | Dynamic adjustable wrist extension/flexion device, includes soft interface material (capped rental) | | E1805KI | 118.73 | Dynamic adjustable wrist extension/flexion device, includes soft interface material (capped rental) | | E1805KJ | 89.05 | Dynamic adjustable wrist extension/flexion device, includes soft interface material (capped rental) | | E1805NU | 1,187.28 | Dynamic adjustable wrist extension/flexion device, includes soft interface material (new equipment purchase) | | E1805UE | 890.46 | Dynamic adjustable wrist extension/flexion device, includes soft interface material (used durable medical equipment purchase) | | E1806KH | 99.54 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1806KI | 99.54 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1806KJ | 74.65 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1806NU | 995.35 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (new equipment purchase) | | E1806UE | 746.51 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (used durable medical equipment purchase) | | E1810KH | 99.51 | Dynamic adjustable knee extension/flexion device, includes soft interface material (capped rental) | | E1810KI | 99.51 | Dynamic adjustable knee extension/flexion device, includes soft interface material (capped rental) | | E1810KJ | 74.63 | Dynamic adjustable knee extension/flexion device, includes soft interface material (capped rental) | | E1810NU | 995.10 | Dynamic adjustable knee extension/flexion device, includes soft interface material (new equipment purchase) | | E1810UE | 746.32 | Dynamic adjustable knee extension/flexion device, includes soft interface material (used durable medical equipment) | | E1811KH | 126.03 | Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1811KI | 126.03 | Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1811KJ | 94.52 | Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1811NU | 1,260.30 | Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (new equipment purchase) | | E1811UE | 945.22 | Static progressive stretch knee device, extension and/or flexion, or without with range of motion adjustment, includes all components and accessories (used durable medical equipment) | | E1812KH | 80.80 | Dynamic knee, extension/flexion device with active resistance control (capped rental) | | E1812KI | 80.80 | Dynamic knee, extension/flexion device with active resistance control (capped rental) | | E1812KJ | 60.60 | Dynamic knee, extension/flexion device with active resistance control (capped rental) | | E1812NU | 808.01 | Dynamic knee, extension/flexion device with active resistance control (new equipment purchase) | | E1812UE | 606.01 | Dynamic knee, extension/flexion device with active resistance control (used durable medical equipment purchase) | | E1815KH | 118.73 | Dynamic adjustable ankle extension/flexion device, includes soft interface material (capped rental) | | E1815KI | 118.73 | Dynamic adjustable ankle extension/flexion device, includes soft interface material (capped rental) | | E1815KJ | 89.05 | Dynamic adjustable ankle extension/flexion device, includes soft interface material (capped rental) | | E1815NU | 1,187.28 | Dynamic adjustable ankle extension/flexion device, includes soft interface material (new equipment purchase) | | E1815UE | 890.46 | Dynamic adjustable ankle extension/flexion device, includes soft interface material (used durable medical equipment) | | E1816KH | 128.03 | Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1816KI | 128.03 | Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1816KJ | 96.02 | Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1816NU | 1,280.27 | Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (new equipment purchase) | | E1816UE | 960.20 | Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories (used durable medical equipment) | | E1818KH | 130.70 | Static progressive stretch forearm pronation/supination device with or without range of motion adjustment, includes cuffs (capped rental) | | E1818KI | 130.70 | Static progressive stretch forearm pronation/supination device with or without range of motion adjustment, includes cuffs (capped rental) | | E1818KJ | 98.02 | Static progressive stretch forearm pronation/supination device with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1818NU | 1,306.96 | Static progressive stretch forearm pronation/supination device with or without range of motion adjustment, includes all components and accessories (new equipment purchase) | | E1818UE | 980.22 | Static progressive stretch forearm pronation/supination device with or without range of motion adjustment, includes all components and accessories (used durable medical equipment) | | E1820NU | 76.81 | Replacement soft interface material, dynamic adjustable extension/flexion device (new equipment) | | E1820RR | 7.68 | Replacement soft interface material, dynamic adjustable extension/flexion device (rental) | | E1820UE | 57.62 | Replacement soft interface material, dynamic adjustable extension/flexion device (used durable medical equipment) | | E1821NU | 98.90 | Replacement soft interface material/cuffs for bi-directional static progressive stretch device (new equipment) | | E1821RR | 9.87 | Replacement soft interface material/cuffs for bi-directional static progressive stretch device (rental) | | E1821UE | 74.20 | Replacement soft interface material/cuffs for bi-directional static progressive stretch device (used durable medical equipment) | | E1825KH | 118.73 | Dynamic adjustable finger extension/flexion device, includes soft interface material (capped rental) | | E1825KI | 118.73 | Dynamic adjustable finger extension/flexion device, includes soft interface material (capped rental) | | E1825KJ | 89.05 | Dynamic adjustable finger extension/flexion device, includes soft interface material (capped rental) | | E1825NU | 1,187.28 | Dynamic adjustable finger extension/flexion device, includes soft interface material (new equipment purchase) | | E1825UE | 890.46 | Dynamic adjustable finger extension/flexion device, includes soft interface material (used durable medical equipment purchase) | | E1830KH | 118.73 | Dynamic adjustable toe extension/flexion device, includes soft interface material (capped rental) | | E1830KI | 118.73 | Dynamic adjustable toe extension/flexion device, includes soft interface material (capped rental) | | E1830KJ | 89.05 | Dynamic adjustable toe extension/flexion device, includes soft interface material (capped rental) | | E1830NU | 1,187.28 | Dynamic adjustable toe extension/flexion device, includes soft interface material (new equipment purchase) | | E1830UE | 890.46 | Dynamic adjustable toe extension/flexion device, includes soft interface material (used durable medical equipment purchase) | | E1831KH | 59.71 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1831KI | 59.71 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1831KJ | 44.78 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and | | E1831NU | 626.98 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and | | E1831UE | 470.24 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and | | E1840KH | 359.63 | Dynamic adjustable shoulder flexion/abduction/rotation device, includes soft interface material (capped rental) | | E1840KI | 359.63 | Dynamic adjustable shoulder flexion/abduction/rotation device, includes soft interface material (capped rental) | | E1840KJ | 269.72 | Dynamic adjustable shoulder flexion/abduction/rotation device, includes soft interface material (capped rental) | | E1840NU | 3,596.27 | Dynamic adjustable shoulder flexion/abduction/rotation device, includes soft interface material (new equipment purchase) | | E1840UE | 2,697.20 | Dynamic adjustable shoulder flexion/abduction/rotation device, includes soft interface material (used durable medical equipment purchase) | | E1841KH | 425.66 | Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1841KI | 425.66 | Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1841KJ | 319.25 | Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories (capped rental) | | E1841NU | 4,256.63 | Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories (new equipment purchase) | | E1841UE | 3,192.47 | Static progressive stretch shoulder device, with range of motion adjustment, includes all components and accessories (used durable medical equipment purchase) | | E1902 | AAC+30% | Communication board, non-electronic augmentative or alternative communication device | | E2000KH | 48.71 | Gastric suction pump, home model, portable or stationary, electric (capped rental) | | E2000KI | 48.71 | Gastric suction pump, home model, portable or stationary, electric (capped rental) | | E2000KJ | 36.53 | Gastric suction pump, home model, portable or stationary, electric (capped rental) | | E2000NU | 487.05 | Gastric suction pump, home model, portable or stationary, electric (new equipment purchase) | | E2000UE | 365.29 | Gastric suction pump, home model, portable or stationary, electric (used durable medical equipment purchase) | | E2100NU | 604.38 | Blood glucose monitor with integrated voice synthesizer (new equipment purchase) | | E2100RR | 60.44 | Blood glucose monitor with integrated voice synthesizer (rental) | | E2100UE | 453.30 | Blood glucose monitor with integrated voice synthesizer (used durable medical equipment) | | E2101NU | 177.18 | Blood glucose monitor with integrated lancing/blood sample (new equipment) | | E2101RR | 17.71 | Blood glucose monitor with integrated lancing/blood sample (rental) | | E2101UE | 132.89 | Blood glucose monitor with integrated lancing/blood sample (used durable medical equipment) | | E2120KH | 266.42 | Pulse generator system for tympanic treatment of inner ear endolymphatic fluid (capped rental) | | E2120KI | 266.42 | Pulse generator system for tympanic treatment of inner ear endolymphatic fluid (capped rental) | | E2120KJ | 199.82 | Pulse generator system for tympanic treatment of inner ear endolymphatic fluid (capped rental) | | E2120NU | 2,664.24 | Pulse generator system for tympanic treatment of inner ear endolymphatic fluid (new equipment purchase) | | E2120UE | 1,998.18 | Pulse generator system for tympanic treatment of inner ear endolymphatic fluid (used durable medical equipment) | | DME Wheelchair Accessory | | | | E2201NU | 377.75 | Manual wheelchair accessory, nonstandard seat frame width, greater than or equal to 20 inches but less than 24 inches (new equipment) | | E2201NUKU | 433.46 | Manual wheelchair accessory, nonstandard seat frame width, greater than or equal to 20 inches but less than 24 inches | | E2201RR | 37.77 | Manual wheelchair accessory, nonstandard seat frame width, greater than or equal to 20 inches but less than 24 inches (rental) | | E2201RRKU | 43.35 | Manual wheelchair accessory, nonstandard seat frame width, greater than or equal to 20 inches but less than 24 inches | | E2201UE | 283.31 | Manual wheelchair accessory, nonstandard seat frame width, greater than or equal to 20 inches but less than 24 inches (used durable medical equipment) | | E2201UEKU | 325.09 | Manual wheelchair accessory, nonstandard seat frame width, greater than or equal to 20 inches but less than 24 inches | | E2202NU | 483.23 | Manual wheelchair accessory, nonstandard seat frame width, 24 - 27 inches (new equipment) | | E2202NUKU | 550.63 | Manual wheelchair accessory, nonstandard seat frame width, 24 - 27 inches | | E2202RR | 48.32 | Manual wheelchair accessory, nonstandard seat frame width, 24 - 27 inches (rental) | | E2202RRKU | 55.07 | Manual wheelchair accessory, nonstandard seat frame width, 24 - 27 inches | | E2202UE | 362.44 | Manual wheelchair accessory, nonstandard seat frame width, 24 - 27 inches (used durable medical equipment) | | E2202UEKU | 412.99 | Manual wheelchair accessory, nonstandard seat frame width, 24 - 27 inches | | E2203NU | 468.42 | Manual wheelchair accessory, nonstandard seat frame depth, greater than or equal to 20 inches but less than 22 inches (new equipment) | | E2203NUKU | 556.54 | Manual wheelchair accessory, nonstandard seat frame depth, greater than or equal to 20 inches but less than 22 inches | | E2203RR | 46.84 | Manual wheelchair accessory, nonstandard seat frame depth, greater than or equal to 20 inches but less than 22 inches (rental) | | E2203RRKU | 55.65 | Manual wheelchair accessory, nonstandard seat frame depth, greater than or equal to 20 inches but less than 22 inches | | E2203UE | 351.30 | Manual wheelchair accessory, nonstandard seat frame depth, greater than or equal to 20 inches but less than 22 inches (used durable medical equipment) | | E2203UEKU | 417.37 | Manual wheelchair accessory, nonstandard seat frame depth, greater than or equal to 20 inches but less than 22 inches | | E2204NU | 780.89 | Manual wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches (new equipment) | | E2204NUKU | 944.97 | Manual wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches | | E2204RR | 78.09 | Manual wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches (rental) | | E2204RRKU | 94.51 | Manual wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches | | E2204UE | 585.67 | Manual wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches (used durable medical equipment) | | E2204UEKU | 708.72 | Manual wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches | | E2205NU | 34.19 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each (new equipment) | | E2205NUKU | 37.95 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each | | E2205RR | 3.41 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each (rental) | | E2205RRKU | 3.78 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each | | E2205UE | 25.66 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each (used durable medical equipment) | | E2205UEKU | 28.48 | Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each | | E2206NU | 40.33 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each (new equipment) | | E2206NUKU | 47.25 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only each | | E2206RR | 4.03 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each (rental) | | E2206RRKU | 4.70 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only each | | E2206UE | 30.25 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only, each (used durable medical equipment) | | E2206UEKU | 35.44 | Manual wheelchair accessory, wheel lock assembly, complete, replacement only each | | E2207NU | 38.74 | Wheelchair accessory, crutch and cane holder, each (new equipment) | | E2207NUKU | 48.79 | Wheelchair accessory, crutch and cane holder, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2207RR | 3.88 | Wheelchair accessory, crutch and cane holder, each (rental) | | E2207RRKU | 4.89 | Wheelchair accessory, crutch and cane holder, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2207UE | 29.06 | Wheelchair accessory, crutch and cane holder, each (used durable medical equipment) | | E2207UEKU | 36.60 | Wheelchair accessory, crutch and cane holder, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2208NU | 77.79 | Wheelchair accessory, cylinder tank carrier, each (new equipment) | | E2208NUKU | 115.23 | Wheelchair accessory, cylinder tank carrier, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2208RR | 7.78 | Wheelchair accessory, cylinder tank carrier, each (rental) | | E2208RRKU | 11.52 | Wheelchair accessory, cylinder tank carrier, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2208UE | 58.34 | Wheelchair accessory, cylinder tank carrier, each (used durable medical equipment) | | E2208UEKU | 86.42 | Wheelchair accessory, cylinder tank carrier, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2209NU | 92.97 | Accessory, arm trough, with or without hand support, each (new equipment) | | E2209NUKU | 103.95 | Accessory, arm trough, with or without hand support, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2209RR | 9.31 | Accessory, with or without hand support, arm trough, each (rental) | | E2209RRKU | 10.41 | Accessory, with or without hand support, arm trough, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2209UE | 69.74 | Accessory, arm trough, with or without hand support, each (used durable medical equipment) | | E2209UEKU | 77.98 | Accessory, arm trough, with or without hand support, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2210NU | 5.40 | Wheelchair accessory, bearings, any type, replacement only, each (new equipment) | | E2210NUKU | 6.34 | Wheelchair accessory, bearings, any type, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2210RR | 0.50 | Wheelchair accessory, bearings, any type, replacement only, each (rental) | | E2210RRKU | 0.54 | Wheelchair accessory, bearings, any type, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2210UE | 4.06 | Wheelchair accessory, bearings, any type, replacement only, each (used durable medical equipment) | | E2210UEKU | 4.78 | Wheelchair accessory, bearings, any type, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2211NU | 38.03 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each (new equipment) | | E2211NUKU | 47.53 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each | | E2211RR | 3.73 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each (rental) | | E2211RRKU | 4.59 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each | | E2211UE | 27.77 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each (used durable medical equipment) | | E2211UEKU | 34.05 | Manual wheelchair accessory, pneumatic propulsion tire, any size, each | | E2212NU | 6.29 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each (new equipment) | | E2212NUKU | 6.82 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each | | E2212RR | 0.65 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each (rental) | | E2212RRKU | 0.73 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each | | E2212UE | 4.73 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each (used durable medical equipment) | | E2212UEKU | 5.13 | Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each | | E2213NU | 30.93 | Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each (new equipment) | | E2213NUKU | 35.34 | Manual wheelchair accessory, insert for pneumatic propulsion tire, (removable) any size, each | | E2213RR | 3.10 | Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each (rental) | | E2213RRKU | 3.55 | Manual wheelchair accessory, insert for pneumatic propulsion tire, (removable) any size, each | | E2213UE | 23.18 | Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each (used durable medical equipment) | | E2213UEKU | 26.49 | Manual wheelchair accessory, insert for pneumatic propulsion tire, (removable) any size, each | | E2214NU | 35.50 | Manual wheelchair accessory, pneumatic caster tire, any size, each (new equipment) | | E2214NUKU | 41.82 | Manual wheelchair accessory, pneumatic caster tire, any size each | | E2214RR | 3.75 | Manual wheelchair accessory, pneumatic caster tire, any size, each (rental) | | E2214RRKU | 4.59 | Manual wheelchair accessory, pneumatic caster tire, any size each | | E2214UE | 26.62 | Manual wheelchair accessory, pneumatic caster tire, any size, each (used durable medical equipment) | | E2214UEKU | 31.25 | Manual wheelchair accessory, pneumatic caster tire, any size each | | E2215NU | 10.19 | Manual wheelchair accessory, tube for pneumatic caster tire, any size, each (new equipment) | | E2215NUKU | 11.15 | Manual wheelchair accessory, tube for pneumatic caster tire, any size each | | E2215RR | 1.02 | Manual wheelchair accessory, tube for pneumatic caster tire, any size, each (rental) | | E2215RRKU | 1.11 | Manual wheelchair accessory, tube for pneumatic caster tire, any size each | | E2215UE | 7.64 | Manual wheelchair accessory, tube for pneumatic caster tire, any size, each (used durable medical equipment) | | E2215UEKU | 8.35 | Manual wheelchair accessory, tube for pneumatic caster tire, any size each | | E2216NU | AAC+30% | Manual wheelchair accessory, foam filled propulsion tire, any size, each (new equipment) | | E2216NUKU | 52.92 | Manual wheelchair accessory, foam filled propulsion tire, any size each | | E2216RR | I.C. | Manual wheelchair accessory, foam filled propulsion tire, any size, each (rental) | | E2216RRKU | 5.30 | Manual wheelchair accessory, foam filled propulsion tire, any size each | | E2216UE | I.C. | Manual wheelchair accessory, foam filled propulsion tire, any size, each (used durable medical equipment) | | E2216UEKU | 39.68 | Manual wheelchair accessory, foam filled propulsion tire, any size each | | E2217NU | AAC+30% | Manual wheelchair accessory, foam filled caster tire, any size, each (new equipment) | | E2217NUKU | 46.83 | Manual wheelchair accessory, foam filled caster tire, any size each | | E2217RR | I.C. | Manual wheelchair accessory, foam filled caster tire, any size, each (rental) | | E2217RRKU | 4.68 | Manual wheelchair accessory, foam filled caster tire, any size each | | E2217UE | I.C. | Manual wheelchair accessory, foam filled caster tire, any size, each (used durable medical equipment) | | E2217UEKU | 35.13 | Manual wheelchair accessory, foam filled caster tire, any size each | | E2218NU | AAC+30% | Manual wheelchair accessory, foam propulsion tire, any size, each (new equipment) | | E2218NUKU | 52.92 | Manual wheelchair accessory, foam propulsion tire, any size each | | E2218RR | I.C. | Manual wheelchair accessory, foam propulsion tire, any size, each (rental) | | E2218RRKU | 5.30 | Manual wheelchair accessory, foam propulsion tire, any size each | | E2218UE | I.C. | Manual wheelchair accessory, foam propulsion tire, any size, each (used durable medical equipment) | | E2218UEKU | 39.68 | Manual wheelchair accessory, foam propulsion tire, any size each | | E2219NU | 41.68 | Manual wheelchair accessory, foam caster tire, any size, each (new equipment) | | E2219NUKU | 46.83 | Manual wheelchair accessory, foam caster tire, any size each | | E2219RR | 4.16 | Manual wheelchair accessory, foam caster tire, any size, each (rental) | | E2219RRKU | 4.68 | Manual wheelchair accessory, foam caster tire, any size each | | E2219UE | 31.26 | Manual wheelchair accessory, foam caster tire, any size, each (used durable medical equipment) | | E2219UEKU | 35.13 | Manual wheelchair accessory, foam caster tire, any size each | | E2220NU | 29.67 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each (new equipment) | | E2220NUKU | 33.15 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each | | E2220RR | 2.91 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each (rental) | | E2220RRKU | 3.20 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each | | E2220UE | 22.49 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each (used durable medical equipment) | | E2220UEKU | 25.35 | Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size, replacement only, each | | E2221NU | 26.81 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (new equipment) | | E2221NUKU | 29.68 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each | | E2221RR | 2.70 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (rental) | | E2221RRKU | 3.01 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each | | E2221UE | 20.12 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (used durable medical equipment) | | E2221UEKU | 22.27 | Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each | | E2222NU | 22.15 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (new equipment) | | E2222NUKU | 24.48 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size each | | E2222RR | 2.20 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (rental) | | E2222RRKU | 2.42 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size each | | E2222UE | 16.62 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (used durable medical equipment) | | E2222UEKU | 18.36 | Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size each | | E2224NU | 98.55 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each (new equipment) | | E2224NUKU | 113.92 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each | | E2224RR | 10.12 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each (rental) | | E2224RRKU | 11.96 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each | | E2224UE | 73.92 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each (used durable medical equipment) | | E2224UEKU | 85.44 | Manual wheelchair accessory, propulsion wheel excludes tire, any size, replacement only, each | | E2225NU | 18.52 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (new equipment) | | E2225NUKU | 20.21 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only each | | E2225RR | 1.85 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (rental) | | E2225RRKU | 2.01 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only each | | E2225UE | 13.88 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (used durable medical equipment) | | E2225UEKU | 15.15 | Manual wheelchair accessory, caster wheel excludes tire, any size, replacement only each | | E2226NU | 39.54 | Manual wheelchair accessory, caster fork, any size, replacement only, each (new equipment) | | E2226NUKU | 44.07 | Manual wheelchair accessory, caster fork, any size, replacement only each | | E2226RR | 3.95 | Manual wheelchair accessory, caster fork, any size, replacement only, each (rental) | | E2226RRKU | 4.41 | Manual wheelchair accessory, caster fork, any size, replacement only each | | E2226UE | 29.65 | Manual wheelchair accessory, caster fork, any size, replacement only, each (used durable medical equipment) | | E2226UEKU | 33.06 | Manual wheelchair accessory, caster fork, any size, replacement only each | | E2227KH | 198.84 | Manual wheelchair accessory, gear reduction drive wheel, each (capped rental) | | E2227KI | 198.84 | Manual wheelchair accessory, gear reduction drive wheel, each (capped rental) | | E2227KJ | 149.13 | Manual wheelchair accessory, gear reduction drive wheel, each (capped rental) | | E2227NU | 1,988.40 | Manual wheelchair accessory, gear reduction drive wheel, each (new equipment) | | E2227UE | 1,491.30 | Manual wheelchair accessory, gear reduction drive wheel, each (used durable medical equipment) | | E2228KH | 99.40 | Manual wheelchair accessory, wheel braking system and lock, complete, each (capped rental) | | E2228KHKU | 108.75 | Manual wheelchair accessory, wheel braking system and lock, complete, each | | E2228KI | 99.40 | Manual wheelchair accessory, wheel braking system and lock, complete, each (capped rental) | | E2228KIKU | 108.75 | Manual wheelchair accessory, wheel braking system and lock, complete, each | | E2228KJ | 74.55 | Manual wheelchair accessory, wheel braking system and lock, complete, each (capped rental) | | E2228KJKU | 81.53 | Manual wheelchair accessory, wheel braking system and lock, complete, each | | E2228NU | 994.07 | Manual wheelchair accessory, wheel braking system and lock, complete, each (new equipment) | | E2228NUKU | 1,087.50 | Manual wheelchair accessory, wheel braking system and lock, complete, each | | E2228UE | 745.56 | Manual wheelchair accessory, wheel braking system and lock, complete, each (used durable medical equipment) | | E2228UEKU | 815.62 | Manual wheelchair accessory, wheel braking system and lock, complete, each | | E2230 | AAC+35% | Manual wheelchair accessory, manual standing system | | E2231NU | 154.15 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware (new equipment) | | E2231NUKU | 178.53 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware | | E2231RR | 15.42 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware (rental) | | E2231RRKU | 17.86 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware | | E2231UE | 115.61 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware (used durable medical equipment) | | E2231UEKU | 133.88 | Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware | | E2291 | AAC+35% | Back, planar, for pediatric size wheelchair including fixed attaching hardware | | E2292 | AAC+35% | Seat, planar, for pediatric size wheelchair including fixed attaching hardware | | E2293 | AAC+35% | Back, contoured, for pediatric size wheelchair including fixed attaching hardware | | E2294 | AAC+35% | Seat, contoured, for pediatric size wheelchair including fixed attaching hardware | | E2295 | AAC+35% | Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features | | E2300 | AAC+35% | Wheelchair accessory, power seat elevation system, any type | | E2301 | AAC+35% | Wheelchair accessory, power standing system, any type | | E2310KH | 105.93 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) | | E2310KHKU | 113.50 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2310KI | 105.93 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) | | E2310KIKU | 113.50 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2310KJ | 79.45 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) | | E2310KJKU | 85.13 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2310NU | 1,059.30 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (new equipment) | | E2310NUKU | 1,135.00 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2310UE | 794.48 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (used durable medical equipment) | | E2310UEKU | 851.25 | Power wheelchair accessory, electronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2311KH | 214.14 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) | | E2311KHKU | 229.83 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) , (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2311KI | 214.14 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) | | E2311KIKU | 229.83 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) , (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2311KJ | 160.61 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) \ | | E2311KJKU | 172.37 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (capped rental) , (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2311NU | 2,141.40 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (new equipment) | | E2311NUKU | 2,298.30 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2311UE | 1,606.05 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (used durable medical equipment) | | E2311UEKU | 1,723.73 | Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2312KH | 214.39 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (capped rental) | | E2312KHKC | 273.43 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2312KI | 214.39 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (capped rental) | | E2312KIKC | 273.43 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2312KJ | 160.79 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (capped rental) | | E2312KJKC | 205.07 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2312NU | 2,143.90 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (new equipment) | | E2312NUKC | 2,734.30 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (new equipment) (replacement of special power wheelchair interface) | | E2312UE | 1,607.93 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (used durable medical equipment) | | E2312UEKC | 2,050.73 | Power wheelchair accessory, hand or chin control, interface, mini-proportional remote joystick, proportional, including fixed mounting hardware (used durable medical equipment) (replacement of special power wheelchair interface) | | E2313KH | 34.06 | Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each (capped rental) | | E2313KI | 34.06 | Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each (capped rental) | | E2313KJ | 25.55 | Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each (capped rental) | | E2313NU | 340.60 | Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each (new equipment) | | E2313UE | 255.45 | Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each (used durable medical equipment) | | E2321KH | 143.90 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) | | E2321KHKC | 191.51 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2321KHKU | 251.12 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2321KI | 143.90 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) | | E2321KIKC | 191.51 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2321KIKU | 251.12 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2321KJ | 107.93 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) | | E2321KJKC | 143.63 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2321KJKU | 188.34 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2321NU | 1,439.00 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (new equipment) | | E2321NUKC | 1,915.10 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (new equipment) (replacement of special power wheelchair interface) | | E2321NUKU | 2,511.20 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2321UE | 1,079.25 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (used durable medical equipment) | | E2321UEKC | 1,436.33 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (used durable medical equipment) (replacement of special power wheelchair interface) | | E2321UEKU | 1,883.40 | Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2322KH | 131.60 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) | | E2322KHKC | 195.01 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2322KHKU | 265.91 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2322KI | 131.60 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) | | E2322KIKC | 195.01 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2322KIKU | 265.91 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2322KJ | 98.70 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) | | E2322KJKC | 146.26 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2322KJKU | 199.43 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2322NU | 1,316.00 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (new equipment) | | E2322NUKC | 1,950.10 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (new equipment) (replacement of special power wheelchair interface) | | E2322NUKU | 2,659.10 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2322UE | 987.00 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (used durable medical equipment) | | E2322UEKC | 1,462.58 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (used durable medical equipment) (replacement of special power wheelchair interface) | | E2322UEKU | 1,994.33 | Power wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch and fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2323NU | 64.35 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated (new equipment) | | E2323NUKU | 67.10 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2323RR | 6.43 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated (rental) | | E2323RRKU | 6.70 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2323UE | 48.26 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated (used durable medical equipment) | | E2323UEKU | 50.31 | Power wheelchair accessory, specialty joystick handle for hand control interface, prefabricated (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2324NU | 41.61 | Power wheelchair accessory, chin cup for chin control interface (new equipment) | | E2324NUKU | 42.50 | Power wheelchair accessory, chin cup for chin control interface (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2324RR | 4.15 | Power wheelchair accessory, chin cup for chin control interface (rental) | | E2324RRKU | 4.23 | Power wheelchair accessory, chin cup for chin control interface (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2324UE | 31.20 | Power wheelchair accessory, chin cup for chin control interface (used durable medical equipment) | | E2324UEKU | 31.88 | Power wheelchair accessory, chin cup for chin control interface (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2325KH | 125.74 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual SwingAway mounting hardware (rental) | | E2325KHKU | 130.66 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual SwingAway mounting hardware (rental) (for Medicare billing only), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2325KI | 125.74 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual SwingAway mounting hardware (rental) | | E2325KIKU | 130.66 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual SwingAway mounting hardware (rental) (for Medicare billing only), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2325KJ | 94.31 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual SwingAway mounting hardware (rental) | | E2325KJKU | 98.00 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual SwingAway mounting hardware (rental) (for Medicare billing only), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2325NU | 1,257.40 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware (new equipment) | | E2325NUKU | 1,306.60 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2325UE | 943.05 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware (used durable medical equipment) | | E2325UEKU | 979.95 | Power wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical stop switch, and manual swingaway mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2326KH | 32.69 | Power wheelchair accessory, breath tube kit for sip and puff interface (capped rental) | | E2326KHKU | 33.69 | Power wheelchair accessory, breath tube kit for sip and puff interface (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2326KI | 32.69 | Power wheelchair accessory, breath tube kit for sip and puff interface (capped rental) | | E2326KIKU | 33.69 | Power wheelchair accessory, breath tube kit for sip and puff interface (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2326KJ | 24.52 | Power wheelchair accessory, breath tube kit for sip and puff interface (capped rental) | | E2326KJKU | 25.27 | Power wheelchair accessory, breath tube kit for sip and puff interface (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2326NU | 326.90 | Power wheelchair accessory, breath tube kit for sip and puff interface (new equipment) | | E2326NUKU | 336.90 | Power wheelchair accessory, breath tube kit for sip and puff interface (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2326UE | 245.18 | Power wheelchair accessory, breath tube kit for sip and puff interface (used durable medical equipment) | | E2326UEKU | 252.68 | Power wheelchair accessory, breath tube kit for sip and puff interface (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2327KH | 244.88 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental) | | E2327KHKC | 309.51 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2327KHKU | 385.00 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2327KI | 244.88 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental) | | E2327KIKC | 309.51 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2327KIKU | 385.00 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2327KJ | 183.66 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental) | | E2327KJKC | 232.13 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2327KJKU | 288.75 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2327NU | 2,448.80 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (new equipment) | | E2327NUKC | 3,095.10 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (new equipment) (replacement of special power wheelchair interface) | | E2327NUKU | 3,850.00 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2327UE | 1,836.60 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (used durable medical equipment) | | E2327UEKC | 2,321.33 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (used durable medical equipment) (replacement of special power wheelchair interface) | | E2327UEKU | 2,887.50 | Power wheelchair accessory, head control interface, mechanical proportional, including all related electronics, mechanical direction change switch, and fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2328KH | 463.38 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (capped rental) | | E2328KHKU | 480.69 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2328KI | 463.38 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (capped rental) | | E2328KIKU | 480.69 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2328KJ | 347.54 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (capped rental) | | E2328KJKU | 360.52 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (capped rental), (DMEPOS item | | E2328NU | 4,633.80 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (new equipment) | | E2328NUKU | 4,806.90 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2328UE | 3,475.35 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (used durable medical equipment) | | E2328UEKU | 3,605.18 | Power wheelchair accessory, head control or extremity control interface, electronic, proportional, including all related electronics, and fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2329KH | 166.22 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental) | | E2329KHKU | 171.32 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2329KI | 166.22 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental) | | E2329KIKU | 171.32 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2329KJ | 124.67 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental) | | E2329KJKU | 128.49 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2329NU | 1,662.20 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (new equipment) | | E2329NUKU | 1,713.20 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2329UE | 1,246.65 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (used durable medical equipment) | | E2329UEKU | 1,284.90 | Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2330KH | 320.63 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental) | | E2330KHKU | 331.95 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2330KI | 320.63 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental) | | E2330KIKU | 331.95 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2330KJ | 240.47 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental) | | E2330KJKU | 248.96 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2330NU | 3,206.30 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (new equipment) | | E2330NUKU | 3,319.50 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2330UE | 2,404.73 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (used durable medical equipment) | | E2330UEKU | 2,489.63 | Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2331NU | AAC+35% | Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware (new equipment) | | E2331RR | I.C. | Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware (rental) | | E2331UE | I.C. | Power wheelchair accessory, attendant control, proportional, including all related electronics and fixed mounting hardware (used durable mental medical equipment) | | E2340NU | 396.17 | Power wheelchair accessory, nonstandard seat frame width, 20 - 23 inches (new equipment) | | E2340RR | 39.63 | Power wheelchair accessory, nonstandard seat frame width, 20 - 23 inches (rental) | | E2340UE | 297.16 | Power wheelchair accessory, nonstandard seat frame width, 20 - 23 inches (used durable medical equipment) | | E2341NU | 594.30 | Power wheelchair accessory, nonstandard seat frame width, 24 - 27 inches (new equipment) | | E2341RR | 59.42 | Power wheelchair accessory, nonstandard seat frame width, 24 - 27 inches (rental) | | E2341UE | 445.73 | Power wheelchair accessory, nonstandard seat frame width, 24 - 27 inches (used durable medical equipment) | | E2342NU | 495.25 | Power wheelchair accessory, nonstandard seat frame depth, 20 - 21 inches (new equipment) | | E2342RR | 49.52 | Power wheelchair accessory, nonstandard seat frame depth, 20 - 21 inches (rental) | | E2342UE | 371.45 | Power wheelchair accessory, nonstandard seat frame depth, 20 - 21 inches (used durable medical equipment) | | E2343NU | 792.41 | Power wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches (new equipment) | | E2343RR | 79.23 | Power wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches (rental) | | E2343UE | 594.30 | Power wheelchair accessory, nonstandard seat frame depth, 22 - 25 inches (used durable medical equipment) | | E2351NU | 659.43 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface (new equipment) | | E2351NUKU | 677.72 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2351RR | 65.94 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface (rental) | | E2351RRKU | 67.80 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2351UE | 494.58 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface (used durable medical equipment) | | E2351UEKU | 508.27 | Power wheelchair accessory, electronic interface to operate speech generating device using power wheelchair control interface (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2358NU | AAC+35% | Power wheelchair accessory, group 34 non-sealed lead acid battery, each (new equipment) | | E2358RR | I.C. | Power wheelchair accessory, group 34 non-sealed lead acid battery, each (rental) | | E2358UE | I.C. | Power wheelchair accessory, group 34 non-sealed lead acid battery, each (used durable medical equipment) | | E2359NU | 177.83 | Power wheelchair accessory, group 34 sealed lead acid battery, each ( e.g. , Gel cell, absorbed glassmat) (new equipment) | | E2359NUKU | 188.44 | Power wheelchair accessory, group 34 sealed lead acid battery, each ( e.g. Gel cell, absorbed glassmat) (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2359RR | 17.78 | Power wheelchair accessory, group 34 sealed lead acid battery, each ( e.g. , Gel cell, absorbed glassmat) (rental) | | E2359RRKU | 18.85 | Power wheelchair accessory, group 34 sealed lead acid battery, each ( e.g. Gel cell, absorbed glassmat) (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2359UE | 133.38 | Power wheelchair accessory, group 34 sealed lead acid battery, each ( e.g. , Gel cell, absorbed glassmat) (used durable medical equipment) | | E2359UEKU | 141.33 | Power wheelchair accessory, group 34 sealed lead acid battery, each ( e.g. Gel cell, absorbed glassmat) (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2360NU | 113.10 | Power wheelchair accessory, 22 NF non-sealed lead acid battery, each (new equipment) | | E2360NUKU | 126.45 | Power wheelchair accessory, 22 NF non-sealed lead acid battery, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2360RR | 11.34 | Power wheelchair accessory, 22 NF non-sealed lead acid battery, each (rental) | | E2360RRKU | 12.71 | Power wheelchair accessory, 22 NF non-sealed lead acid battery, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2360UE | 84.82 | Power wheelchair accessory, 22 NF non-sealed lead acid battery, each (used durable medical equipment) | | E2360UEKU | 94.82 | Power wheelchair accessory, 22 NF non-sealed lead acid battery, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2361NU | 120.25 | Power wheelchair accessory, 22 NF sealed lead acid battery, each, ( e.g. , gel cell, absorbed glassmat) (new equipment) | | E2361NUKU | 135.29 | Power wheelchair accessory, 22 NF sealed lead acid battery, each, ( e.g. gel cell, absorbed glassmat) (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2361RR | 12.02 | Power wheelchair accessory, 22 NF sealed lead acid battery, each, ( e.g. , gel cell, absorbed glassmat) (rental) | | E2361RRKU | 13.53 | Power wheelchair accessory, 22 NF sealed lead acid battery, each, ( e.g. gel cell, absorbed glassmat) (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2361UE | 90.20 | Power wheelchair accessory, 22 NF sealed lead acid battery, each, ( e.g. , gel cell, absorbed glassmat) (used durable medical equipment) | | E2361UEKU | 101.49 | Power wheelchair accessory, 22 NF sealed lead acid battery, each, ( e.g. gel cell, absorbed glassmat) (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2362NU | 96.25 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each (new equipment) | | E2362NUKU | 103.53 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2362RR | 9.62 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each (rental) | | E2362RRKU | 10.35 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2362UE | 72.18 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each (used durable medical equipment) | | E2362UEKU | 77.63 | Power wheelchair accessory, group 24 non-sealed lead acid battery, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2363NU | 157.57 | Power wheelchair accessory, group 24 sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (new equipment) | | E2363NUKU | 180.44 | Power wheelchair accessory, group 24 sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2363RR | 15.75 | Power wheelchair accessory, group 24 sealed lead acid battery, each ( e.g. , gel cell, absorbed glassmat) (rental) | | E2363RRKU | 18.04 | Power wheelchair accessory, group 24 sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2363UE | 118.18 | Power wheelchair accessory, group 24 sealed lead acid battery, each ( e.g. , gel cell, absorbed glassmat) (used durable medical equipment) | | E2363UEKU | 135.32 | Power wheelchair accessory, group 24 sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2364NU | 107.09 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each (new equipment) | | E2364NUKU | 126.45 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2364RR | 10.74 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each (rental) | | E2364RRKU | 12.71 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2364UE | 80.31 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each (used durable medical equipment) | | E2364UEKU | 94.82 | Power wheelchair accessory, u-1 non-sealed lead acid battery, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2365NU | 88.76 | Power wheelchair accessory, u-1 sealed lead acid battery, each ( e.g. , gel cell, absorbed glassmat) (new equipment) | | E2365NUKU | 108.81 | Power wheelchair accessory, u-1 sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2365RR | 8.87 | Power wheelchair accessory, u-1 sealed lead acid battery, each ( e.g. , gel cell, absorbed glassmat) (rental) | | E2365RRKU | 10.87 | Power wheelchair accessory, u-1 sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2365UE | 66.58 | Power wheelchair accessory, u-1 sealed lead acid battery, each ( e.g. , gel cell, absorbed glassmat) (used durable medical equipment) | | E2365UEKU | 81.64 | Power wheelchair accessory, u-1 sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2366NU | 198.25 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each (new equipment) | | E2366NUKU | 255.73 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2366RR | 19.86 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each (rental) | | E2366RRKU | 25.65 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2366UE | 148.69 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each (used durable medical equipment) | | E2366UEKU | 191.81 | Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2367NU | 346.96 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each (new equipment) | | E2367NUKU | 406.53 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2367RR | 34.70 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each (rental) | | E2367RRKU | 40.65 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2367UE | 260.23 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each (used durable medical equipment) | | E2367UEKU | 304.91 | Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2368KH | 42.63 | Power wheelchair component, drive wheel motor, replacement only (capped rental) | | E2368KHKU | 50.11 | Power wheelchair component, drive wheel motor, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2368KI | 42.63 | Power wheelchair component, drive wheel motor, replacement only (capped rental) | | E2368KIKU | 50.11 | Power wheelchair component, drive wheel motor, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2368KJ | 31.97 | Power wheelchair component, drive wheel motor, replacement only (capped rental) | | E2368KJKU | 37.58 | (Power wheelchair component, drive wheel motor, replacement only capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2368NU | 426.25 | Power wheelchair component, drive wheel motor, replacement only (new equipment) | | E2368NUKU | 501.10 | Power wheelchair component, drive wheel motor, replacement only (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2368UE | 319.69 | Power wheelchair component, drive wheel motor, replacement only (used durable medical equipment) | | E2368UEKU | 375.83 | Power wheelchair component, drive wheel motor, replacement only (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2369KH | 37.75 | Power wheelchair component, drive wheel gear box, replacement only (capped rental) | | E2369KHKU | 43.67 | Power wheelchair component, drive wheel gear box, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2369KI | 37.75 | Power wheelchair component, drive wheel gear box, replacement only (capped rental) | | E2369KIKU0 | 43.67 | Power wheelchair component, drive wheel gear box, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2369KJ | 28.31 | Power wheelchair component, drive wheel gear box, replacement only (capped rental) (for Medicare billing only) | | E2369KJKU | 32.75 | Power wheelchair component, drive wheel gear box, replacement only (capped rental) (for Medicare billing only), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2369NU | 377.37 | Power wheelchair component, drive wheel gear box, replacement only (new equipment) | | E2369NUKU | 436.70 | Power wheelchair component, drive wheel gear box, replacement only (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2369UE | 283.03 | Power wheelchair component, drive wheel gear box, replacement only (used durable medical equipment) | | E2369UEKU | 327.53 | Power wheelchair component, drive wheel gear box, replacement only (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2370KH | 65.60 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (capped rental) | | E2370KHKU | 77.89 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2370KI | 65.60 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (capped rental) | | E2370KIKU | 77.89 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2370KJ | 49.20 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (capped rental) | | E2370KJKU | 58.42 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2370NU | 655.96 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only | | E2370NUKU | 778.90 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only, (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2370UE | 491.97 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (used durable medical equipment) | | E2370UEKU | 584.18 | Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2371NU | 135.77 | Power wheelchair accessory, group 27 sealed lead acid battery, ( e.g. , gel cell, absorbed glassmat), each (new equipment) | | E2371NUKU | 146.23 | Power wheelchair accessory, group 27 sealed lead acid battery, ( e.g. , gel cell, absorbed glassmat), each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2371RR | 13.58 | Power wheelchair accessory, group 27 sealed lead acid battery, ( e.g. , gel cell, absorbed glassmat), each (rental) | | E2371RRKU | 14.63 | Power wheelchair accessory, group 27 sealed lead acid battery, ( e.g. , gel cell, absorbed glassmat), each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2371UE | 101.84 | Power wheelchair accessory, group 27 sealed lead acid battery, ( e.g. , gel cell, absorbed glassmat), each (used durable medical equipment) | | E2371UEKU | 109.68 | Power wheelchair accessory, group 27 sealed lead acid battery, ( e.g. , gel cell, absorbed glassmat), each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2372NU | AAC+35% | Power wheelchair accessory, group 27 nonsealed lead acid battery, each (new equipment) | | E2372RR | I.C. | Power wheelchair accessory, group 27 nonsealed lead acid battery, each (rental) | | E2372UE | I.C. | Power wheelchair accessory, group 27 nonsealed lead acid battery, each (used durable medical equipment) | | E2373KH | 74.74 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental) | | E2373KHKC | 114.06 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2373KHKU | 117.40 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2373KI | 74.74 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental) | | E2373KIKC | 114.06 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2373KIKU | 117.40 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2373KJ | 56.06 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental) | | E2373KJKC | 85.55 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental) (replacement of special power wheelchair interface) | | E2373KJKU | 88.05 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2373NU | 747.40 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (new equipment) | | E2373NUKC | 1,140.60 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (new equipment) (replacement of special power wheelchair interface) | | E2373NUKU | 1,174.00 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2373UE | 560.55 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (used durable medical equipment) | | E2373UEKC | 855.45 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (used durable medical equipment) (replacement of special power wheelchair interface) | | E2373UEKU | 880.50 | Power wheelchair accessory, hand or chin control interface, compact remote joystick, proportional, including fixed mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2374KH | 48.57 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (capped rental) | | E2374KHKU | 51.82 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2374KI | 48.57 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (capped rental) | | E2374KIKU | 51.82 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2374KJ | 36.43 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (capped rental) | | E2374KJKU | 38.87 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2374NU | 485.70 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (new equipment) | | E2374NUKU | 518.20 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2374UE | 364.28 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (used durable medical equipment) | | E2374UEKU | 388.65 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2375KH | 74.72 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (capped rental) | | E2375KHKU | 83.07 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2375KI | 74.72 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (capped rental) | | E2375KIKU | 83.07 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2375KJ | 56.04 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (capped rental) | | E2375KJKU | 62.30 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2375NU | 747.30 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (new equipment) | | E2375NUKU | 830.70 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2375UE | 560.47 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (used durable medical equipment) | | E2375UEKU | 623.03 | Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2376KH | 121.39 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (capped rental) | | E2376KHKU | 130.22 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2376KI | 121.39 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (capped rental) | | E2376KIKU | 130.22 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2376KJ | 91.04 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (capped rental) | | E2376KJKU | 97.67 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2376NU | 1,213.90 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (new equipment) | | E2376NUKU | 1,302.20 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2376UE | 910.43 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (used durable medical equipment) | | E2376UEKU | 976.65 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2377KH | 45.77 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (capped rental) | | E2377KHKU | 47.10 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2377KI | 45.77 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (capped rental) | | E2377KIKU | 47.10 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2377KJ | 34.33 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (capped rental) | | E2377KJKU | 35.33 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2377NU | 444.20 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (new equipment) | | E2377NUKU | 471.00 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2377UE | 333.15 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (used durable medical equipment) | | E2377UEKU | 353.25 | Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2378KH | 56.57 | Power wheelchair component, actuator, replacement only (rental) | | E2378KHKU | 57.60 | Power wheelchair component, actuator, replacement only (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2378KI | 56.57 | Power wheelchair component, actuator, replacement only (rental) | | E2378KIKU | 57.60 | Power wheelchair component, actuator, replacement only (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2378KJ | 42.43 | Power wheelchair component, actuator, replacement only (rental) | | E2378KJKU | 43.20 | Power wheelchair component, actuator, replacement only (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2378NU | 565.70 | Power wheelchair component, actuator, replacement only (new equipment purchase) | | E2378NUKU | 576.00 | Power wheelchair component, actuator, replacement only (new equipment purchase), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2378UE | 424.28 | Power wheelchair component, actuator, replacement only (used durable medical equipment purchase) | | E2378UEKU | 432.00 | Power wheelchair component, actuator, replacement only (used durable medical equipment purchase), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2381NU | 63.25 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each (new equipment) | | E2381NUKU | 73.89 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2381RR | 6.34 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each (rental) | | E2381RRKU | 7.41 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2381UE | 47.45 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each (used durable medical equipment) | | E2381UEKU | 55.42 | Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2382NU | 18.32 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each (new equipment) | | E2382NUKU | 20.14 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2382RR | 1.83 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each (rental) | | E2382RRKU | 2.00 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2382UE | 13.75 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each (used durable medical equipment) | | E2382UEKU | 15.11 | Power wheelchair accessory, tube for pneumatic drive wheel tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2383NU | 127.85 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each (new equipment) | | E2383NUKU | 147.33 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2383RR | 12.79 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each (rental) | | E2383RRKU | 14.73 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2383UE | 95.89 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each (used durable medical equipment) | | E2383UEKU | 110.49 | Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2384NU | 66.33 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each (new equipment) | | E2384NUKU | 78.49 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2384RR | 6.64 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each (rental) | | E2384RRKU | 7.87 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2384UE | 49.75 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each (used durable medical equipment) | | E2384UEKU | 58.88 | Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2385NU | 43.81 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each (new equipment) | | E2385NUKU | 48.02 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2385RR | 4.39 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each (rental) | | E2385RRKU | 4.82 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2385UE | 32.85 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each (used durable medical equipment) | | E2385UEKU | 36.00 | Power wheelchair accessory, tube for pneumatic caster tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2386NU | 117.14 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each (new equipment) | | E2386NUKU | 145.99 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2386RR | 11.71 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each (rental) | | E2386RRKU | 14.60 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2386UE | 87.86 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each (used durable medical equipment) | | E2386UEKU | 109.50 | Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2387NU | 53.36 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each (new equipment) | | E2387NUKU | 65.46 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2387RR | 5.34 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each (rental) | | E2387RRKU | 6.55 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2387UE | 40.04 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each (used durable medical equipment) | | E2387UEKU | 49.14 | Power wheelchair accessory, foam filled caster tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2388NU | 46.01 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each (new equipment) | | E2388NUKU | 48.87 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2388RR | 4.61 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each (rental) | | E2388RRKU | 4.89 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2388UE | 34.51 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each (used durable medical equipment) | | E2388UEKU | 36.67 | Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2389NU | 25.34 | Power wheelchair accessory, foam caster tire, any size, replacement only, each (new equipment) | | E2389NUKU | 26.55 | Power wheelchair accessory, foam caster tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2389RR | 2.54 | Power wheelchair accessory, foam caster tire, any size, replacement only, each (rental) | | E2389RRKU | 2.67 | Power wheelchair accessory, foam caster tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2389UE | 18.99 | Power wheelchair accessory, foam caster tire, any size, replacement only, each (used durable medical equipment) | | E2389UEKU | 19.89 | Power wheelchair accessory, foam caster tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2390NU | 39.43 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each (new equipment) | | E2390NUKU | 41.51 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2390RR | 3.94 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each (rental) | | E2390RRKU | 4.15 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2390UE | 29.56 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each (used durable medical equipment) | | E2390UEKU | 31.11 | Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2391NU | 17.13 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (new equipment) | | E2391NUKU | 19.88 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2391RR | 1.72 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (rental) | | E2391RRKU | 1.99 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2391UE | 12.85 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (used durable medical equipment) | | E2391UEKU | 14.91 | Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2392NU | 42.71 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (new equipment) | | E2392NUKU | 52.26 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2392RR | 4.28 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (rental) | | E2392RRKU | 5.26 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2392UE | 32.04 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (used durable medical equipment) | | E2392UEKU | 39.21 | Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2394NU | 64.63 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each (new equipment) | | E2394NUKU | 74.47 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2394RR | 6.47 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each (rental) | | E2394RRKU | 7.46 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2394UE | 48.47 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each (used durable medical equipment) | | E2394UEKU | 55.85 | Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2395NU | 45.24 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (new equipment) | | E2395NUKU | 52.91 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2395RR | 4.53 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (rental) | | E2395RRKU | 5.31 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2395UE | 33.94 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (used durable medical equipment) | | E2395UEKU | 39.69 | Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2396NU | 53.61 | Power wheelchair accessory, caster fork, any size, replacement only, each (new equipment) | | E2396NUKU | 62.15 | Power wheelchair accessory, caster fork, any size, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2396RR | 5.70 | Power wheelchair accessory, caster fork, any size, replacement only, each (rental) | | E2396RRKU | 6.91 | Power wheelchair accessory, caster fork, any size, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2396UE | 40.22 | Power wheelchair accessory, caster fork, any size, replacement only, each (used durable medical equipment) | | E2396UEKU | 46.64 | Power wheelchair accessory, caster fork, any size, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2397NU | 443.59 | Power wheelchair accessory, lithium-based battery, each (new equipment) | | E2397NUKU | 466.10 | Power wheelchair accessory, lithium-based battery, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2397RR | 44.36 | Power wheelchair accessory, lithium-based battery, each (rental) | | E2397RRKU | 46.62 | Power wheelchair accessory, lithium-based battery, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2397UE | 332.68 | Power wheelchair accessory, lithium-based battery, each (used durable medical equipment) | | E2397UEKU | 349.55 | Power wheelchair accessory, lithium-based battery, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2398 | I.C. | Wheelchair accessory, dynamic positioning hardware for back | | Wound Therapy | | | | E2402KH | 1,026.17 | Negative pressure wound therapy electrical pump, stationary or portable (capped rental) | | E2402KI | 1,026.17 | Negative pressure wound therapy electrical pump, stationary or portable (capped rental) | | E2402KJ | 769.63 | Negative pressure wound therapy electrical pump, stationary or portable (capped rental) | | E2402NU | 10,261.71 | Negative pressure wound therapy electrical pump, stationary or portable (new equipment purchase) | | E2402UE | 7,696.28 | Negative pressure wound therapy electrical pump, stationary or portable (used durable medical equipment purchase) | | Speech Generating Device | | | | E2500NU | 367.46 | Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time (new equipment) | | E2500RR | 36.75 | Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time (rental) | | E2500UE | 275.60 | Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time (used durable medical equipment) | | E2502NU | 1,123.67 | Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time (new equipment) | | E2502RR | 112.37 | Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time (rental) | | E2502UE | 842.77 | Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time (used durable medical equipment) | | E2504NU | 1,482.26 | Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time (new equipment) | | E2504RR | 148.25 | Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time (rental) | | E2504UE | 1,111.70 | Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time (used durable medical equipment) | | E2506NU | 2,173.45 | Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time (new equipment) | | E2506RR | 217.33 | Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time (rental) | | E2506UE | 1,630.05 | Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time (used durable medical equipment) | | E2508NU | 3,360.87 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device (new equipment) | | E2508RR | 336.08 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device (rental) | | E2508UE | 2,520.66 | Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device (used durable medical equipment) | | E2510NU | 6,360.00 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access (new equipment) | | E2510RR | 636.00 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access (rental) | | E2510TW | - | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access (MassHealth-only usage of this code with modifier is for a non-dedicated alternative and augmentative communication device pursuant to 130 CMR 409.000: Durable Medical Equipment and Medical Supplies Services ). | | E2510UE | 4,770.00 | Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access (used durable medical equipment) | | E2511NU | AAC+30% | Speech generating software program, for personal computer or personal digital assistant (new equipment) | | E2511RR | I.C. | Speech generating software program, for personal computer or personal digital assistant (rental) | | E2511TW | - | Speech generating software program (MassHealth-only usage of this code with modifier is for a non-dedicated alternative and augmentative communication device pursuant to 130 CMR 409.000: Durable Medical Equipment and Medical Supplies Services .) | | E2511UE | I.C. | Speech generating software program, for personal computer or personal digital assistant (used durable medical equipment) | | E2512NU | AAC+30% | Accessory for speech generating device, mounting system (new equipment) | | E2512RR | I.C. | Accessory for speech generating device, mounting system (rental) | | E2512TW | - | Accessory for speech generating device, mounting system (MassHealth-only usage of this code with modifier is for a non-dedicated alternative and augmentative communication device pursuant to 130 CMR 409.000: Durable Medical Equipment and Medical Supplies Services .) | | E2512UE | I.C. | Accessory for speech generating device, mounting system (used durable medical equipment) | | E2599NU | AAC+30% | Accessory for speech generating device, not otherwise classified (new equipment) | | E2599RR | AAC+30% | Accessory for speech generating device, not otherwise classified (rental) | | E2599TW | - | Accessory for speech generating device, not otherwise classified (protective case) [not covered if used as a modification to home internet or phone services.] (MassHealth-only usage of this code with modifier is for a non-dedicated alternative and augmentative communication device pursuant to 130 CMR 409.000: Durable Medical Equipment and Medical Supplies Services .) | | E2599UE | I.C. | Accessory for speech generating device, not otherwise classified (used durable medical equipment) | | Wheelchair Cushion | | | | E2601NU | 49.64 | General use wheelchair seat cushion, width less than 22 inches, any depth (new equipment) | | E2601NUKU | 59.33 | General use wheelchair seat cushion, width less than 22 inches, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2601RR | 4.97 | General use wheelchair seat cushion, width less than 22 inches, any depth (rental) | | E2601RRKU | 5.95 | General use wheelchair seat cushion, width less than 22 inches, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2601UE | 37.24 | General use wheelchair seat cushion, width less than 22 inches, any depth (used durable medical equipment) | | E2601UEKU | 44.50 | General use wheelchair seat cushion, width less than 22 inches, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2602NU | 98.59 | General use wheelchair seat cushion, width 22 inches or greater, any depth (new equipment) | | E2602NUKU | 115.82 | General use wheelchair seat cushion, width 22 inches or greater, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2602RR | 9.86 | General use wheelchair seat cushion, width 22 inches or greater, any depth (rental) | | E2602RRKU | 11.59 | General use wheelchair seat cushion, width 22 inches or greater, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2602UE | 73.94 | General use wheelchair seat cushion, width 22 inches or greater, any depth (used durable medical equipment) | | E2602UEKU | 86.88 | General use wheelchair seat cushion, width 22 inches or greater, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2603NU | 121.14 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth (new equipment) | | E2603NUKU | 147.04 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2603RR | 12.12 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth (rental) | | E2603RRKU | 14.71 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2603UE | 90.86 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth (used durable medical equipment) | | E2603UEKU | 110.29 | Skin protection wheelchair seat cushion, width less than 22 inches, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2604NU | 156.83 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth (new equipment) | | E2604NUKU | 182.78 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2604RR | 15.68 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth (rental) | | E2604RRKU | 18.28 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2604UE | 117.63 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth (used durable medical equipment) | | E2604UEKU | 137.10 | Skin protection wheelchair seat cushion, width 22 inches or greater, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2605NU | 227.94 | Positioning wheelchair seat cushion, width less than 22 inches, any depth (new equipment) | | E2605NUKU | 261.12 | Positioning wheelchair seat cushion, width less than 22 inches, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2605RR | 22.80 | Positioning wheelchair seat cushion, width less than 22 inches, any depth (rental) | | E2605RRKU | 26.12 | Positioning wheelchair seat cushion, width less than 22 inches, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2605UE | 170.97 | Positioning wheelchair seat cushion, width less than 22 inches, any depth (used durable medical equipment) | | E2605UEKU | 195.87 | Positioning wheelchair seat cushion, width less than 22 inches, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2606NU | 344.73 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth (new equipment) | | E2606NUKU | 407.36 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2606RR | 34.48 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth (rental) | | E2606RRKU | 40.74 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2606UE | 258.54 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth (used durable medical equipment) | | E2606UEKU | 305.49 | Positioning wheelchair seat cushion, width 22 inches or greater, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2607NU | 238.61 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth (new equipment) | | E2607NUKU | 281.17 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2607RR | 23.86 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth (rental) | | E2607RRKU | 28.12 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2607UE | 178.96 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth (used durable medical equipment) | | E2607UEKU | 210.88 | Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2608NU | 283.40 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth (new equipment) | | E2608NUKU | 337.66 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2608RR | 28.34 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth (rental) | | E2608RRKU | 33.76 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2608UE | 212.55 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth (used durable medical equipment) | | E2608UEKU | 253.25 | Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2609NU | AAC+35% | Custom fabricated wheelchair seat cushion, any size | | E2609RR | I.C. | Custom fabricated wheelchair seat cushion, any size (rental) | | E2609UE | I.C. | Custom fabricated wheelchair seat cushion, any size (used durable medical equipment) | | E2610NU | AAC+35% | Wheelchair seat cushion, powered (new equipment) | | E2610RR | I.C. | Wheelchair seat cushion, powered (rental) | | E2610UE | I.C. | Wheelchair seat cushion, powered (used durable medical equipment) | | E2611NU | 226.54 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware (new equipment) | | E2611NUKU | 303.00 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2611RR | 22.65 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware (rental) | | E2611RRKU | 30.29 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2611UE | 169.92 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware (used durable medical equipment) | | E2611UEKU | 227.27 | General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2612NU | 340.36 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware (new equipment) | | E2612NUKU | 409.89 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2612RR | 34.03 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware (rental) | | E2612RRKU | 40.99 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2612UE | 255.27 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware (used durable medical equipment) | | E2612UEKU | 307.41 | General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2613NU | 338.48 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware (new equipment) | | E2613NUKU | 381.28 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2613RR | 33.85 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware (rental) | | E2613RRKU | 38.13 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2613UE | 253.86 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware (used durable medical equipment) | | E2613UEKU | 285.96 | Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2614NU | 451.17 | Positioning wheelchair back cushion, posterior, 22 inches or greater, any height, including any type mounting hardware (new equipment) | | E2614NUKU | 527.66 | Positioning wheelchair back cushion, posterior, 22 inches or greater, any height, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2614RR | 45.12 | Positioning wheelchair back cushion, posterior, 22 inches or greater, any height, including any type mounting hardware (rental) | | E2614RRKU | 52.76 | Positioning wheelchair back cushion, posterior, 22 inches or greater, any height, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2614UE | 338.38 | Positioning wheelchair back cushion, posterior, 22 inches or greater, any height, including any type mounting hardware (used durable medical equipment) | | E2614UEKU | 395.76 | Positioning wheelchair back cushion, posterior, 22 inches or greater, any height, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2615NU | 391.46 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware (new equipment) | | E2615NUKU | 438.77 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2615RR | 39.15 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware (rental) | | E2615RRKU | 43.89 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2615UE | 293.59 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware (used durable medical equipment) | | E2615UEKU | 329.07 | Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2616NU | 501.23 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware (new equipment) | | E2616NUKU | 590.36 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2616RR | 50.12 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware (rental) | | E2616RRKU | 59.04 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2616UE | 375.93 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware (used durable medical equipment) | | E2616UEKU | 442.78 | Positioning wheelchair back cushion, posterior-lateral, width 22 inches or greater, any height, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2617NU | AAC+35% | Custom fabricated wheelchair back cushion, any size, including any type mounting hardware (new equipment) | | E2617RR | I.C. | Custom fabricated wheelchair back cushion, any size, including any type mounting hardware (rental) | | E2617UE | I.C. | Custom fabricated wheelchair back cushion, any size, including any type mounting hardware (used durable medical equipment) | | E2619NU | 47.11 | Replacement cover for wheelchair seat cushion or back cushion, each (new equipment) | | E2619NUKU | 49.77 | Replacement cover for wheelchair seat cushion or back cushion, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2619RR | 4.71 | Replacement cover for wheelchair seat cushion or back cushion (rental) | | E2619RRKU | 4.97 | Replacement cover for wheelchair seat cushion or back cushion (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2619UE | 35.35 | Replacement cover for wheelchair seat cushion or back cushion (used durable medical equipment) | | E2619UEKU | 37.37 | Replacement cover for wheelchair seat cushion or back cushion (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2620NU | 451.25 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware (new equipment) | | E2620NUKU | 531.29 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2620RR | 45.13 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware (rental) | | E2620RRKU | 53.14 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2620UE | 338.44 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware (used durable medical equipment) | | E2620UEKU | 398.49 | Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2621NU | 470.39 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware (new equipment) | | E2621NUKU | 557.56 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2621RR | 47.04 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware (rental) | | E2621RRKU | 55.76 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2621UE | 352.79 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware (used durable medical equipment) | | E2621UEKU | 418.17 | Positioning wheelchair back cushion, planar back with lateral supports, width 22 inches or greater, any height, including any type mounting hardware (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2622NU | 301.67 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth (new equipment) | | E2622NUKU | 321.54 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2622RR | 30.17 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth (rental) | | E2622RRKU | 32.16 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2622UE | 226.25 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth (used durable medical equipment) | | E2622UEKU | 241.15 | Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2623NU | 382.72 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (new equipment) | | E2623NUKU | 409.15 | kin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2623RR | 38.28 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (rental) | | E2623RRKU | 40.93 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2623UE | 287.04 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (used durable medical equipment) | | E2623UEKU | 306.85 | Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2624NU | 305.29 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth (new equipment) | | E2624NUKU | 324.19 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2624RR | 30.53 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth (rental) | | E2624RRKU | 32.42 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2624UE | 228.98 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth (used durable medical equipment) | | E2624UEKU | 243.16 | Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2625NU | 382.34 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (new equipment) | | E2625NUKU | 410.40 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2625RR | 38.23 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (rental) | | E2625RRKU | 41.03 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2625UE | 286.75 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (used durable medical equipment) | | E2625UEKU | 307.80 | Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | Wheelchair Arm Support | | | | E2626NU | 651.51 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable (new equipment) | | E2626NUKU | 699.08 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2626RR | 65.14 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable (rental) | | E2626RRKU | 69.88 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2626UE | 488.61 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable (used durable medical equipment) | | E2626UEKU | 524.24 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2627NU | 1,033.91 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type (new equipment) | | E2627NUKU | 1,115.50 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2627RR | 103.41 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type (rental) | | E2627RRKU | 111.58 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2627UE | 775.43 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type (used durable medical equipment) | | E2627UEKU | 836.61 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2628NU | 775.09 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining (new equipment) | | E2628NUKU | 840.35 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2628RR | 77.51 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining (rental) | | E2628RRKU | 84.03 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2628UE | 581.31 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining (used durable medical equipment) | | E2628UEKU | 630.25 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2629NU | 949.59 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) (new equipment) | | E2629NUKU | 966.76 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2629RR | 94.95 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) (rental) | | E2629RRKU | 96.66 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2629UE | 712.20 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) (used durable medical equipment) | | E2629UEKU | 725.08 | Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints) (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2630NU | 684.22 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support (new equipment) | | E2630NUKU | 743.66 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2630RR | 68.42 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support (rental) | | E2630RRKU | 74.37 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2630UE | 513.16 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support (used durable medical equipment) | | E2630UEKU | 557.74 | Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow forearm hand sling support, yoke type suspension support (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2631NU | 248.36 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm (new equipment) | | E2631NUKU | 252.87 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2631RR | 24.84 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm (rental) | | E2631RRKU | 25.28 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2631UE | 186.27 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm (used durable medical equipment) | | E2631UEKU | 189.64 | Wheelchair accessory, addition to mobile arm support, elevating proximal arm (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2632NU | 174.58 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control (new equipment) | | E2632NUKU | 189.15 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2632RR | 17.46 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control (rental) | | E2632RRKU | 18.92 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2632UE | 130.93 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control (used durable medical equipment) | | E2632UEKU | 141.86 | Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2633NU | 146.61 | Wheelchair accessory, addition to mobile arm support, supinator (new equipment) | | E2633NUKU | 160.44 | Wheelchair accessory, addition to mobile arm support, supinator (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2633RR | 14.66 | Wheelchair accessory, addition to mobile arm support, supinator (rental) | | E2633RRKU | 16.05 | Wheelchair accessory, addition to mobile arm support, supinator (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | E2633UE | 109.96 | Wheelchair accessory, addition to mobile arm support, supinator (used durable medical equipment) | | E2633UEKU | 120.34 | Wheelchair accessory, addition to mobile arm support, supinator (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | Gait Trainer E8000 | AAC+35% | Gait trainer, pediatric size, posterior support, includes all accessories and components | | E8001 | AAC+35% | Gait trainer, pediatric size, upright support, includes all accessories and components | | E8002 | AAC+35% | Gait trainer, pediatric size, anterior support, includes all accessories and components | | Drugs Administered Other Than Oral Method | | | | G0333 | 48.45 | Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary | | J0133 | 0.40 | Injection, acyclovir, 5 mg | | J0153 | 0.82 | Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) | | J0285 | 8.74 | Injection, amphotericin b, 50 mg | | J0287 | 18.57 | Injection, amphotericin b lipid complex, 10 mg | | J0288 | 12.92 | Injection, amphotericin b cholesteryl sulfate complex, 10 mg | | J0289 | 30.43 | Injection, amphotericin b liposome, 10 mg | | J0882 | 3.53 | Injection, darbepoetin alfa, 1 microgram (for ESRD on dialysis) | | J0895 | 13.29 | Injection, deferoxamine mesylate, 500 mg | | J1170 | 1.27 | Injection, hydromorphone, up to 4 mg | | J1250 | 4.03 | Injection, dobutamine hydrochloride, per 250 mg | | J1265 | 0.52 | Injection, dopamine hcl, 40 mg | | J1325 | 10.74 | Injection, epoprostenol, 0.5 mg | | J1455 | 11.11 | Injection, foscarnet sodium, per 1000 mg | | J1459 | 32.52 | Injection, immune globulin (privigen), intravenous, non-lyophilized ( e.g. liquid), 500 mg | | J1555 | AAC+20% | Injection, immune globulin (cuvitru), 100 mg | | J1557 | 31.72 | Injection, immune globulin, (gammaplex), intravenous, non-lyophilized ( e.g. liquid), 500 mg | | J1559 | 12.21 | Injection, immune globulin (hizentra),100 mg | | J1561 | 35.50 | Injection, immune globulin, (gamunex-c/cammaked), intravenous, non-lyophilized ( e.g. , liquid), 500 mg | | J1561JB | 39.24 | Injection, immune globulin, (gamunex-c/cammaked), intravenous, non-lyophilized ( e.g. , liquid), 500 mg (administered subcutaneously) | | J1562 | 9.69 | Injection, immune globulin (vivaglobin), 100 mg | | J1566 | 29.66 | Injection, immune globulin, intravenous, lyophilized ( e.g. powder), not otherwise specified, 500 mg | | J1568 | 36.08 | Injection, immune globulin (octagam), intravenous, non-lyophilized ( e.g. , liquid), 500 mg | | J1569 | 32.40 | Injection, immune globulin, (gammagard liquid), intravenous, non-lyophilized ( e.g. liquid), 500 mg | | J1569JB | 44.62 | Injection, immune globulin, (gammagard liquid), intravenous, non-lyophilized ( e.g. liquid), 500 mg (administered subcutaneously) | | J1570 | 29.96 | Injection, ganciclovir sodium, 500 mg | | J1572 | 33.46 | Injection, immune globulin, (flebogamma/flebogama dif), intravenous, non-lyophilized ( e.g. liquid), 500 mg | | J1575 | 14.72 | Injection, immune globulin/hyaluronidase, (Hyqvia), 100 mg immune globulin | | J1599 | AAC | Injection, immune globulin, intravenous, non-lyophilized ( e.g. liquid), not otherwise specified, 500 mg | | J1644AX | 0.18 | Injection, heparin sodium, per 1000 units | | J1815 | 0.67 | Injection, insulin, per 5 units | | J1817 | 2.38 | Insulin for administration through DME ( i.e. , insulin pump) per 50 units | | J2175 | 0.48 | Injection, meperidine hydrochloride, per 100 mg | | J2260 | 43.84 | Injection, milrinone lactate, 5 mg | | J2270 | 0.60 | Injection, morphine sulfate, up to 10 mg | | J2274 | 7.28 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10mg | | J2407 | 21.77 | Injection, oritavancin, 10 mg | | J2545 | 96.68 | Pentamidine isethionate, inhalation solution, FDA-approved final product, on-compounded, administered through DME, unit dose form, per 300 mg | | J2920 | 2.46 | Injection, methylprednisolone sodium succinate, up to 40 mg | | J2930 | 3.49 | Injection, methylprednisolone sodium succinate, up to 125 mg | | J3010 | 0.60 | Injection, fentanyl citrate, 0.1 mg | | J3090 | 1.03 | Injection, tedizolid phosphate, 1 mg | | J3285 | 52.49 | Injection, treprostinil, 1 mg | | J3380 | 14.47 | Injection, vedolizumab, 1 mg | | J3489 | 23.40 | Injection, zoledronic acid, 1 mg | | Miscellaneous Drugs and Solutions | | | | J7340 | AAC | Carbidopa 5 mg/levodopa 20 mg enteral suspension | | J7500 | 0.14 | Azathioprine, oral, 50 mg | | J7501 | 77.66 | Azathioprine, parenteral, 100 mg | | J7502 | 2.86 | Cyclosporine, oral, 100 mg | | J7503 | AAC | Tacrolimus, extended release, (Envarsus XR), oral, 0.25 mg | | J7504 | 966.39 | Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg | | J7505 | 982.67 | Muromonab-CD3, parenteral, 5 mg | | J7507 | 0.72 | Tacrolimus, oral, per 1 mg | | J7508 | 0.33 | Tacrolimus, extended release, (Astagraf XL). oral, 0.1 mg | | J7509 | 0.28 | Methylprednisolone oral, per 4 mg | | J7510 | 0.11 | Prednisolone oral, per 5 mg | | J7511 | 546.55 | Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25mg | | J7512 | 0.01 | Prednisone, immediate release or delayed release, oral, 1 mg | | J7513 | 447.39 | Daclizumab, parenteral, 25 mg | | J7515 | 0.83 | Cyclosporine, oral, 25 mg | | J7516 | 36.29 | Cyclosporine, parenteral, 250 mg | | J7517 | 0.86 | Mycophenolate mofetil, oral, 250 mg | | J7518 | 2.60 | Mycophenolic acid, oral, 180 mg | | J7520 | 7.50 | Sirolimus, oral, 1 mg | | J7525 | 139.77 | Tacrolimus, parenteral, 5 mg | | J7527 | AAC | Everolimus, oral, 0.25 mg | | Inhalation Drugs | | | | J7605KO | 7.02 | Arformoterol, inhalation solution, FDA approved final product, non-compounded administered through DME, unit dose form, 15 micrograms (single drug unit dose formulation) | | J7606KO | 8.00 | Formoterol fumarate, inhalation solution, FDA approved final product, non-compounded, administered through DME, unit dose form, 20 micrograms | | J7608KO | 3.42 | Acetylcysteine, inhalation solution, FDA-approved final product, non-compunded, administered through DME, unit dose form, per gram (single drug unit dose formulation) | | J7609 | 0.05 | Albuterol, inhalation solution, compounded product, administered through DME, unit dose, 1 mg | | J7611 | 0.10 | Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 1 mg | | J7612 | 0.24 | Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, 0.5 mg | | J7613KO | 0.04 | Albuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1mg (single drug unit dose formulation) | | J7614KO | 0.07 | Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 0.5mg (single drug unit dose formulation) | | J7620 | 0.13 | Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, FDA-approved final product, non-compounded, administered through DME | | J7626KO | 4.52 | Budesonide inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, up to 0.50 mg (single drug unit dose formulation) | | J7631KO | 0.68 | Cromolyn sodium, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, per 10 milligrams (single drug unit dose formulation) | | J7639KO | 33.14 | Dornase alpha, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, per milligram (single drug unit dose formulation) | | J7644KO | 0.18 | Ipratropium bromide, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, per milligram (single drug unit dose formulation) | | J7669KO | 0.37 | Metaproterenol sulfate, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, per 10 milligrams (single drug unit dose formulation) | | J7682KO | 47.27 | Tobramycin, inhalation solution, FDA-approved final product, non-compounded, unit dose form, 300 mg, inhalation solution, administered through DME (single drug unit dose formulation) | | J7686KO | 430.47 | Treprostinil, inhalation solution, FDA-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg | | J7999 | AAC | Compounded drug, not otherwise classified | | J8501 | 8.67 | Aprepitant, oral, 5 mg | | J8520 | 4.45 | Capecitabine, oral, 150 mg | | J8521 | 14.15 | Capecitabine, oral, 500 mg | | J8530 | 3.12 | Cyclophosphamide; oral, 25 mg | | J8540 | 0.11 | Dexamethasone, oral, 0.25 mg | | J8610 | 1.18 | Methotrexate; oral, 2.5 mg | | J8650 | 28.99 | Nabilone, oral, 1 mg | | J8655 | 419.97 | Netupitant 300 Mg and Palonosetron 0.5 Mg, oral | | J8670 | 2.65 | Rolapitant, oral, 1 mg | | Chemotherapy Drugs | | | | J9000 | 10.66 | Injection, doxorubicin hydrochloride, 10 mg | | J9032 | 27.63 | Injection, belinostat, 10 mg | | J9039 | AAC | Injection, blinatumomab, 1 microgram | | J9040 | 245.96 | Injection, bleomycin sulfate, 15 units | | J9065 | 52.46 | Injection, cladribine, per 1 mg | | J9100 | 6.96 | Cytarabine, 100 mg | | J9190 | 1.76 | Injection, fluorouracil, 500 mg | | J9200 | 116.28 | Floxuridine, 500 mg | | J9208 | 127.82 | Ifosfamide, 1 gm | | J9271 | 38.84 | Injection, pembrolizumab, 1 mg | | J9299 | 21.56 | Injection, nivolumab, 1 mg | | J9308 | 45.91 | Injection, ramucirumab, 5 mg | | J9360 | 3.49 | Injection, vinblastine sulfate, 1 mg | | J9370 | 28.88 | Vincristine sulfate, 1 mg | | J9390 | 92.65 | Injection, vinorelbine tartrate, 10 mg | | K Codes (Temporary) K0000-K9999 | | | | Wheelchair and Wheelchair Accessories | | | | K0001KH | 36.41 | Standard wheelchair (capped rental) | | K0001KI | 36.41 | Standard wheelchair (capped rental) | | K0001KJ | 27.31 | Standard wheelchair (capped rental) | | K0001NU | 364.14 | Standard wheelchair (new equipment purchase) | | K0001UE | 273.11 | Standard wheelchair (used equipment purchase) | | K0002KH | 53.61 | Standard hemi (low seat) wheelchair (capped rental) | | K0002KI | 53.61 | Standard hemi (low seat) wheelchair (capped rental) | | K0002KJ | 40.21 | Standard hemi (low seat) wheelchair (capped rental) | | K0002NU | 536.10 | Standard hemi (low seat) wheelchair (new equipment purchase) | | K0002UE | 402.08 | Standard hemi (low seat) wheelchair (used durable medical equipment purchase) | | K0003KH | 59.43 | Lightweight wheelchair (capped rental) | | K0003KI | 59.43 | Lightweight wheelchair (capped rental) | | K0003KJ | 44.57 | Lightweight wheelchair (capped rental) | | K0003NU | 594.32 | Lightweight wheelchair (new equipment purchase) | | K0003UE | 445.74 | Lightweight wheelchair (used durable medical equipment purchase) | | K0004KH | 84.77 | High strength, lightweight wheelchair (capped rental) | | K0004KI | 84.77 | High strength, lightweight wheelchair (capped rental) | | K0004KJ | 63.58 | High strength, lightweight wheelchair (capped rental) | | K0004NU | 847.71 | High strength, lightweight wheelchair (new equipment purchase) | | K0004UE | 635.78 | High strength, lightweight wheelchair (used durable medical equipment purchase) | | K0005NU | 1,737.26 | Ultralightweight wheelchair (new equipment) | | K0005RR | 173.71 | Ultralightweight wheelchair (rental) | | K0005UE | 1,302.91 | Ultralightweight wheelchair (used durable medical equipment) | | K0006KH | 90.73 | Heavy duty wheelchair (capped rental) | | K0006KI | 90.73 | Heavy duty wheelchair (capped rental) | | K0006KJ | 68.05 | Heavy duty wheelchair (capped rental) | | K0006NU | 907.29 | Heavy duty wheelchair (new equipment purchase) | | K0006UE | 680.47 | Heavy duty wheelchair (used durable medical equipment) | | K0007KH | 132.20 | Extra heavy duty wheelchair (capped rental) | | K0007KI | 132.20 | Extra heavy duty wheelchair (capped rental) | | K0007KJ | 99.15 | Extra heavy duty wheelchair (capped rental) | | K0007NU | 1,322.01 | Extra heavy duty wheelchair (new equipment purchase) | | K0007UE | 991.51 | Extra heavy duty wheelchair (used durable medical equipment) | | K0008 | AAC+35% | Custom manual wheelchair base | | K0009KH | 79.01 | Other manual wheelchair/base (capped rental) | | K0009KI | 79.01 | Other manual wheelchair/base (capped rental) | | K0009KJ | 59.26 | Other manual wheelchair/base (capped rental) | | K0009NU | 790.10 | Other manual wheelchair/base (new equipment) | | K0009UE | 592.58 | Other manual wheelchair/base (used durable medical equipment) | | K0010KH | 470.93 | Standard-weight frame, motorized/power wheelchair (capped rental) | | K0010KI | 470.93 | Standard-weight frame, motorized/power wheelchair (capped rental) | | K0010KJ | 353.20 | Standard-weight frame, motorized/power wheelchair (capped rental) | | K0010NU | 4,709.30 | Standard-weight frame, motorized/power wheelchair (new equipment purchase) | | K0010UE | 3,531.98 | Standard-weight frame, motorized/power wheelchair (used durable medical equipment) | | K0011KH | 566.33 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (capped rental) | | K0011KHKF | 628.76 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (capped rental) (FDA class III device) | | K0011KI | 566.33 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (capped rental) | | K0011KIKF | 628.76 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (capped rental) (FDA class III device) | | K0011KJ | 424.75 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (capped rental) | | K0011KJKF | 471.57 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (capped rental) (FDA class III device) | | K0011NU | 5,663.30 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (new equipment purchase) | | K0011NUKF | 6,287.60 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (new equipment purchase) (FDA class III device) | | K0011UE | 4,247.48 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (used durable medical equipment) | | K0011UEKF | 4,715.70 | Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking (used durable medical equipment) (FDA class III device) | | K0012KH | 359.21 | Lightweight portable motorized/power wheelchair (capped rental) | | K0012KI | 359.21 | Lightweight portable motorized/power wheelchair (capped rental) | | K0012KJ | 269.41 | Lightweight portable motorized/power wheelchair (capped rental) | | K0012NU | 3,592.10 | Lightweight portable motorized/power wheelchair (new equipment purchase) | | K0012UE | 2,694.08 | Lightweight portable motorized/power wheelchair (used durable medical equipment) | | K0013 | AAC+35% | Custom motorized/power wheelchair base | | K0015KH | 14.59 | Detachable, non-adjustable height armrest, replacement only, each (capped rental) | | K0015KHKU | 17.62 | Detachable, non-adjustable height armrest, replacement only, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0015KI | 14.59 | Detachable, non-adjustable height armrest, replacement only, each (capped rental) | | K0015KIKU | 17.62 | Detachable, non-adjustable height armrest, replacement only, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0015KJ | 10.94 | Detachable, non-adjustable height armrest, replacement only, each (capped rental) | | K0015KJKU | 13.22 | Detachable, non-adjustable height armrest, replacement only, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0015NU | 145.89 | Detachable, non-adjustable height armrest, replacement only, each (new equipment) | | K0015NUKU | 176.20 | Detachable, non-adjustable height armrest, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0015UE | 109.41 | Detachable, non-adjustable height armrest, replacement only, each (used durable medical equipment) | | K0015UEKU | 132.15 | Detachable, non-adjustable height armrest, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0017NU | 46.16 | Detachable, adjustable height armrest, base, replacement only, each (new equipment) | | K0017NUKU | 49.57 | Detachable, adjustable height armrest, base, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0017RR | 4.62 | Detachable, adjustable height armrest, base, replacement only, each (rental) | | K0017RRKU | 4.95 | Detachable, adjustable height armrest, base, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0017UE | 34.62 | Detachable, adjustable height armrest, base, replacement only, each (used durable medical equipment) | | K0017UEKU | 37.18 | Detachable, adjustable height armrest, base, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0018NU | 25.93 | Detachable, adjustable height armrest, upper portion, replacement only, each (new equipment) | | K0018NUKU | 27.69 | Detachable, adjustable height armrest, upper portion, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0018RR | 2.59 | Detachable, adjustable height armrest, upper portion, replacement only, each (rental) | | K0018RRKU | 2.76 | Detachable, adjustable height armrest, upper portion, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0018UE | 19.45 | Detachable, adjustable height armrest, upper portion, replacement only, each (used durable medical equipment) | | K0018UEKU | 20.78 | Detachable, adjustable height armrest, upper portion, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0019NU | 13.59 | Arm pad, replacement only, each (new equipment) | | K0019NUKU | 16.65 | Arm pad, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0019RR | 1.36 | Arm pad, replacement only, each (rental) | | K0019RRKU | 1.66 | Arm pad, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0019UE | 10.19 | Arm pad, replacement only, each (used durable medical equipment) | | K0019UEKU | 12.50 | Arm pad, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0020NU | 43.51 | Fixed, adjustable height armrest, pair (new equipment) | | K0020NUKU | 45.07 | Fixed, adjustable height armrest, pair (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0020RR | 4.35 | Fixed, adjustable height armrest, pair (rental) | | K0020RRKU | 4.51 | Fixed, adjustable height armrest, pair (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0020UE | 32.63 | Fixed, adjustable height armrest, pair (used durable medical equipment) | | K0020UEKU | 33.80 | Fixed, adjustable height armrest, pair (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0037NU | 43.47 | High mount flip-up footrest, each (new equipment) | | K0037NUKU | 46.72 | High mount flip-up footrest, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0037RR | 3.78 | High mount flip-up footrest, each (rental) | | K0037RRKU | 3.85 | High mount flip-up footrest, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0037UE | 32.61 | High mount flip-up footrest, each (used durable medical equipment) | | K0037UEKU | 35.05 | High mount flip-up footrest, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0038NU | 22.47 | Leg strap, each (new equipment) | | K0038NUKU | 23.55 | Leg strap, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0038RR | 2.25 | Leg strap, each (rental) | | K0038RRKU | 2.36 | Leg strap, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0038UE | 16.84 | Leg strap, each (used durable medical equipment) | | K0038UEKU | 17.64 | Leg strap, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0039NU | 49.08 | Leg strap, H style, each (new equipment) | | K0039NUKU | 52.26 | Leg strap, H style, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0039RR | 4.92 | Leg strap, H style, each (rental) | | K0039RRKU | 5.26 | Leg strap, H style, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0039UE | 36.81 | Leg strap, H style, each (used durable medical equipment) | | K0039UEKU | 39.21 | Leg strap, H style, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0040NU | 59.48 | Adjustable angle footplate, each (new equipment) | | K0040NUKU | 72.44 | Adjustable angle footplate, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0040RR | 5.94 | Adjustable angle footplate, each (rental) | | K0040RRKU | 7.23 | Adjustable angle footplate, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0040UE | 44.60 | Adjustable angle footplate, each (used durable medical equipment) | | K0040UEKU | 54.30 | Adjustable angle footplate, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0041NU | 47.58 | Large size footplate, each (new equipment) | | K0041NUKU | 51.33 | Large size footplate, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0041RR | 4.78 | Large size footplate, each (rental) | | K0041RRKU | 5.18 | Large size footplate, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0041UE | 35.69 | Large size footplate, each (used durable medical equipment) | | K0041UEKU | 38.49 | Large size footplate, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0042NU | 31.73 | Standard size footplate, replacement only, each (new equipment) | | K0042NUKU | 35.34 | Standard size footplate, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0042RR | 3.17 | Standard size footplate, replacement only, each (rental) | | K0042RRKU | 3.53 | Standard size footplate, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0042UE | 23.79 | Standard size footplate, replacement only, each (used durable medical equipment) | | K0042UEKU | 26.50 | Standard size footplate, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0043NU | 18.17 | Footrest, lower extension tube, replacement only, each (new equipment) | | K0043NUKU | 18.94 | Footrest, lower extension tube, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0043RR | 1.81 | Footrest, lower extension tube, replacement only, each (rental) | | K0043RRKU | 1.88 | Footrest, lower extension tube, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0043UE | 13.65 | Footrest, lower extension tube, replacement only, each (used durable medical equipment) | | K0043UEKU | 14.23 | Footrest, lower extension tube, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0044NU | 15.65 | Footrest, upper hanger bracket, replacement only, each (new equipment) | | K0044NUKU | 16.15 | Footrest, upper hanger bracket, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0044RR | 1.57 | Footrest, upper hanger bracket, replacement only, each (rental) | | K0044RRKU | 1.62 | Footrest, upper hanger bracket, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0044UE | 11.73 | Footrest, upper hanger bracket, replacement only, each (used durable medical equipment) | | K0044UEKU | 12.10 | Footrest, upper hanger bracket, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0045NU | 52.36 | Footrest, complete assembly, replacement only, each (new equipment) | | K0045NUKU | 54.93 | Footrest, complete assembly, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0045RR | 5.32 | Footrest, complete assembly, replacement only, each (rental) | | K0045RRKU | 5.66 | Footrest, complete assembly, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0045UE | 39.28 | Footrest, complete assembly, replacement only, each (used durable medical equipment) | | K0045UEKU | 41.20 | Footrest, complete assembly, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0046NU | 18.23 | Elevating legrest, lower extension tube, replacement only, each (new equipment) | | K0046NUKU | 18.94 | Elevating legrest, lower extension tube, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0046RR | 1.82 | Elevating legrest, lower extension tube, replacement only, each (rental) | | K0046RRKU | 1.88 | Elevating legrest, lower extension tube, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0046UE | 13.69 | Elevating legrest, lower extension tube, replacement only, each (used durable medical equipment) | | K0046UEKU | 14.23 | Elevating legrest, lower extension tube, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0047NU | 67.99 | Elevating legrest, upper hanger bracket, replacement only, each (new equipment) | | K0047NUKU | 74.19 | Elevating legrest, upper hanger bracket, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0047RR | 6.81 | Elevating legrest, upper hanger bracket, replacement only, each (rental) | | K0047RRKU | 7.44 | Elevating legrest, upper hanger bracket, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0047UE | 50.98 | Elevating legrest, upper hanger bracket, replacement only, each (used durable medical equipment) | | K0047UEKU | 55.62 | Elevating legrest, upper hanger bracket, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0050NU | 30.12 | Ratchet assembly replacement only (new equipment) | | K0050NUKU | 32.55 | Ratchet assembly, replacement only | | K0050RR | 3.01 | Ratchet assembly replacement only (rental) | | K0050RRKU | 3.24 | Ratchet assembly, replacement only | | K0050UE | 22.60 | Ratchet assembly replacement only (used durable medical equipment) | | K0050UEKU | 24.62 | Ratchet assembly, replacement only | | K0051NU | 48.22 | Cam release assembly, footrest or legrest, replacement only, each (new equipment) | | K0051NUKU | 51.03 | Cam release assembly, footrest or legrest, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0051RR | 4.84 | Cam release assembly, footrest or legrest, replacement only, each (rental) | | K0051RRKU | 5.14 | Cam release assembly, footrest or legrest, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0051UE | 36.16 | Cam release assembly, footrest or legrest, replacement only, each (used durable medical equipment) | | K0051UEKU | 38.26 | Cam release assembly, footrest or legrest, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0052NU | 74.44 | Swingaway, detachable footrests, replacement only, each (new equipment) | | K0052NUKU | 89.69 | Swingaway, detachable footrests, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0052RR | 7.44 | Swingaway, detachable footrests, replacement only, each (rental) | | K0052RRKU | 8.96 | Swingaway, detachable footrests, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0052UE | 55.82 | Swingaway, detachable footrests, each (used durable medical equipment) | | K0052UEKU | 67.23 | Swingaway, detachable footrests, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0053NU | 90.84 | Elevating footrests, articulating (telescoping), each (new equipment) | | K0053NUKU | 98.96 | Elevating footrests, articulating (telescoping), each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0053RR | 9.08 | Elevating footrests, articulating (telescoping), each (rental) | | K0053RRKU | 9.89 | Elevating footrests, articulating (telescoping), each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0053UD | AAC+35% | Elevating footrests, articulating (telescoping), each (bariatric equipment) | | K0053UE | 68.13 | Elevating footrests, articulating (telescoping), each (used durable medical equipment) | | K0053UEKU | 74.22 | Elevating footrests, articulating (telescoping), each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0056NU | 96.40 | Seat height less than 17 inches or equal to or greater than 21 inches for a high strength, lightweight, or ultralightweight wheelchair (new equipment) | | K0056NUKU | 107.04 | Seat height less than 17 inches or equal to or greater than 21 inches for a high strength, lightweight, or ultralightweight wheelchair (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0056RR | 9.64 | Seat height less than 17 inches or equal to or greater than 21 inches for a high strength, lightweight, or ultralightweight wheelchair (rental) | | K0056RRKU | 10.71 | Seat height less than 17 inches or equal to or greater than 21 inches for a high strength, lightweight, or ultralightweight wheelchair (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0056UE | 72.31 | Seat height less than 17 inches or equal to or greater than 21 inches for a high strength, lightweight, or ultralightweight wheelchair (used durable medical equipment) | | K0056UEKU | 80.29 | Seat height less than 17 inches or equal to or greater than 21 inches for a high strength, lightweight, or ultralightweight wheelchair (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0065NU | 46.17 | Spoke protectors, each (new equipment) | | K0065NUKU | 50.02 | Spoke protectors, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0065RR | 4.62 | Spoke protectors, each (rental) | | K0065RRKU | 5.00 | Spoke protectors, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0065UE | 34.63 | Spoke protectors, each (used durable medical equipment) | | K0065UEKU | 37.53 | Spoke protectors, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0069NU | 97.90 | Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each (new equipment) | | K0069NUKU | 112.47 | Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0069RR | 10.02 | Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each (rental) | | K0069RRKU | 11.71 | Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0069UE | 73.42 | Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each (used durable medical equipment) | | K0069UEKU | 84.35 | Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0070KH | 17.48 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (capped rental) | | K0070KHKU | 20.63 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0070KI | 17.48 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (capped rental) | | K0070KIKU | 20.63 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0070KJ | 13.11 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (capped rental) | | K0070KJKU | 15.47 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (capped rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0070NU | 174.74 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (new equipment) | | K0070NUKU | 206.30 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0070UE | 131.06 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (used durable medical equipment) | | K0070UEKU | 154.73 | Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0071NU | 112.26 | Front caster assembly, complete, with pneumatic tire, replacement only, each (new equipment) | | K0071NUKU | 122.96 | Front caster assembly, complete, with pneumatic tire, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0071RR | 11.23 | Front caster assembly, complete, with pneumatic tire, replacement only, each (rental) | | K0071RRKU | 12.30 | Front caster assembly, complete, with pneumatic tire, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0071UE | 84.18 | Front caster assembly, complete, with pneumatic tire, replacement only, each (used durable medical equipment) | | K0071UEKU | 92.19 | Front caster assembly, complete, with pneumatic tire, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0072NU | 68.29 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each (new equipment) | | K0072NUKU | 74.03 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0072RR | 6.83 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each (rental) | | K0072RRKU | 7.40 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0072UE | 51.21 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each (used durable medical equipment) | | K0072UEKU | 55.50 | Front caster assembly, complete, with semi-pneumatic tire, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0073NU | 36.51 | Caster pin lock, each (new equipment) | | K0073NUKU | 39.18 | Caster pin lock, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0073RR | 3.65 | Caster pin lock, each (rental) | | K0073RRKU | 3.92 | Caster pin lock, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0073UE | 27.38 | Caster pin lock, each (used durable medical equipment) | | K0073UEKU | 29.37 | Caster pin lock, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0077NU | 55.88 | Front caster assembly, complete, with solid tire, replacement only, each (new equipment) | | K0077NUKU | 66.25 | Front caster assembly, complete, with solid tire, replacement only, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0077RR | 5.58 | Front caster assembly, complete, with solid tire, replacement only, each (rental) | | K0077RRKU | 6.61 | Front caster assembly, complete, with solid tire, replacement only, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0077UE | 41.90 | Front caster assembly, complete, with solid tire, replacement only, each (used durable medical equipment) | | K0077UEKU | 49.66 | Front caster assembly, complete, with solid tire, replacement only, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0098NU | 24.56 | Drive belt for power wheelchair replacement only (new equipment) | | K0098NUKU | 26.40 | Drive belt for power wheelchair replacement only (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0098RR | 2.46 | Drive belt for power wheelchair replacement only (rental) | | K0098RRKU | 2.65 | Drive belt for power wheelchair replacement only (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0098UE | 18.41 | Drive belt for power wheelchair replacement only (used durable medical equipment) | | K0098UEKU | 19.78 | Drive belt for power wheelchair replacement only (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0105NU | 102.99 | IV hanger, each (new equipment) | | K0105NUKU | 111.91 | IV hanger, each (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0105RR | 10.30 | IV hanger, each (rental) | | K0105RRKU | 11.19 | IV hanger, each (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0105UE | 77.25 | IV hanger, each (used durable medical equipment) | | K0105UEKU | 83.93 | IV hanger, each (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0108NU | AAC+35% | Wheelchair component or accessory, not otherwise specified (new equipment) | | K0108RA | 47.03 | Wheelchair component or accessory, not otherwise specified (for MassHealth purposes only K0108RA is to be a separate line item on a PA/claim for the sole usage of the direct service components RE1-RE23) (per hour) | | K0108RB | AAC+35% | Wheelchair component or accessory, not otherwise specified (for MassHealth purposes only K0108RB is to be used for replacement of a part that has no HIPAA-compliant HCPCCS code) | | K0195KH | 14.01 | Elevating leg rests, pair (for use with capped rental wheelchair base) (capped rental) | | K0195KHKU | 17.94 | Elevating leg rests, pair (for use with capped rental wheelchair base) | | K0195KI | 14.01 | Elevating leg rests, pair (for use with capped rental wheelchair base) (capped rental) | | K0195KIKU | 17.94 | Elevating leg rests, pair (for use with capped rental wheelchair base) | | K0195KJ | 10.51 | Elevating leg rests, pair (for use with capped rental wheelchair base) (capped rental) | | K0195KJKU | 13.46 | Elevating leg rests, pair (for use with capped rental wheelchair base) | | K0195NU | 140.10 | Elevating leg rests, pair (for use with capped rental wheelchair base) (new equipment purchase) | | K0195NUKU | 179.40 | Elevating leg rests, pair (for use with capped rental wheelchair base) | | K0195UE | 105.08 | Elevating leg rests, pair (for use with capped rental wheelchair base) (used durable medical equipment purchase) | | K0195UEKU | 134.55 | Elevating leg rests, pair (for use with capped rental wheelchair base) | | Equipment, Replacement, Repair, Rental | | | | K0455RR | 248.89 | Infusion pump used for uninterrupted parenteral administration of medication, epoprostenol or treprostinol (rental) | | K0462 | I.C. | Temporary replacement of patient-owned equipment being repaired, any type | | K0552 | 2.35 | Supplies for external non-insulin infusion pump, syringe type cartridge, sterile, each | | K0553 | 248.38 | Supply allowance for therapeutic continuous glucose monitor (CGM), includes all supplies and accessories, 1 unit = 1 month's supply | | K0554NU | 239.37 | Receiver (monitor), dedicated, for use with therapeutic continuous glucose monitor system (new equipment) | | K0554RR | 23.94 | Receiver (monitor), dedicated, for use with therapeutic continuous glucose monitor system (rental) | | K0554UE | 179.53 | Receiver (monitor), dedicated, for use with therapeutic continuous glucose monitor system (used durable medical equipment) | | K0601NU | 1.02 | Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each | | K0602NU | 5.81 | Replacement battery for external infusion pump owned by patient, silver oxide, 3 volt, each | | K0603NU | 0.52 | Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each | | K0604NU | 5.58 | Replacement battery for external infusion pump owned by patient, lithium, 3.6 volt, each | | K0605NU | 13.38 | Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each | | K0606KHKF | 2,366.38 | Automatic external defibrillator with integrated electrocardiogram analysis, garment type (capped rental) (FDA class III device) | | K0606KIKF | 2,366.38 | Automatic external defibrillator with integrated electrocardiogram analysis, garment type (capped rental) (FDA class III device) | | K0606KJKF | 1,774.79 | Automatic external defibrillator with integrated electrocardiogram analysis, garment type (capped rental) (FDA class III device) | | K0606NUKF | 23,663.83 | Automatic external defibrillator with integrated electrocardiogram analysis, garment type (new equipment purchase) (FDA class III device) | | K0606UEKF | 17,747.87 | Automatic external defibrillator with integrated electrocardiogram analysis, garment type (used durable medical equipment purchase) (FDA class III device) | | K0607KH | 18.26 | Replacement battery for automatic external defibrillator, each (capped rental) | | K0607KHKF | 20.26 | Replacement battery for automatic external defibrillator, each (capped rental) (FDA class III device) | | K0607KI | 18.26 | Replacement battery for automatic external defibrillator, each (capped rental) | | K0607KIKF | 20.26 | Replacement battery for automatic external defibrillator, each (capped rental) (FDA class III device) | | K0607KJ | 13.69 | Replacement battery for automatic external defibrillator, each (capped rental) | | K0607KJKF | 15.20 | Replacement battery for automatic external defibrillator, each (capped rental) (FDA class III device) | | K0607NU | 182.58 | Replacement battery for automatic external defibrillator, each (new equipment) | | K0607NUKF | 202.64 | Replacement battery for automatic external defibrillator, each (new equipment) (FDA class III device) | | K0607UE | 136.94 | Replacement battery for automatic external defibrillator, each (used durable medical equipment) | | K0607UEKF | 151.98 | Replacement battery for automatic external defibrillator, each (used durable medical equipment) (FDA class III device) | | K0608NU | 113.89 | Replacement garment for use with automatic external defibrillator, each (new equipment) | | K0608NUKF | 126.47 | Replacement garment for use with automatic external defibrillator, each (new equipment) (FDA class III device) | | K0608RR | 11.42 | Replacement garment for use with automatic external defibrillator, each (rental) | | K0608RRKF | 12.67 | Replacement garment for use with automatic external defibrillator, each (rental) (FDA class III device) | | K0608UE | 85.43 | Replacement garment for use with automatic external defibrillator, each (used durable medical equipment) | | K0608UEKF | 94.84 | Replacement garment for use with automatic external defibrillator, each (used durable medical equipment) (FDA class III device) | | K0609NU | 757.46 | Replacement electrodes for use with automatic external defibrillator, each (new equipment) | | K0609NUKF | 840.98 | Replacement electrodes for use with automatic external defibrillator, each (new equipment) (FDA class III device) | | K0669 | AAC+35% | Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from DME PDAC | | K0730KH | 162.00 | Controlled dose inhalation drug delivery system (capped rental) | | K0730KI | 162.00 | Controlled dose inhalation drug delivery system (capped rental) | | K0730KJ | 121.50 | Controlled dose inhalation drug delivery system (capped rental) | | K0730NU | 1,620.02 | Controlled dose inhalation drug delivery system (new equipment) | | K0730UE | 1,215.02 | Controlled dose inhalation drug delivery system (used durable medical equipment purchase) | | K0733NU | 23.32 | Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (new equipment) | | K0733NUKU | 29.30 | Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (new equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0733RR | 2.34 | Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (rental) | | K0733RRKU | 2.95 | Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (rental), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0733UE | 17.50 | Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (used durable medical equipment) | | K0733UEKU | 21.99 | Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each ( e.g. gel cell, absorbed glassmat) (used durable medical equipment), (DMEPOS item subject to DMEPOS competitive bidding program number 3) | | K0738RR | 40.26 | Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing (rental) | | K0739RB | 21.11 | Repair or nonroutine service for durable medical equipment other than oxygen requiring the skill of a technician, labor component, per 15 minutes (repair, excluding ATP providers) | | K0739U3 | 1000.00 | Add-on payment for eligible Mobility System repairs | | K0739U5 | 46.33 | Direct Service Component (RE) units for evaluation of complex mobility systems, for installation of custom movable and fixed patient lift systems RE1-RE23, and installation of pediatric/turned adult safety beds RE1-RE5. One RE unit equals 1 hour | | K0739UB | 24.83 | Repair or nonroutine service for durable medical equipment other than oxygen requiring the skill of a technician, labor component, per 15 minutes (repair, ATP providers only) | | K0740RB | 24.83 | Repair or nonroutine service for oxygen equipment requiring the skill of a technician, labor component, per 15 minutes (repair, excluding ATP providers) | | K0743RR | I.C. | Suction pump, home model, portable, for use on wounds (rental) | | K0744 | AAC+20% | Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less | | K0745 | AAC+20% | Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches | | K0746 | AAC+20% | Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches | | Power Operated Vehicle and Accessories | | | | K0800NU | 1,041.09 | Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds (new equipment) | | K0800RR | 104.12 | Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds (rental) | | K0800UE | 780.82 | Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0801NU | 1,802.66 | Power operated vehicle, group 1 heavy duty, patient weight capacity, 301 to 450 pounds (new equipment) | | K0801RR | 180.25 | Power operated vehicle, group 1 heavy duty, patient weight capacity, 301 to 450 pounds (rental) | | K0801UE | 1,351.99 | Power operated vehicle, group 1 heavy duty, patient weight capacity, 301 to 450 pounds (used durable medical equipment) | | K0802NU | 2,036.55 | Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds (new equipment) | | K0802RR | 203.65 | Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds (rental) | | K0802UE | 1,527.41 | Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0806NU | 1,391.75 | Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds (new equipment) | | K0806RR | 139.17 | Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds (rental) | | K0806UE | 1,043.82 | Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0807NU | 2,132.76 | Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds (new equipment) | | K0807RR | 213.28 | Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds (rental) | | K0807UE | 1,599.58 | Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0808NU | 3,298.44 | Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds (new equipment) | | K0808RR | 329.84 | Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds (rental) | | K0808UE | 2,473.83 | Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0812NU | AAC+35% | Power operated vehicle, not otherwise classified (new equipment) | | K0812RR | I.C. | Power operated vehicle, not otherwise classified (rental) | | K0812UE | I.C. | Power operated vehicle, not otherwise classified (used durable medical equipment) | | Power Wheelchairs | | | | K0813KH | 301.04 | Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds (capped rental) | | K0813KI | 301.04 | Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds (capped rental) | | K0813KJ | 120.42 | Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds (capped rental) | | K0813NU | 2,006.93 | Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0813UE | 1,505.20 | Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0814KH | 358.84 | Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0814KI | 358.84 | Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0814KJ | 143.54 | Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0814NU | 2,392.27 | Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (new equipment) | | K0814UE | 1,794.20 | Power wheelchair, group 1 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0815KH | 383.91 | Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds (capped rental) | | K0815KI | 383.91 | Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds (capped rental) | | K0815KJ | 153.56 | Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds (capped rental) | | K0815NU | 2,559.40 | Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds (new equipment) | | K0815UE | 1,919.55 | Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0816KH | 380.17 | Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0816KI | 380.17 | Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0816KJ | 152.07 | Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0816NU | 2,534.47 | Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0816UE | 1,900.85 | Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0820KH | 316.77 | Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0820KI | 316.77 | Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0820KJ | 126.71 | Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0820NU | 2,111.80 | Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0820UE | 1,583.85 | Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0821KH | 375.89 | Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0821KI | 375.89 | Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0821KJ | 150.36 | Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0821NU | 2,505.93 | Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0821UE | 1,879.45 | Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0822KH | 452.62 | Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (rental) | | K0822KI | 452.62 | Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (rental) | | K0822KJ | 181.05 | Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (rental) | | K0822NU | 3,017.47 | Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment) | | K0822UE | 2,263.10 | Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0823KH | 427.33 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0823KI | 427.33 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0823KJ | 170.93 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0823NU | 2,848.87 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0823UE | 2,136.65 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0824KH | 568.43 | Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0824KI | 568.43 | Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0824KJ | 227.37 | Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0824NU | 3,789.53 | Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0824UE | 2,842.15 | Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0825KH | 507.85 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0825KI | 507.85 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0825KJ | 203.14 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0825NU | 3,385.67 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (new equipment equipment) | | K0825UE | 2,539.25 | Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0826KH | 768.52 | Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0826KI | 768.52 | Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0826KJ | 307.41 | Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0826NU | 5,123.47 | Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (new equipment purchase) | | K0826UE | 3,842.60 | Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0827KH | 667.58 | Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds (capped rental) | | K0827KI | 667.58 | Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds (capped rental) | | K0827KJ | 267.03 | Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds (capped rental) | | K0827NU | 4,450.53 | Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds (new equipment purchase) | | K0827UE | 3,337.90 | Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0828KH | 865.25 | Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0828KI | 866.25 | Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0828KJ | 346.10 | Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0828NU | 5,768.33 | Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (new equipment purchase) | | K0828UE | 4,326.25 | Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (used durable medical equipment) | | K0829KH | 840.60 | Power wheelchair, group 2 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (capped rental) | | K0829KI | 840.60 | Power wheelchair, group 2 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (capped rental) | | K0829KJ | 336.24 | Power wheelchair, group 2 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (capped rental) | | K0829NU | 5,604.00 | Power wheelchair, group 2 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (new equipment purchase) | | K0829UE | 4,203.00 | Power wheelchair, group 2 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (used durable medical equipment) | | K0830NU | 3,914.10 | Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment) | | K0830RR | 391.41 | Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds (rental) | | K0830UE | 2,935.58 | Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0831NU | 3,914.10 | Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds (new equipment) | | K0831RR | 391.41 | Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds (rental) | | K0831UE | 2,935.58 | Power wheelchair, group 2 standard, seat elevator, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0835KH | 456.11 | Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0835KI | 456.11 | Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0835KJ | 182.44 | Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0835NU | 3,040.73 | Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0835UE | 2,280.55 | Power wheelchair, group 2 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0836KH | 473.04 | Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0836KI | 473.04 | Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0836KJ | 189.22 | Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0836NU | 3,153.60 | Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0836UE | 2,365.20 | Power wheelchair, group 2 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0837KH | 559.19 | Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0837KI | 559.19 | Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0837KJ | 223.68 | Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0837NU | 3,727.93 | Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0837UE | 2,795.95 | Power wheelchair, group 2 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0838KH | 498.48 | Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0838KI | 498.48 | Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0838KJ | 199.39 | Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0838NU | 3,323.20 | Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0838UE | 2,492.40 | Power wheelchair, group 2 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0839KH | 731.13 | Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0839KI | 731.13 | Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0839KJ | 292.45 | Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0839NU | 4,874.20 | Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (new equipment purchase) | | K0839UE | 3,655.65 | Power wheelchair, group 2 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0840KH | 1,113.40 | Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0840KI | 1,113.40 | Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0840KJ | 445.36 | Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0840NU | 7,422.67 | Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more (new equipment purchase) | | K0840UE | 5,567.00 | Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more (used durable medical equipment) | | K0841KH | 495.88 | Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0841KI | 495.88 | Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0841KJ | 198.35 | Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0841NU | 3,305.87 | Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0841UE | 2,479.40 | Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0842KH | 495.60 | Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0842KI | 495.60 | Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0842KJ | 198.24 | Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0842NU | 3,304.00 | Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0842UE | 2,478.00 | Power wheelchair, group 2 standard, multiple power option, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0843KH | 593.54 | Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0843KI | 593.54 | Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0843KJ | 237.42 | Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0843NU | 3,956.93 | Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0843UE | 2,967.70 | Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0848KH | 755.28 | Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0848KI | 755.28 | Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0848KJ | 302.11 | Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0848NU | 5,035.20 | Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0848UE | 3,776.40 | Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0849KH | 726.16 | Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0849KI | 726.16 | Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0849KJ | 290.46 | Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0849NU | 4,841.07 | Power wheelchair, group 3 standard, captains chair, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0849UE | 3,630.80 | Power wheelchair | | K0850KH | 876.10 | Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0850KI | 876.10 | Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0850KJ | 350.44 | Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0850NU | 5,840.67 | Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0850UE | 4,380.50 | Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0851KH | 842.37 | Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0851KI | 842.37 | Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0851KJ | 336.95 | Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0851NU | 5,615.80 | Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0851UE | 4,211.85 | Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0852KH | 1,012.27 | Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0852KI | 1,012.27 | Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0852KJ | 404.91 | Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0852NU | 6,748.47 | Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (new equipment purchase) | | K0852UE | 5,061.35 | Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0853KH | 1,039.86 | Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity, 451 to 600 pounds (capped rental) | | K0853KI | 1,039.86 | Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity, 451 to 600 pounds (capped rental) | | K0853KJ | 415.94 | Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity, 451 to 600 pounds (capped rental) | | K0853NU | 6,932.40 | Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity, 451 to 600 pounds (new equipment purchase) | | K0853UE | 5,199.30 | Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity, 451 to 600 pounds (used durable medical equipment) | | K0854KH | 1,377.59 | Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0854KI | 1,377.59 | Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0854KJ | 551.04 | Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0854NU | 9,183.93 | Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (new equipment purchase) | | K0854UE | 6,887.95 | Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient weight capacity 601 pounds or more (used durable medical equipment) | | K0855KH | 1,301.34 | Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (capped rental) | | K0855KI | 1,301.34 | Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (capped rental) | | K0855KJ | 520.54 | Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (capped rental) | | K0855NU | 8,675.60 | Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (new equipment purchase) | | K0855UE | 6,506.70 | Power wheelchair, group 3 extra heavy duty, captains chair, patient weight capacity 601 pounds or more (used durable medical equipment) | | K0856KH | 810.71 | Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0856KI | 810.71 | Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0856KJ | 324.28 | Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0856NU | 5,404.73 | Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0856UE | 4,053.55 | Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0857KH | 826.96 | Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0857KI | 826.96 | Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0857KJ | 330.78 | Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (capped rental) | | K0857NU | 5,513.07 | Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0857UE | 4,134.80 | Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0858KH | 1,005.86 | Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0858KI | 1,005.86 | Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0858KJ | 402.34 | Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0858NU | 6,705.73 | Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0858UE | 5,029.30 | Power wheelchair, group 3 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0859KH | 959.28 | Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0859KI | 959.28 | Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0859KJ | 383.71 | Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (capped rental) | | K0859NU | 6,395.20 | Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0859UE | 4,796.40 | Power wheelchair, group 3 heavy duty, single power option, captains chair, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0860KH | 1,436.99 | Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0860KI | 1,436.99 | Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0860KJ | 574.80 | Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0860NU | 9,579.93 | Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (new equipment purchase) | | K0860UE | 7,184.95 | Power wheelchair, group 3 very heavy duty, single power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0861KH | 812.01 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0861KHKF | 1,045.98 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) (FDA class III device) | | K0861KI | 812.01 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0861KIKF | 1,046.98 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) (FDA class III device) | | K0861KJ | 324.80 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) | | K0861KJKF | 418.39 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (capped rental) (FDA class III device) | | K0861NU | 5,413.40 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment purchase) | | K0861NUKF | 6,973.20 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment purchase) (FDA class III device) | | K0861UE | 4,060.05 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds ((used durable medical equipment) | | K0861UEKF | 5,229.90 | Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) (FDA class III device) | | K0862KH | 1,005.86 | Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0862KI | 1,005.86 | Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0862KJ | 402.34 | Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (capped rental) | | K0862NU | 6,705.73 | Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (new equipment purchase) | | K0862UE | 5,029.30 | Power wheelchair, group 3 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0863KH | 1,421.44 | Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0863KI | 1,421.44 | Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0863KJ | 568.58 | Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (capped rental) | | K0863NU | 9,476.27 | Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (new equipment purchase) | | K0863UE | 7,107.20 | Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0864KH | 1,691.53 | Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0864KI | 1,691.53 | Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0864KJ | 676.61 | Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more (capped rental) | | K0864NU | 11,276.87 | Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more (new equipment) | | K0864UE | 8,457.65 | Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 601 pounds or more (used durable medical equipment) | | K0868NU | AAC+35% | Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment) | | K0868RR | I.C. | Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment) (rental) | | K0868UE | I.C. | Power wheelchair, group 4 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment) (used durable medical equipment) | | K0869NU | AAC+35% | Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds (new equipment) | | K0869RR | I.C. | Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds (rental) | | K0869UE | I.C. | Power wheelchair, group 4 standard, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0870NU | AAC+35% | Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (new equipment) | | K0870RR | I.C. | Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (rental) | | K0870UE | I.C. | Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0871NU | AAC+35% | Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (new equipment) | | K0871RR | I.C. | Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (rental) | | K0871UE | I.C. | Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds (used durable medical equipment) | | K0877NU | AAC+35% | Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment) | | K0877RR | I.C. | Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (rental) | | K0877UE | I.C. | Power wheelchair, group 4 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0878NU | AAC+35% | Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (new equipment) | | K0878RR | I.C. | Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (rental) | | K0878UE | I.C. | Power wheelchair, group 4 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0879NU | AAC+35% | Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds | | K0879RR | I.C. | Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (rental) | | K0879UE | I.C. | Power wheelchair, group 4 heavy duty, single power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (used durable medical equipment) | | K0880NU | AAC+35% | Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds (new equipment) | | K0880RR | I.C. | Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds (rental) | | K0880UE | I.C. | Power wheelchair, group 4 very heavy duty, single power option, sling/solid seat/back, patient weight 451 to 600 pounds (used durable medical equipment) | | K0884NU | AAC+35% | Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (new equipment) | | K0884RR | I.C. | Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (rental) | | K0884UE | I.C. | Power wheelchair, group 4 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds (used durable medical equipment) | | K0885NU | AAC+35% | Power wheelchair, group 4 standard, multiple power option, captains chair, weight capacity up to and including 300 pounds (new equipment) | | K0885RR | I.C. | Power wheelchair, group 4 standard, multiple power option, captains chair, weight capacity up to and including 300 pounds (rental) | | K0885UE | I.C. | Power wheelchair, group 4 standard, multiple power option, captains chair, weight capacity up to and including 300 pounds (used durable medical equipment) | | K0886NU | AAC+35% | Power wheelchair, group 4 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds (new equipment) | | K0890RR | I.C. | Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds (rental) | | K0890UE | I.C. | Power wheelchair, group 5 pediatric, single power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds (used durable medical equipment) | | K0891NU | AAC+35% | Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds (new equipment) | | K0891RR | I.C. | Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight cpacity up to and including 125 pounds (rental) | | K0891UE | I.C. | Power wheelchair, group 5 pediatric, multiple power option, sling/solid seat/back, patient weight capacity up to and including 125 pounds (used durable medical equipment) | | K0898NU | AAC+35% | Power wheelchair, not otherwise classified (new equipment) | | K0898RR | I.C. | Power wheelchair, not otherwise classified (rental) | | K0898UE | I.C. | Power wheelchair, not otherwise classified (used durable medical equipment) | | K0899NU | AAC+35% | Power mobility device, not coded by DME PDAC or does not meet criteria (new equipment) | | K0899RR | I.C. | Power mobility device, not coded by DME PDAC or does not meet criteria (rental) | | K0899UE | I.C. | Power mobility device, not coded by DME PDAC or does not meet criteria (used durable medical equipment) | | K0900 | AAC+30% | Custom durable medical equipment, other than wheelchair | | K1001 | I.C. | Electronic positional obstructive sleep apnea treatment, with sensor, includes all components and accessories, any type | | K1002 | I.C. | Cranial electrotherapy stimulation(CES) system, includes all supplies and accessories, any type | | K1003 | I.C. | Whirlpool tub, walk-in, portable | | K1005 | 0.20 | Disposable collection and storage for bag for breast milk, any size, any type, each | | Prosthetic Procedures | | | | Larynx and Trachea Prosthetics and Accessories | | | | L8501 | 130.02 | Tracheostomy speaking valve | | Q Codes (Temporary) | | | | Q0161 | AAC | Chlorpromazine hydrochloride, 5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0162 | 0.02 | Ondansetron 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0163 | 0.22 | Diphenhydramine hydrochloride, 50 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen | | Q0164 | 0.04 | Prochlorperazine maleate, 5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0166 | 1.11 | Granisetron hydrochloride, 1 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen | | Q0167 | 1.39 | Dronabinol, 2.5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0169 | 0.03 | Promethazine hydrochloride, 12.5 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0173 | 0.30 | Trimethobenzamide hydrochloride, 250 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0174 | AAC | Thiethylperazine maleate, 10 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0175 | 1.72 | Perphenazine, 4 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0177 | 0.12 | Hydroxyzine pamoate, 25 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen | | Q0180 | 94.79 | Dolasetron mesylate, 100 mg, oral, FDA approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen | | Q0510 | 42.50 | Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant | | Q0511 | 20.40 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period | | Q0512 | 13.60 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period | | Q0513 | 28.05 | Pharmacy dispensing fee for inhalation drug(s); per 30 days | | Q0514 | 56.10 | Pharmacy dispensing fee for inhalation drug(s); per 90 days | | Q2052 | AAC | Services, supplies and accessories used in the home under the Medicare Intravenous Immune Globulin (IVIG) Demonstration | | Q4074 | 94.85 | Iloprost, inhalation solution, FDA-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms | | Q5101 | 0.82 | Injection, filgrastim (g-csf), biosimilar, one microgram | | Temporary National Codes (Non-Medicare) | | | | S5035 | I.C. | Home infusion therapy, routine service of infusion device ( e.g. pump maintenance) | | S5036 | I.C. | Home infusion therapy, repair of infusion device ( e.g. pump repair) | | S5160 | 38.53 | Emergency response system; installation and testing | | S5161RR | 20.00 | Emergency response system; service fee, per month (excludes installation and testing) | | S5162 | AAC+30% | Emergency response system; purchase only | | S5162TW | 30.00 | Emergency response system; purchase only (back-up equipment; for MassHealth members only, use this HCPCS code and modifier combination for a replacement auto alert transmitter button for PERS, used for a lost button only, cannot be billed separately at the time the unit is installed) | | S5497 | 13.95 | Home infusion therapy, catheter care / maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S5498 | 13.95 | Home infusion therapy, catheter care / maintenance, simple (single lumen), includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem | | S5501 | 13.95 | Home infusion therapy, catheter care / maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S5502 | 13.95 | Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use) | | S5517 | 13.95 | Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting | | S5518 | 13.95 | Home infusion therapy, all supplies necessary for catheter repair | | S5520 | 125.83 | Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion | | S5521 | 120.79 | Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion | | S5522SD | 86.99 | Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included) (services provided by registered nurse with specialized, highly technical home infusion training) | | S5523SD | 86.99 | Home infusion therapy, insertion of midline central venous catheter, nursing services only (no supplies or catheter included) (services provided by registered nurse with specialized, highly technical home infusion training) | | S8097 | AAC+20% | Asthma kit (including but not limited to portable peak expiratory flow meter, instructional video, brochure, and/or spacer) | | S8186 | AAC+20% | Swivel adaptor | | S8189 | AAC+20% | Tracheostomy supply, not otherwise classified | | S8210 | AAC+20% | Mucus trap | | S8262 | AAC+30% | Mandibular orthopedic repositioning device, each | | S8265 | AAC+20% | Haberman feeder for cleft lip/palate | | S8420 | AAC+20% | Gradient pressure aid (sleeve and glove combination), custom made | | S8421 | AAC+20% | Gradient pressure aid (sleeve and glove combination), ready made | | S8422 | AAC+20% | Gradient pressure aid (sleeve), custom made, medium weight | | S8423 | AAC+20% | Gradient pressure aid (sleeve), custom made, heavy weight | | S8424 | AAC+20% | Gradient pressure aid (sleeve), ready made | | S8425 | AAC+20% | Gradient pressure aid (glove), custom made, medium weight | | S8426 | AAC+20% | Gradient pressure aid (glove), custom made, heavy weight | | S8427 | AAC+20% | Gradient pressure aid (glove), ready made | | S8428 | AAC+20% | Gradient pressure aid (gauntlet), ready made | | S8429 | AAC+20% | Gradient pressure exterior wrap | | S8430 | AAC+20% | Padding for compression bandage, roll | | S8431 | AAC+20% | Compression bandage, roll | | S8450 | AAC+20% | Splint, prefabricated, digit (specify digit by use of modifier) | | S8451 | AAC+20% | Splint, prefabricated, wrist or ankle | | S8452 | AAC+20% | Splint, prefabricated, elbow | | S8490 | AAC+20% | Insulin syringes (100 syringes, any size) | | S8999 | AAC+20% | Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event) | | S9325 | 37.51 | Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (do not use this code with S9326, SS9327 or S9328) | | S9326 | 37.51 | Home infusion therapy, continuous pain management infusion; administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9327 | 37.51 | Home infusion therapy, intermittent pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9328 | 37.51 | Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9329 | 46.68 | Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with S9330 or S9331) | | S9330 | 46.68 | Home infusion therapy, continuous chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9331 | 46.68 | Home infusion therapy, intermittent chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9336 | 44.86 | Home infusion therapy, continuous anticoagulant infusion therapy ( e.g. heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9338 | 51.51 | Home infusion therapy, immunotherapy therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drug and nursing visits coded separately), per diem | | S9339 | 35.58 | Home therapy; peritoneal dialysis, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9340 | 14.84 | Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem | | S9341 | 12.28 | Home therapy; enteral nutrition via gravity; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem | | S9342 | 14.84 | Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem | | S9343 | 12.28 | Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem | | S9345 | 51.51 | Home infusion therapy, anti-hemophilic agent infusion therapy ( e.g. , factor viii); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9346 | 44.86 | Home infusion therapy, alpha-1-proteinase inhibitor ( e.g. , prolastin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9347 | 44.86 | Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy ( e.g. epoprostenol); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9348 | 73.22 | Home infusion therapy, sympathomimetic/inotropic agent infusion therapy ( e.g. , dobutamine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9349 | 44.86 | Home infusion therapy, tocolytic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9351 | 44.86 | Home infusion therapy, continuous anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9353 | 44.86 | Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9355 | 73.22 | Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9357 | 73.22 | Home infusion therapy, enzyme replacement intravenous therapy; ( e.g. imiglucerase); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9359 | 73.22 | Home infusion therapy, anti-tumor necrosis factor intravenous therapy; ( e.g. infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9361 | 73.22 | Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9363 | 73.22 | Home infusion therapy, anti-spasmotic therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9364 | 43.95 | Home infusion therapy, total parenteral nutrition (TPN); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (standard TPN formula, lipids, specialty amino acid formulas, drugs, and nursing visits coded separately), per diem (do not use with home infusion codes S9365-S9368 using daily volume scales) | | S9365 | 43.95 | Home infusion therapy, total parenteral nutrition (TPN); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (standard TPN formula, lipids, specialty amino acid formulas, drugs, and nursing visits coded separately), per diem | | S9366 | 43.95 | Home infusion therapy, total parenteral nutrition (TPN); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (standard TPN formula, lipids, specialty amino acid formulas, drugs, and nursing visits coded separately), per diem | | S9367 | 43.95 | Home infusion therapy, total parenteral nutrition (TPN); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (standard TPN formula, lipids, specialty amino acids, drugs, and nursing visits coded separately), per diem | | S9368 | 43.95 | Home infusion therapy, total parenteral nutrition (TPN); more than three liters per day, administrative services, professional pharmacy services, care | | | | coordination, and all necessary supplies and equipment (standard TPN formula, lipids, specialty amino acid formulas, drugs, and nursing visits coded separately), per diem | | S9370 | 9.62 | Home therapy, intermittent anti-emetic injection therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9372 | 9.62 | Home therapy; intermittent anticoagulant injection therapy ( e.g. heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with hydration therapy codes S9374-S9377) | | S9373 | 30.04 | Home infusion therapy, hydration therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use with hydration therapy codes S9374-S9377 using daily volume scales) | | S9374 | 30.04 | Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9375 | 30.04 | Home infusion therapy, hydration therapy; more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9376 | 30.04 | Home infusion therapy, hydration therapy; more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9377 | 30.04 | Home infusion therapy, hydration therapy; more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies (drugs and nursing visits coded separately), per diem | | S9379 AA | C+20%+$8.00 | Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9434 | AAC+20% | Modified solid food supplements for inborn errors of metabolism | | S9435 | AAC+20% | Medical foods for inborn errors of metabolism | | S9490 | 44.86 | Home infusion therapy, corticosteroid infusion; administrative services, | | | | professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9494 | 44.86 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drug and nursing visits coded separately), per diem (do not use with | | S9497 | 51.51 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9500 | 44.86 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9501 | 51.73 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9502 | 56.20 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9503 | 61.87 | Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9504 | 73.22 | Home infusion therapy, antibiotic, antiviral, or antifungal; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9537 | 9.62 | Home therapy; hematopoietic hormone injection therapy ( e.g. , crythropoietin, G-CSF, GM-CSF); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9538 | 51.51 | Home transfusion of blood product(s); administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (blood products, drugs, and nursing visits coded separately), per diem | | S9542 | 9.62 | Home injectable therapy; not otherwise classified, including administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9558 | 9.62 | Home injectable therapy; growth hormone, including administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9559 | 9.62 | Home injectable therapy; interferon, including administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9560 | 9.62 | Home injectable therapy; hormonal therapy ( e.g. ; leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9562 | 9.62 | Home injectable therapy, palivizumab, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | S9590 | 23.55 | Home therapy, irrigation therapy ( e.g. sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem | | Miscellaneous | | | | T4521 | 0.46 | Adult sized disposable incontinence product, brief/diaper, small each | | T4522 | 0.53 | Adult sized disposable incontinence product, brief/diaper, medium each | | T4522U6 | 0.65 | Enhanced: Adult sized disposable incontinence product, brief/diaper, medium, each | | T4523 | 0.71 | Adult sized disposable incontinence product, brief/diaper, large each | | T4523U6 | 0.87 | Enhanced: Adult sized disposable incontinence product, brief/diaper, large each | | T4524 | 0.74 | Adult sized disposable incontinence product, brief/diaper, extra large each | | T4524U6 | 1.04 | Enhanced: Adult sized disposable incontinence product, brief/diaper, extralarge, each | | T4525 | 0.66 | Adult sized disposable incontinence product, protective underwear/pull-on, small size, each | | T4526 | 0.79 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | | T4527 | 0.79 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | | T4528 | 0.79 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | | T4529 | 0.66 | Pediatric sized disposable incontinence product, brief/diaper, small/medium, each | | T4530 | 0.83 | Pediatric sized disposable incontinence product, brief/diaper, large size, each | | T4531 | 0.70 | Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size each | | T4532 | 0.58 | Pediatric sized disposable incontinence product, protective underwear/pull-on, large size each | | T4533 | 0.46 | Youth sized disposable incontinence product, brief/diaper, each | | T4534 | 0.72 | Youth sized disposable incontinence product, protective underwear/pull-on, each | | T4535 | 0.40 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | | T4535UD | AAC+20% | Disposable liner/shield/guard/pad/undergarment, for incontinence, each (bariatric) | | T4536 | AAC+20% | Incontinence product, protective underwear/pull-on, reusable, bed size, each | | T4537 | 13.83 | Incontinence product, protective underpad, reusable, bed size, each | | T4538 | AAC+20% | Diaper service, reusable diaper, each diaper | | T4539 | AAC+20% | Incontinence product, diaper/brief, reusable, any size, each | | T4540 | AAC+20% | Incontinence product, protective underpad, reusable, chair size, each | | T4541 | 0.34 | Incontinence product, disposable underpad, large, each | | T4542 | 0.29 | Incontinence product, disposable underpad, small size, each | | T4543 | AAC+20% | Disposable incontinence product, brief/diaper, bariatric, size up to XXL, each | | T4543UD | 2.19 | Disposable incontinence product, brief/diaper, bariatric, size XXXL and above, each | | T4544 | AAC+20% | Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each | | T5001NU | AAC+35% | Positioning seat for persons with special orthopedic needs, for use in vehicle (new equipment) | | T5001RR | I.C. | Positioning seat for persons with special orthopedic needs, for use in vehicle (rental) | | T5001UE | I.C. | Positioning seat for persons with special orthopedic needs, for use in vehicle (used durable medical equipment) | | Home Infusion | | | | 99601SD | 86.99 | Home infusion/specialty drug administration, per visit (up to two hours) (services provided by registered nurse with specialized, highly technical home infusion training) | | 99602SD | 45.48 | Home infusion/specialty drug administration, each additional hour (services provided by registered nurse with specialized, highly technical home infusion training) (use in conjunction with (99601SD) |

History

Adopted by Mass Register Issue 1359, eff. 3/1/2018.

101 CMR, § 322.07 Severability

The provisions of 101 CMR 322.00 are severable. If any provision of 101 CMR 322.00 or the application of any provision to the sale or rental of durable medical equipment, medical/surgical supplies, oxygen and respiratory therapy equipment should be held invalid or unconstitutional, such determination will not be construed to affect the validity or constitutionality of any other provision of 101 CMR 322.00 or the application of any other provision.

History

Adopted by Mass Register Issue 1359, eff. 3/1/2018.

Rates for Hearing Services Rates for Hearing Services

101 CMR, § 323.01 General Provisions

(1) Scope and Purpose. 101 CMR 323.00 governs the payment rates to be used by all governmental units and purchasers under M.G.L. c. 152 (the Workers' Compensation Act) for hearing services provided to publicly aided individuals and industrial accident patients.

(2) Applicable Dates of Service. Rates contained in 101 CMR 323.00 apply for dates of service provided on or after November 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 323.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 323.00. Governmental units and purchasers under M.G.L. c. 152 that purchase care are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals and industrial accident patients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 323.00 and to update billing codes in accordance with 101 CMR 323.01(5).

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology® (CPT) and Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list

(a) codes for which the code numbers change, with the corresponding cross-references between new codes and codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same, but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

History

Amended by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 323.02 Definitions

As used in 101 CMR 323.00, terms have the meanings in 101 CMR 323.02.

Accessories. Those essential items or options on a hearing aid purchased by a hearing instrument specialist that are not intrinsic components of the basic hearing aid unit. Accessories do not include nonessential items such as carrying cases.

Adjusted Acquisition Cost (AAC). The actual unit price paid to a manufacturer by a hearing aid dispenser for a hearing aid or accessories, including costs for shipping and handling, and excluding postal insurance charges.

Assessment of Hearing Aid. A procedure that includes

(a) assessment of a patient's performance by appropriate tests with hearing aid devices;

(b) a recheck of the patient and hearing aid after the prescribed aid has been fitted and used for a trial period; and

Audiological Evaluation. A routine audiological evaluation that includes

(a) pure tone audiogram, by air and bone conduction testing; and

(b) speech reception and discrimination testing.

Aural Rehabilitation. Therapy provided by a qualified audiologist either in a group or individually including, but not limited to:

(a) Lip-reading. Training of the visual modality to improve the understanding of the speech or language of other speakers.

(b) Auditory Training. Training of the auditory modality to improve the understanding of the speech or language of other speakers.

Binaural. The type of fitting or aid necessitated by varying degrees of hearing loss in both ears that requires unparalleled amplification via the use of two microphones and/or receivers.

Binaural Fitting. The fitting of two hearing aids, one to each ear, by a provider; the fitting to the second ear taking place no later than six months after the fitting to the first ear.

Contralateral Routing Hearing Aid. A type of hearing aid configuration that routes sounds from the hearing-impaired ear to the hearing ear via the use of a microphone.

Electroacoustic Evaluation for Hearing Aid. A check of the patient's personal hearing aid (includes electroacoustical analysis of the aid).

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any department, agency, board, division, or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Hearing Aid. A small electronic device consisting of a microphone, an amplifier, and a receiver.

Hearing Aid Check. A check of the functioning of the patient's monaural or binaural hearing aid.

Hearing Services. Services including testing related to the determination of hearing loss, evaluation of hearing aids, the prescription of hearing aid devices, and aural rehabilitation.

Individual Consideration (I.C.). A designation indicating that there is no specified rate for a given service. Payment amounts for services designated "I.C." are determined by the governmental unit purchasing such services. The governmental unit determines the appropriate payment based on the provider's report of services provided and documentation as requested by the governmental unit. The report must include a pertinent history and diagnosis, a description of the service rendered, and the length of time spent with the patient. In making the determination of the appropriate payment amount, the governmental unit uses the following criteria:

(a) the policies, procedures, and practices of other third-party purchasers of care, both governmental and private;

(b) the severity and complexity of the patient's disorder or disability;

(d) the time, degree of skill, and cost including equipment cost required to perform the procedure(s).

Industrial Accident Patient. A person who receives medical services for which persons, corporations, or other entities are in whole or part liable under M.G.L. c. 152 (the Workers' Compensation Act).

Major Repairs. Repairs to a hearing aid that must be made by a repair facility other than the provider's place of business.

Minor Repairs. Repairs performed at the provider's place of business such as, but not limited to, replacement and cleaning of tubing.

Monaural Fitting. The fitting of one hearing aid by a provider.

Non organic Test Battery. Tests done to determine functional hearing loss.

Out-of-office Rates. Providers must use the appropriate place of service (POS) code when billing for out-of-office services. Out-of-office rates are 115% of their respective in-office counterparts.

Out-of-office Services. Authorized services provided in a nursing home, school, patient's home, or any other setting where the provider travels from his or her usual place of business to provide the service. Out-of-office services include only the codes in the following sections.

101 CMR 323.03(5)(b)1.: Hearing Aid Dispensing Fees

101 CMR 323.03(5)(c): Maximum Fee for Earmolds

101 CMR 323.03(5)(d): Maximum Fee for Ear Impressions

101 CMR 323.03(5)(e): Maximum Fee for Batteries

101 CMR 323.03(5)(i): Maximum Fee for Minor Repairs

101 CMR 323.03(5)(j): Maximum Fee for Major Repairs

Place of Service (POS). Providers who file claims with MassHealth must use the following CMS POS codes.

03 - School

04 - Homeless shelter

11 - Office

12 - Home

22 - Outpatient hospital

26 - Military treatment facility

31 - Skilled nursing facility

32 - Nursing facility

99 - Other place of service

Provider. A provider acting within the scope of the provider's license, in accordance with all applicable state and federal laws, who meets such conditions of participation as have been adopted by governmental units purchasing audiological services or by purchasers under M.G.L. c. 152 (the Workers' Compensation Act), and who is one of the following:

(a) an audiologist who is currently licensed by the Massachusetts Board of Speech language Pathology and Audiology;

(b) any speech and hearing center (proprietorship, partnership, or corporation) that is not part of a hospital and provides authorized speech, hearing, or language services provided by a licensed, certified audiologist or a certified speech and language pathologist and does not bill separately from such facility for professional services;

(c) an audiology assistant who is currently licensed by the Massachusetts Board of Registration in Speech-language Pathology and Audiology; or

(d) a hearing instrument specialist who is currently licensed by the Massachusetts Board of Registration of Hearing Instrument Specialists.

Publicly aided Individual. A person who receives health care and other services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Used Hearing Aid. Any hearing aid that has been worn for any period of time by a user.

History

Amended by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 323.03 General Rate Provisions, Requirements, and Rates

(1) General Rate Provisions. Payment for the purchase of hearing aids and authorized related accessories and services for the care and maintenance of hearing aid instruments are the lowest of

(a) the provider's usual charge to persons other than publicly aided individuals and industrial accident patients;

(b) the provider's actual charge submitted; or

(2) Reimbursement as Full Payment. The payment rates under 101 CMR 323.03 are full compensation for care rendered to publicly aided individuals and industrial accident patients, as well as for any related administrative or supervisory duties and costs in connection with the services provided. Each provider must, as a condition of acceptance of payment made by the governmental unit purchasing audiological services or purchaser under M.G.L. c. 152 (the Workers' Compensation Act), accept the rate as full payment and discharge of all obligations for the services rendered.

(3) General Requirements and Services Included.

(a) Purchase of Hearing Aids. Payment for a hearing aid includes

the hearing aid and standard accessories for the proper operation of the hearing aid and proper fitting and instruction in the use, care, and maintenance of the hearing aid; and minor repairs and services as usually provided non-publicly aided individuals and industrial accident patients that may be necessary during the operational life of the hearing aid;
a mandatory one year manufacturer's warranty and/or insurance against loss or damage; and
the cost of a loaner hearing aid when necessary.

(b) Earmold. Payment for an earmold includes the proper fitting of the earmold on delivery, and adjustments as may be needed. The maximum fee stipulated in 101 CMR 323.03(5)(c) is not allowed if an earmold is included in the manufacturer's price of the aid or the client already has an earmold.

(c) Ear Impression. Payment for an ear impression includes one properly formed ear impression for each in-the-ear (ITE), in-the-canal (ITC), and behind-the-ear (BTE) aid purchased. The fee stipulated in 101 CMR 323.03(5)(d) is allowed only at the time an aid is purchased. The fee listed in 101 CMR 323.03(5)(d) includes provision for all associated costs.

(d) Batteries. Proper freshness of batteries must be ensured. The maximum fee listed in 101 CMR 323.03(5)(e) includes provision for all associated costs. Batteries must be new and unused at the time of purchase.

(e) Other Accessories or Options for a Hearing Aid. Proper fitting and adjustment of the accessory must be provided as needed. The maximum fee listed in 101 CMR 323.03(5)(g) includes provision for all associated costs. Accessories must be new and unused at the time of purchase.

(f) Refitting Services/Other Professional Services. Additional fitting/refitting services are reimbursed only if the hearing aid was dispensed more than one year prior to the date of service of the refitting services. These professional services include refitting of the aid, orientation, counseling the member or member's family, contact with interpreters, fitting of a loaner aid, and similar services. Reimbursement for such services must include a face-to-face encounter with the publicly aided individual or industrial accident patient.

(g) Minor Repairs and Office Visits for Evaluation and Management Services. An office visit for evaluation and management services is reimbursed only when one or more of the following services is required and is provided as part of the visit:

minor adjustments to the hearing aid to ensure a proper fitting, such as an earmold adjustment, when a provider is not the provider who initially fit the hearing aid, and the provider who initially fit the hearing aid no longer provides services to publicly aided individuals or industrial accident patients;

minor office repairs for which the provider customarily charges patients who are neither publicly aided individuals nor industrial accident patients;

cleaning of the hearing aid; or
replacement of parts such as, but not limited to, tubing, hooks, battery doors, and replacement. No fee is allowed when the provider does not customarily charge clients other than publicly aided individuals and industrial accident patients for these repairs.

(h) Major Repairs. A provider may submit a bill for major repairs to a hearing aid only after all warranties and/or insurance have expired. The hearing aid in need of a major repair must be sent directly to the repair facility or manufacturer that will perform the repair. Handling charges by an intermediary may not be submitted. Repair services must include a written warranty against all defects for a minimum of six months, unless otherwise documented by the repair facility or manufacturer. The provider of the repair services is responsible for the quality of the workmanship and parts, and for ensuring that the repaired aid is in proper working condition. The maximum fee listed in 101 CMR 323.03(5)(j) includes provision for all associated costs.

(i) Extended Insurance Covering Loss and Damage. The manufacturer's insurance policy must provide coverage for the loss or damage of a hearing aid for no less than one year and up to three years following purchase.

(j) Other Services. No payment is allowed when the provider does not customarily charge clients other than publicly aided individuals and industrial accident patients for such items.

(4) Two Audiologists. MassHealth pays for two audiologists working together to perform an evaluation of an individual member when the knowledge, skills, and experience of the primary audiologist have identified a need for a second audiologist to aid in completing the initial test battery, such as for the testing of very young children or those with other pertinent developmental, physical, cognitive, or maturational factors. Circumstances warranting the services of two audiologists must be fully documented in the member's medical record. To receive full payment, both audiologists must use the appropriate service code and modifier combination listed in Subchapter 6 of the MassHealth Audiologist Manual . MassHealth will pay 1/2 of the total allowable payment for two audiologists to each individual provider.

(5) Rates. 101 CMR 323.03(5) sets forth maximum fees for the items and services listed in 101 CMR 323.03(5).

(a) Maximum Fees for Audiological Services.

Vestibular Function Tests, with Recording and Medical Diagnostic Evaluation.

| Code | Description | Rate | | --- | --- | --- | | 92541 | Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording | $52.21 | | 92542 | Positional nystagmus test, minimum of four positions, with recording | $53.86 | | 92544 | Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording | $43.19 | | 92545 | Oscillating tracking test, with recording | $39.30 | | 92546 | Sinusoidal vertical axis rotational testing | $81.48 | | 92547 | Use of vertical electrodes (List separately in addition to code for primary procedure) | $24.52 |

Audiologic Function Tests with Medical Diagnostic Evaluation.

| Code | Description | Rate | | --- | --- | --- | | 92551 | Screening test, pure tone, air only | $9.49 | | 92552 | Pure tone audiometry (threshold); air only | $18.37 | | 92553 | Pure tone audiometry (threshold); air and bone | $26.26 | | 92555 | Speech audiometry threshold | $15.05 | | 92556 | Speech audiometry threshold; with speech recognition | $22.20 | | 92557 | Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) | $49.51 | | 92562 | Loudness balance test, alternate binaural or monaural | $18.73 | | 92563 | Tone decay test | $16.17 | | 92565 | Stenger test, pure tone | $14.31 | | 92567 | Tympanometry (impedance testing) | $20.36 | | 92568 | Acoustic reflex testing, threshold | $14.26 | | 92572 | Staggered spondaic word test | $8.39 | | 92576 | Synthetic sentence identification test | $18.61 | | 92577 | Stenger test, speech | $23.91 | | 92579 | Visual reinforcement audiometry (VRA) | $29.59 | | 92582 | Conditioning play audiometry | $31.82 | | 92583 | Select picture audiometry | $33.04 | | 92584 | Electrocochleography | $84.33 | | 92587 | Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report | $56.57 | | 92588 | Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report | $79.19 | | 92590 | Hearing aid examination and selection; monaural | $24.23 | | 92591 | Hearing aid examination and selection; binaural | $35.94 | | 92592 | Hearing aid check; monaural | $15.19 | | 92593 | Hearing aid check; binaural | $30.38 | | 92594 | Electroacoustic evaluation for hearing aid; monaural | $41.64 | | 92595 | Electroacoustic evaluation for hearing aid; binaural | $83.32 | | 92596 | Ear protector attenuation measurements | $26.62 | | 92650 | Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis | $67.81 | | 92651 | Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report | $67.81 | | 92652 | Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report | $94.37 | | 92653 | Auditory evoked potentials; neurodiagnostic, with interpretation and report | $94.37 | | V5020 | Conformity evaluation | $90.94 |

Evaluative and Therapeutic Services.

| Code | Description | Rate | | --- | --- | --- | | 92517 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) | I.C. | | 92518 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP) | I.C. | | 92519 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP) | I.C. | | 92601 | Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming | $143.78 | | 92602 | Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming (do not report 92602 in addition to 92601) | $98.64 | | 92603 | Diagnostic analysis of cochlear implant, 7 years or older; with programming | $90.51 | | 92604 | Diagnostic analysis of cochlear implant, 7 years or older; subsequent reprogramming (do not report 92604 in addition to 92603) | $58.69 | | 92620 | Evaluation of central auditory function, with report; initial 60 minutes | $59.45 | | 92621 | Evaluation of central auditory function, with report; each additional 15 minutes (List separately in addition to code for primary procedure) | $14.87 | | 92626 | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour | $59.45 | | 92627 | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (List separately in addition to code for primary procedure) | $14.87 | | 92700 | Unlisted otorhinolaryngologic service or procedure | I.C. |

Miscellaneous.

| Code | Description | Rate | | --- | --- | --- | | V5008 | Hearing screening | $30.83 | | V5010 | Assessment for hearing | $62.53 |

(b) Maximum Fees for Hearing Aids. The maximum fees are the adjusted acquisition cost (AAC) of the hearing aid, plus the appropriate dispensing fee.

Hearing Aid Dispensing Fees.

| Code | Description | Rate | | --- | --- | --- | | V5090 | Dispensing fee, unspecified hearing aid | $331.26 | | V5110 | Dispensing fee, bilateral | $662.73 | | V5160 | Dispensing fee, binaural | $662.73 | | V5200 | Dispensing fee, CROS contralateral, monaural | $662.73 | | V5240 | Dispensing fee, contralateral routing system, binaural | $662.73 | | V5241 | Dispensing fee, monaural hearing aid, any type | $331.26 |

Hearing Aid Purchases.

| Code | Description | Rate | | --- | --- | --- | | V5030 | Hearing aid, monaural, body worn, air conduction | AAC | | V5040 | Hearing aid, monaural, body worn, bone conduction | AAC | | V5050 | Hearing aid, monaural, in the ear | AAC | | V5060 | Hearing aid, monaural, behind the ear | AAC | | V5070 | Glasses, air conduction | AAC | | V5080 | Glasses, bone conduction | AAC | | V5095 | Semi-implantable middle ear hearing prosthesis | AAC | | V5100 | Hearing aid, bilateral, body worn | AAC | | V5120 | Binaural, body | AAC | | V5130 | Binaural, in the ear | AAC | | V5140 | Binaural, behind the ear | AAC | | V5150 | Binaural, glasses | AAC | | V5171 | Hearing aid, contralateral routing device, monaural, in the ear (ITE) | I.C. | | V5172 | Hearing aid, contralateral routing device, monaural, in the canal (ITC) | I.C. | | V5181 | Hearing aid, contralateral routing device, monaural, behind the ear (BTE) | I.C. | | V5190 | Hearing aid, contralateral routing, monaural, glasses | AAC | | V5211 | Hearing aid, contralateral routing device, monaural, behind the ear (BTE) | I.C. | | V5212 | Hearing aid, contralateral routing system, binaural, ITE/ITC | I.C | | V5213 | Hearing aid, contralateral routing system, binaural, ITE/BTE | I.C. | | V5214 | Hearing aid, contralateral routing system, binaural, ITC/ITC | I.C. | | V5215 | Hearing aid, contralateral routing system, binaural, ITC/BTE | I.C. | | V5221 | Hearing aid, contralateral routing system, binaural, BTE/BTE | I.C. | | V5230 | Hearing aid, contralateral routing system, binaural, glasses | AAC | | V5242 | Hearing aid, analog, monaural, CIC (completely in the ear canal) | AAC | | V5243 | Hearing aid, analog, monaural, ITC (in the canal) | AAC | | V5244 | Hearing aid, digitally programmable analog, monaural, CIC | AAC | | V5245 | Hearing aid, digitally programmable analog, monaural, ITC | AAC | | V5246 | Hearing aid, digitally programmable analog, monaural, ITE (in the ear) | AAC | | V5247 | Hearing aid, digitally programmable analog, monaural, BTE (behind the ear) | AAC | | V5248 | Hearing aid, analog, binaural, CIC | AAC | | V5249 | Hearing aid, analog, binaural, ITC | AAC | | V5250 | Hearing aid, digitally programmable analog, binaural, CIC | AAC | | V5251 | Hearing aid, digitally programmable analog, binaural, ITC | AAC | | V5252 | Hearing aid, digitally programmable, binaural, ITE | AAC | | V5253 | Hearing aid, digitally programmable, binaural, BTE | AAC | | V5254 | Hearing aid, digital, monaural, CIC | AAC | | V5255 | Hearing aid, digital, monaural, ITC | AAC | | V5256 | Hearing aid, digital, monaural, ITE | AAC | | V5257 | Hearing aid, digital, monaural, BTE | AAC | | V5258 | Hearing aid, digital, binaural, CIC | AAC | | V5259 | Hearing aid, digital, binaural, ITC | AAC | | V5260 | Hearing aid, digital, binaural, ITE | AAC | | V5261 | Hearing aid, digital, binaural, BTE | AAC | | V5262 | Hearing aid, disposable, any type, monaural | AAC | | V5263 | Hearing aid, disposable, any type, binaural | AAC | | V5298 | Hearing aid, not otherwise classified | AAC |

| Code | Description | Rate | | --- | --- | --- | | V5264 | Ear mold/insert, not disposable, any type | AAC+ $15.74 | | V5265 | Ear mold/insert, disposable, any type | AAC+ $15.74 |

(d) Maximum Fee for Ear Impressions.

| Code | Description | Rate | | --- | --- | --- | | V5275 | Ear impression, each | $15.74 |

(e) Maximum Fees for Batteries.

| Code | Description | Rate | | --- | --- | --- | | V5266 | Battery for use in hearing device | $1.67 | | L8621 | Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each | AAC | | L8622 | Alkaline battery for use with cochlear implant device, any size, replacement, each | AAC | | L8623 | Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each | AAC | | L8624 | Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each | AAC |

(f) Maximum Fees for Bone-anchored Hearing Aids (BAHA).

| Code | Description | Rate | | --- | --- | --- | | L8691 | Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each | $1,931.37 | | L8692 | Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment | I.C. | | L8693 | Auditory osseointegrated device abutment, any length, replacement only | $1,700.57 | | L8694 | Auditory osseointegrated device, transducer/actuator, replacement only, each | $1,059.11 |

(g) Maximum Fees for Other Accessories. Provider's adjusted acquisition cost (AAC), plus a 45% markup.

| Code | Description | Rate | | --- | --- | --- | | V5267 | Hearing aid or assistive listening device/supplies/accessories, not otherwise specified | AAC+ 45% | | V5274 | Assistive listening device, not otherwise specified | AAC+ 45% |

(h) Maximum Fee for Refitting Services.

| Code | Description | Rate | | --- | --- | --- | | V5011 | Fitting/orientation/checking of hearing aid | $37.35 |

(i) Maximum Fee for Minor Repairs.

| Code | Description | Rate | | --- | --- | --- | | 99499 | Unlisted evaluation and management service | $5.38 |

(j) Maximum Fee for Major Repairs.

| Code | Description | Rate | | --- | --- | --- | | V5014 | Repair/modification of a hearing aid | AAC+ 45% |

(k) Maximum Fees for Cochlear Implant Services.

| Code | Description | Rate | | --- | --- | --- | | L7510MS | Repair of prosthetic device, repair or replace minor parts (six-month maintenance and servicing fee for reasonable and necessary parts and labor that are not covered under any manufacturer or supplier warranty) (I.C.) (for use only for the purchase of a cochlear implant service contract in accordance with 130 CMR 426.416: Reimbursable Services .) | I.C. | | L8615 | Headset/headpiece for use with cochlear implant device, replacement | $337.44 | | L8616 | Microphone for use with cochlear implant device, replacement | $78.60 | | L8617 | Transmitting coil for use with cochlear implant device, replacement | $68.65 | | L8618 | Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement | $19.62 | | L8619 | Cochlear implant, external speech processor and controller, integrated system, replacement | $7,259.54 | | L8627 | Cochlear implant, external speech processor, component, replacement | $6,518.03 | | L8628 | Cochlear implant, external controller component, replacement | $1,130.05 | | L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device, replacement | $163.56 | | L9900 | Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code | I.C. |

(l) Maximum Fee for Other Services.

| Code | Description | Rate | | --- | --- | --- | | V5299 | Hearing service, miscellaneous | I.C. |

(6) Medical Services. The payment rates for medical services are set forth in 101 CMR 317.00: Rates for Medicine Services .

(7) Therapeutic Services. The payment rates for therapeutic services are set forth in 101 CMR 339.00: Rates for Restorative Services .

History

Amended by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 323.04 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Amended by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 323.05 Severability

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

Nonpublic Ambulance Service Reimbursement Trust Fund Assessment and Funding Nonpublic Ambulance Service Reimbursement Trust Fund Assessment and Funding

101 CMR, § 324.01 General Provisions

(1) Scope and Purpose. 101 CMR 324.00 governs the Nonpublic Ambulance Service Reimbursement Trust Fund assessment and funding.

(2) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 324.00.

(3) Applicable Assessment Period. Assessment described in 101 CMR 324.00 is applicable for periods on or after July 1, 2021.

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

101 CMR, § 324.02 General Definitions

As used in 101 CMR 324.00, terms have the meanings set forth in 101 CMR 324.02, except where the context clearly indicates otherwise.

Ambulance Service. Ambulance service as defined in M.G.L. c. 111C, § 1.

Ambulance Service Cost Report. The Ambulance Service Report of Costs, Revenues, and Statistics reported to the Center pursuant to 957 CMR 6.00: Cost Reporting Requirements.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Gross Patient Service Revenue (GPSR). The total dollar amount of nonpublic ambulance charges for services rendered in a provider's fiscal year.

Nonpublic Ambulance Provider. Ambulance provider licensed pursuant to M.G.L. c. 111C, § 6 that is not a city or town, county, district, or other governmental body.

Nonpublic Emergency Ambulance Assessed Charges. Massachusetts gross patient service revenue earned from all patients attributable to emergency ground ambulance service, less bad debt, charity care, or payer discounts. For each provider's fiscal year, assessed charges are determined using data reported in an ambulance provider's Cost Report for that fiscal year, or if that Cost Report is not submitted, using any alternative data available to EOHHS. EOHHS may reasonably calculate the portion of revenue attributable to emergency ground ambulance service, the allocation of bad debt, or any other element of the Nonpublic Emergency Ambulance Assesed Charges based on the data submitted by providers or other data possessed by EOHHS.

Trust Fund. The Nonpublic Ambulance Service Reimbursement Trust Fund established under M.G.L. c. 29, § 2KKKKK, to provide money to be expended for Medicaid payments to nonpublic ambulance providers, as specified in 101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Services. The Secretary of EOHHS, as trustee, will administer the fund and will make expenditures from the fund consistent with M.G.L. c. 29, § 2KKKKK.

Uniform Assessment. The percentage of nonpublic emergency ambulance assessed charges set by EOHHS as described in 101 CMR 324.04(1).

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

101 CMR, § 324.03 Sources and Uses of Fund

(1) General. The Trust Fund includes

(a) an amount equal to all revenues generated from the funds collected pursuant to 101 CMR 324.00;

(b) an amount equal to any federal financial participation revenues claimed and received by the Commonwealth for eligible expenditures made from the Trust Fund;

(c) any revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the Trust Fund; and

(d) interest earned on any money in the Trust Fund.

(2) Payment to Nonpublic Ambulance Providers. Each quarter, EOHHS will, to the extent possible, expend all funding in the Trust Fund for Medicaid payments to nonpublic ambulance providers pursuant to 101 CMR 327.05: Nonpublic Ambulance Supplemental Payment Provisions. No expenditure will be made from the Trust Fund that will cause the Trust Fund to be in deficit at the close of a fiscal year.

(3) Administrative Costs. $500,000 annually will be transferred to the EOHHS for its administrative costs.

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

101 CMR, § 324.04 Nonpublic Ambulance Provider's Liability and Payment to the Nonpublic Ambulance Service Reimbursement Trust Fund

(1) Uniform Assessment. EOHHS will annually set the uniform assessment at a percentage not less than 0.25% lower than the maximum limit for a provider assessment pursuant to 42 CFR 433.68(f), inclusive of an annual amount of $500,000; provided, that the annual amount of $500,000 will be for administrative costs of EOHHS as described in 101 CMR 324.03(3). This percentage will be listed before October 1^st of each year and will be set as a percentage of the nonpublic emergency ambulance assessed charges of each such nonpublic ambulance provider for its most recently completed fiscal year (unless EOHHS determines that the most recent fiscal year does not accurately represent typical total operating revenue for the nonpublic ambulance provider because of exceptional circumstances, in which case EOHHS may use nonpublic emergency ambulance assessed charges from an earlier completed fiscal year). Such uniform assessment will not be implemented unless and until EOHHS receives notice of approval from the Centers for Medicare & Medicaid Services of federal financial participation for expenditures related to the assessment. Upon receiving such approval, EOHHS may implement the assessment for the quarter beginning July 1, 2021, and later as described in 101 CMR 324.04(4)(c), and require payment within 45 days (or such additional period designated by EOHHS by administrative bulletin or other written guidance) of such approval or the end of the relevant quarter, whichever comes later.

(2) Applicability of Assessment. All nonpublic ambulance providers, regardless of payment model, are subject to the uniform assessment including, but not limited to, those nonpublic ambulance providers in fee-for-service and managed care arrangements. A nonpublic ambulance provider's liability to the fund will, in the case of a transfer of ownership or other change in control, be assumed by the successor in interest to the nonpublic ambulance provider or any provider under common interest.

(3) Reporting of Nonpublic Emergency Ambulance Assessed Charges.

(a) Each nonpublic ambulance provider is required to report its nonpublic emergency ambulance assessed charges each year. Such reporting will be completed through the filing of the Ambulance Cost Report with the Center, subject to all requirements under 957 CMR 6.00: Cost Reporting Requirements and using the total operating revenue for basic life and advanced life service of Schedule E of the Ambulance Cost Reports, or through an alternative reporting method designated by EOHHS via administrative bulletin or other written issuance.

(b) If a nonpublic ambulance provider fails to report nonpublic emergency ambulance assessed charges, or, if in the determination of EOHHS, the nonpublic ambulance provider has improperly reported its nonpublic emergency ambulance assessed charges or the assessed charges do not accurately represent typical total operating revenue for the nonpublic ambulance provider because of exceptional circumstances, EOHHS may calculate such amounts based on data within its possession or audit the nonpublic ambulance provider. If EOHHS determines through its review that a nonpublic ambulance assessed charges were materially different than reported, EOHHS may require a payment adjustment. Payment adjustments are subject to interest penalties and late fees, pursuant to 101 CMR 324.06(1), from the date the original payment was owed to the Trust Fund.

(4) Nonpublic Ambulance Provider Liability Calculation.

(a) Each nonpublic ambulance provider's gross liability to the Trust Fund is equal to the product of

the amount of nonpublic emergency ambulance assessed charges in the nonpublic ambulance provider's most recent fiscal year as reported on the Ambulance Service Cost Report, or as otherwise determined by EOHHS as described in 101 CMR 324.04(1) and (3); and
the uniform assessment.

(b) For each provider who has submitted its revenue to the Center or EOHHS by September 20^th of each year, EOHHS will notify the nonpublic ambulance provider of its gross liability to the Trust Fund by September 30^th, split into quarterly payments. EOHHS will update each nonpublic ambulance service's liability to the Trust Fund as updated information becomes available.

(5) Payment. Upon implementation of the uniform assessment consistent with the requirements of 101 CMR 324.04(1), each nonpublic ambulance provider must pay its quarterly gross liability to the Trust Fund within 45 days (or such additional period designated by EOHHS by administrative bulletin or other written guidance) of the end of each calendar quarter, starting with the quarter beginning July 1, 2021. The nonpublic ambulance provider may adjust the amount owed for any over- or under-payments in a previous period.

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

101 CMR, § 324.05 Filing and Reporting Requirements

(1) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the chief executive officer, president, or chief financial officer of the eligible nonpublic ambulance provider.

(2) Examination of Records. Each eligible nonpublic ambulance provider must make available all records relating to its operation and all records relating to a holding company or any entity in which there may be a common ownership or interrelated directorate upon request of EOHHS for examination.

(3) Field Audits. EOHHS or its designee may conduct field audits of eligible nonpublic ambulance providers to verify compliance with any aspect of 101 CMR 324.00.

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

101 CMR, § 324.06 Noncompliance

(1) Penalty for Nonpayment. If a nonpublic ambulance provider does not pay the amount required pursuant to 101 CMR 324.04, or a specified portion thereof, by the due date established by EOHHS, EOHHS may assess up to a 3% penalty on the outstanding balance. EOHHS will calculate the penalty on the outstanding balance as of the due date. EOHHS may assess up to an additional 3% penalty against the outstanding balance and prior penalties for each month that a nonpublic ambulance provider remains delinquent. EOHHS will credit partial payments from delinquent nonpublic ambulance providers to the current outstanding liability. If any amount remains from the partial payment, EOHHS will then credit such amount to the penalty amount.

(2) Penalty for Failure to Report Nonpublic Emergency Ambulance Assessed Charges. If a nonpublic ambulance provider fails to report nonpublic emergency ambulance assessed charges as required under 101 CMR 324.04(3)(a), EOHHS may assess penalties consistent with 101 CMR 327.06: Reporting and Registration Requirements.

(3) Penalty Amount Determination. In determining the penalty amount, EOHHS may consider factors including, but not be limited to, the nonpublic ambulance provider's payment history, financial situation, and relative share of the payments.

(4) Reduction in Payment. EOHHS may deny, reduce, or withhold payments that would otherwise be made to an eligible nonpublic ambulance provider pursuant to 101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Van Services if that nonpublic ambulance provider fails to make full payment under 101 CMR 324.04 or is assessed penalties under 101 CMR 324.06(1). EOHHS will notify the nonpublic ambulance provider of its intention to deny, reduce, or withhold payment.

(5) Successors in Interests or Providers under Common Control. EOHHS may apply all penalties and reductions in payments to successor in interest to the nonpublic ambulance provider or any provider under common interest.

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

101 CMR, § 324.07 Severability

The provisions of 101 CMR 324.00 are severable. If any provision of 101 CMR 324.00 or the application of such provision of 101 CMR 324.00 is held invalid or unconstitutional, such determination will not be construed to affect the validity or constitutionality of any other provision of 101 CMR 324.00 or the application of any other provision.

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

Rates of Payment for Ambulance and Wheelchair Van Services Rates of Payment for Ambulance and Wheelchair Van Services

101 CMR, § 327.01 General Provisions

(1) Scope and Purpose. 101 CMR 327.00 governs the rates of payment to eligible ambulance and wheelchair van service providers to be used by all governmental units for services provided to publicly aided individuals. The ground transport rates set forth in 101 CMR 327.00 also apply to individuals covered by the Workers' Compensation Act, M.G.L. c. 152.

(2) Applicable Dates of Service. Rates in 101 CMR 327.00 are applicable for dates of service on or after April 1, 2025, except as otherwise noted.

(3) Disclaimer of Authorization of Services. 101 CMR 327.00 is not authorization for or approval of the services for which rates are determined pursuant to 101 CMR 327.00. Governmental units that purchase services are responsible for the definition, authorization, and approval of care and services provided to publicly aided individuals.

(4) Coverage. The rates of payment in 101 CMR 327.00 constitute payment in full for all services provided by an eligible provider, including administration and professional supervision services. The payment rates will apply to ambulance and wheelchair van services provided by eligible providers to publicly aided individuals whose medical condition requires the use of such vehicles under the conditions described by the purchasing governmental unit.

(5) Exclusions. 101 CMR 327.00 and the payment rates in 101 CMR 327.03 will not, under any conditions, apply when the purchasing governmental unit determines that

(a) no medical necessity exists; or

(b) some means of transportation other than an ambulance or wheelchair van may be used without endangering the patient's health; or

(6) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list

(b) codes for which the code number remains the same, but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

(7) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 327.00; to issue coding updates and corrections under 101 CMR 327.01(6); to describe services, rates, or payment methods set forth in a special contract with a provider or selective contract with a broker under 101 CMR 327.04, as determined necessary by EOHHS; to describe conditions of payment for the nonpublic ambulance supplemental payments under 101 CMR 327.05(2); or to update the distribution factor percentage for the nonpublic ambulance assessment as provided under 101 CMR 327.05(5)(a), though such administrative bulletin may not change the distribution factor percentage by more than 5%.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 327.02 General Definitions

Terms, as used in 101 CMR 327.00, have the meanings set forth in 101 CMR 327.02.

Ambulance. An aircraft, boat, motor vehicle or other means of transportation, however named, whether privately or publicly owned, which is intended to be used for, and is maintained and operated for, the response to and the transportation of sick or injured individuals.

Center. The Center for Health Information and Analysis, established under M.G.L. c. 12C.

Eligible Provider. A person, partnership, corporation, governmental unit, or other entity that provides authorized emergency ambulance, nonemergency ambulance, and/or wheelchair van services and that also meets such conditions of participation as have been or may be adopted from time to time by a governmental unit purchasing ambulance services.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

Individual Consideration (IC). Rates of payment to eligible providers for services authorized, but not listed herein, or authorized services performed in exceptional circumstances will be determined on an individual consideration basis by the governmental unit upon receipt of a bill that describes the services rendered. Eligible providers must maintain adequate records to determine the appropriateness of their IC claims and must provide these documents to the governmental unit upon request.

Loaded Mileage. The actual distance a person or persons is (are) transported in an ambulance or wheelchair van.

Nonpublic Ambulance Service. Ambulance services which are not provided by a city or town, county, district, or other governmental body and are licensed pursuant to M.G.L. c. 111C § 6.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

Trip. The event of pick-up, transport, and delivery of a person or persons to or from a hospital or other health care facility by an ambulance or wheelchair van.

Trust Fund. The Nonpublic Ambulance Service Reimbursement Trust Fund established under M.G.L. c. 29, § 2KKKKK, to provide money to be expended for Medicaid payments to nonpublic ambulance services, as specified in 101 CMR 324.00: Nonpublic Ambulance Service Reimbursement Trust Fund Assessment and Funding . The Secretary of Health and Human Services, as trustee, will administer the fund and will make expenditures from the fund consistent with M.G.L. c. 29, § 2KKKKK.

Wheelchair Van. A motor vehicle that is specifically equipped to carry one or more persons who have a mobility disability or who are using a wheelchair.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 327.03 General Rate Provisions and Payment

(1) Rate Determination. The rates for authorized ambulance and wheelchair van services under 101 CMR 327.00 are the lowest of

(a) the eligible provider's usual fee to patients other than publicly-aided individuals; or

(b) the eligible provider's actual charge submitted; or

(2) Allowable Trip Fees for Ambulance Services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | A0170 | IC | Transportation ancillary; parking fees, tolls, other (used only for ferry charges) | | A0425 | $6.45 | Ground mileage, per statute mile (loaded mileage) | | A0426 | $250.65 | Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1) | | A0427 | $396.86 | Ambulance service, advanced life support, emergency transport, level 1 (ALS 1 -emergency) | | A0428 | $208.87 | Ambulance service, basic life support, nonemergency transport (BLS) | | A0429 | $334.19 | Ambulance service, basic life support, emergency transport (BLS-emergency) | | A0430 | $4,036.04 | Ambulance service, conventional air services, transport, one way (fixed wing) | | A0431 | $4,036.04 | Ambulance service, conventional air services, transport, one way (rotary wing) | | A0433 | $574.40 | Advanced life support, level 2 (ALS 2) | | A0434 | $678.83 | Specialty care transport (SCT) | | A0999 | IC | Unlisted ambulance service. (Used for transporting patients who require special resources to be safely transported including, but not limited to, bariatric patients.) |

(3) Billing Certification. Each eligible provider who submits an invoice to a governmental unit for authorized ambulance services must certify to the accuracy of the level of services provided, as listed on its invoice.

(4) Allowable Trip Fees for Wheelchair Van Services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | A0130 | $40.55 | Nonemergency transportation; wheelchair van (each way) | | S0215 | $1.46 | Nonemergency transportation; mileage, per mile (wheelchair van, loaded mileage) | | T2001 | $8.00 | Nonemergency transportation; patient attendant/escort (wheelchair van, each way) |

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 327.04 Special Contracts

(1) Notwithstanding 101 CMR 327.03, a governmental unit may enter into a special contract with an eligible provider under which the governmental unit will pay for services authorized but not listed in 101 CMR 327.00, or authorized services performed in exceptional circumstances.

(2) Notwithstanding 101 CMR 327.03, a governmental unit may enter into a selective contract with a transportation broker under which the governmental unit will pay for authorized services arranged by the broker at rates or through payment methodologies different than those set forth in 101 CMR 327.03.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 327.05 Nonpublic Ambulance Supplemental Payment Provisions

(1) Provider Eligibility. To be eligible to receive supplemental payments from the Trust Fund, a nonpublic ambulance provider must be

(a) licensed under M.G.L. c. 111C, § 6, as defined by the Department of Public Health (DPH);

(b) a MassHealth enrolled ambulance provider; and

(2) Payment Conditions.

(a) Nonpublic ambulance service expenditures will be made only under federally approved payment methods and consistent with federal funding requirements and all federal payment limits as determined by the Secretary of Health and Human Services.

(b) Payments under the Trust Fund will only be made to eligible nonpublic ambulance providers that

provide service to MassHealth members without limitations or restrictions based on origin point or diagnosis code, so long as the origin point is consistent with the locality requirements under 130 CMR 407.411(C): Locality Restrictions ;
meet service quality standards as defined by EOHHS via administrative bulletin or other written issuance, including quality standards related to timely service and waiting times;
demonstrate compliance with other conditions of payment as described by EOHHS via administrative bulletin or other written issuance, including compliance with applicable requirements under 42 CFR § 433.68; and
comply with all applicable requirements of 130 CMR 407.000: Transportation Services .

(3) Compliance with Conditions of Payment.

(a) EOHHS may audit compliance with conditions of payment.

(b) EOHHS may, via administrative bulletin or other written issuance, establish standards governing various conditions of payment including, but not limited to, attestations, reporting requirements, compliance with payment conditions, penalties for noncompliance, and recovery.

(4) Timing of Payments.

(a) EOHHS will direct payments to eligible nonpublic ambulance providers from the Trust Fund each state fiscal year in which funding is available in the Trust Fund. Within 45 days of the end of each quarter, starting with the quarter beginning July 1, 2021, EOHHS will calculate and distribute payments to eligible nonpublic ambulance providers consistent with the payment methodology described in 101 CMR 327.05(5).

(b) Notwithstanding 101 CMR 327.05(4)(a), EOHHS will not make final supplemental payments to nonpublic ambulance providers, unless and until EOHHS receives notice of approval from the Centers for Medicare & Medicaid Services (CMS) for federal financial participation for expenditures related to the assessment described in 101 CMR 324.00: Nonpublic Ambulance Service Reimbursement Trust Fund Assessment and Funding . Upon receiving such approval, EOHHS will make supplemental payments for dates of service on or after July 1, 2021, within 180 days of such approval or the end of the relevant quarter, whichever is later.

(c) EOHHS may elect to make interim supplemental payments to nonpublic ambulance providers prior to receiving notice of approval from CMS for federal financial participation for expenditures related to the assessment. Any interim supplemental payment made to a provider is subject to adjustment to conform final supplement payments to the payment methodology ultimately approved by CMS. In the event CMS does not approve federal financial participation for such expenditures, EOHHS may recover any portion of the interim supplemental payment made to a provider. The adjustment or recovery may include, without limitation, the denial, reduction, or withholding of future payment to that provider or its successor in interest or any provider under common interest.

(5) Payment Methodology. Each quarter starting with the quarter beginning July 1, 2023, and subject to available state and federal funding and allowable under federal law, EOHHS will allocate payments to eligible nonpublic ambulance providers in the following amounts, subject to the limitations described in 101 CMR 327.05(5)(c).

(a) To calculate the supplemental payments, EOHHS will assign eligible nonpublic ambulance providers to one of the following classifications and set the distribution factor percentage to be applied to the supplemental payments determined in 101 CMR 327.05(5)(b) as follows, provided that EOHHS may prospectively update the distribution factor percentage for a given quarterly payment by not more than plus or minus 5% via administrative bulletin or other written issuance:

Not-for-profit nonpublic ambulance providers, 4.00%;
Not-for-profit hospital nonpublic ambulance providers, 11.50%;
For-profit nonpublic ambulance providers in region 1 as defined by DPH Office of Emergency Medical Services (OEMS), 3.60%;
For-profit nonpublic ambulance providers in region 2 as defined by DPH OEMS, 1.45%;
For-profit nonpublic ambulance providers in region 3 as defined by DPH OEMS, 11.55%;
For-profit nonpublic ambulance providers in region 4 as defined by DPH OEMS, 43.30%;
For-profit nonpublic ambulance providers in region 5 as defined by DPH OEMS, 3.60%; and
For-profit nonpublic ambulance providers assigned to multiple regions or no region as defined by DPH OEMS, 21.00%.

EOHHS will assign affiliated for-profit nonpublic ambulance providers located in multiple regions as defined by DPH OEMS to classification 8.

(b) EOHHS will distribute 100 % of the payment to eligible nonpublic ambulance providers as follows, with the amount paid to each nonpublic ambulance provider equaling the product of:

the ratio of the amount of ground ambulance services billed to MassHealth by that nonpublic ambulance provider to the amount of all nonpublic ambulance providers' in that nonpublic ambulance providers' classification as defined in 101 CMR 327.05(5)(a) billing to MassHealth for ground ambulance services;
100% of the amount calculated to be payable from the Trust Fund; and

the applicable distribution factor percentage of the nonpublic ambulance provider's classification set forth in 101 CMR 327.05(5)(a).

(c) The payments to eligible nonpublic ambulance providers described in 101 CMR 327.05(5)(b) may not exceed the sum of the difference between the Medicaid payments otherwise made to these providers for the provision of ground ambulance services and the amount that would have been paid at the equivalent average commercial rate (ACR) in aggregate, as determined by EOHHS, as follows.

For all eligible nonpublic ambulance providers, EOHHS will identify the emergency and non-emergency ground ambulance services for which the provider is eligible to receive supplemental payment.
The supplemental payment amount will be calculated by first determining the equivalent ACR for all eligible emergency and non-emergency ground ambulance services identified under 101 CMR 327.05(5)(c)1.
EOHHS will then subtract an amount equal to the base Medicaid reimbursement amount for all of the emergency and non-emergency ground ambulance services from the ACR calculated in 101 CMR 327.05(5)(c)2. and divide that by the base Medicaid reimbursement amount to determine the percentage increase for each emergency and non-emergency ground ambulance service provided by eligible nonpublic ambulance providers.
The supplemental payment due to eligible nonpublic ambulance providers will be subject to available funding and will not exceed the product of

a. the percentage increase calculated in 101 CMR 327.05(5)(c)3.;

b. multiplied by the base Medicaid reimbursement amount; and

c. multiplied by the total number of units for each service.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 327.06 Reporting and Registration Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements and any reporting or registration requirements set forth in 101 CMR 324.00: Nonpublic Ambulance Service Reimbursement Trust Fund Assessment and Funding . In addition, each eligible nonpublic ambulance provider that receives a supplemental payment pursuant to 101 CMR 327.05 must file or make available all records and information necessary to demonstrate compliance with conditions of payment upon EOHHS request, including documentation of the uses of such payments.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 327.07 Reductions in Payment

EOHHS may deny, reduce, or withhold payment to an eligible nonpublic ambulance provider that fails to comply with any condition of payment set forth in 101 CMR 327.05. EOHHS will notify the nonpublic ambulance provider of its intention to deny, reduce, or withhold payment. EOHHS may apply reductions in payments to the successor in interest or any provider under common interest.

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

101 CMR, § 327.08 Severability

The provisions of 101 CMR 327.00 are severable. If any provision of 101 CMR 327.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 327.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1451, eff. 8/20/2021.

101 CMR, 101 CMR 328.00 Chiropractic Services (Repealed)

History

Repealed by Mass Register Issue S1345, eff. 8/11/2017.
REGULATORY AUTHORITY 101 CMR 328.00: M.G.L. c. 118E.

101 CMR, § 329.01 General Provisions

(1) Scope and Purpose. 101 CMR 329.00 governs the rates of payment used by all governmental units in making payments to eligible providers of psychological and licensed independent behavioral health clinician services to publicly aided individuals in any suitable location, such as a private office, the client's place of residence, using telehealth, or other appropriate facility. The rates set forth in 101 CMR 329.00 do not apply to individuals covered by M.G.L. c. 152, Workers' Compensation. Rates for services rendered to such individuals are set forth in 114.3 CMR 40.03(2): Services and Rates Covered by other Regulations .

(2) Applicable Dates of Service. Rates contained in 101 CMR 329.00 apply for dates of service on or after April 25, 2025.

(3) Coverage. 101 CMR 329.00 and the rates of payment contained in 101 CMR 329.00 apply to psychological and licensed independent behavioral health clinician services rendered by eligible providers to publicly aided individuals. As set forth in 101 CMR 329.03(2), the rates of payment under 101 CMR 329.00 are full compensation for all services rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 329.00 is not authorization for or approval of the services for which rates are determined pursuant to 101 CMR 329.00. Purchasing agencies and insurers are responsible for the definition, authorization, and approval of care and services extended to publicly aided clients.

(5) Coding Updates and Corrections. The Executive Office of Health and Human Services (EOHHS) may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list:

(a) codes for which only the code numbers change, with the corresponding cross references between existing and new codes;

(b) codes for which the code remains the same but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (IC) reimbursement for these new codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on, and understanding of, substantive provisions of 101 CMR 329.00.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 329.02 General Definitions

As used in 101 CMR 329.00, unless the context requires otherwise, terms have the meanings in 101 CMR 329.02.

Case Consultation. Intervention, including scheduled audio-only telephonic, audio-video, or inperson meetings, for behavioral and medical management purposes on an individual's behalf with agencies, employers, or institutions, which may include the preparation of reports of the individual's psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

Child and Adolescent Needs and Strengths (CANS). A tool that provides a standardized way to organize information gathered during behavioral-health clinical assessments. A Massachusetts version of the tool has been developed and is intended to be used as a treatment decision support tool for behavioral-health providers serving MassHealth members younger than 21 years old.

Couple Therapy. Psychotherapeutic services provided to a couple whose primary complaint is the disruption of their marriage, family, or relationship.

Developmental Assessment. The assessment of developmental status including the administration of developmental testing to assess fine and/or gross motor, language, cognitive level, social, memory, and/or executive functions.

Developmental Testing. The assessment of fine and/or gross motor, language, cognitive level, social, memory, and/or executive functions by standardized developmental instruments, which may include the interpretation and reporting of results.

Diagnostic Services Evaluation. The examination by interview techniques and determination of a patient's physical, psychological, social, economic, educational, and vocational capabilities and disabilities for purposes of developing a diagnostic formulation and designing a treatment plan.

Eligible Provider. Any psychologist, licensed independent behavioral health clinician, or technician for test administration who meets the conditions of participation that have been or may be adopted by a governmental unit purchasing psychological and licensed independent behavioral health clinician services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Family Consultation. A scheduled meeting of at least one-half hour with one or more of the parents, legal guardian, or foster parents of a child who is being treated by the provider, when the parents, legal guardian, or foster parents are not clients of the provider.

Family Therapy. The psychotherapeutic treatment of more than one member of a family simultaneously in the same session.

Governmental Unit. The Commonwealth, any department, agency, board or commission of the Commonwealth and any political subdivision of the Commonwealth. Governmental Units include public school departments.

Group Therapy. The application of psychotherapeutic or counseling techniques to a group of persons, most of whom are not related by blood, marriage, or legal guardianship.

Individual Consideration (IC). Those rates for psychological and licensed independent behavioral health clinician services for which no total allowable fee is specified in 101 CMR 329.00 and which are determined by a governmental unit based on the nature, extent, and need for such service and the degree of skill and time required for its provision. Providers must maintain adequate records to determine the appropriateness of their IC claims and must provide these documents to the purchasing agency upon demand.

Individual Therapy. Psychotherapeutic services provided to an individual.

Intelligence Assessment. A battery of tests to measure intelligence and cognitive ability, listed in the Mental Measurement Yearbook , or that conforms to the Standards for Educational and Psychological Tests of the American Psychological Association, such as a full Wechsler Adult Intelligence Scale, Wechsler Intelligence Scale for Children, or Stanford-Binet Intelligence Scales.

Licensed Independent Behavioral Health Clinician. A licensed independent clinical social worker (LICSW), licensed mental health counselor (LMHC), or licensed marriage and family therapist (LMFT) who meets the requirements of 130 CMR 462.404: Provider Eligibility .

Multiple-family Group Therapy. The treatment of more than one family unit, at the same time in the same visit, by one or more authorized staff member. In this type of therapy, there must be more than one family member present per family unit and at least one of the family members per family unit must be an identified patient of the center.

Neuropsychological Assessment. A battery of performance-based assessments provided by an eligible provider that assesses cognitive functioning and developmental delays, in order to examine the cognitive consequences of brain damage, brain disease, physical, and mental illness, and other conditions that may impact cognitive functioning and achievement of developmental milestones. A neuropsychological or developmental assessment may include tests of intelligence, attention and concentration, learning and memory, processing speed, visual spatial perception, language skills, visual motor and fine motor skills, sensory perception, executive functioning and emotional functioning. Developmental assessments must rely on standardized developmental instruments when performed, and they may include assessment of gross motor skills.

Personality Assessment. A battery of techniques that yield an evaluation of personality, using at least two personality tests that are listed in the Mental Measurement Yearbook , or that conform to the Standards for Educational and Psychological Tests of the American Psychological Association, unless clinically contraindicated.

Psychological Assessment. The use of standardized test instruments and procedures to evaluate aspects of an individual's functioning. Psychological assessment includes intelligence, neuropsychological and developmental, and personality assessment. Testing items used for psychological assessment must be published, valid, and in general use as defined by listing in the current Mental Measurement Yearbook , or by conformity to the Standards for Educational and Psychological Tests of the American Psychological Association.

Psychotherapy. The utilization of psychological and interpersonal theories and related practice methodologies to assess, interpret, and modify conscious and unconscious processes of behavior.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

Telehealth. The use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to:

(a) interactive audio-video technology;

(b) remote patient monitoring devices;

Treatment Service. A service related to diminishing the distress and symptoms of mental health or substance use disorder, as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders including, but not limited to, individual, couple, family, and group psychotherapy. The use of evidence-based treatment modalities is encouraged.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 329.03 General Rate Provisions

(1) General Rate Provisions. The rates of payment for psychological and licensed independent behavioral health clinician services to which 101 CMR 329.00 applies are the lower of:

(a) The eligible provider's usual charge to the general public for the same or similar services; or

(b) The schedule of allowable fees listed in 101 CMR 329.04 and 101 CMR 329.05.

(2) Rates as Full Compensation. The rates of payment contained in 101 CMR 329.00 constitute full compensation for psychological and licensed independent behavioral health clinician services provided by eligible providers to publicly aided individuals, including full compensation for necessary administration (including, but not limited to, interviewing, testing, scoring, interpreting, and writing of reports) and professional supervision associated with patient care.

(3) Individual Consideration.

(a) Rates of payment to eligible providers for services authorized in 101 CMR 329.00 but not listed herein or for authorized services performed in exceptional circumstances are determined on an Individual Consideration (IC) basis by the governmental unit purchaser upon receipt of a report that describes the services rendered. Degree of skill and/or expertise and extension of time, associated with the accommodation of functional limitations of publicly aided individuals with disabilities will be considered for IC and must be adequately documented to support the appropriateness of such claims.

(b) Hours. The determination of the number of hours of services purchased for authorized IC procedures is in accordance with the following criteria:

time required to perform the service;
severity or complexity of the client's disorder or disability;
prevailing professional ethics and accepted practice; and
such other standards and criteria as may be adopted occasionally by EOHHS or the governmental purchaser.

(4) Modifiers.

(a) -AH: Clinical psychologist (This modifier is to be applied to service codes billed by the mental health center that were performed by doctoral level clinician, including PhD, PsyD, or EdD);

(b) -HO: Master's degree level (This modifier is to be applied to service codes billed by the mental health center that were performed by LMHCs, LMFTs, or LICSWs;

(c) -HA: Child/adolescent program (This modifier is to be applied to service codes billed when performed with a Children and Adolescent Needs and Strengths (CANS)).

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 329.04 Allowable Fees for Psychological Assessments

The payment rates for psychological assessments provided by a psychologist or technician for test administration and scoring are as follows.

| Service Code | Allowable Fee | Description | | --- | --- | --- | | 96112 | $180.72 | Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour. | | 96113 | $90.36 | Each additional 30 minutes (List separately in addition to code for primary procedure.) (Add-on code to 96112.) | | 96116 | $120.46 | Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, ( e.g ., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour. | | 96121 | $120.46 | Each additional hour (List separately in addition to code for primary procedure.) (Add-on code to 96116.) | | 96130 | $107.73 | Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour. | | 96131 | $91.39 | Each additional hour. (List separately in addition to code for primary procedure.) (Add-on code to 96130.) | | 96132 | $122.11 | Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour. | | 96133 | $100.53 | Each additional hour (List separately in addition to code for primary procedures.) (Add-on code to 96132.) | | 96136 | $50.27 | Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes. | | 96137 | $45.70 | Each additional 30 minutes. (List separately in addition to code for primary procedure.) (Add-on code to 96136.) | | 96138 | $37.83 | Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes. | | 96139 | $37.83 | Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes. (List separately in addition to code for primary procedure.) (Add-on code to 96138.) |

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 329.05 Allowable Fees for Other Psychological and Licensed Independent Behavioral Health Clinician Services

(1) The payment rates for psychological services provided by a psychologist are as follows.

| Service Code | Allowable Fee | Description | | --- | --- | --- | | 90791-AH | $143.48 | Psychiatric diagnostic evaluation. (Diagnostic services.) | | 90791-HA-AH | $158.48 | Psychiatric diagnostic evaluation performed with a CANS (Children and Adolescent Needs and Strengths) | | 90832-AH | $59.16 | Psychotherapy, 30 minutes with patient. (Individual therapy.) | | 90834-AH | $95.89 | Psychotherapy, 45 minutes with patient. (Individual therapy.) | | 90837-AH | $127.53 | Psychotherapy, 60 minutes with patient. (Individual therapy.) | | 90846-AH | $101.43 | Family psychotherapy (without the patient present), 50 minutes. | | 90847-AH | $101.43 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes. | | 90849-AH | $35.86 | Multiple-family group psychotherapy. | | 90853-AH | $35.86 | Group psychotherapy (other than of a multiple-family group). (Group therapy. Limited to 12 clients per group. Billed per client. 90 minutes.) | | 90882-AH | $71.80 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions. | | 90887-AH | $67.31 | Interpretation or explanation of results of psychiatric, or other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient (per % hour) |

(2) The payment rates for licensed independent behavioral health clinician services provided by a LMHC, LMFT, or LICSW are as follows.

| Service Code | Allowable Fee | Description | | --- | --- | --- | | 90791-HO | $130.48 | Psychiatric diagnostic evaluation. (Diagnostic services.) | | 90791-HA-HO | $145.48 | Psychiatric diagnostic evaluation performed with a CANS (Children and Adolescent Needs and Strengths) | | 90832-HO | $52.20 | Psychotherapy, 30 minutes with patient. (Individual therapy.) | | 90834-HO | $95.46 | Psychotherapy, 45 minutes with patient. (Individual therapy.) | | 90837-HO | $125.69 | Psychotherapy, 60 minutes with patient. (Individual therapy.) | | 90846-HO | $101.43 | Family psychotherapy (without the patient present), 50 minutes. | | 90847-HO | $101.43 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes. | | 90849-HO | $27.69 | Multiple-family group psychotherapy. | | 90853-HO | $33.12 | Group psychotherapy (other than of a multiple-family group). (Group therapy. Limited to 12 clients per group. Billed per client. 90 minutes.) | | 90882 -HO | $71.80 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions. | | 90887-HO | $59.40 | Interpretation or explanation of results of psychiatric, or other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient (per % hour). |

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 329.06 Special Provisions

Preferred Provider Agreements

(1) A purchaser may apply for approval of a Preferred Provider Agreement under which the governmental unit will purchase specialized services at a reimbursement rate that reflects the particular requirements of the services to be provided.

(2) In order for EOHHS to approve the Agreement, the Agreement must

(a) Identify the clinical needs of the purchaser's clients;

(b) Establish specific criteria for evaluating provider qualifications to meet the clinical needs of the purchaser's clients;

(c) Specify the purchaser's role in managing the services provided to its clients, including but not limited to prior authorizations;

(d) Specify the provider's duties in complying with the administrative requirements established by the purchasing agency;

(e) Demonstrate that the rates to be paid are reasonable and reflect the additional services to be provided; and

(f) If the governmental unit is a state agency, the agency must demonstrate that the provisions of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services relative to the procurement and form of the Agreement have been satisfied.

(3) If the governmental unit has adopted formal procedures for contracting with providers under Preferred Provider Agreements, and the procedures satisfy the criteria set forth in 101 CMR 329.06(2), the governmental unit may request approval of its formal procedures rather than approval of the individual agreements. The governmental unit must supply to EOHHS the services for which Preferred Provider Agreements will be executed and the range of rates to be paid.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 329.07 Severability

The provisions of 101 CMR 329.00 are severable. If any provision of 101 CMR 329.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 329.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

Rates for Team Evaluation Services Rates for Team Evaluation Services

101 CMR, § 330.01 General Provisions

(1) Scope. 101 CMR 330.00 governs the rates of payment for team evaluation services purchased by a governmental unit.

(2) Applicable Dates of Service. Rates contained in 101 CMR 330.00 apply for dates of service provided on or after September 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 330.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 330.00. Governmental units that purchase the services described in 101 CMR 330.00 are responsible for the definition, authorization, and approval of services provided to clients.

(4) Exclusion. 101 CMR 330.00 does not govern rates of payment to hospitals, community health centers, and mental health centers for team evaluation services. Community health center rates are governed by 101 CMR 304.00: Rates for Community Health Centers . Mental health center rates are governed by 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health Centers and Mental Health Centers . Pursuant to M.G.L. c. 118E, § 13F, no acute hospital may charge governmental units at a rate higher than the rate payable by the MassHealth agency for these services.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 330.00

(6) Services and Rates Covered by Other Regulations. Rates of payment for the following services are not included within the scope of 101 CMR 330.00 and instead are governed by other regulations promulgated by EOHHS as described in 101 CMR 330.01(6).

| Service(s) | Regulation | | --- | --- | | Medical evaluations | 101 CMR 317.00: Rates for Medicine Services | | Physical therapy evaluations, and those for occupational therapy and speech pathology | 101 CMR 339.00: Rates for Restorative Services | | Audiological evaluations | 101 CMR 323.00: Rates for Hearing Services | | Radiological evaluations | 101 CMR 318.00: Rates for Radiology Services | | Visual evaluations | 101 CMR 315.00: Rates for Vision Care Services and Ophthalmic Materials | | Clinical laboratory testing | 101 CMR 320.00: Rates for Clinical Laboratory Services | | Psychological assessments/evaluations Comprehensive neuropsychological assessments are an exception. For this specific service, see the definition in 101 CMR 330.02 and the rate in 330.04(2). | 101 CMR 329.00: Rates for Psychological and Independent Clinical Social Work Services |

History

Adopted by Mass Register Issue 1364, eff. 5/4/2018.

101 CMR, § 330.02 Definitions

Assessment. A professionally sound, complete, and suitably individualized examination and assessment of a child's need for special education and treatment services described in 603 CMR 28.00: Special Education , in the context of the child's physical, developmental, social, and educational history and current circumstances. This assessment is rendered by an authorized professional as defined in 101 CMR 330.02 who is trained in the area of suspected need and generally includes a written assessment report as defined in 101 CMR 330.02. Types of assessments may include, but are not limited to, the following.

(a) Medical Assessment. A comprehensive health assessment by an authorized physician that identifies medical problems that may affect the child's education, such as physical constraints, chronic illness, neurological and sensory deficits, and developmental dysfunction. The medical assessment generally includes at least the following:

a medical history to include health of family, prenatal and birth history, developmental history, and history of significant medical conditions, including hospitalization, injuries, and accidents;

a complete physical examination to include blood pressure and nutritional assessment;
neurological and developmental assessments to include gross motor functioning, fine motor functioning, language, and visual and auditory functioning;

tests for visual acuity and hearing by audiometry;

the ordering and interpretation of diagnostic tests to include, if indicated, hematocrit or hemoglobin, sickle cell test (if appropriate), blood lead test, urinalysis (with culture for females), tuberculosis skin test, and other tests as indicated; and
a dental assessment and referral for a complete dental examination, if one has not been done within six months.
a written assessment report.

(b) Psychological Assessment/Evaluation. An assessment by an authorized psychologist or school psychologist including an individual psychological examination and culminating in specific recommendations. Sensory, motor, language, perceptual, attentional, cognitive, affective, attitudinal, self-image, interpersonal, behavioral, interest, and vocational factors are evaluated regarding the child's maturity, integrity, and dynamic interaction within the educational context. The assessment is based on the child's developmental and social history, diagnostic observation of the child in familiar surroundings (such as a classroom), and psychological testing as indicated. Psychological testing may include, but is not limited to, a vocational interest evaluation, educational achievement testing, intelligence testing, personality evaluation, and neuropsychological examination.

(c) Home Assessment. An assessment by an authorized social worker, nurse, or counselor of pertinent family history and home situation factors including, with prior written parental consent, a home visit. This assessment includes a description of pertinent family history and individual developmental history and estimates of adaptive behavior at home, in the neighborhood, and in local peer groups. Estimates of adaptive behavior are based to the greatest possible degree on information obtained by direct observation of the child or direct interview of the child in the neighborhood setting.

(d) Educational Assessment. An assessment of the student's educational progress and status in relation to the general education curriculum consistent with 603 CMR 28.04(2): Initial Evaluation and conducted by a certified educator(s).

(e) Other Assessment. An assessment, other than a medical, psychological, or home assessment, by an authorized professional in a medically related area that is related to a child's suspected need for special education and services described in 603 CMR 28.00: Special Education . Such assessments, when necessary, may include, but are not limited to, assessments by a medical specialist (for example, a neurologist, a psychiatrist, or an ophthalmologist), a physical therapist, an occupational therapist, a speech pathologist, or an audiologist.

Authorized Professional. An individual who, at a minimum, meets the qualifications for the particular assessment services to be performed as specified in 101 CMR 330.02: Authorized Professional (a) through (i), as well as those requirements adopted by a governmental unit purchasing assessments from eligible providers.

(a) Medical Assessment Services. These services must be performed by a pediatrician or other physician, other than an intern, resident, fellow, or house officer, who is licensed to practice by the Massachusetts Board of Registration in Medicine.

(b) Radiology Services. These services must be performed by a licensed physician or licensed osteopath other than an intern, resident, fellow, or house officer.

a psychologist who is licensed to practice by the Massachusetts Board of Registration of Psychologists; or
a school psychologist who is certified by the Massachusetts Department of Elementary and Secondary Education.

(d) Home Assessment Services. These services must be performed by

a social worker who has a master's degree in social work and who is licensed by the Massachusetts Board of Registration of Social Workers as

a. a certified social worker; or

b. an independent clinical social worker;

a nurse who is registered by the Massachusetts Board of Registration in Nursing; or
a counselor who has a master's degree in counseling education, counseling psychology, or rehabilitation counseling.

(e) Medical Specialist Services. These services must be performed by a physician, other than an intern, resident, fellow, or house officer, who is licensed to practice by the Massachusetts Board of Registration in Medicine.

(f) Restorative Services. These services must be performed by

a physical therapist who is currently licensed by the Board of Registration in Allied Health Professions;
an occupational therapist who is currently licensed by the Board of Registration in Allied Health Professions; or
a speech pathologist who is currently licensed by the Board of Registration for Speech-language Pathology and Audiology.

(g) Rehabilitation Clinic Services. These services must be performed by

a physical therapist who is currently licensed by the Board of Registration in Allied Health Professions;
an occupational therapist who is licensed by the Board of Registration in Allied Health Professions;
a speech pathologist who is currently licensed by the Board of Registration for Speech-language Pathology and Audiology; or
a physician who is licensed to practice by the Massachusetts Board of Registration in Medicine.

(h) Audiological Services. These services must be performed by an audiologist who is currently licensed by the Board of Registration for Speech-language Pathology and Audiology.

(i) Educational Assessment Services. These services must be performed by a teacher holding certification by the Massachusetts Department of Elementary and Secondary Education, or a licensed psychologist.

Comprehensive Neuropsychological Assessment.

(a) A comprehensive neurological assessment generally includes, but is not limited to

record review;
patient interview: presenting problems and history (medical, psychological, educational, vocational);
collateral interview(s), for example of a teacher or parent(s) of the child, as indicated;
testing of neuropsychological functions (attention, executive and other frontally based functions, language, visuoperceptual and visuoconstructional functions, memory, sensory functions, motor functions, some emotional and personality functions, and other functions as indicated); scoring and analysis; and interpretation of data;
educational assessment, as indicated;
integration of test results with information from interview(s) and records;
formulations of conclusions, diagnosis(es), and recommendations;
report preparation; and
a follow-up meeting to review findings.

(b) If a provider performs a comprehensive neuropsychological assessment, then the provider may not also bill for a neurobehavioral interview or a partial neuropsychological assessment. The allowed range of hours for this assessment is nine through 24 hours.

Comprehensive Pediatric (21 Years of Age and Younger) Restorative Evaluation. An all-inclusive, in-depth assessment of a child's medical condition and level of functioning and limitations by a physical, occupational, or speech pathologist, to determine the need for treatment and, if necessary, to develop a plan of treatment. This evaluation includes a written report.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth. Governmental Units include public school departments.

Individual Consideration (I.C.). Those rates for authorized services that are determined by a governmental unit based upon the nature, extent, and need for the service and the degree of skill and time required for its provision. Providers must maintain adequate records to determine the appropriateness of their I.C. claims and must provide these documents to the purchasing agency upon demand.

Physician's Comprehensive Rehabilitation Evaluation. A cardiopulmonary, neuromuscular, orthopedic, functional assessment performed at a rehabilitation clinic by a physician.

Psychological Testing. The use of standardized test instruments and procedures by an eligible provider in order to evaluate aspects of an individual's functioning including, but not limited to, aptitudes, educational achievements, cognitive processes, emotional conflicts, and type and degree of psychopathology. These tests must be published, valid, and in general use as defined by listing in the Mental Measurements Yearbook or by conforming to the Standards for Educational and Psychological Tests of the American Psychological Association.

Publicly Aided Individual. A person for whose mental and physical health evaluation, as defined by 603 CMR 28.00: Special Education , governmental units of the Commonwealth are in whole or in part liable under a statutory public program.

Team Evaluation. An evaluation by a multidisciplinary team that consists of assessments in all areas related to the child's suspected need for special education and services described in 603 CMR 28.00: Special Education . Such assessments may include, but are not limited to, a medical assessment and associated diagnostic medical laboratory and radiological testing, a psychological assessment, a home assessment, and such other assessments as may be required in a child's diagnosis. (For the purposes of 101 CMR 330.00, Team Evaluation excludes the educational assessment by the school department and the classroom assessment by a teacher defined in 603 CMR 28.00. Rates of payment for these assessments are not the subject of 101 CMR 330.00.) Independent evaluation services are included under the authority of 101 CMR 330.00.

Team Evaluation Services. The individual services comprising team evaluation assessments. This includes services performed in independent team evaluation assessments.

Therapist Evaluation. Evaluation performed by a physical therapist, an occupational therapist, or a speech pathologist at a rehabilitation clinic.

Written Assessment Report. A report summarizing in writing the procedures employed in an assessment, the results, and the diagnostic impression. This report defines in detail and in educationally relevant and common terms, the child's needs and offers explicit means of meeting those needs.

603 CMR 28.00: Special Education. Regulations for the implementation of M.G.L. c. 71B.

History

Adopted by Mass Register Issue 1364, eff. 5/4/2018.

101 CMR, § 330.03 General Rate Provisions

(1) Approved Rates. The rates of payment for team evaluation services described in 101 CMR 330.00 are the lower of

(a) the eligible provider's usual charge to the general public for the same or similar services; or

(b) the rates of payment listed in 101 CMR 330.04.

(2) Reimbursement as Full Payment. The rates of payment contained in 101 CMR 330.00 constitute full compensation for services rendered to publicly aided individuals as well as for administrative or supervisory duties associated with those services. Any third-party payments or sliding fees received on behalf of a publicly assisted client reduces, by that amount, the amount of the purchasing unit's obligation for services rendered.

(3) Written Assessment Report. The provision of a written report in connection with a team evaluation assessment is considered an administrative duty associated with patient services for which, in accordance with 101 CMR 330.03(2), no additional payment will be received.

History

Adopted by Mass Register Issue 1364, eff. 5/4/2018.

101 CMR, § 330.04 Rates of Payment

(1) The team evaluation services listed in 101 CMR 330.01(6) are reimbursed on a fee-for-service basis. The rates of payment for those services are found in the corresponding regulations listed in 101 CMR 330.01(6).

(2) For the team evaluation services listed in 101 CMR 330.04(2), no other EOHHS regulation contains rates of payment for that service. The rates of payment for these services are as stated below in 101 CMR 330.04(2).

| Service/Description | Rate of Payment | | --- | --- | | Home assessment, including a written assessment, not to exceed 2.5 hours | $127.76 | | Participation in team meeting by psychologist (if requested by an administrator of special education, or the parent) | $98.03/hour | | Participation in team meeting by authorized social worker, nurse, or counselor | $51.10/hour | | Educational assessment by certified educational personnel, or a licensed psychologist, including a written assessment report, not to exceed 7.5 hours | $106.76/hour | | Diagnostic observation: Observation by an authorized psychologist or school psychologist of a child in a familiar setting such as the home, workplace, the classroom or proposed classroom, or other community settings to examine and determine the child's physical, psychological, social, economic, educational, and vocational assets and disabilities for purposes of developing a diagnostic formulation and designing a treatment plan | $98.03/hour | | Comprehensive neuropsychological assessment. The allowed range of hours is nine through 24 hours. | $115.67/hour |

History

Adopted by Mass Register Issue 1364, eff. 5/4/2018.

101 CMR, § 330.05 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the executive director or chief financial officer of the provider.

(b) Examination of Records. Each provider must make available to EOHHS or purchasing governmental unit upon request all records relating to its reported costs, including costs of any entity related by common ownership or control.

(2) Required Reports. Each provider must file

(a) an annual Uniform Financial Statements and Independent Auditor's Report completed in accordance with the filing requirements of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services ;

(b) any cost report supplemental schedule as issued by EOHHS; and

(3) Penalty for Noncompliance. The purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 330.05(3).

History

Adopted by Mass Register Issue 1364, eff. 5/4/2018.

101 CMR, § 330.06 Severability

The provisions of 101 CMR 330.00 are severable. If any provision of 101 CMR 330.00 or application of any provision to an applicable individual, entity, or circumstances is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 330.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1399, eff. 9/6/2019.

Prescribed Drugs Prescribed Drugs

101 CMR, § 331.01 General Provisions

(1) Scope, Purpose and Effective Date. 101 CMR 331.00 governs the payment rates effective April 1, 2017 for drugs dispensed by providers to publicly-aided individuals and industrial accident patients.

(2) Coverage. The rates of payment under 101 CMR 331.00 are full compensation for professional services rendered, as well as for any related administrative or supervisory duties.

(3) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and meaning of substantive provisions of 101 CMR 331.00, to publish procedure code updates and corrections and as otherwise specified in 101 CMR 331.00.

(4) Disclaimer for Authorization of Services. 101 CMR 331.00 is not authorization for, or approval of, the services for which rates are established by 101 CMR 331.00. Purchasers are responsible for the definition, authorization, and approval of care and services provided to publicly-aided individuals and industrial accident patients.

History

Adopted by Mass Register Issue 1319, eff. 8/12/2016.

101 CMR, § 331.02 General Definitions

340B Actual Acquisition Cost (340B AAC). The amount a 340B covered entity pays for a drug purchased through the 340B Drug Pricing Program, net of discounts, rebates, chargebacks, and other adjustments to the price of the drug.

340B Ceiling Price. The maximum amount that a manufacturer can charge a 340B covered entity for a drug purchased through the 340B Drug Pricing Program pursuant to Section 340B of Public Health Law 102-585, the Veterans Health Act of 1992.

340B Covered Entities. Facilities and programs eligible to purchase discounted drugs through a program established by Section 340B of Public Health Law 102-585, the Veterans Health Act of 1992.

340B Drug Pricing Program. A program established by Section 340B of Public Health Law 102-585, the Veterans Health Act of 1992.

Actual Acquisition Cost (AAC). The lowest price for the drug available from one or more surveys of pharmacy costs designated by EOHHS via administrative bulletin or other written issuance, or if EOHHS has not so designated one or more surveys, the drug's National Average Drug Acquisition Cost (NADAC). For a given drug, if no price is available from a survey of pharmacy costs designated by EOHHS via administrative bulletin or other written issuance, or, if EOHHS has not so designated one or more surveys and no NADAC is available for the drug, the drug's AAC is the drug's wholesale acquisition cost (WAC).

Brand Name Preferred. A multiple source drug that is designated pursuant to 130 CMR 406.413(A)(3).

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Compounded Drug. Any drug, excluding cough preparations, in which two or more ingredients are extemporaneously mixed by a registered pharmacist.

Dispensing Fee. The fee paid, over and above the ingredient cost of the drug, to providers by governmental units and purchasers under M.G.L. c. 152 for dispensing drugs to publicly aided individuals and/or industrial accident patients.

Drug. A substance containing one or more active ingredients in a specified dosage form and strength and authorized by the purchasing governmental unit or purchaser under M.G.L. c. 152. Each dosage form and strength is a separate drug.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Federal Upper Limit. The Federal Upper Limit as established by the Centers for Medicare and Medicaid Services (CMS) by regulation or otherwise.

Fiscal Year. The annual accounting period adopted by a provider.

Governmental Unit. The Commonwealth, any department, agency, board or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Industrial Accident Patient. A person who receives medical services for which persons, corporations or other entities are in whole or part liable under M.G.L. c. 152.

Massachusetts Maximum Allowable Cost (MMAC). For multiple source drugs not designated as Brand Name Preferred and not certified as medically necessary ( i.e ., drugs for which the prescriber has not designated "no substitution" and "brand name medically necessary" on the prescription form), an amount equal to 100% of the lowest price for a therapeutic equivalent of the drug available from one or more surveys of pharmacy costs designated by EOHHS via administrative bulletin or other written issuance, or if EOHHS has not so designated one or more surveys, the lowest National Average Drug Acquisition Cost (NADAC) for a therapeutic equivalent of the drug, for the most frequently purchased package size.

For multiple source drugs designated as Brand Name Preferred, the MMAC is an amount equal to the drug's AAC.

Most Frequently Purchased Package Size. The package size of a drug most frequently purchased by providers based on utilization data compiled by the MassHealth agency. Thus, that NDC number which is most often paid by the MassHealth agency, and verified by audit, if necessary, will be considered the most frequently purchased package size.

Multiple Source Drug. A drug marketed or sold by two or more manufacturers or labelers or a drug marketed or sold by the same manufacturer or labeler under two or more different names.

National Average Drug Acquisition Cost (NADAC). The National Average Drug Acquisition Cost as published by CMS.

National Drug Code (NDC) Number. A unique number issued by the United States Food and Drug Administration to identify drug products. The NDC number has three components: the first component identifies the drug manufacturer (Labeler No.); the second component identifies the product (Product No.); and the third component identifies the package size (Pkg.).

Over-the-counter Drug. Any drug for which no prescription is required by federal or state law. These drugs are sometimes referred to as non-legend drugs. The MassHealth agency requires a prescription for both prescription drugs and over-the-counter drugs ( see 130 CMR 406.411(A): Legal Prescription Requirements ).

Prescription Drug. Any drug for which a prescription is required by applicable federal and/or state laws or regulations other than MassHealth regulations. These drugs are sometimes referred to as legend drugs.

Provider. A pharmacy that is licensed by the Board of Registration in Pharmacy in accordance with the provisions of M.G.L. c. 112 or by the Department of Public Health in accordance with the provisions 105 CMR 700.004: Registration Requirements , and which also meets the current conditions of participation of the purchasing governmental unit, purchaser under M.G.L. c. 152, or the 340B Program, as applicable and out of state pharmacies described in 130 CMR 406.404(C): Out-of-state Providers .

Publicly-aided Individual. A person for whose medical or other services a governmental unit is in whole or in part liable under a statutory public program.

Purchaser under M.G.L. c. 152. An insurance company, self insurer, or worker's compensation agent of a department of the Commonwealth, county, city or district which purchases medical services subject to M.G.L. c. 152, § 1.

Single Source Drug. A drug marketed or sold by only one manufacturer or labeler under one proprietary name.

Usual and Customary Charge. The lowest price that a provider charges or accepts from any payer for the same quantity of a drug on the same date of service, in Massachusetts, including but not limited to the shelf price, sale price, or advertised price for any drug including an over-the-counter drug. If an insurer and the provider have a contract that specifies that the insurer will pay an average or similarly computed fixed amount for multiple therapeutic categories of drugs with different acquisition costs, the fixed amount will not be the provider's usual and customary charge.

Wholesale Acquisition Cost (WAC). A manufacturer's price published in a national price compendium or other publicly available source or an adjusted list price.

History

Adopted by Mass Register Issue 1319, eff. 8/12/2016.

101 CMR, § 331.03 Reporting Requirements

(1) Required Reports. Required reports include, but are not limited to, reports required by the Center's regulation 957 CMR 6.00: Cost Reporting Requirements , and any additional reports requested by EOHHS to facilitate compliance with the requirements of 42 CFR Part 447.

(2) Penalty for Noncompliance. A purchasing governmental unit may reduce the payment rates of any provider that fails to timely file required information with the Center or EOHHS, as applicable, by 5% during the first month of noncompliance, and by an additional 5% during each month of noncompliance thereafter ( i.e ., 5% reduction during the first month of noncompliance, 10% reduction during the second month of noncompliance, and so on). The purchasing governmental unit must notify the provider in advance of its intention to impose a penalty for noncompliance.

History

Adopted by Mass Register Issue 1319, eff. 8/12/2016.

101 CMR, § 331.04 Payment for Prescription Drugs

(1) Payment for Multiple Source Drugs. Payment for multiple source drugs not designated as Brand Name Preferred and not certified as medically necessary ( i.e ., drugs for which the prescriber has not designated "no substitution" and "brand name medically necessary" on the prescription form), other than blood clotting factor and drugs obtained through the 340B Drug Pricing Program, must not exceed the lowest of

(a) the Federal Upper Limit of the drug, if any, plus the appropriate dispensing fee as listed in 101 CMR 331.06; or

(b) the Massachusetts Maximum Allowable Cost of the drug, if any, plus the appropriate dispensing fee as listed in 101 CMR 331.06; or

(d) the usual and customary charge.

(2) Payment for Blood Clotting Factor. Payment for blood clotting factor not obtained through the 340B Drug Pricing Program must not exceed the lowest of

(a) the Federal Upper Limit of the drug, if any, plus the appropriate dispensing fee as listed in 101 CMR 331.06; or

(b) the AAC of the drug, plus the appropriate dispensing fee as listed in 101 CMR 331.06; or

(d) the usual and customary charge.

(3) Payment for All Other Drugs. Payment for all other drugs not priced in accordance with 101 CMR 331.04(1) or (2), and not obtained through the 340B Drug Pricing Program, including single source drugs, multiple source drugs designated as Brand Name Preferred, and brand name drugs which have been certified as medically necessary ( i.e ., drugs for which the prescriber has designated "no substitution" and "brand name medically necessary" on the prescription form), must not exceed the lowest of

(a) The Massachusetts Maximum Allowable Cost of the drug, if any, plus the appropriate dispensing fee as listed in 101 CMR 331.06; or

(b) The AAC of the drug, plus the appropriate dispensing fee as listed in 101 CMR 331.06; or

(4) Rate Limitation.

(a) Payments for multiple source drugs for which CMS has established Federal Upper Limits, and that have not been certified as medically necessary ( i.e ., drugs for which the prescriber has not designated "no substitution" and "brand name medically necessary" on the prescription form), must not exceed, in the aggregate and prior to the application of an federal or state drug rebates, the aggregate upper limit based on those Federal Upper Limits, regardless of whether payment amounts for individual drugs are determined pursuant to 101 CMR 331.04(1) or (3).

(b) Payments for multiple source drugs that have been certified as medically necessary ( i.e ., drugs for which the prescriber has designated "no substitution" and "brand name medically necessary" on the prescription form), must not exceed, in the aggregate and prior to the application of federal or state drug rebates, the lower of AAC plus the appropriate dispensing fee as listed in 101 CMR 331.06 and the usual and customary charge.

History

Adopted by Mass Register Issue 1319, eff. 8/12/2016.

101 CMR, § 331.05 Payment for Over-the-counter Drugs

Payment to providers for an over-the-counter drug dispensed is the lowest of

(1) the Massachusetts Maximum Allowable Cost of the drug, if any, plus the appropriate dispensing fee as listed in 101 CMR 331.06; or

(2) the AAC of the drug, plus the appropriate dispensing fee as listed in 101 CMR 331.06; or

(3) the usual and customary charge.

History

Adopted by Mass Register Issue 1319, eff. 8/12/2016.

101 CMR, § 331.06 Dispensing Fees

(1) Drugs. Except for compounded drugs and blood clotting factor obtained through the 340B Drug Pricing Program, the dispensing fee is $10.02 per prescription.

(2) Compounded Drugs. For compounded drugs, the dispensing fee is $10.02 plus

(a) an additional $7.50 for compounded drugs whose dispensing involves the mixing two or more commercially prepared products, compounding requiring the mixing two or more commercially prepared products; or

(b) an additional $10.00 for compounded drugs whose dispensing involves compounding lotions, shampoos, suspensions, or the mixing of powders or liquids into cream, ointment, or gel base; or

(c) an additional $15.00 for compounded drugs whose dispensing involves compounding capsules, troches, suppositories, or pre-filled syringes; or

(d) an additional $30.00 for compounded drugs needing a sterile environment when mixing.

History

Adopted by Mass Register Issue 1319, eff. 8/12/2016.

101 CMR, § 331.07 Special Provisions

(1) Payment for Drugs Obtained Through the 340b Drug Pricing Program.

(a) The payment for drugs other than blood clotting factor obtained through the 340B Drug Pricing Program and dispensed by 340B covered entities is the 340B AAC of the drug plus the appropriate dispensing fee as listed in 101 CMR 331.06.

(b) The payment for blood clotting factor obtained through the 340B Drug Pricing Program and dispensed by 340B covered entities is the 340B ceiling price of the drug, plus 2.75¢ per unit (IU/RCo/Fu/mcg) or such other amount as EOHHS may specify via administrative bulletin upon guidance or approval by CMS.

(2) Payment for Innovative Programs. Governmental units may elect to purchase drugs pursuant to a written agreement between a provider and the purchasing agency. Such agreement must relate to an innovative program sponsored by the purchasing agency, and is subject to the approval of EOHHS authorizing special payment rates for drugs dispensed pursuant to such agreement.

History

Adopted by Mass Register Issue 1319, eff. 8/12/2016.

101 CMR, § 331.08 Severability

The provisions of 101 CMR 331.00 are severable, and if any provision of 101 CMR 331.00 or application of such provisions to any provider or any circumstances shall be held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 331.00 or application of such provisions to any providers or circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1319, eff. 8/12/2016.

Rates for Prostheses, Prosthetic Devices, and Orthotic Devices Rates for Prostheses, Prosthetic Devices, and Orthotic Devices

101 CMR, § 334.01 General Provisions

(1) Scope and Purpose. 101 CMR 334.00 governs the payment rates to be used by all governmental units for prostheses, prosthetic devices, and orthotic devices provided to publicly aided individuals. The rates set forth in 101 CMR 334.00 do not apply to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act). Rates for services provided to these individuals are set forth in 114.3 CMR 40.03(2): Services and Rates Covered by Other Regulations .

(2) Applicable Dates of Service. Rates contained in 101 CMR 334.00 apply for dates of service provided on or after April 1, 2024, unless otherwise specified.

(3) Coverage. 101 CMR 334.00 and the payment rates established under 101 CMR 334.00 apply to the direct purchase and repair of prescribed custom-made prostheses and prosthetic devices manufactured and supplied by providers, including the cost of customized fitting and client service. 101 CMR 334.00 also applies to the purchase and repair of orthotic devices. These rates are full payment for prostheses, prosthetic devices, and orthotic devices provided by sale, as well as full payment for any related supervisory or administrative duties, fittings and adjustments rendered in connection with the provision of prostheses, prosthetic devices, and orthotic devices.

(4) Disclaimer of Authorization of Services. 101 CMR 334.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 334.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care to publicly aided individuals.

(5) Coding Updates and Corrections. The Executive Office of Health and Human Services (EOHHS) may publish procedure code updates and corrections in the form of an Administrative Bulletin. The publication of such updates and corrections will list:

(a) codes for which the code numbers only changed, with the corresponding crosswalk;

(b) codes for which the codes remain the same, but the descriptions have changed;

(d) entirely new codes.

For new codes without Medicare fees as of the date of the Administrative Bulletin EOHHS will apply individual consideration in establishing payment for such codes. Rates established by administrative bulletin will remain in effect until such time EOHHS adopts a revised regulation or superseding administrative bulletin.

History

Amended by Mass Register Issue 1381, eff. 12/28/2018.

101 CMR, § 334.02 General Definitions

Meaning of Terms. Terms used in 101 CMR 334.00 have the meanings set forth in 101 CMR 334.02.

ABC. American Board for Certification in Orthotics and Prosthetics.

Additions to. If a code is listed as "Additions to", the code is added to the base procedure code if additional and more complicated services are provided. The value assigned to the "Additions to" codes does not represent the actual value of the component but only the difference in value between the base procedure code and the additional component.

Adjusted Acquisition Cost (A.A.C.). The price paid to a supplier by a provider for prostheses, prosthetic devices and orthotic devices after adjusting for quantity discounts and excluding all associated costs such as, but not limited to, shipping, handling, and insurance costs, etc . A.A.C. does not exceed the price to the Provider as listed or determined in the manufacturer's current catalogue and must be evidenced by a current invoice. Where the manufacturer is the Provider, the A.A.C. cannot exceed the actual cost of raw materials. Low cost items (those with an A.A.C. less than $5.00) may be grouped together and billed at $5.00, plus the mark-up listed in 101 CMR 334.02: Individual Consideration.

Above Elbow (AE) Trans-humeral. Relating to prostheses or levels of amputation across the long axis of the humerus.

AFO. Ankle foot orthosis.

Above Knee (AK) Trans-femoral. Relating to prostheses or levels of amputation across the long axis of the femur.

Adjusted Acquisition Cost (AAC). The price paid to a supplier by a provider for prostheses, prosthetic devices and orthotic devices after adjusting for manufacturer, dealer, trade, and volume discounts and excluding all associated costs such as, but not limited to, shipping, handling, and insurance costs. The AAC may not exceed the price to the provider as listed or determined in the manufacturer's current catalogue and must be evidenced by a current invoice. The standard markup applied to the AAC corresponds to the complexity of the item and are set forth in 101 CMR 334.02.

Ankle Foot Orthosis (AFO). An orthosis beginning at the toes, crossing the ankle, and terminating on the calf. Devised to control, limit, or assist foot and ankle motion and provide leg support.

American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC). An accrediting organization for orthotic, prosthetic, and pedorthic services.

Base Code. A code that describes the essential or fundamental design of a device.

Below Elbow (BE) Trans-radial. Relating to prostheses or levels of amputation across the long axis of the radius/ulna.

Below Knee (BK) Trans-tibial. Relating to prostheses or levels of amputation across the long axis of the tibia/fibula.

Bilateral. Of, or pertaining to, both sides of the body.

BK (Below Knee) Trans-tibial. Relating to prostheses or levels of amputation across the long axis of the tibia/fibula.

BOC. Board for Orthotics/Prosthetic Certification.

BCP. Board for Certification in Pedorthics.

Board of Certification/Accreditation (BOC). An accrediting organization for prosthetic and orthotic services.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Cervical Orthosis (CO). Orthosis that traverses the cervical vertebrae.

Cervical-thoracic Orthosis (CTO). Orthosis that traverses the listed areas.

Cervical-thoracic-lumbar-sacral Orthosis (CTLSO). Orthosis that traverses the listed areas.

Cross-walk. A cross-reference in which a code is deleted and replaced with another code or series of codes.

Custom Fabricated Device. A device or product made for a specific patient from his/her individual measurements and/or pattern.

Custom Fitted/Prefabricated. A prefabricated device or product that has been manufactured from standard molds or patterns and that requires modification for fitting by a certified orthotist or an individual who has equivalent specialized training.

Definitive Prosthesis. A prosthesis intended for long-term use containing components suitable for the full range of functional activities the amputee may be able to perform.

Direct Formed. Material is molded over the involved portion of the patient's body and ultimately used as an essential part of the device.

Dynamic Response. A prosthetic foot with a spring keel which deflects under load and returns to neutral.

Early Fitting. A prosthetic device provided during the initial wound healing phase following amputation.

Elastic Keel Foot. See Flexible Keel Foot.

Elastic Type Material Being. Of, or with properties similar to, elastic.

Elbow Orthosis (EO). Orthosis that traverses the elbow.

Endoskeletal. A prosthesis composed of an internal pylon system which provides structural integrity to the device.

Energy Storing Foot. A prosthetic foot designed to collect a substantial amount of strain energy and return it to the gait cycle via deflection on the foot.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Exoskeletal. A prosthesis composed of a rigid external shell that provides structural integrity to the device.

Fabrication and Fitting. Time spent in examining the patient; making necessary patterns and measurements; and performing fittings, including static and dynamic alignments and fitting refinements.

Finger Orthosis or Foot Orthosis (FO). Orthosis that traverses the finger or the foot. While this abbreviation represents two types of orthoses, these two types of orthoses are so different that the context will clearly indicate which is meant.

Flexible. Referring to devices which are bendable in nature and occasionally reinforced with stays of metal or other semi-rigid materials.

Flexible Keel Foot. A prosthetic foot with a compliant, elastomeric keel which absorbs forces during rollover.

Governmental Unit. The Commonwealth, any department, agency, board or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Hand-finger Orthosis (HFO). Orthosis that traverses the listed areas.

Hand Orthosis (HO). Orthosis that encompasses the whole or any part of the hand.

Heavy Duty. Being of stronger nature than standard.

Hemi Pelvectomy - Trans-pelvic. Relating to an amputation which is performed through a portion of the pelvis or a prosthesis for this type of amputation.

Hip Disarticulation (HD). An amputation through the hip joint or to describe a prosthesis for this level of amputation.

Hip-knee-ankle-foot Orthosis (HKAFO). Orthosis that traverses the listed areas.

Immediate Fitting. Beginning prosthetic management immediately following surgical closure of the wound.

Individual Consideration (I.C.). Services or devices designated I.C. are items individually considered by the purchasing governmental unit based on the provider's report of services. The purchasing governmental unit analyzes the provider's report of services submitted before making a determination. Providers must keep adequate records to substantiate their I.C. claims and must provide these documents including a copy of current invoice to the purchasing agency upon demand. See 101 CMR 334.02 for the definition of Standard Markup and 101 CMR 334.03(8): AAC Methodology and Documentation .

(a) the provider's usual and customary charge;

(b) the A.A.C. to the provider, plus a markup not to exceed:

70% for any item described as being custom fabricated;
50% for any item described as being prefabricated; or
40% for any item described as being off-the-shelf.

Initial. Direct formed prosthetic devices provided as early as patient management.

Interface Material. Flexible lining material integral to the device.

Knee-ankle-foot Orthosis (KAFO). Orthosis that traverses the listed areas.

Knee Disarticulation (KD). Relating to an amputation that is performed through the knee joint or a prosthesis for his type of amputation.

Knee Orthosis (KO). Orthosis that traverses the knee.

Lumbar-sacral Orthosis (LSO). Orthosis that traverses the listed areas.

Molded Socket. In orthotics, this term refers to an impression that was taken and modified, and that a socket of thermoplastic or other material was made over the model. In prosthetics, this term refers to a generally accepted fitting procedure, such as PTB or quadrilateral socket, was molded over a modified patient model.

Molded to Patient. See Direct Formed.

Molded to Patient Model. Custom manufactured item individually fabricated over a positive model of the patient, based on a three-dimensional negative impression or digital scanning.

Multiaxial. Having two or more axes of rotation.

Multi-density. Composed of two or more materials of varying shore hardness.

Multi-durometer. Composed of two or more materials, with sectional areas of differing shore hardness.

Non-removable. Attached to shoe when the device is permanently affixed and therefore a part of the shoe.

Off-the-shelf. A prefabricated device or product that requires minimal self-adjustment as defined at 42 CFR 414.402 for appropriate use, i.e. , does not require the services of a certified orthotist or an individual who has specialized training to adjust the device.

Orthosis. Externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal systems.

Passive. A device that cannot be actively moved.

Polycentric. Having many centers of rotation in a single plane.

Prefabricated. A device that has been manufactured from standard molds or patterns.

Premolded. See Prefabricated.

Preparatory. A prosthetic device applied to prepare the limb for eventual fitting and to evaluate the appropriateness of selected technology and the patient's ability to use a definitive prosthesis.

Production. See Prefabricated.

Prosthesis. Externally applied device used to replace wholly, or in part, an absent or deficient body segment.

Provider. Any person, partnership, corporation, or other entity that is authorized by the Commonwealth of Massachusetts to engage in the business of providing prosthetic, orthotic, or pedorthic services and related supplies. An eligible provider of prosthetic, orthotic, or pedorthic services and related supplies must be ABC-certified or BOC-certified and must meet the conditions of participation adopted by the purchasing governmental unit.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

Recall. An action taken by the manufacturer to retrieve, replace, or repair dangerous ordefective orthotic or prosthetic devices whether or not such action is taken at the direction of the Food and Drug Administration (FDA).

Retail Price. The total price charged for a product sold to a customer, which includes the manufacturer's cost plus a retail markup.

Rigid. Not bending; inflexible.

Sale Price. The price at which something sells or is sold after its retail price has been reduced.

Semi-rigid. Partially rigid; having some rigid elements.

Shelf Price. The sign or tag placed by an authorized person at each point of display that clearly sets forth the retail price of the item.

Shoulder-elbow-wrist-hand Orthosis (SEWHO). Orthosis that traverses the listed areas.

Shoulder Orthosis (SO). Orthosis that traverses the shoulder.

Single Axis. Having only one axis of rotation.

Standard Markup. Except where otherwise indicated in an applicable section of101 CMR 334.03, the standard markup for the purchase of prostheses, prosthetic devices, and orthotic devices that is applied to the AAC, net of any discounts as specified in the definition of AAC at 101 CMR 334.02, to a supplier by an eligible provider cannot exceed:

(a) 70% for any item described as being custom fabricated; or

(b) 50% for any item described as being prefabricated; or

Thermoplastic. Able to be remolded with the application of heat.

Thoracic-lumbar-sacral Orthosis (TLSO). An orthosis that traverses the listed areas.

Thoracic Orthosis (TO). An orthosis that traverses the thoracic vertebrae.

Ultra-light Material. Materials such as titanium, carbon fiber, or equal.

Unilateral. Being of, or pertaining to, one side of the body.

Usual and Customary Charge. The lowest price that an eligible provider charges to any payer in Massachusetts other than for publicly aided individuals for the same equipment or item, including but not limited to the shelf price, sale price, or advertised price.

Wrist-hand Orthosis (WHO). Orthosis that traverses the wrist and hand. Sometimes referred to as wrist orthosis (WO).

History

Amended by Mass Register Issue 1381, eff. 12/28/2018.

101 CMR, § 334.03 General Rate Provisions

(1) General Rate Provisions for the Purchase of Prostheses, Prosthetic Devices, and Orthotic Devices. Payment to provider of prosthetic or orthotic devices or services are the lower of:

(a) the provider's usual and customary charge; or

(b) the rates set forth in 101 CMR 334.03(10) or any applicable administrative bulletin.

(2) Rates for New Codes. New codes that have established Medicare fees as of the date of the Administrative Bulletin will have rates established at:

(a) 94.00% of the corresponding Medicare fee for any item described as being custom fabricated; or

(b) 82.00% of the corresponding Medicare fee for any item described as being prefabricated; or

(d) When Medicare fees are not available for new codes, and for certain orthotics and prosthetics, rates will be established at individual consideration at adjusted acquisition cost plus the standard markup as defined in 101 CMR 334.03(9).

(3) Effect of Rates. The rates of payment contained in 101 CMR 334.00 are maximum allowable rates that a governmental unit or purchaser under M.G.L. c. 152 may pay for prostheses, prosthetic devices, or orthotic devices. A governmental unit may pay less than the rates established for a provider under 101 CMR 334.00 provided that any such discount or reduction in charge by the provider is equally available to all governmental units purchasing prostheses, prosthetic devices and orthotic devices from the provider. No rate of payment under 101 CMR 334.00 may exceed the provider's usual and customary charge for the same or similar device.

(4) Terms and Warranties. All terms and warranties, expressed and implied, that are customarily extended by the provider or manufacturer must apply to purchases made under 130 CMR 334.00. A purchaser will not pay for replacement or repair of any item or service covered by such terms or warranties.

(5) Repairs. For repair services providers must maintain and submit adequate documentation on the repair performed as indicated by the purchasing governmental unit. Repair may be billed using codes for the labor component (L7520 for prosthetics or L4205 for orthotic devices) and the parts used in the repair (L7510 for prosthetics or L4210 for orthotic devices).

(6) Modifiers. The following list of letter modifiers must be added, where appropriate, to Healthcare Common Procedure Coding System (HCPCS) procedure codes to determine the percent fee to be paid on claims. Refer to purchasers' manuals for specific coding instructions.

(a) Informational modifiers:

LT - Left
RT - Right
CG - Policy Criteria Applied

(b) Additional modifiers used for MassHealth reimbursement when using the following miscellaneous codes, L0999, L1499, L2999, L3999, L5999, L7499, and L8499:

U1 - AAC 40% Off the Shelf (used for not otherwise classified (NOC) codes only -identified in 334.03(10)
U2 - AAC 50% Prefabricated (used for NOC codes only - identified in 101 CMR 334.03(10)
U3 - AAC 70% Custom (used for NOC codes only - identified in 101 CMR 334.03(10)

(7) Recall Provisions. Whenever an orthotic or prosthetic is subject to recall, the provider will fully address the recall as specified in the manufacturer's recall instructions. For recalls of potentially dangerous or defective orthotic or prosthetic that predictably could cause serious health problems, including death, the provider must provide the publicly aided individual with a copy of the recall notice and fully address the recall as specified in the recall instructions no later than five business days from the date the provider receives the recall notice. Any costs not covered by the manufacturer or other third party for activity associated with amelioration, repair or replacement of recalled equipment is included in the general rate provision.

(8) AAC Methodology and Documentation.

(a) Except where otherwise stipulated in 101 CMR 334.03, payment to an eligible provider is for the AAC as defined in 101 CMR 334.02, plus a standard markup.

(b) The eligible provider must accurately indicate the amount of any discounts set forth in the definition of AAC at 101 CMR 334.02. The provider must maintain documentation evidencing the amount and application of discounts.

(c) Current Catalogue Price. The AAC to the eligible provider will not exceed the manufacturer's current catalogue price.

(d) Where the manufacturer is the provider, the AAC cannot exceed the actual cost of raw materials. Low-cost items (those with an AAC less than $5.00) may be grouped together and billed at $5.00 plus the mark up listed in 101 CMR 334.03(9): Individual Consideration .

(9) Individual Consideration. Except where otherwise stipulated in 101 CMR 334.03, payment to an eligible provider for individual consideration will be the lower of:

(a) the eligible provider's usual and customary charge; or

(b) the AAC to the provider, plus a markup not to exceed:

70% for any item described as being custom fabricated; or
50% for any item described as being prefabricated; or
40% for any item described as being off-the-shelf; or

(10) Payment Rates. For code descriptions, see the O&P service code spreadsheet at www.mass.gov/regulations/101-CMR-33400-prostheses-prosthetic-devices-and-orthotic-devices

| Code | Rate | Description ( see the O&P service code spreadsheet at www.mass.gov/regulations/101-CMR-33400-prosthesesprosthetic- devices-and-orthotic-devices) | | --- | --- | --- | | A5500 | $79.50 | | | A5501 | $238.41 | | | A5503 | $40.48 | | | A5504 | $40.48 | | | A5505 | $40.48 | | | A5506 | $40.48 | | | A5507 | $40.48 | | | A5508 | AAC + 70% | | | A5510 | AAC + 50% | | | A5512 | $32.42 | | | A5513 | $48.38 | | | A5514 | $48.38 | | | A6530 | $49.64 | | | A6531 | $47.17 | | | A6532 | $66.48 | | | A6533 | $85.10 | | | A6534 | $85.10 | | | A6535 | $73.77 | | | A6536 | $94.57 | | | A6540 | AAC + 50% | | | A6541 | $191.49 | | | A6544 | $28.36 | | | A6545 | AAC + 40% | | | A6549 | AAC + 50% | | | A8000 | $167.25 | | | A8001 | $167.25 | | | A8002 | AAC + 70% | | | A8003 | AAC + 70% | | | A8004 | AAC + 40% | | | A9283 | AAC + 70% | | | A9285 | AAC + 40% | | | K0672 | $77.82 | | | K1007 | AAC + 70% | | | K1014 | $7,931.58 | | | K1015 | AAC + 50% | | | K1022 | $743.36 | | | L0112 | $1,472.63 | | | L0113 | $261.74 | | | L0120 | $20.14 | | | L0130 | $171.62 | | | L0140 | $72.77 | | | L0150 | $124.26 | | | L0160 | $183.61 | | | L0170 | $828.94 | | | L0172 | $111.63 | | | L0174 | $322.06 | | | L0180 | $434.40 | | | L0190 | $526.44 | | | L0200 | $493.70 | | | L0220 | $134.08 | | | L0450 CG | $176.59 | | | L0452 | AAC + 70% | | | L0454 CG | $366.51 | | | L0455 | $203.81 | | | L0456 | $1,046.46 | | | L0457 | $584.47 | | | L0458 | $818.56 | | | L0460 | $1,056.17 | | | L0462 | $1,146.01 | | | L0464 | $1,364.30 | | | L0466 | $434.47 | | | L0467 | $233.32 | | | L0468 | $489.73 | | | L0469 | $346.23 | | | L0470 | $695.52 | | | L0472 | $423.77 | | | L0480 | $1,678.68 | | | L0482 | $1,751.64 | | | L0484 | $2,388.39 | | | L0486 | $2,533.96 | | | L0488 | $921.34 | | | L0490 | $259.65 | | | L0491 | $704.90 | | | L0492 | $463.87 | | | L0621CG | $95.41 | | | L0622 | $347.20 | | | L0623 | AAC + 50% | | | L0624 | AAC + 70% | | | L0625CG | $50.77 | | | L0626 | $71.53 | | | L0627 | $377.30 | | | L0628CG | $77.35 | | | L0629 | AAC + 70% | | | L0630 | $148.65 | | | L0631 | $942.24 | | | L0632 | AAC + 70% | | | L0633 | $263.20 | | | L0634 | AAC + 70% | | | L0635 | $860.03 | | | L0636 | $1,588.01 | | | L0637 | $1,074.72 | | | L0638 | $1,387.69 | | | L0639 | $1,074.72 | | | L0640 | $1,101.01 | | | L0641 | $53.09 | | | L0642 | $279.98 | | | L0643 | $95.19 | | | L0648 | $699.21 | | | L0649 | $168.54 | | | L0650 | $694.79 | | | L0651 | $805.16 | | | L0700 | $2,264.04 | | | L0710 | $2,442.73 | | | L0810 | $3,408.91 | | | L0820 | $2,903.06 | | | L0830 | $3,775.52 | | | L0859 | $1,304.52 | | | L0861 | $197.83 | | | L0970 | $100.50 | | | L0972 | $90.50 | | | L0974 | $198.36 | | | L0976 | $150.29 | | | L0978 | $182.02 | | | L0980 | $20.48 | | | L0982 | $19.09 | | | L0984 | $60.14 | | | L0999 U1 | AAC + 40% | | | L0999 U2 | AAC + 50% | | | L0999 U3 | AAC + 70% | | | L1000 | $2,593.50 | | | L1001 | AAC + 50% | | | L1005 | $2,937.69 | | | L1010 | $74.66 | | | L1020 | $87.13 | | | L1025 | $134.98 | | | L1030 | $64.12 | | | L1040 | $78.63 | | | L1050 | $83.92 | | | L1060 | $100.23 | | | L1070 | $90.70 | | | L1080 | $59.39 | | | L1085 | $155.16 | | | L1090 | $92.39 | | | L1100 | $194.97 | | | L1110 | $303.81 | | | L1120 | $40.03 | | | L1200 | $1,874.70 | | | L1210 | $263.75 | | | L1220 | $223.31 | | | L1230 | $644.28 | | | L1240 | $85.08 | | | L1250 | $85.03 | | | L1260 | $85.08 | | | L1270 | $85.08 | | | L1280 | $115.94 | | | L1290 | $85.08 | | | L1300 | $1,791.08 | | | L1310 | $1,927.64 | | | L1499 U1 | AAC + 40% | | | L1499 U2 | AAC + 50% | | | L1499U3 | AAC + 70% | | | L1600 | $156.08 | | | L1610 | $41.72 | | | L1620 | $158.89 | | | L1630 | $227.73 | | | L1640 | $620.14 | | | L1650 | $269.27 | | | L1652 | $327.17 | | | L1660 | $185.00 | | | L1680 | $1,228.13 | | | L1681 | $1,768.59 | | | L1685 | $1,598.62 | | | L1686 | $884.30 | | | L1690 | $1,774.87 | | | L1700 | $1,955.97 | | | L1710 | $2,402.52 | | | L1720 | $1,358.65 | | | L1730 | $1,428.41 | | | L1755 | $2,127.81 | | | L1810 | $104.20 | | | L1812 | $61.25 | | | L1820 | $133.85 | | | L1830 | $54.12 | | | L1831 | $270.14 | | | L1832 | $697.99 | | | L1833 | $420.86 | | | L1834 | $1,043.26 | | | L1836 | $92.10 | | | L1840 | $983.21 | | | L1843 | $823.54 | | | L1844 | $1,721.52 | | | L1845 | $765.77 | | | L1846 | $1,306.54 | | | L1847 | $527.92 | | | L1848 | $455.55 | | | L1850 | $189.35 | | | L1851 | $534.42 | | | L1852 | $505.54 | | | L1860 | $1,143.56 | | | L1900 | $320.15 | | | L1902 | $80.85 | | | L1904 | $631.98 | | | L1906 | $118.42 | | | L1907 | $592.04 | | | L1910 | $278.78 | | | L1920 | $468.35 | | | L1930 | $240.06 | | | L1932 | $819.04 | | | L1940 | $664.66 | | | L1945 | $1,244.09 | | | L1950 | $961.29 | | | L1951 | $770.82 | | | L1960 | $744.94 | | | L1970 | $956.32 | | | L1971 | $430.21 | | | L1980 | $478.53 | | | L1990 | $569.28 | | | L2000 | $1,160.64 | | | L2005 | $4,311.44 | | | L2006 | $35,630.23 | | | L2010 | $1,054.93 | | | L2020 | $1,503.49 | | | L2030 | $1,214.08 | | | L2034 | $2,114.58 | | | L2035 | $161.71 | | | L2036 | $2,493.47 | | | L2037 | $2,238.49 | | | L2038 | $1,921.50 | | | L2040 | $228.81 | | | L2050 | $640.21 | | | L2060 | $651.69 | | | L2070 | $157.31 | | | L2080 | $483.40 | | | L2090 | $464.57 | | | L2106 | $913.78 | | | L2108 | $1,388.14 | | | L2112 | $497.06 | | | L2114 | $600.35 | | | L2116 | $771.01 | | | L2126 | $1,447.41 | | | L2128 | $2,304.52 | | | L2132 | $742.76 | | | L2134 | $1,045.57 | | | L2136 | $1,168.68 | | | L2180 | $121.47 | | | L2182 | $123.13 | | | L2184 | $129.26 | | | L2186 | $156.01 | | | L2188 | $330.39 | | | L2190 | $102.39 | | | L2192 | $378.71 | | | L2200 | $47.92 | | | L2210 | $67.76 | | | L2220 | $82.54 | | | L2230 | $77.34 | | | L2232 | $104.72 | | | L2240 | $103.72 | | | L2250 | $358.16 | | | L2260 | $202.05 | | | L2265 | $158.28 | | | L2270 | $63.30 | | | L2275 | $132.71 | | | L2280 | $503.60 | | | L2300 | $271.39 | | | L2310 | $124.00 | | | L2320 | $254.22 | | | L2330 | $442.90 | | | L2335 | $302.57 | | | L2340 | $450.50 | | | L2350 | $898.15 | | | L2360 | $52.15 | | | L2370 | $258.75 | | | L2375 | $122.01 | | | L2380 | $124.09 | | | L2385 | $172.10 | | | L2387 | $222.41 | | | L2390 | $147.12 | | | L2395 | $210.28 | | | L2397 | $108.41 | | | L2405 | $91.73 | | | L2415 | $127.79 | | | L2425 | $150.81 | | | L2430 | $150.81 | | | L2492 | $119.58 | | | L2500 | $423.99 | | | L2510 | $815.37 | | | L2520 | $600.62 | | | L2525 | $1,638.27 | | | L2526 | $890.29 | | | L2530 | $268.61 | | | L2540 | $568.20 | | | L2550 | $289.49 | | | L2570 | $480.11 | | | L2580 | $521.97 | | | L2600 | $207.02 | | | L2610 | $244.79 | | | L2620 | $359.34 | | | L2622 | $411.94 | | | L2624 | $333.78 | | | L2627 | $2,303.94 | | | L2628 | $1,969.34 | | | L2630 | $309.48 | | | L2640 | $443.58 | | | L2650 | $121.29 | | | L2660 | $250.16 | | | L2670 | $171.94 | | | L2680 | $157.73 | | | L2750 | $112.33 | | | L2755 | $137.44 | | | L2760 | $61.24 | | | L2768 | $137.07 | | | L2780 | $90.95 | | | L2785 | $34.55 | | | L2795 | $114.20 | | | L2800 | $143.36 | | | L2810 | $104.97 | | | L2820 | $116.24 | | | L2830 | $126.26 | | | L2840 | $38.54 | | | L2850 | $69.70 | | | L2999 U1 | AAC + 40% | | | L2999 U2 | AAC + 50% | | | L2999 U3 | AAC + 70% | | | L3000 | $330.51 | | | L3001 | $139.17 | | | L3002 | $169.93 | | | L3003 | $183.37 | | | L3010 | $183.37 | | | L3020 | $208.74 | | | L3030 | $80.30 | | | L3031 | $128.87 | | | L3040 | $43.19 | | | L3050 | $43.19 | | | L3060 | $67.68 | | | L3070 | $29.16 | | | L3080 | $29.16 | | | L3090 | $37.37 | | | L3100 | $34.24 | | | L3140 | $81.73 | | | L3150 | $74.71 | | | L3160 | AAC + 50% | | | L3170 | $40.30 | | | L3201 | $73.33 | | | L3202 | $64.17 | | | L3203 | $77.38 | | | L3204 | AAC + 50% | | | L3206 | AAC + 50% | | | L3207 | AAC + 50% | | | L3208 | AAC + 50% | | | L3209 | AAC + 50% | | | L3211 | AAC + 50% | | | L3212 | AAC + 50% | | | L3213 | AAC + 50% | | | L3214 | AAC + 50% | | | L3215 | AAC + 50% | | | L3216 | AAC + 50% | | | L3217 | AAC + 50% | | | L3219 | AAC + 50% | | | L3221 | AAC + 50% | | | L3222 | $146.67 | | | L3224 | $75.13 | | | L3225 | $90.92 | | | L3230 | AAC + 70% | | | L3250 | $460.51 | | | L3251 | AAC + 70% | | | L3252 | $467.17 | | | L3253 | AAC + 50% | | | L3254 | AAC + 70% | | | L3255 | AAC + 70% | | | L3257 | AAC + 70% | | | L3260 | AAC + 70% | | | L3265 | AAC + 50% | | | L3300 | $54.86 | | | L3310 | $85.64 | | | L3320 | $70.92 | | | L3330 | $595.47 | | | L3332 | $77.59 | | | L3334 | $40.16 | | | L3340 | $89.69 | | | L3350 | $24.10 | | | L3360 | $37.47 | | | L3370 | $52.15 | | | L3380 | $52.15 | | | L3390 | $52.15 | | | L3400 | $42.84 | | | L3410 | $97.68 | | | L3420 | $57.56 | | | L3430 | $168.61 | | | L3440 | $80.30 | | | L3450 | $111.09 | | | L3455 | $42.84 | | | L3460 | $36.10 | | | L3465 | $61.54 | | | L3470 | $65.56 | | | L3480 | $65.56 | | | L3485 | $21.27 | | | L3500 | $30.78 | | | L3510 | $30.78 | | | L3520 | $33.43 | | | L3530 | $33.43 | | | L3540 | $53.54 | | | L3550 | $9.34 | | | L3560 | $24.10 | | | L3570 | $89.69 | | | L3580 | $68.24 | | | L3590 | $56.20 | | | L3595 | $44.14 | | | L3600 | $80.30 | | | L3610 | $105.71 | | | L3620 | $80.30 | | | L3630 | $105.71 | | | L3640 | $45.49 | | | L3649 | AAC + 70% | | | L3650 | $63.24 | | | L3660 | $117.92 | | | L3670 | $97.29 | | | L3671 | $862.84 | | | L3674 | $1,131.86 | | | L3675 | $168.04 | | | L3677 | AAC + 50% | | | L3678 | AAC + 40% | | | L3702 | $276.49 | | | L3710 | $133.57 | | | L3720 | $645.15 | | | L3730 | $1,185.52 | | | L3740 | $1,405.54 | | | L3760 | $417.72 | | | L3761 | $417.72 | | | L3762 | $90.22 | | | L3763 | $696.74 | | | L3764 | $910.47 | | | L3765 | $1,227.82 | | | L3766 | $1,300.17 | | | L3806 | $434.99 | | | L3807 | $208.88 | | | L3808 | $404.52 | | | L3809 | $208.88 | | | L3900 | $1,283.23 | | | L3901 | $1,585.08 | | | L3904 | $3,039.43 | | | L3905 | $949.63 | | | L3906 | $462.71 | | | L3908 | $68.73 | | | L3912 | $81.60 | | | L3913 | $259.35 | | | L3915 | $444.02 | | | L3916 | $444.02 | | | L3917 | $88.28 | | | L3918 | $88.28 | | | L3919 | $259.35 | | | L3921 | $307.58 | | | L3923 | $99.79 | | | L3924 | $99.79 | | | L3925 | $44.90 | | | L3927 | $29.18 | | | L3929 | $67.26 | | | L3930 | $67.26 | | | L3931 | $177.58 | | | L3933 | $204.28 | | | L3935 | $211.53 | | | L3956 | AAC+ 50% | | | L3960 | $751.31 | | | L3961 | $1,403.42 | | | L3962 | $823.14 | | | L3967 | $1,899.46 | | | L3971 | $1,803.04 | | | L3973 | $1,899.46 | | | L3975 | $1,608.80 | | | L3976 | $1,608.80 | | | L3977 | $1,803.04 | | | L3978 | $1,899.46 | | | L3980 | $354.67 | | | L3981 | $840.80 | | | L3982 | $373.81 | | | L3984 | $371.86 | | | L3995 | $37.52 | | | L3999 U1 | AAC + 40% | | | L3999 U2 | AAC + 50% | | | L3999 U3 | AAC + 70% | | | L4000 | $1,540.53 | | | L4002 | AAC + 70% | | | L4010 | $676.46 | | | L4020 | $876.97 | | | L4030 | $508.91 | | | L4040 | $450.48 | | | L4045 | $440.86 | | | L4050 | $506.83 | | | L4055 | $359.29 | | | L4060 | $335.50 | | | L4070 | $317.57 | | | L4080 | $135.94 | | | L4090 | $105.90 | | | L4100 | $118.99 | | | L4110 | $102.27 | | | L4130 | $500.08 | | | L4205 | $22.86 | | | L4210 | AAC + 70% | | | L4350 | $91.31 | | | L4360 | $324.62 | | | L4361 | $324.62 | | | L4370 | $221.33 | | | L4386 | $145.51 | | | L4387 | $125.56 | | | L4392 | $22.55 | | | L4394 | $16.47 | | | L4396 | $160.91 | | | L4397 | $138.85 | | | L4398 | $74.08 | | | L4631 | $1,725.88 | | | L5000 | $542.58 | | | L5010 | $1,315.14 | | | L5020 | $2,237.48 | | | L5050 | $2,925.61 | | | L5060 | $2,966.02 | | | L5100 | $2,999.95 | | | L5105 | $4,569.22 | | | L5150 | $3,857.52 | | | L5160 | $4,523.68 | | | L5200 | $4,498.53 | | | L5210 | $2,832.68 | | | L5220 | $3,040.23 | | | L5230 | $4,286.17 | | | L5250 | $5,983.14 | | | L5270 | $6,423.67 | | | L5280 | $6,434.58 | | | L5301 | $2,634.23 | | | L5312 | $3,542.14 | | | L5321 | $3,716.15 | | | L5331 | $5,537.58 | | | L5341 | $5,427.27 | | | L5400 | $1,292.43 | | | L5410 | $493.53 | | | L5420 | $1,632.29 | | | L5430 | $565.38 | | | L5450 | $437.49 | | | L5460 | $643.25 | | | L5500 | $1,570.76 | | | L5505 | $2,198.75 | | | L5510 | $1,958.30 | | | L5520 | $2,051.00 | | | L5530 | $2,235.01 | | | L5535 | $2,033.91 | | | L5540 | $2,216.92 | | | L5560 | $2,111.42 | | | L5570 | $2,546.41 | | | L5580 | $2,640.91 | | | L5585 | $2,578.76 | | | L5590 | $2,978.07 | | | L5595 | $5,310.67 | | | L5600 | $6,279.68 | | | L5610 | $2,656.61 | | | L5611 | $2,306.91 | | | L5613 | $3,508.95 | | | L5614 | $1,778.94 | | | L5616 | $1,646.51 | | | L5617 | $619.62 | | | L5618 | $402.69 | | | L5620 | $398.07 | | | L5622 | $485.27 | | | L5624 | $520.54 | | | L5626 | $619.91 | | | L5628 | $587.35 | | | L5629 | $455.03 | | | L5630 | $548.80 | | | L5631 | $629.11 | | | L5632 | $271.76 | | | L5634 | $424.99 | | | L5636 | $364.82 | | | L5637 | $357.17 | | | L5638 | $522.60 | | | L5639 | $1,605.32 | | | L5640 | $686.66 | | | L5642 | $665.33 | | | L5643 | $2,228.54 | | | L5644 | $832.28 | | | L5645 | $954.27 | | | L5646 | $784.51 | | | L5647 | $1,138.96 | | | L5648 | $707.00 | | | L5649 | $2,044.57 | | | L5650 | $524.25 | | | L5651 | $1,719.50 | | | L5652 | $578.50 | | | L5653 | $654.48 | | | L5654 | $474.86 | | | L5655 | $338.99 | | | L5656 | $402.21 | | | L5658 | $454.03 | | | L5661 | $871.33 | | | L5665 | $733.12 | | | L5666 | $91.75 | | | L5668 | $133.04 | | | L5670 | $309.50 | | | L5671 | $534.16 | | | L5672 | $376.50 | | | L5673 | $847.18 | | | L5676 | $509.74 | | | L5677 | $705.96 | | | L5678 | $42.64 | | | L5679 | $705.96 | | | L5680 | $371.06 | | | L5681 | $1,386.70 | | | L5682 | $895.44 | | | L5683 | $1,386.70 | | | L5684 | $64.74 | | | L5685 | $135.03 | | | L5686 | $64.67 | | | L5688 | $76.25 | | | L5690 | $140.11 | | | L5692 | $168.76 | | | L5694 | $259.76 | | | L5695 | $197.17 | | | L5696 | $254.62 | | | L5697 | $114.94 | | | L5698 | $129.02 | | | L5699 | $259.02 | | | L5700 | $3,129.15 | | | L5701 | $3,881.97 | | | L5702 | $4,892.64 | | | L5703 | $2,538.85 | | | L5704 | $638.04 | | | L5705 | $1,169.72 | | | L5706 | $1,140.92 | | | L5707 | $1,532.83 | | | L5710 | $436.08 | | | L5711 | $731.56 | | | L5712 | $581.28 | | | L5714 | $523.34 | | | L5716 | $940.24 | | | L5718 | $1,129.38 | | | L5722 | $1,059.62 | | | L5724 | $1,949.13 | | | L5726 | $2,421.29 | | | L5728 | $3,407.01 | | | L5780 | $1,310.33 | | | L5781 | $4,218.07 | | | L5782 | $4,446.79 | | | L5785 | $743.91 | | | L5790 | $1,029.51 | | | L5795 | $1,537.32 | | | L5810 | $697.09 | | | L5811 | $1,044.25 | | | L5812 | $789.97 | | | L5814 | $3,915.16 | | | L5816 | $984.77 | | | L5818 | $1,375.00 | | | L5822 | $2,438.25 | | | L5824 | $1,913.41 | | | L5826 | $3,348.20 | | | L5828 | $4,043.36 | | | L5830 | $2,716.93 | | | L5840 | $3,978.32 | | | L5845 | $1,889.54 | | | L5848 | $1,133.62 | | | L5850 | $137.37 | | | L5855 | $331.64 | | | L5856 | $25,595.62 | | | L5857 | $9,268.37 | | | L5858 | $19,592.72 | | | L5859 | $11,514.22 | | | L5910 | $518.57 | | | L5920 | $759.72 | | | L5925 | $360.83 | | | L5930 | $3,727.46 | | | L5940 | $538.66 | | | L5950 | $1,049.03 | | | L5960 | $1,153.87 | | | L5961 | $4,901.22 | | | L5962 | $631.21 | | | L5964 | $1,143.58 | | | L5966 | $1,473.11 | | | L5968 | $3,830.93 | | | L5969 | $14,203.36 | | | L5970 | $290.79 | | | L5971 | $290.79 | | | L5972 | $441.17 | | | L5973 | $18,495.80 | | | L5974 | $326.25 | | | L5975 | $488.72 | | | L5976 | $737.86 | | | L5978 | $398.85 | | | L5979 | $2,543.48 | | | L5980 | $4,674.05 | | | L5981 | $3,480.96 | | | L5982 | $824.28 | | | L5984 | $743.36 | | | L5985 | $312.71 | | | L5986 | $696.57 | | | L5987 | $7,583.69 | | | L5988 | $2,106.01 | | | L5990 | $1,912.58 | | | L5991 | $7,761.83 | | | L5999 U1 | AAC + 40% | | | L5999 U2 | AAC + 50% | | | L5999 U3 | AAC + 70% | | | L6000 | $1,426.84 | | | L6010 | $1,587.83 | | | L6020 | $1,480.40 | | | L6026 | $4,543.03 | | | L6050 | $2,259.92 | | | L6055 | $3,567.70 | | | L6100 | $2,274.11 | | | L6110 | $2,270.25 | | | L6120 | $2,868.95 | | | L6130 | $3,117.94 | | | L6200 | $3,569.39 | | | L6205 | $4,947.99 | | | L6250 | $2,958.43 | | | L6300 | $5,331.17 | | | L6310 | $3,258.75 | | | L6320 | $1,843.60 | | | L6350 | $4,206.25 | | | L6360 | $3,420.45 | | | L6370 | $2,249.89 | | | L6380 | $1,259.88 | | | L6382 | $1,641.98 | | | L6384 | $2,047.44 | | | L6386 | $485.69 | | | L6388 | $629.46 | | | L6400 | $2,491.79 | | | L6450 | $4,335.92 | | | L6500 | $3,737.44 | | | L6550 | $4,395.15 | | | L6570 | $5,969.55 | | | L6580 | $1,741.88 | | | L6582 | $1,541.44 | | | L6584 | $2,549.35 | | | L6586 | $2,228.51 | | | L6588 | $3,748.15 | | | L6590 | $3,309.05 | | | L6600 | $201.43 | | | L6605 | $198.89 | | | L6610 | $178.79 | | | L6611 | $434.06 | | | L6615 | $186.55 | | | L6616 | $67.25 | | | L6620 | $345.95 | | | L6621 | $2,411.30 | | | L6623 | $757.48 | | | L6624 | $3,970.28 | | | L6625 | $761.51 | | | L6628 | $610.86 | | | L6629 | $162.24 | | | L6630 | $308.58 | | | L6632 | $74.98 | | | L6635 | $193.52 | | | L6637 | $525.75 | | | L6638 | $2,636.31 | | | L6640 | $300.80 | | | L6641 | $204.17 | | | L6642 | $285.60 | | | L6645 | $342.81 | | | L6646 | $3,324.98 | | | L6647 | $547.38 | | | L6648 | $3,429.23 | | | L6650 | $396.37 | | | L6655 | $88.28 | | | L6660 | $125.04 | | | L6665 | $60.14 | | | L6670 | $54.99 | | | L6672 | $181.07 | | | L6675 | $171.95 | | | L6676 | $136.22 | | | L6677 | $312.73 | | | L6680 | $253.53 | | | L6682 | $308.50 | | | L6684 | $461.37 | | | L6686 | $845.30 | | | L6687 | $619.41 | | | L6688 | $601.20 | | | L6689 | $739.37 | | | L6690 | $775.42 | | | L6691 | $494.24 | | | L6692 | $668.72 | | | L6693 | $2,992.91 | | | L6694 | $847.18 | | | L6695 | $705.96 | | | L6696 | $1,386.70 | | | L6697 | $1,386.70 | | | L6698 | $534.16 | | | L6703 | $415.51 | | | L6704 | $628.90 | | | L6706 | $429.50 | | | L6707 | $1,546.96 | | | L6708 | $930.54 | | | L6709 | $1,301.03 | | | L6711 | $618.27 | | | L6712 | $1,138.37 | | | L6713 | $1,436.76 | | | L6714 | $1,216.91 | | | L6715 | $3,328.28 | | | L6721 | $2,162.92 | | | L6722 | $1,864.61 | | | L6805 | $388.31 | | | L6810 | $200.51 | | | L6880 | $25,187.74 | | | L6881 | $4,309.88 | | | L6882 | $3,269.24 | | | L6883 | $1,704.09 | | | L6884 | $2,418.11 | | | L6885 | $3,420.45 | | | L6890 | $176.19 | | | L6895 | $799.51 | | | L6900 | $1,622.04 | | | L6905 | $1,576.66 | | | L6910 | $1,535.99 | | | L6915 | $721.72 | | | L6920 | $8,190.34 | | | L6925 | $9,522.22 | | | L6930 | $7,985.51 | | | L6935 | $9,296.88 | | | L6940 | $10,192.40 | | | L6945 | $11,601.32 | | | L6950 | $10,716.32 | | | L6955 | $12,974.04 | | | L6960 | $14,300.88 | | | L6965 | $16,853.00 | | | L6970 | $17,960.63 | | | L6975 | $20,243.74 | | | L7007 | $3,893.14 | | | L7008 | $6,578.20 | | | L7009 | $4,081.25 | | | L7040 | $3,120.07 | | | L7045 | $1,735.72 | | | L7170 | $6,357.81 | | | L7180 | $40,421.00 | | | L7181 | $42,240.23 | | | L7185 | $6,622.39 | | | L7186 | $10,450.86 | | | L7190 | $8,875.04 | | | L7191 | $11,002.10 | | | L7259 | $4,528.70 | | | L7360 | $289.11 | | | L7362 | $298.81 | | | L7364 | $540.69 | | | L7366 | $736.07 | | | L7367 | $410.43 | | | L7368 | $532.05 | | | L7400 | $323.11 | | | L7401 | $361.72 | | | L7402 | $390.64 | | | L7403 | $388.21 | | | L7404 | $585.96 | | | L7405 | $766.34 | | | L7499 U1 | AAC + 40% | | | L7499 U2 | AAC + 50% | | | L7499 U3 | AAC + 70% | | | L7510 | AAC + 70% | | | L7520 | $31.88 | | | L7600 | AAC + 70% | | | L7700 | $117.41 | | | L7900 | $557.55 | | | L7902 | AAC + 70% | | | L8000 | $34.83 | | | L8001 | $115.37 | | | L8002 | $151.71 | | | L8010 | $57.99 | | | L8015 | $55.13 | | | L8020 | $187.93 | | | L8030 | $340.04 | | | L8031 | $340.04 | | | L8032 | $31.09 | | | L8033 | AAC + 70% | | | L8035 | $3,862.24 | | | L8039 | AAC + 50% | | | L8300 | $79.02 | | | L8310 | $124.76 | | | L8320 | $66.32 | | | L8330 | $61.66 | | | L8400 | $16.79 | | | L8410 | $25.87 | | | L8415 | $26.77 | | | L8417 | $69.06 | | | L8420 | $19.48 | | | L8430 | $22.81 | | | L8435 | $25.42 | | | L8440 | $44.06 | | | L8460 | $71.83 | | | L8465 | $55.04 | | | L8470 | $6.25 | | | L8480 | $10.92 | | | L8485 | $10.95 | | | L8499 U1 | AAC + 40% | | | L8499 U2 | AAC + 50% | | | L8499 U3 | AAC + 70% | | | L8600 | $590.06 | | | L8603 | $353.98 | | | L8604 | AAC + 40% | | | L8605 | $568.39 | | | L8606 | $173.97 | | | L8609 | $5,991.81 | | | L8610 | $548.31 | | | L8612 | $672.13 | | | L8613 | $292.68 | | | L8614 | $17,935.61 | | | L8701 | AAC + 70% | | | L8702 | AAC + 70% | | | S1040 | $1,848.89 | |

History

Amended by Mass Register Issue 1381, eff. 12/28/2018.

101 CMR, § 334.04 Reporting Requirements

(1) Required Reports. All providers must comply with the requirements of 957 CMR 6.00: Cost Reporting Requirements .

History

Amended by Mass Register Issue 1381, eff. 12/28/2018.

101 CMR, § 334.05 Severability

The provisions of 101 CMR 334.00 are severable. If any provision of 101 CMR 334.00 or the application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 334.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1381, eff. 12/28/2018.

Rates for Dialysis Treatments and Home Dialysis Supplies Rates for Dialysis Treatments and Home Dialysis Supplies

101 CMR, § 337.01 General Provisions

(1) Scope and Purpose. 101 CMR 337.00 governs the payment rates to be used by all governmental units and purchasers under M.G.L. c. 152, § 1 (the Workers' Compensation Act) for dialysis treatments, treatment for acute kidney injuries (AKIs), and home dialysis supplies provided to publicly aided and industrial accident patients.

(2) Applicable Dates of Service. Rates contained in 101 CMR 337.00 apply for dates of service provided on or after April 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 337.00 is not authorization for or approval of the services for which rates are determined pursuant to 101 CMR 337.00. The governmental purchasers and purchasers under M.G.L. c. 152 of these services are responsible for

(a) the definitions and authorization of services for their beneficiaries; and

(b) providing information as to program policies and benefit limitations.

(4) Rate as Full Payment. The rates of payment under 101 CMR 337.00 are full compensation for all services rendered by the provider in connection with the provision of dialysis treatments and home dialysis supplies. Any patient resources or third-party payments on behalf of a publicly aided patient, e.g ., Medicare payments, will reduce the amount of the obligation for these services to the governmental purchaser or purchaser under M.G.L. c. 152.

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an Administrative Bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology® (CPT). The publication of such updates and corrections will list

(a) codes for which the code numbers change, with the corresponding cross references between new codes and the codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced;

(b) codes for which the code number remains the same but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on, and interpretation of, substantive provisions of 101 CMR 337.00.

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

101 CMR, § 337.02 Definitions

Terms used in 101 CMR 337.00 have the meanings set forth in 101 CMR 337.02.

Acute Kidney Injury (AKI). A sudden and often reversible reduction in the kidney function, as measured by increased creatinine or decreased urine volume.

Calcimimetics. A class of drugs used to treat hyperparathyroidism, a condition in which the parathyroid glands produce a high amount of parathyroid hormone in patients with chronic kidney disease.

Center. The Center for Health Information and Analysis, established under M.G.L. c. 12C.

Centers for Medicare & Medicaid Services (CMS). The federal agency in the Department of Health and Human Services that is responsible for the determination of reimbursement for the provision of services to Medicare-covered patients.

Chronic Maintenance Dialysis Treatment. Dialysis treatment provided on an outpatient basis for a stabilized patient. The treatment may take the form of hemodialysis, hemofiltration, intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, or continuous cycling peritoneal dialysis and may occur in a facility or at home.

Dialysis Program Rate(s). A provider's rate(s) established by CMS for the end stage renal disease (ESRD) program of Medicare.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Established Charge. The lowest rate paid by any payer for treatment.

Governmental Purchaser. The Commonwealth of Massachusetts and any of its departments, agencies, boards, commissions, and political subdivisions, which purchase dialysis services.

Home Dialysis Supplies. Supplies used in conjunction with home dialysis treatment identified in 101 CMR 322.00: Rates for Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment .

Industrial Accident Patient. A person who receives medical services for which persons, corporations, or other entities are in whole or part liable under M.G.L. c. 152.

Provider. Any independent outpatient dialysis facility licensed by the Department of Public Health and certified by the MassHealth agency.

Publicly Aided Individual. A person who receives health care and other services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Purchaser under M.G.L. c. 152. An insurance company, self insurer, or worker's compensation agent of a department of the Commonwealth, county, city, or district that purchases medical services subject to M.G.L. c. 152, § 1.

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

101 CMR, § 337.03 Rate(s) Determination

(1) Rates paid to providers will be subject to the following adjustments and limitations.

(a) In a case where the established charge(s) is lower than the dialysis rate(s) and is not based upon an established income-related sliding fee scale for self-payers, the established charge(s) is the rate(s) paid to the provider.

(b) If home training is included as part of a provider's dialysis program, governmental purchasers and purchasers under M.G.L. c. 152 who choose to purchase the service must pay the dialysis rate(s) plus an add-on listed in 101 CMR 337.03(3) under the appropriate service code.

(2) Rates for Dialysis Treatment and Treatment for Acute Kidney Injuries.

| Procedure Code | Description | Rate | | --- | --- | --- | | 90999 | Unlisted dialysis procedure, inpatient or outpatient (all-inclusive service per dialysis treatment per patient) | $204.94 | | G0491 | Dialysis procedure at a Medicare certified end stage renal disease (ESRD) facility for acute kidney injury without ESRD | $204.94 |

The all-inclusive rate identified in 101 CMR 337.03(2) covers all services and supplies as defined in 42 CFR § 410.50, with the exception of physician services and applicable procedure codes in 101 CMR 337.03(3).

(3) The following codes and add-ons must be used when the treatment includes these services:

| Procedure Code | Description | Rate | | --- | --- | --- | | 90989 | Dialysis training, patient, including helper where applicable, any mode, completed course | $20.00 | | 90993 | Dialysis training, patient, including helper where applicable, any mode, course not completed, per training session | $20.00 | | J0604 | Cinacalcet, oral, 1 mg (for ESRD on dialysis) | $0.01 |

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

101 CMR, § 337.04 Rates for Home Dialysis Supplies

Rates for home dialysis supplies that a governmental purchaser chooses to purchase separately from other services are contained in 101 CMR 322.00: Rates for Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment .

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

101 CMR, § 337.05 Rates for Laboratory Services

Rates for laboratory services associated with dialysis that a governmental purchaser or purchaser under M.G.L. c. 152 chooses to purchase separately from other services are contained in 101 CMR 320.00: Rates for Clinical Laboratory Services .

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

101 CMR, § 337.06 Rates for Prescribed Drugs

Payment for allowed drugs is included in the all-inclusive bundled payment, except that calcimimetics are paid separately from the bundled payment, as described in 101 CMR 337.03(3).

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

101 CMR, § 337.07 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

101 CMR, § 337.08 Bad Debt Settlement

Governmental purchasers and purchasers under M.G.L. c. 152 cannot participate in the Medicare bad debt settlement negotiated between CMS and the provider at the end of the provider's fiscal year.

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

101 CMR, § 337.09 Severability

The provisions of 101 CMR 337.00 are severable. If any provision of 101 CMR 337.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 337.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1328, eff. 12/16/2016.

Rates for Restorative Services Rates for Restorative Services

101 CMR, § 339.01 General Provisions

(1) Scope, Purpose, and Effective Date. 101 CMR 339.00 governs the rates of payment to be used by all governmental units for rehabilitation center services and restorative services provided to publicly aided individuals by eligible providers. Rates for services rendered to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act) are set forth at 114.3 CMR 40.06(12): Restorative Services Description .

(2) Applicable Dates of Service. Rates contained in 101 CMR 339.00 apply for dates of service provided on or after June 6, 2025.

(3) Coverage. Except as provided otherwise, 101 CMR 339.00 and the rates of payment contained in 101 CMR 339.00 apply to services rendered by eligible providers of rehabilitation center services and eligible providers of restorative services to publicly aided individuals. The rates of payment specified in 101 CMR 339.00 are full compensation for professional services rendered, as well as for any administrative or supervisory duties.

(4) Exceptions. Rates of payment contained in 101 CMR 339.00 do not apply to indirect services, such as case conferences or in-service education programs provided by eligible providers in long-term-care facilities.

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list

(a) codes for which only the code number has changed, with the corresponding crossreference between new and existing codes;

(b) codes for which the code remains the same, but the description has changed;

(d) entirely new codes that require new pricing. EOHHS may list these codes and price them at a percentage of the prevailing Medicare fees, when Medicare fees are available. When Medicare fees are not available or when otherwise designated by EOHHS, EOHHS may apply individual consideration in reimbursing for these new codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 339.00.

(7) Disclaimer of Authorization of Services. 101 CMR 339.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 339.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals.

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 339.02 General Definitions

As used in 101 CMR 339.00, unless the context requires otherwise, terms have the meanings in 101 CMR 339.02.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Comprehensive Restorative and Rehabilitation Center Evaluation. An all-inclusive, in-depth assessment of medical condition and level of functioning and limitations, to determine the need for treatment and, if necessary, to develop a plan of treatment. The comprehensive evaluation includes a written report.

Eligible Provider of Rehabilitation Center Services. Freestanding centers providing rehabilitation services that are licensed by the Massachusetts Department of Public Health, that are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), and that meet such conditions of participation as may be required by a governmental unit purchasing rehabilitation services, or by a purchaser under M.G.L. c. 152 (the Workers' Compensation Act).

Eligible Provider of Restorative Services. A provider who meets the conditions of participation adopted by a governmental unit purchasing restorative services or by purchasers under M.G.L. c. 152 (the Workers' Compensation Act), and who is

(a) a physical therapist - a person who is currently licensed by and in good standing with the Massachusetts Division of Professional Licensure, Board of Allied Health Professionals;

(b) a physical therapy assistant - a person who is currently licensed by and in good standing with the Massachusetts Division of Professional Licensure, Board of Allied Health Professional and works under the supervision of a physical therapist;

(c) an occupational therapist - a person who is currently licensed by and in good standing with the Massachusetts Division of Professional Licensure, Board of Allied Health Professionals;

(d) an occupational therapy assistant - a person who is licensed by and in good standing with the Massachusetts Division of Professional Licensure, Board of Allied Health Professionals and works under the supervision of an occupational therapist;

(e) a speech/language therapist (speech/language pathologist) - a person who is currently licensed by and in good standing with the Massachusetts Board of Registration in Speech-language Pathology and Audiology;

(f) a speech/language therapist assistant (speech/language pathologist assistant) - a person who is currently licensed by and in good standing with the Massachusetts Board of Registration in Speech Language Pathology and Audiology and works under the supervision of a speech/language therapist; or

(g) any speech and hearing center (proprietorship, partnership, or corporation) that provides authorized speech or language services rendered by a qualified speech pathologist who does not bill separately from such facility for professional services rendered.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any department, agency, board, division, or commission of the Commonwealth, or any political subdivision of the Commonwealth.

Group Therapy. Simultaneous therapy services provided to two to six patients who may or may not be doing the same activities.

HCPCS. The Healthcare Common Procedure Coding System.

Individual Consideration (IC). A designation indicating that there is no specified rate for a given service. Payment amounts for services designated "IC" are determined by the governmental unit purchasing such services. The governmental unit determines the appropriate payment based on the provider's report of services provided, and documentation as requested by the governmental unit. The report must include a pertinent history and diagnosis, a description of the service rendered, and the length of time spent with the patient. In making the determination of the appropriate payment amount, the governmental unit uses the following criteria:

(a) the policies, procedures, and practices of other third-party purchasers of care, both governmental and private;

(b) the severity and complexity of the patient's disorder or disability;

(d) the time, degree of skill, and cost including equipment cost required to perform the procedure(s).

Occupational Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of functions that affect the activities of daily living that have been lost, impaired, or reduced because of acute or chronic medical conditions, congenital anomalies, or injuries. Occupational therapy programs are designed to improve quality of life by recovering competence, preventing further injury or disability, and to improve the individual's ability to perform tasks required for independent functioning, so that the individual can engage in activities of daily living.

Office Visit. Patient treatments rendered in a speech and hearing center, a licensed clinic or center, or in a practitioner's office (whether an individual practice, a group practice, or an association of practitioners). If a practitioner has an office in their home that is used for patient treatment, then services rendered there must be billed as office visits.

Out-of-office Visit. Patient treatments rendered in a nursing home, school, a patient's home, or in any other setting where the practitioner travels from their usual place of business to render patient treatment.

Physical Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of physical functions that have been lost, impaired, or reduced because of acute or chronic medical conditions, congenital anomalies, or injuries. Physical therapy emphasizes a form of rehabilitation focused on treatment of dysfunctions involving neuromuscular, musculoskeletal, cardiovascular/pulmonary, or integumentary systems through the use of therapeutic interventions to optimize functioning levels.

Physician's Comprehensive Rehabilitation Evaluation. A cardiopulmonary, neuromuscular, orthopedic, and functional assessment performed at a rehabilitation center by a physician.

Publicly-aided Individual. A person who receives health care and services for which a governmental unit is in whole or part liable under a statutory program of public assistance.

Rehabilitation. The process of providing, in a coordinated manner, those comprehensive services deemed appropriate to the needs of the physically disabled individual, in a program designed to achieve objectives of improved health and welfare with realization of their maximum physical, social, psychological, and vocational potential.

Restorative Services. Services provided by a physical therapist, an occupational therapist, or a speech pathologist at the referral of a prescribing provider as defined by the governmental entity for the purpose of maximum reduction of physical and speech disability and restoration of the patient to a maximum functional level.

Speech/Language Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, that are designed to improve, develop, correct, rehabilitate, or prevent the worsening of speech/language communication and swallowing disorders that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Speech and language disorders are those that affect articulation of speech, sounds, fluency, voice, swallowing (regardless of presence of a communication disability), and those that impair comprehension, spoken, written, or other symbol systems used for communication.

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 339.03 General Rate Provisions

(1) Rate Determination. Rates of payment for authorized services to which 101 CMR 339.00 applies are the lower of

(a) the usual fee of the eligible provider of rehabilitation center services or the eligible provider of restorative services to patients other than publicly aided individuals; or

(b) the schedule of allowable fees set forth in 101 CMR 339.04.

(2) Out-of-office Rates. With the exception of services provided by rehabilitation centers and speech and hearing centers, the fee for any service provided out of the office will be 115% of the respective in-office fee.

(3) Multiple Procedures in Physical Therapy. When more than one type of physical therapy treatment is provided in a single visit, the provider receives 100% of the applicable fee for each procedure, with a maximum of four procedures (or a total of one hour) allowed in a given visit.

(4) Special Contracts. In certain circumstances, purchasing agencies may pay for services on an hourly basis, rather than a per visit basis as described in 101 CMR 339.00. A special contract would be appropriate where a large number of patients are treated by an individual practitioner on a regular basis for a particular purchaser at one site and/or where the treatment times described in the service codes in 101 CMR 339.00 do not define the treatment times authorized by the purchaser.

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 339.04 Allowable Fees

(1) Fee Schedule.

| Service Code | Allowable Fee | Service Description | | --- | --- | --- | | Special Otorhinolaryngologic Services | | | | 92507 | $73.64 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual (maximum one unit per visit) | | 92508 | $31.53 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two or more individuals (maximum one unit per visit) | | 92521 | $102.21 | Evaluation of speech fluency ( e.g ., stuttering, cluttering) | | 92521 HA | $102.21 | Evaluation of speech fluency ( e.g ., stuttering, cluttering) (for patients younger than 21 years old) | | 92521 TF | $102.21 | Evaluation of speech fluency ( e.g ., stuttering, cluttering) (for developmentally disabled adults 22 years of age or older) | | 92522 | $85.32 | Evaluation of speech sound production ( e.g ., articulation, phonological process, apraxia, dysarthria) | | 92522 HA | $85.32 | Evaluation of speech sound production ( e.g ., articulation, phonological process, apraxia, dysarthria) (for patients younger than 21 years old) | | 92522 TF | $85.32 | Evaluation of speech sound production ( e.g ., articulation, phonological process, apraxia, dysarthria) (for developmentally disabled adults 22 years of age or older) | | 92523 | $175.24 | Evaluation of speech sound production ( e.g. , articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression ( e.g ., receptive and expressive language) | | 92523 HA | $175.24 | Evaluation of speech sound production ( e.g ., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression ( e.g ., receptive and expressive language) (for patients younger than 21 years old) | | 92523 TF | $175.24 | Evaluation of speech sound production ( e.g ., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression ( e.g ., receptive and expressive language) (for developmentally disabled adults 22 years of age or older) | | 92524 | $83.97 | Behavioral and qualitative analysis of voice and resonance | | 92524 HA | $83.97 | Behavioral and qualitative analysis of voice and resonance (for patients younger than 21 years old) | | 92524 TF | $83.97 | Behavioral and qualitative analysis of voice and resonance (for developmentally disabled adults 22 years of age or older) | | 92526 | $65.33 | Treatment of swallowing dysfunction and/or oral function for feeding (maximum one unit per visit) | | Evaluative and Therapeutic Services | | | | 92605 | $79.26 | Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour | | 92606 | $19.82 | Therapeutic service(s) for the use of non-speech-generating device, including programming and modification | | 92607 | $95.90 | Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour | | 92608 | $37.70 | Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (list separately in addition to code for primary procedure) | | 92609 | $80.04 | Therapeutic services for the use of speech-generating device, including programming and modification | | 92610 | $65.90 | Evaluation of oral and pharyngeal swallowing function (per hour, maximum of one hour) | | 92630 | $18.06 | Auditory rehabilitation; prelingual hearing loss | | 92633 | $18.06 | Auditory rehabilitation; postlingual hearing loss | | Physical Medicine and Rehabilitation | | | | 97161 | $77.50 | Physical therapy evaluation - Low complex 20 min | | 97162 | $77.50 | Physical therapy evaluation - Mod complex - 30 min | | 97163 | $77.50 | Physical therapy evaluation High complex - 45 min | | 97164 | $64.41 | Physical therapy reevaluation Est. Plan Care - 20 min | | 97165 | $78.31 | Occupational therapy evaluation Low complex - 30 min | | 97166 | $78.31 | Occupational therapy evaluation Mod complex - 45 min | | 97167 | $78.31 | Occupational therapy evaluation High complex - 60 min | | 97168 | $64.41 | Occupational therapy re-evaluation Est. Plan Care - 30 min | | Modalities - Supervised | | | | 97010 | $5.25 | Application of a modality to one or more areas; hot or cold packs | | 97012 | $12.63 | Application of a modality to one or more areas; traction, mechanical | | 97014 | $15.62 | Application of a modality to one or more areas; electrical stimulation (unattended) | | 97016 | $13.04 | Application of a modality to one or more areas; vasopneumatic devices | | 97018 | $6.47 | Application of a modality to one or more areas; paraffin bath | | 97022 | $13.32 | Application of a modality to one or more areas; whirlpool | | 97024 | $5.74 | Application of a modality to one or more areas; diathermy ( e.g ., microwave) | | 97026 | $5.24 | Application of a modality to one or more areas; infrared | | 97028 | $6.51 | Application of a modality to one or more areas; ultraviolet | | Modalities - Constant Attendance | | | | 97032 | $14.68 | Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes | | 97033 | $15.01 | Application of a modality to one or more areas; iontophoresis, each 15 minutes | | 97034 | $14.68 | Application of a modality to one or more areas; contrast baths, each 15 minutes | | 97035 | $14.68 | Application of a modality to one or more areas; ultrasound, each 15 minutes | | 97036 | $27.68 | Application of a modality to one or more areas; Hubbard tank, each 15 minutes | | 97039 | $18.06 | Unlisted modality (specify type and time if constant attendance) | | Therapeutic Procedures | | | | 97110 | $22.67 | Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | | 97112 | $26.07 | Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities | | 97113 | $28.55 | Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises | | 97116 | $22.67 | Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing) | | 97124 | $23.72 | Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) | | 97139 | $19.82 | Unlisted therapeutic procedure (specify) (each 15 minutes) | | 97140 | $20.83 | Manual therapy techniques ( e.g ., mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes | | 97150 | $25.56 | Therapeutic procedure(s), group (two or more individuals) (services delivered under an outpatient plan of care) (maximum one unit per visit ) | | 97530 | $28.65 | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | | 97532 | $18.06 | Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes | | 97533 | $49.38 | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes | | 97535 | $25.38 | Self-care/home management training ( e.g ., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes | | 97537 | $24.49 | Community/work reintegration training ( e.g ., shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment) direct one-on-one contact, each 15 minutes | | 97542 | $24.49 | Wheelchair management ( e.g ., assessment, fitting, training), each 15 minutes | | 97545 | $117.41 | Work hardening/conditioning; initial two hours | | 97546 | $58.70 | Work hardening/conditioning; each additional hour (list separately in addition to code for primary procedure) (use in conjunction with 97545) | | Active Wound Care Management | | | | 97597 | $79.74 | Debridement ( e.g ., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound ( e.g ., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 square centimeters or less | | 97598 | $58.90 | Debridement ( e.g ., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound ( e.g ., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq. cm., or part thereof (list separately in addition to code for primary procedure) | | 97602 | IC | Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia ( e.g ., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session | | 97605 | $33.53 | Negative pressure wound therapy ( e.g ., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters | | 97606 | $39.90 | Negative pressure wound therapy ( e.g ., vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters | | Tests and Measurements | | | | 97750 | $26.46 | Physical performance test or measurement ( e.g. , musculoskeletal, functional capacity), with written report, each 15 minutes | | 97755 | $29.50 | Assistive technology assessment ( e.g ., to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 15 minutes | | Orthotic Management and Prosthetic Management | | | | 97760 | $37.43 | Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes | | 97761 | $32.57 | Prosthetic training, upper and/or lower extremity(s), each 15 minutes | | 97762 | $18.06 | Checkout for orthotic/prosthetic use, established patient, each 15 minutes | | Other Procedures | | | | 97799 | $19.82 | Unlisted physical medicine/rehabilitation service or procedure (each 15 minutes, maximum six units per visit) | | Evaluation and Management - Office or Other Outpatient Services | | | | 99203 | $85.74 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: - a detailed history; - a detailed examination; and - medical decision making of low complexity | | 99205 | $168.54 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components (written report required): - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity | | 99212 | $43.92 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: - a problem focused history; - a problem focused examination; and - straightforward medical decision making | | 99214 | $98.65 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components (written report required): - a detailed history; - a detailed examination; and - medical decision making of moderate complexity | | 99215 | $138.48 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components (written report required): - a comprehensive history; - a comprehensive examination; and - medical decision making of high complexity | | Caregiver Training Codes | | | | 97550 | $40.44 | Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community ( e.g ., activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; initial 30 minutes | | 97551 | $20.02 | Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community ( e.g ., activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face; each additional 15 minutes (Use 97551 in conjunction with 97550) | | 97552 | $17.51 | Group caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community ( e.g ., activities of daily living [ADLs], instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding, problem solving, safety practices) (without the patient present), face to face with multiple sets of caregivers |

(2) Hourly Rates for I.C. Designated Services, Special Contracts, and Unlisted Procedures. As a guideline, rates for restorative and rehabilitation center services for aquatic therapy, nautilus training, work evaluations/job site analysis, work hardening programs, and other unlisted services are determined by applying the appropriate portion of the hourly rate specified in 101 CMR 339.04(2). Diagnostic procedures that require specialized machinery, such as muscle testing during isometric and isokinetic exercises ( e.g ., use of cybex machine), should be reimbursed with consideration for additional equipment costs and technical assistance, in addition to the prorated hourly fee for therapists' services and routine overhead expenses.

| Rehabilitation Center Physical Therapist | $64.41/hr. | | --- | --- | | Rehabilitation Center Occupational Therapist | $64.41/hr. | | Rehabilitation Center Speech Therapist | $64.41/hr. | | Restorative Physical Therapy office visit | $64.41/hr. | | Restorative Occupational Therapy office visit | $64.41/hr. | | Restorative Speech Therapy office visit | $64.41/hr. | | Restorative Physical Therapy out-of-office visit | $74.07/hr. | | Restorative Occupational Therapy out-of-office visit | $74.07/hr. | | Restorative Speech Therapy out-of-office visit | $74.07/hr. |

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 339.05 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 339.06 Severability

The provisions of 101 CMR 339.00 are severable. If any provision of 101 CMR 339.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 339.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

Rates for Hospice Services Rates for Hospice Services

101 CMR, § 343.01 General Provisions

(1) Scope and Purpose. 101 CMR 343.00 governs the rates of payment used by all governmental units to eligible providers for hospice services provided to publicly aided individuals. The rates set forth in 101 CMR 343.00 also apply to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act).

(2) Applicable Dates of Service. Rates in 101 CMR 343.00 apply for dates of service provided on or after October 1, 2023, unless otherwise indicated.

(3) Disclaimer of Authorization of Services. 101 CMR 343.00 is not authorization for or approval of the services for which rates are determined pursuant to 101 CMR 343.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care and services extended to publicly aided clients.

(4) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list:

(a) codes for which the code numbers only changed, with a corresponding crosswalk;

(b) codes for which the code remains the same, but the description has changed;

(d) new codes that require new pricing. For such new codes, EOHHS applies individual consideration in reimbursement until appropriate rates can be developed.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify the substantive provisions of 101 CMR 343.00 and to notify interested parties of payment updates pursuant to 101 CMR 343.04(3)(b).

History

Amended by Mass Register Issue 1324, eff. 10/21/2016.

101 CMR, § 343.02 Definitions

A number of common words and expressions are specifically defined in 101 CMR 343.02. Whenever one of them is used in 101 CMR 343.00, it will have the meaning given in the definition, unless the context clearly requires a different meaning. When appropriate, definitions may include a reference to federal and state laws and regulations.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Compliant Rate. Hospice service rates for eligible providers that are in compliance with federal quality reporting requirements established in accordance with the Social Security Act, §§ 1814(i)(5)(A)(i).

Continuous Home Care. Care provided only during a period of crisis in which a patient requires continuous care, predominantly nursing care, at home to achieve palliation or management of acute medical symptoms. Homemaker and/or home health aide services may also be covered on a continuous basis. The continuous home care rate is paid on an hourly rate basis for each day, or portion thereof, that an individual qualifies for and receives such care. A minimum of eight hours must be provided in a 24-hour period to qualify for the continuous home care rate.

Eligible Provider. Any Medicare-certified organization licensed under state law as a provider of hospice services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

General Inpatient Care. Care provided in a participating hospice inpatient unit, hospital, or skilled nursing facility that additionally meets the Centers for Medicare & Medicaid Services (CMS) special hospice standards for staffing and patient areas. Services provided in an inpatient setting must conform to the written plan of care. General inpatient care may be required for procedures necessary for pain control or acute or chronic symptom management that cannot be managed in other settings.

Governmental Unit. The Commonwealth; any department, agency, board, or commission of the Commonwealth; and any political subdivision of the Commonwealth.

Hospice. A public agency or private organization or a subdivision of either that is providing care to terminally ill individuals and meets the Medicare conditions of participation specified in 42 CFR 418.52 through 418.116 for hospices. If it is a freestanding hospice that provides inpatient care directly, it must meet the conditions of 42 CFR 418.110.

(a) Core services (provided directly by hospice employees) include

nursing services;
physician services;
medical social services; and
counseling services.

(b) Supplemental services (may be on a contract basis) include

short-term inpatient care;
medical appliances and supplies, including drugs and biologicals;
home health aide and homemaker services;
physical therapy, occupational therapy, and speech-language; and

pathology services.

Inpatient Care Limitation. For Medicaid, the total payment to the hospice for inpatient care (general or respite) is subject to a limitation that total inpatient care days for all Medicaid patients for a 12-month period may not exceed 20% of total days for which all Medicaid patients have elected hospice care; however, days to be used by individuals with Acquired Immune Deficiency Syndrome (AIDS) are exempt from the number of inpatient care days counted toward the 20% limitation.

Inpatient Respite Care. Short-term inpatient care provided to the individual in an approved inpatient facility only when necessary to relieve the family members or other persons caring for that individual. Respite care may be provided only on an occasional basis and will be limited to no more than five consecutive days. Reimbursement for the sixth and any subsequent days is made at the routine home care rate.

Noncompliant Rate. Hospice service rates for eligible providers that are not in compliance with the federal quality reporting requirements established in accordance with the Social Security Act, §§ 1814(i)(5)(A)(i).

Publicly Aided Individual. A person who receives medical services for which a governmental unit is liable, in whole or in part, under a statutory program.

Room and Board. An additional per diem amount that equals at least 95% of the amount the Commonwealth would pay the facility for a non-hospice Medicaid beneficiary, for routine or continuous-care days in an intermediate care or skilled nursing facility. Room and board includes performance of personal care services, including assistance in activities of daily living, socializing activities, administration of medication, maintaining the cleanliness of a resident's room, and supervision and assistance in the use of durable medical equipment and prescribed therapies.

Routine Home Care (RHC). Payment for each day the patient is at home, under the care of the hospice, and not receiving continuous home care. There are two rates for RHC: one rate for days one through 60 and a lower rate for days greater than 60. Rates for RHC are paid without regard to the volume or intensity of RHC services provided on any day.

Routine Home Care (Days from One to 60). Payment for each day (one through 60 days) when the member has elected to receive hospice in their home and is not receiving continuous home care. This rate is paid without regard to the volume or intensity of RHC services provided on any day. A 60-day gap in hospice services is required to reset the counter that determines if a patient is qualified for the one through 60 payment category.

Routine Home Care (Days Greater than 60). Payment for each day (61+ days) when the member has elected to receive hospice in their home and is not receiving continuous home care. This rate is paid without regard to the volume or intensity of RHC services provided on any day.

Service Intensity Add-on (SIA). The SIA rate is an addition to the RHC rate, for a minimum of 15 minutes and up to four hours per day (excluding a social worker's phone calls), when all of the following criteria are met

(a) The day is a RHC level of care day;

(b) The RHC day occurs during the last seven days of the member's life, and the member is discharged deceased; and

Terminally Ill. The individual has a medical prognosis that their life expectancy is six months or less.

History

Amended by Mass Register Issue 1324, eff. 10/21/2016.

101 CMR, § 343.03 Filing and Reporting Requirements

(1) Cost Reporting. Providers must satisfy the applicable filing and reporting requirements of 957 CMR 6.00: Cost Reporting Requirements .

(2) Penalty for Noncompliance. The purchasing governmental unit may reduce the payment rates by 15% for any provider that fails to submit required information to the Center. The purchasing governmental unit will notify the provider in advance of its intention to impose a rate reduction.

History

Amended by Mass Register Issue 1324, eff. 10/21/2016.

101 CMR, § 343.04 General Rate Provisions

(1) Effect of 101 CMR 343.00. The rates of payment under 101 CMR 343.00 constitute full compensation for hospice services provided to publicly aided individuals, including necessary administration and professional supervision. These established rates of payment for authorized services, with the exception of payment for room and board, will be set in accordance with Centers for Medicare & Medicaid Services (CMS) regulation at 42 CFR 418.302.

(2) Rate Determination. Each payment rate is determined by CMS to reflect the cost incurred by a hospice in efficiently providing the core and supplemental services associated with that type of hospice care to Medicaid beneficiaries. The allowable Medicaid hospice rates are determined in accordance with 42 CFR 418.302. The Medicaid rates are determined by adding the unweighted amount to the wage component, as adjusted to reflect local differences in wages, in accordance with 42 CFR 418.306.

(3) Rates. Allowable rates for hospice services are outlined in 101 CMR 343.04(3)(a) and (b).

(a) Providers will be paid at the compliant or noncompliant rates established by CMS based on compliance with federal quality reporting requirements.

(b) If CMS amends the amounts listed in 42 CFR 418.306, the Medicaid rates will change accordingly. Said changes will be listed in an EOHHS administrative bulletin.

(c) For those hospice clients residing in nursing facilities, the per diem rate will equal 95% of the rate that would have been paid by the Commonwealth to a particular nursing facility for a non-hospice Medicaid beneficiary.

(d) Use modifier transmittal number TN for codes T2042 and T2043 when billing for members outside the county in which the provider is located.

(e) MassHealth-enrolled hospice providers located out of state must bill MassHealth using the TN modifier for all codes using the TN modifier. The rates of payment will be based on the rate applicable to the county in which the member resides. Absent use of the TN modifier, the rate of payment for hospice services provided by an out-of-state hospice provider is the lowest applicable rate listed in 101 CMR 343.04(3)(f).

(f) The rates of payment for authorized hospice services effective October 1, 2021, are the rates listed in 101 CMR 343.04(3)(f).

| Barnstable | Compliant Rate | Noncompliant Rate | | | | --- | --- | --- | --- | --- | | T2042 | Routine Home Care (one-60 days) | Per Diem | $237.32 | $228.12 | | T2042 UD | Routine Home Care (61+ days) | Per Diem | $187.34 | $180.07 | | G0299 (RN services) G0155 (Social Worker services) | Service Intensity Add-on | Per Hour/Max four hours | $71.61 | $68.84 | | T2043 | Continuous Home Care | Per Hour | $71.62 | $68.84 | | T2044 | Inpatient Respite | Per Diem | $576.71 | $554.33 | | T2045 | General Inpatient | Per Diem | $1,239.64 | $1,191.54 |

| Berkshire | Compliant Rate | Noncompliant Rate | | | | --- | --- | --- | --- | --- | | T2042 | Routine Home Care (one-60 days) | Per Diem | $223.82 | $215.14 | | T2042 UD | Routine Home Care (61+ days) | Per Diem | $176.68 | $169.82 | | G0299 (RN services) G0155 (Social Worker services) | Service Intensity Add-on | Per Hour/Max four hours | $67.02 | $64.42 | | T2043 | Continuous Home Care | Per Hour | $67.02 | $64.42 | | T2044 | Inpatient Respite | Per Diem | $546.20 | $525.00 | | T2045 | General Inpatient | Per Diem | $1,171.56 | $1,126.11 |

| Bristol | Compliant Rate | Noncompliant Rate | | | | --- | --- | --- | --- | --- | | T2042 | Routine Home Care (one-60 days) | Per Diem | $218.78 | $210.30 | | T2042 UD | Routine Home Care (61+ days) | Per Diem | $172.71 | $166.00 | | G0299 (RN services) G0155 (Social Worker services) | Service Intensity Add-on | Per Hour/Max four hours | $65.31 | $62.78 | | T2043 | Continuous Home Care | Per Hour | $65.31 | $62.78 | | T2044 | Inpatient Respite | Per Diem | $534.82 | $514.07 | | T2045 | General Inpatient | Per Diem | $1,146.18 | $1,101.71 |

| Essex/Middlesex | Compliant Rate | Noncompliant Rate | | | | --- | --- | --- | --- | --- | | T2042 | Routine Home Care (one-60 days) | Per Diem | $225.56 | $216.81 | | T2042 UD | Routine Home Care (61+ days) | Per Diem | $178.06 | $171.15 | | G0299 (RN services) G0155 (Social Worker services) | Service Intensity Add-on | Per Hour/Max four hours | $67.62 | $64.99 | | T2043 | Continuous Home Care | Per Hour | $67.62 | $64.99 | | T2044 | Inpatient Respite | Per Diem | $550.14 | $528.79 | | T2045 | General Inpatient | Per Diem | $1,180.36 | $1,134.56 |

| Franklin/Hampden/Hampshire | Compliant Rate | Noncompliant Rate | | | | --- | --- | --- | --- | --- | | T2042 | Routine Home Care (one-60 days) | Per Diem | $218.61 | $210.13 | | T2042 UD | Routine Home Care (61+ days) | Per Diem | $172.57 | $165.87 | | G0299 (RN services) G0155 (Social Worker services) | Service Intensity Add-on | Per Hour/Max four hours | $65.25 | $62.72 | | T2043 | Continuous Home Care | Per Hour | $65.25 | $62.72 | | T2044 | Inpatient Respite | Per Diem | $534.43 | $513.69 | | T2045 | General Inpatient | Per Diem | $1,145.31 | $1,100.87 |

| Norfolk/Plymouth/Suffolk | Compliant Rate | Noncompliant Rate | | | | --- | --- | --- | --- | --- | | T2042 | Routine Home Care (one-60 days) | Per Diem | $241.23 | $231.88 | | T2042 UD | Routine Home Care (61+ days) | Per Diem | $190.43 | $180.04 | | G0299 (RN services) G0155 (Social Worker services) | Service Intensity Add-on | Per Hour/Max four hours | $72.94 | $70.12 | | T2043 | Continuous Home Care | Per Hour | $72.95 | $70.12 | | T2044 | Inpatient Respite | Per Diem | $585.55 | $562.82 | | T2045 | General Inpatient | Per Diem | $1,259.35 | $1,210.48 |

| Worcester | Compliant Rate | Noncompliant Rate | | | | --- | --- | --- | --- | --- | | T2042 | Routine Home Care (one-60 days) | Per Diem | $229.20 | $220.31 | | T2042 UD | Routine Home Care (61+ days) | Per Diem | $180.93 | $173.91 | | G0299 (RN services) G0155 (Social Worker services) | Service Intensity Add-on | Per Hour/Max four hours | $68.85 | $66.18 | | T2043 | Continuous Home Care | Per Hour | $68.85 | $66.18 | | T2044 | Inpatient Respite | Per Diem | $558.36 | $536.69 | | T2045 | General Inpatient | Per Diem | $1,198.69 | $1,152.18 |

| Rural: Dukes and Nantucket | Compliant Rate | Noncompliant Rate | | | | --- | --- | --- | --- | --- | | T2042 | Routine Home Care (one-60 days) | Per Diem | $256.14 | $246.20 | | T2042 UD | Routine Home Care (61+ days) | Per Diem | $202.20 | $194.34 | | G0299 (RN services) G0155 (Social Worker services) | Service Intensity Add-on | Per Hour/Max four hours | $78.01 | $74.99 | | T2043 | Continuous Home Care | Per Hour | $78.02 | $74.99 | | T2044 | Inpatient Respite | Per Diem | $619.22 | $595.19 | | T2045 | General Inpatient | Per Diem | $1,334.47 | $1,282.69 |

Use modifier TN for T2042 and T2043 when billing for members outside the county in which the provider is located.

History

Amended by Mass Register Issue 1324, eff. 10/21/2016.

101 CMR, § 343.05 Severability

The provisions of 101 CMR 343.00 are severable. If any provisions or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 343.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1324, eff. 10/21/2016.

Rates for Temporary Nursing Services Rates for Temporary Nursing Services

101 CMR, § 345.01 General Purpose

(1) Scope and Purpose. 101 CMR 345.00 governs the rates paid by health-care providers to temporary nursing agencies registered with the Department of Public Health.

(2) Applicable Dates of Service. The rates contained in 101 CMR 345.00 apply for dates of service provided on or after October 1, 2021.

History

Amended by Mass Register Issue 1265, eff. 8/1/2014.

101 CMR, § 345.02 Definitions

As used in 101 CMR 345.00, terms have the meanings in 101 CMR 345.02.

Department. The Department of Public Health established under M.G.L. c. 111.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Fixed-term Employees. Employees who work exclusively at a particular health-care facility for a specified period of at least 90 days pursuant to a contract between the provider and a temporary nursing agency.

Governmental Unit. The Commonwealth, any department, agency, board, division, or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Health Service Area (HSA). Regional boundaries created for the purposes of health-care planning pursuant to P.L. 93-641. A list of the municipalities in each HSA is included in an appendix to 101 CMR 345.00.

Hospital. A hospital licensed under M.G.L. c. 111, § 51 including, but not limited to, an acute hospital, chronic hospital, rehabilitation hospital, or psychiatric hospital.

Medical Personnel. Registered nurses, licensed practical nurses, and certified nursing assistants, associated with a temporary nursing agency. All such medical personnel are employees unless the agency demonstrates that they should be treated as independent contractors.

Nursing Facility. A nursing or convalescent home; an infirmary maintained in a town; a charitable home for the aged, as defined in M.G.L. c. 111, § 71; or a nursing facility operating under a hospital license issued by the Department pursuant to M.G.L. c. 111, and certified by the Department for participation in MassHealth. It includes facilities that operate a licensed residential-care unit within the nursing facility.

Overtime. Per hour of care in excess of 40 hours per week or eight hours per day, as defined in an agreement between the health-care facility and the agency.

Price. The total amount per hour charged by the agency for a specific service to the provider.

Registered Nurse Specialist. A registered nurse with advanced nursing knowledge and clinical skills acquired through an appropriate nursing education program in accordance with 244 CMR 4.00: Advanced Practice Registered Nursing including, but not limited to, an operating room nurse, clinical nurse specialist, intensive-care unit nurse, coronary-care unit nurse, and infectioncontrol nurse.

Related Party. An individual or organization associated or affiliated with, or that has control of, or is controlled by, the agency; or is related to the agency or any director, stockholder, trustee, partner, or administrator of the agency by common ownership or control or in a manner specified in §§ 267(b) and (c) of the Internal Revenue Code of 1954, provided, however, that 10% is the operative factor as set out in §§ 267(b)(2) and (3). Related individuals include spouses, parents, children, spouses of children, grandchildren, siblings, fathers-in-law, mothers-in-law, brothers-in-law, and sisters-in-law.

Temporary Nursing Agency (Agency). An agency is defined in accordance with the provisions of 105 CMR 157.010: Scope and Applicability . It includes any person, firm, corporation, partnership, or association registered with the Department that is engaged for hire in the business of procuring or providing temporary employment in health-care facilities for medical personnel, referred to as "nursing pools" in M.G.L. c. 111, § 72Y. Each separate location of the business of an agency registered with the Department is an agency. An agency does not include a medical personnel staff arrangement set up by a health-care facility solely for its own use in which the only costs are the salaries paid to such medical personnel; or an individual who engages only in providing his or her own services on a temporary basis to health-care facilities.

Travel Nurse Employees. Nurses employed by temporary nursing agencies who are required to move to temporary housing to provide services with rate limits established by 101 CMR 345.00 and for whom such agencies cover costs that must include temporary housing costs, but which also may include other costs including, but not necessarily limited to, meals.

History

Amended by Mass Register Issue 1265, eff. 8/1/2014.

101 CMR, § 345.03 Rate Provisions

(1) General. All prices are per hour. An agency's price for a service provided to a nursing facility or hospital may not exceed the maximum price set forth in 101 CMR 345.03(2) or (3). Rates vary by health service area (HSA). The location of the nursing facility or hospital determines the maximum price that may be charged.

(a) Holidays. Rates for holidays may not exceed 150% of the maximum prices set forth in 101 CMR 345.03(2) or (3). An agency and the purchasing nursing facility or hospital may define the specific times for each shift and the days that constitute holidays in the written agreement for services as required by 105 CMR 157.220: Written Agreements .

(b) Overtime. An agency and a nursing facility or hospital may agree to an overtime differential to be added to a maximum service price to compensate an employee for overtime hours worked.

(d) 12-hour Shift. An agency and a nursing facility or hospital may agree to a single price per hour for services provided during a 12-hour shift. The price per hour cannot exceed the weighted average of the combined maximum prices for the applicable shifts as set forth in 101 CMR 345.03(2) or (3). For example, an RN in HSA 1 providing weekday services at a nursing facility from 7:00 A.M. to 7:00 P.M. could be billed at a single rate of $72.45, using eight hours at $71.03 and four hours at $75.29. (Example calculation: 8 x $71.03 + 4 x $75.29 = $869.40. $869.40/12 = $72.45.)

(e) Travel Nurse Factor. For temporary nursing services provided at nursing facilities or hospitals that are performed by travel nurse employees, agencies may charge, and nursing facilities and hospitals may purchase, temporary nursing services performed by such travel nurse employees at a factor of 19.7% above the rate limits established in 101 CMR 345.03.

(2) Maximum Prices, Nursing Facilities.

(a) Registered Nurse (RN) - Nursing Facility.

| Shift | HSA 1 Western | HSA 2 Central | HSA 3 Merrimack Valley | HSA 4 Greater Boston | HSA 5 Southeastern | HSA 6 North Shore | | --- | --- | --- | --- | --- | --- | --- | | Weekday 1 | $71.03 | $68.84 | $69.49 | $71.37 | $69.80 | $70.51 | | Weekday 2 | $75.29 | $73.10 | $73.75 | $75.63 | $74.06 | $74.76 | | Weekday 3 | $77.42 | $75.22 | $75.88 | $77.76 | $76.18 | $76.89 | | Weekend 1 | $76.35 | $74.16 | $74.81 | $76.69 | $75.12 | $75.83 | | Weekend 2 | $78.48 | $76.29 | $76.94 | $78.82 | $77.25 | $77.96 | | Weekend 3 | $78.48 | $76.29 | $76.94 | $78.82 | $77.25 | $77.96 |

(b) Licensed Practical Nurse (LPN) - Nursing Facility.

| Shift | HSA 1 Western | HSA 2 Central | HSA 3 Merrimack Valley | HSA 4 Greater Boston | HSA 5 Southeastern | HSA 6 North Shore | | --- | --- | --- | --- | --- | --- | --- | | Weekday 1 | $60.06 | $58.77 | $59.93 | $63.24 | $61.28 | $63.15 | | Weekday 2 | $64.32 | $63.03 | $64.19 | $67.50 | $65.54 | $67.41 | | Weekday 3 | $66.44 | $65.15 | $66.32 | $69.63 | $67.67 | $69.54 | | Weekend 1 | $65.38 | $64.09 | $65.25 | $68.57 | $66.60 | $68.47 | | Weekend 2 | $67.51 | $66.22 | $67.38 | $70.69 | $68.73 | $70.60 | | Weekend 3 | $67.51 | $66.22 | $67.38 | $70.69 | $68.73 | $70.60 |

| Shift | HSA 1 Western | HSA 2 Central | HSA 3 Merrimack Valley | HSA 4 Greater Boston | HSA 5 Southeastern | HSA 6 North Shore | | --- | --- | --- | --- | --- | --- | --- | | Weekday 1 | $32.43 | $32.86 | $33.45 | $33.33 | $32.89 | $34.00 | | Weekday 2 | $34.56 | $34.99 | $35.58 | $35.46 | $35.02 | $36.12 | | Weekday 3 | $35.62 | $36.06 | $36.64 | $36.53 | $36.08 | $37.19 | | Weekend 1 | $35.62 | $36.06 | $36.64 | $36.53 | $36.08 | $37.19 | | Weekend 2 | $36.69 | $37.12 | $37.70 | $37.59 | $37.14 | $38.25 | | Weekend 3 | $37.22 | $37.65 | $38.24 | $38.12 | $37.68 | $38.78 |

(3) Maximum Prices, Hospitals.

(a) Registered Nurse (RN) - Hospital.

| Shift | HSA 1 Western | HSA 2 Central | HSA 3 Merrimack Valley | HSA 4 Greater Boston | HSA 5 Southeastern | HSA 6 North Shore | | --- | --- | --- | --- | --- | --- | --- | | Weekday 1 | $96.76 | $102.35 | $100.28 | $105.00 | $100.21 | $100.08 | | Weekday 2 | $106.81 | $112.40 | $110.33 | $115.05 | $110.27 | $110.13 | | Weekday 3 | $110.49 | $116.08 | $114.01 | $118.73 | $113.94 | $113.81 | | Weekend 1 | $107.16 | $112.75 | $110.68 | $115.40 | $110.61 | $110.48 | | Weekend 2 | $110.99 | $116.57 | $114.51 | $119.23 | $114.44 | $114.31 | | Weekend 3 | $112.74 | $118.32 | $116.26 | $120.98 | $116.19 | $116.06 |

(b) Registered Nurse Specialist (RN-Specialist) - Hospital .

| Shift | HSA 1 Western | HSA 2 Central | HSA 3 Merrimack Valley | HSA 4 Greater Boston | HSA 5 Southeastern | HSA 6 North Shore | | --- | --- | --- | --- | --- | --- | --- | | Weekday 1 | $106.75 | $108.12 | $111.73 | $113.62 | $103.50 | $109.16 | | Weekday 2 | $131.09 | $132.46 | $136.07 | $137.97 | $127.84 | $133.51 | | Weekday 3 | $134.60 | $135.96 | $139.58 | $141.47 | $131.34 | $137.01 | | Weekend 1 | $133.21 | $134.58 | $138.19 | $140.08 | $129.96 | $135.63 | | Weekend 2 | $134.19 | $135.55 | $139.16 | $141.06 | $130.93 | $136.60 | | Weekend 3 | $135.87 | $137.24 | $140.85 | $142.74 | $132.62 | $138.29 |

| Shift | HSA 1 Western | HSA 2 Central | HSA 3 Merrimack Valley | HSA 4 Greater Boston | HSA 5 Southeastern | HSA 6 North Shore | | --- | --- | --- | --- | --- | --- | --- | | Weekday 1 | $63.35 | $61.66 | $63.93 | $64.24 | $65.47 | $62.72 | | Weekday 2 | $71.66 | $69.96 | $72.24 | $72.54 | $73.77 | $71.02 | | Weekday 3 | $73.91 | $72.21 | $74.48 | $74.79 | $76.02 | $73.27 | | Weekend 1 | $72.37 | $70.67 | $72.95 | $73.25 | $74.49 | $71.73 | | Weekend 2 | $75.53 | $73.83 | $76.11 | $76.41 | $77.65 | $74.89 | | Weekend 3 | $76.33 | $74.63 | $76.91 | $77.21 | $78.45 | $75.69 |

(d) Certified Nurse Aide (CNA) - Hospital.

| Shift | HSA 1 Western | HSA 2 Central | HSA 3 Merrimack Valley | HSA 4 Greater Boston | HSA 5 Southeastern | HSA 6 North Shore | | --- | --- | --- | --- | --- | --- | --- | | Weekday 1 | $35.76 | $35.31 | $36.03 | $36.61 | $36.10 | $37.26 | | Weekday 2 | $44.32 | $43.87 | $44.59 | $45.17 | $44.66 | $45.82 | | Weekday 3 | $46.18 | $45.73 | $46.45 | $47.03 | $46.52 | $47.68 | | Weekend 1 | $45.53 | $45.08 | $45.81 | $46.38 | $45.87 | $47.03 | | Weekend 2 | $49.58 | $49.13 | $49.85 | $50.42 | $49.92 | $51.08 | | Weekend 3 | $50.38 | $49.93 | $50.65 | $51.22 | $50.72 | $51.88 |

(4) Rates for Temporary Nursing Services Related to COVID-19. Temporary nursing services related to COVID-19 may be purchased by governmental units at individually considered rates that exceed the maximum rates established in 101 CMR 345.00, and governmental units may enter into contracts for the provision of these services in alternate service locations other than a hospital or nursing facility. A governmental unit, in its sole discretion, may determine whether a rate above the maximum rates established in 101 CMR 345.00 is necessary and appropriate, as well as the appropriate rate for services provided in a service location other than a hospital or nursing facility.

History

Amended by Mass Register Issue 1265, eff. 8/1/2014.

101 CMR, § 345.04 General Rate Provisions

(1) The rates determined in accordance with 101 CMR 345.00 are full compensation for temporary nursing services rendered to a nursing facility or hospital, including any related administrative or supervising duties provided by the agency in connection with patient care.

(2) An agency may charge a nursing facility or hospital less than the rate determined by 101 CMR 345.00.

(3) An agency may not bill, receive payments, or propose to do business with a nursing facility or hospital at a rate greater than the rate established by EOHHS, and such acts constitute an unfair or deceptive act or practice in violation of M.G.L. c. 93A. If an agency violates this requirement, EOHHS or the nursing facility or hospital may

(a) notify the Department, which may seek to suspend or revoke the agency's registration, or take other action as appropriate, in accordance with the provisions of 105 CMR 157.000: The Registration and Operation of Temporary Nursing Service Agencies ; or

(b) request that the Attorney General bring an action against the agency pursuant to its enforcement of M.G.L. c. 93A or take further action to restrain or prevent the agency from operating.

History

Amended by Mass Register Issue 1265, eff. 8/1/2014.

101 CMR, § 345.05 Reporting Requirements

(1) Temporary Nursing Service Cost Report. Each agency must complete and file a Temporary Nursing Service Cost Report with EOHHS or its designee each calendar year.

(a) EOHHS will issue an administrative bulletin to inform providers of the issuance of the cost report and the due date for filing the cost report. The cost report will be issued at least 45 days prior to the due date.

(b) Agencies that employ only fixed-term employees are not required to file a Temporary Nursing Service Cost Report. Such agencies must file a certified or audited financial statement with EOHHS or its designee annually, due no later than the required due date of the Temporary Nursing Service Cost Report.

(2) Employee Records . Each agency that provides the services of a fixed-term employee or travel nurse employee must maintain records documenting that such employees in its employ who provide these services meet criteria for fixed-term employees or travel nurse employees pursuant to 101 CMR 345.00, and must make such records available to EOHHS, the Department, or the purchasing governmental unit upon request. Providers are required to maintain such documentation concerning fixed-term employees and travel nurse employees for a period of two years following the expiration of the contract concerning such employees.

(3) Additional Information. Each agency must make available all records, books, and reports relating to its operation including such data and statistics as EOHHS or its designee may request.

(4) Extension of Filing Date. EOHHS or its designee may grant a request for an extension of the filing due date for a maximum of 15 calendar days. In order to receive an extension, the agency must demonstrate exceptional circumstances that prevent the agency from meeting the deadline and file the request no later than the filing due date.

(5) Audit. Agencies are subject to the duties and responsibilities set forth in M.G.L. c. 12C, § 22, whether or not receiving payment from a governmental unit. All information submitted by an agency is subject to audit. An agency must maintain supporting documentation sufficient to demonstrate compliance with all provisions of 101 CMR 345.00.

(6) Failure to File Information. If an agency fails to file timely and complete information required by EOHHS or its designee, including cost reports and supporting documentation, EOHHS may notify the Department and request revocation of such agency's registration.

History

Amended by Mass Register Issue 1265, eff. 8/1/2014.

101 CMR, § 345.06 Transfer of Ownership

All issues related to the transfers of ownership including, but not limited to, merger, acquisition, or name change, are governed by the Department regulations set forth in 105 CMR 157.000: The Registration and Operation of Temporary Nursing Service Agencies .

History

Amended by Mass Register Issue 1265, eff. 8/1/2014.

101 CMR, § 345.07 Severability

The provisions of 101 CMR 345.00 are severable. If any such provisions or the application of such provisions to any eligible provider or circumstances are held invalid or unconstitutional, such invalidity will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 345.00 or the application of such provisions to eligible providers or circumstances other than those held invalid.

History

Amended by Mass Register Issue 1265, eff. 8/1/2014.

101 CMR, § 346.01 General Provisions

(1) Scope. 101 CMR 346.00 governs the payment rates for certain substance-related and addictive disorders services purchased by a governmental unit. The rates for health care services set forth in 101 CMR 346.00 also apply to individuals covered by the Workers' Compensation Act, M.G.L. c. 152.

(2) Applicable Dates of Service. Rates contained in 101 CMR 346.00 apply for dates of service provided on or after July 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 346.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 346.00. Governmental units that purchase the services described in 101 CMR 346.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list

(a) codes for which only the code numbers change, with the corresponding cross references between existing and new codes;

(b) deleted codes for which there are no corresponding new codes; and

(c) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (IC) reimbursement for these codes until appropriate rates can be developed.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 346.00.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 346.02 Definitions

As used in 101 CMR 346.00, unless the context requires otherwise, terms have the meanings in 101 CMR 346.02.

Acute Treatment Provider (ATP). An eligible provider of acute treatment services.

Acute Treatment Services (Inpatient). Those medically managed and/or monitored acute intervention and stabilization services that provide supervised detoxification to individuals in acute withdrawal from alcohol or other drugs and address the biopsychosocial problems associated with alcoholism and other drug addictions requiring a 24-hour supervised inpatient stay.

Approved Program Rate. The rate per service unit approved by EOHHS and filed with the Secretary of the Commonwealth.

Case Consultation. A meeting with a professional of another agency to resolve treatment issues or to exchange other relevant client information. Case consultation may be billed only for face-to-face meetings that are necessary as a result of the inability or inappropriateness of other forms of communication, such as telephone and letter. Such circumstances and services must be documented in the client's record and be available as part of any record audit that the purchasing agency may perform.

Case Management. Services, as specified by the MassHealth program, that coordinate the substance-related and addictive disorders treatment of pregnant individuals with other medical and community services that are critical to the needs of the individual and their pregnancy. Case management is billable only for individuals enrolled in the Day Treatment Program. Service is limited to one hour per week per enrollee, provided in no less than 15-minute increments.

Child Enhancement for Residential Rehabilitation Services. A supplemental rate to reflect the costs of young children who may be accompanying their parents in the program.

Client. An individual that receives substance-related and addictive disorders services purchased by a governmental unit.

Client Resources. Revenue received in cash or in kind from publicly assisted clients to defray all or a portion of the cost of program services. Client resources may include payments made by publicly assisted clients to defray the room and board expense of residential services, clients' food stamps, or payments made by clients according to their ability to pay or a sliding fee scale.

Clinical Case Management Master's Level. Individualized case management provided as part of a clinical outpatient service that facilitates ongoing engagement in community-based treatment and recovery services; links to community resources such as housing, employment, education, and health care; and facilitates access to mainstream benefits and includes evidence-based models that integrate clinical treatment and case management services.

Clinical Case Management Non-master's Level. Individualized case management provided as part of a clinical outpatient service that facilitates ongoing engagement in community-based treatment and recovery services; links to community resources such as housing, employment, education, and health care; and facilitates access to mainstream benefits.

Clinically Managed Detoxification Services. Medical assessment, intensive counseling, and case management services to clients who are not intoxicated or have been safely withdrawn from alcohol or other drugs or are addicted to a drug that does not require medical withdrawal. These clients require a 24-hour supervised inpatient stay to address the acute emotional, behavioral, or biomedical distress resulting from an individual's use of alcohol or other drugs. This level of service includes four hours of nursing services seven days a week. These services are governed by the Massachusetts Department of Public Health at 105 CMR 164.100: 24-hour Diversionary Services .

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Couple Counseling. Therapeutic counseling provided to a couple whose primary complaint or concern is disruption of their relationship or family due to substance-related and addictive disorders.

Day Treatment. A highly structured day treatment program for substance-related and addictive disorders that meets the service criteria set forth by the Massachusetts Department of Public Health pursuant to 105 CMR 164.231 through 164.234 and by MassHealth. A day treatment program operates at least 3½ hours per day, five days per week.

Driver Alcohol Education. The program of services, provided through licensed outpatient substance-related and addictive disorders counseling programs, legislated by M.G.L. c. 90, § 24D to first offender drunk drivers adjudicated in Massachusetts courts.

Educational/Motivational Session. A meeting between staff of a driver alcohol education program and not more than 15 clients. Clients are required to participate in 32 hours of this interactive group programming through 16 two-hour groups.

Enhanced Acute Treatment Services. A program that is medically managed and/or monitored acute intervention and stabilization services, provides supervised detoxification to dually diagnosed individuals in acute withdrawal from alcohol or other drugs, and addresses the mental health needs and biopsychosocial problems associated with alcoholism and other drug addictions requiring a 24-hour supervised inpatient stay.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Established Charge. The lowest fee that is charged or accepted as payment by the provider to the general public or any third-party payer, other than a governmental unit, for the provision of services. Fees based upon the client's ability to pay, as in the case of a sliding fee scale, and fees subject to EOHHS review and approval are not established charges.

Extraordinary Circumstances/Flex Funding. A method whereby a purchasing governmental unit may provide resource allocations to a client and/or provider for specific support services in order to address extraordinary circumstances.

Family Counseling. The therapeutic counseling of more than one member of a family at the same time in the same session, where the primary complaint or concern is disruption of the family due to substance-related and addictive disorders.

Family Residential Treatment Service. A structured and comprehensive rehabilitative environment in programs ranging in size from 11 to 16 family units. Such services support a resident's recovery from alcohol and/or other drug problems, support the family's recovery from the effects of substance-related and addictive disorders, and encourage movement toward independence.

Family Supportive Housing Program. A transitional sober living environment for families recovering from substance-related and addictive disorders that assists and supports families in their recovery to achieve self-sufficiency and independent living. This is achieved through

(a) case management services within an alcohol- and drug-free living environment that supports the active search for permanent housing and employment and reinforces recovery; and

(b) establishing community-based supports to maintain ongoing goals in the recovery process.

Federally Qualified Health Centers (FQHCs) Office Based Opioid Treatment (OBOT). Community-based programs offering medication-assisted treatment (MAT) options in Federally Qualified Health Centers (FQHCs), community health centers (CHCs), or entities fully licensed under 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs , 105 CMR 130.000: Hospital Licensure , or 105 CMR 140.000: Licensure of Clinics who are in good standing.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Group Counseling. Therapeutic counseling to an unrelated group of people having a common problem or concern that is associated with substance-related and addictive disorders.

Individual Assessment Session. A meeting between a clinician and a client to explore the client's current and past substance-related and addictive disorders, psychosocial history, and motivation for change and to make recommendations for an appropriate level of care for treatment. Full assessment documentation is required.

Individual Consideration (IC). Payment rates for certain services are designated as individual consideration (IC). Where IC rates are designated, the purchasing governmental unit will determine the appropriate payment as the actual cost of the item or service as evidenced by invoice, published tuition amount, or other price reasonably obtained by a competitive market for the product or service.

Individual Counseling. A therapeutic meeting between the staff of an eligible provider and an individual whose primary complaint or concern is their substance-related and addictive disorder or that of a significant other.

In-home Therapy. A therapeutic counseling service for substance-related and addictive disorders provided in the home by a clinician. In-home therapy is allowed when specific barriers to accessing services at a clinic site are identified for the client. The need for in-home therapy is reassessed at least every 90 days.

Jail Diversion. A continuum of services prescribed by the courts as an alternative to jail. The first phase consists of approximately three months in a 24-hour, structured, therapeutic, semi-secure residential setting. Evidence-based treatment services are provided to address resistance to care, co-occurring disorders, and criminogenic issues, and prepare individuals to engage in ongoing substance-related and addictive disorders treatment. In the second phase, a case manager is assigned to each client for approximately nine months to assist the client's transition to community treatment and ancillary services.

Medically Monitored Inpatient Detoxification Services. Acute detoxification and related treatment services provided to individuals whose current or potential withdrawal symptoms constitute a risk to the patient's health and well-being and require medical monitoring. These services are governed by the Massachusetts Department of Public Health at 105 CMR 164.100: 24-hour Diversionary Services .

Medical Services Visit. A medical services visit to an opioid treatment program includes medical assessment, medical case management, and dispensing of medication to opiate-addicted individuals who require support of opioid substitution therapy, as noted in the Department of Public Health's standard RFR program description of Opioid Treatment Programs and pursuant to 105 CMR 164.302: Authority to Operate an Opioid Treatment Program and 164.303: Inspections .

Office-based Opioid Treatment (OBOT). These programs provide medically monitored treatment services for clients who are addicted to opiate drugs such as heroin or pain medications in a primary care setting. Services combine medical and pharmacological interventions with case management and supportive services. Services are offered on both a short- and long-term basis.

Office-based Opioid Treatment (OBOT) Wraparound Services. Services that provide administrative support to OBOT programs and case management services to individuals who are participating in an OBOT program utilizing medication-assisted treatment (MAT).

Operating Agency. An individual, group, partnership, corporation, trust, or other legal entity that operates a program.

Opioid Treatment. Medically monitored treatment services for opiate-addicted clients that combine medical and pharmacological interventions with professional counseling, education, and vocational services. Services are offered on both a short-term (detoxification) and long-term (treatment) basis. Any individuals who are addicted to opiate drugs and are medically screened as appropriate are eligible.

P4P Eligible Provider (P4PEP). A provider that provides a pay for performance (P4P) eligible service.

P4P Eligible Service. A substance-related and addictive disorders treatment class of services, such as transitional support services or acute treatment services, that has been identified by the purchasing governmental unit as eligible for participation in a P4P program.

Pay for Performance (P4P). A value-based purchasing program implemented by a purchasing governmental unit to pay providers to perform activities related to improving the quality of care delivered to clients.

Postpartum Enhancement for Residential Rehabilitation and Co-occurring Enhanced Residential Rehabilitation Services. A supplemental rate to cover the additional staffing and other costs necessary to meet the needs of postpartum individuals and their infants in the program.

Pregnant Enhancement for Residential Rehabilitation and Co-occurring Enhanced Residential Rehabilitation Services. A supplemental rate to cover the additional staffing and other costs necessary to meet the needs of pregnant individuals in the program.

Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been adopted by a purchasing governmental unit.

Psycho-educational Group. An educational group that provides intervention and motivation for individuals who may need substance-related and addictive disorders treatment/intervention services or who are family members of those in need of addiction treatment services.

Publicly Assisted Client. A person who receives program services for which a governmental unit is liable, in whole or in part, under a statutory program of financial assistance.

Purchasing Governmental Unit. A governmental unit that has purchased or is purchasing service units from an eligible provider.

Recovery Coaching. A non-clinical service provided by a trained recovery advocate who provides guidance and coaching for individuals to meet their recovery goals.

Recovery Support Centers (RSC). A service that provides a broad range of supports that can help individuals build a stable life in recovery. The RSCs provide peer-to-peer recovery support to individuals in recovery from substance use disorder, as well as serving families and loved ones affected by addiction. RSCs support multiple pathways, provide hope, promote wellness, and assist clients in building capital and developing their own unique individual, social, and community support, to help prevent relapse and promote long-term recovery from alcohol, opioids, and other addictions.

Related Party. A person or organization that is associated or affiliated with, has control of, or is controlled by the operating agency or any director, stockholder, partner, or administrator of the operating agency by common ownership or control or in a manner specified in §§ 267(b) and (c) of the Internal Revenue Code of 1954; provided, however, that 10% is the operative factor as set out in §§ 267(b)(2) and (3) and provided further that the definition of "family members" found in § 267(c)(4) includes the following for the purpose of 101 CMR 346.00:

(a) husband and wife;

(b) natural parent, child, and sibling;

(d) stepparent and stepchild;

(e) father-in-law, mother-in-law, sister-in-law, brother-in-law, son-in-law, and daughter-inlaw; and

(f) grandparent and grandchild.

Reporting Year. The operating agency's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR), normally July 1^st to June 30^th.

Residential Rehabilitation. The program of services defined as organized substance-related and addictive disorders treatment and education services featuring a planned program of care in a 24-hour residential setting. These services are provided to clients who require safe and stable living environments in order to develop their recovery skills. Types of residential rehabilitation services are those designed for adult individuals, adults with their families, adolescents, and driving-under-the-influence second offenders pursuant to the Massachusetts Department of Public Health at 105 CMR 164.000: Licensure of Substance Use DisorderTreatment Programs .

Residential Rehabilitation Co-occurring Enhanced. The program of services defined as organized substance-related and addictive disorders treatment and education services featuring a planned program of care in a 24-hour residential setting for individuals with a moderate-to-severe substance use and mental health disorder. These services are provided to clients in a safe, structured, and developmentally appropriate environment. This specialized program offers appropriate psychiatric and substance use treatment services, including medication evaluation and laboratory services. These services are provided on-site and as appropriate to the severity and urgency of the patient's mental condition.

School-based Targeted Prevention. Developmentally focused, competency-enhancement programs targeting six- through 12-year-old elementary/middle school students who are at risk for early development of conduct problems, emotional dysregulation, or substance use. Program components may include needs assessment, case management, case consultation, individual counseling, psychoeducation groups, parent education and skills training, after-school and summer activities, education services, mentoring, and contingency management.

Second Offender Driver Alcohol Education Residential Rehabilitation. The program of services described in M.G.L. c. 90, § 24 and provided through licensed residential counseling programs to driving-under-the-influence second offenders.

Substance-related and Addictive Disorders Outpatient Counseling. The services defined by the Massachusetts Department of Public Health at 105 CMR 164.200: Outpatient Services .

Supportive Case Management. A program for individuals and families residing in recovery-focused transitional and permanent housing settings that includes care coordination, recovery support, housing stabilization, and facilitated access to mainstream benefits, especially primary health care. There are seven services for supportive case management: Permanent Adult, Permanent Families, Permanent Y oung Adults, Transitional Adults, Transitional Families, Transitional Young Adults, and Low Threshold.

Telephone Recovery Support. A telephone support service provided by a counselor who is trained in an evidence-based model of telephone recovery support.

Transitional Support Services. Residential case management services provided to bridge the gap between detoxification and residential rehabilitation and/or community ambulatory aftercare services. This level of service includes four hours of nursing services seven days a week.

Transitional Support Services with Special Programming for Women. Residential case management services provided to bridge the gap between detoxification and residential rehabilitation and/or community ambulatory aftercare services, and that focus on the unique needs of women; are structured in a smaller residential setting (16 versus 36 beds); and offer more intensive services (more counseling and smaller staff/client ratio).

Treatment for Civilly Committed Persons Add-on. An enhanced level of care that includes transportation, extra medical, psychiatric, recovery specialist care, family counseling, and additional administrative staff for the intake for all civilly committed persons in the Commonwealth. May be purchased in addition to medically monitored detoxification services, clinically managed detoxification services, and transitional support services for individuals who have been civilly committed by a district court of the Commonwealth, under M.G.L. c. 123, § 35.

Triage, Engagement, and Assessment Program. The Triage, Engagement, and Assessment (TEA) Program (formerly known as Substance Abuse Shelters for Individuals, or SASI) has as its focused populations homeless and chronically homeless adults active in their addiction who are under the influence at the point of contact with the program. Individuals are assessed, engaged, and stabilized with the intention of moving them into the substance use disorder continuum of care to provide treatment and to access permanent housing. The TEA program provides a specialized setting for these individuals who often present as behaviorally difficult to manage due to active substance use and are often inappropriate (and frequently ineligible) for non-specialized shelter settings. Individuals in the TEA program setting are treated with respect in a caring, judgment-free environment.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 346.03 Filing and Reporting Requirements

(1) Reporting for Annual Review. Unless exempted in 101 CMR 346.03, each operating agency must, on or before the 15^th day of the fifth month after the end of its fiscal year, submit to EOHHS

(a) a copy of its Uniform Financial Statements and Independent Auditor's Report completed in accordance with the filing requirements of the Operational Services Division, Executive Office for Administration and Finance; and

(b) a supplemental program questionnaire, if requested by EOHHS.

(3) General Provisions.

(b) Examination of Records. Each operating agency must make available all records relating to its operation and all records relating to a realty service or related party or holding company or any entity in which there may be a common ownership or interrelated directorate upon request of EOHHS for examination.

(c) Field Audits. EOHHS may conduct a field audit. EOHHS will make reasonable attempts to schedule an audit at the mutual convenience of both parties.

(4) Additional Information Requested by EOHHS. Each operating agency must file such additional information as EOHHS may require no later than 21 days after the date of mailing of that written request. If EOHHS's request for the additional information and/or documentation is not fully satisfied through the submission of written explanation(s) and/or documentation within 21 days of the mailing of that request, all costs relative to that request will be excluded from rate development by EOHHS.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 346.04 Rate Provisions

(1) Services Included in the Rate. The approved rate includes payment for all care and services that are part of the program of services of an eligible provider, as explicitly set forth in the terms of the purchase agreement between the eligible provider and the purchasing governmental unit(s).

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other sources will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate, except as provided in 101 CMR 346.04(2) and (6).

(4) Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 346.04(5). Refer to purchasers' manuals for special coding instructions and limitations on the number of units.

| Code | Rate | Description | | --- | --- | --- | | Inpatient Services | | | | H0010 | $438.61 | Alcohol and/or drug services; subacute detoxification (residential addiction program inpatient) (Clinically Managed Detoxification Services) | | H0011 | $568.09 | Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (Medically Monitored Inpatient Detoxification Services Facility) | | H0011-H9 | $39.44 | Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (court ordered) (Treatment for Civilly Committed Persons Add-on) | | Residential Services | | | | H0018 | $228.58 | Behavioral health; short-term residential (nonhospital residential treatment program), per diem (Transitional Support Services) | | H0018-H9 | $191.29 | Behavioral health; short-term residential (nonhospital residential treatment program), per diem (court ordered) (Second Offender-driver Alcohol Education Residential) | | H0019 | $179.04 | Alcohol and/or drug abuse halfway house services, per diem (Residential Rehabilitation), without room and board | | H0019-TH | $43.77 | Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (pregnant/parenting individuals' program) (Pregnant Enhancement for Residential Rehabilitation and Co-occurring Enhanced Residential Rehabilitation) | | H0019-HD | $99.83 | Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (obstetrical treatment/services, prenatal or postpartum) (Postpartum Enhancement for Residential Rehabilitation and Co-occurring Enhanced Residential Rehabilitation) | | H0019-HV | $49.92 | Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (Residential Rehabilitation Child Enhancement) | | H0019-H9 | $265.77 | Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (court ordered) (Jail Diversion-Phase I) | | H0006-H9 | $72.84 | Alcohol and/or drug services; case management (court ordered) (Jail Diversion-Phase II, per hour) |

| H0019-HR | $249.31 | Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (family/couple with client present) (Family Supportive Housing) | | --- | --- | --- | | H0019-HR | $412.17 | Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (substance abuse program) (Family Residential Treatment) | | H0047-HR | $64.11 | Alcohol and/or drug abuse services, not otherwise specified (family/couple with client present) (Family Residential 2^nd Partner Enhancement, per diem ) | | H0019-HH | $363.13 | Alcohol and/or drug abuse halfway house services, per diem (Residential Rehabilitation Co-occurring Enhanced for 16 beds) | | Opioid Treatment Services | | | | Medical Services Visit | | | | H0020 | $11.26 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) (dose only visit) | | Counseling | | | | H0004-TF | $20.11 | Behavioral health counseling and therapy, per 15 minutes (opioid individual counseling, intermediate level of care, four units maximum per day) | | H0005-HQ | $17.64 | Alcohol and/or drug services; group counseling by a clinician (group setting) (per 45 minutes, opioid group counseling, one unit maximum per day) | | H0005-HF | $35.28 | Alcohol and/or drug services; group counseling by a clinician (per 90-minute unit) (one unit maximum per day) | | T1006-HR | $40.52 | Alcohol and/or substance abuse services, family/couple counseling (family/couple with client present) (opioid family/couples counseling, per 30 minutes, one unit maximum per day) | | T1006-HG | $81.04 | Alcohol and/or substance abuse services, family/couple counseling (family/couple with client present) (opioid family/couples counseling, per 60 minutes, one unit maximum per day) | | Ambulatory Services | | | | Outpatient Counseling | | | | 90882-HF | $57.85 | Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions (substance abuse program) (Consultation with another professional or involved party to clarify and coordinate the treatment of an individual receiving substance-related and addictive disorders treatment services, case consultation, per 30 minutes) | | H0001 | $28.94 | Alcohol and/or drug assessment (per 15 minutes) | | H0004 | $28.94 | Behavioral health counseling and therapy, per 15 minutes (individual counseling) | | H0005 | $26.04 | Alcohol and/or drug services; group counseling by a clinician (per 45 minutes, group counseling, one unit maximum per day) | | H0005-HG | $52.09 | Alcohol and/or drug services group counseling by a clinician (methadone/opioid counseling) (per 90-minute unit) (one unit maximum per day) |

| T1006 | See 101 CMR 306.00: Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers (code 90847) | Alcohol and/or substance abuse services; family/couple counseling (per 30 minutes, one unit maximum per day) | | --- | --- | --- | | T1006-HF | See 101 CMR 306.00: Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers (code 90847) | Alcohol and/or substance abuse services; family/couple counseling (per 60 minutes, one unit maximum per day) | | H2015-HF | $15.88 | Comprehensive community support services, per 15 minutes (substance abuse program) (Telephone Recovery support service by a counselor trained in evidence-based model) | | H2019-HF | $24.05 | Therapeutic behavioral services, per 15 minutes (substance abuse program) (in-home counseling by a clinician) | | H2027 | $4.64 | Psychoeducational service, per 15 minutes (Educational and motivational nonclinical group, per client) | | H2016-HM | $19.70 | Comprehensive community support program, per diem (Enrolled Client Day) (recovery support service by a recovery advocate trained in Peer Recovery Coaching) | | Clinical Case Management | | | | H0006-HO | $28.94 | Alcohol and/or drug services; case management (Substance-related and addictive disorders service by master's level clinician that uses an evidence-based model that integrates clinical and case management services, per 15 minutes) | | H0006-HN | $18.21 | Alcohol and/or drug services; case management (Substance-related and addictive disorders service by non-master's level counselor to engage and link client to treatment and community resources, per 15 minutes) | | H0001-H9 | $28.94 | Alcohol and/or drug assessment (court ordered) (per 15 minutes) | | H0004-H9 | $28.94 | Behavioral health counseling and therapy, per 15 minutes (court ordered) (individual counseling) | | H0005-H9 | $8.68 | Alcohol and/or drug services; group counseling by a clinician (court ordered) (per 15 minutes) | | Day Treatment | | | | H2012-HF | $104.44 | Behavioral health day treatment (substance abuse program) (3.5 hours) | | Outpatient Services | | | | H0004-HD | $28.94 | Behavioral health counseling and therapy, per 15 minutes (pregnant/parenting women's program) (individual counseling) | | H0005-HD | $26.04 | Alcohol and/or drug services; group counseling by a clinician (pregnant/parenting women's program) (per 45 minutes, group counseling, one unit maximum per day) | | H0005-TH | $52.09 | Alcohol and/or drug services group counseling by a clinician (pregnant/parenting women's program) (per 90-minute unit) (one unit maximum per day) | | H0006-HD | $18.21 | Alcohol and/or drug services; case management (pregnant/parenting women's program) (per 15 minutes) |

| Outpatient Services | | | | --- | --- | --- | | T1006-HD | See 101 CMR 306.00: Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers (code 90847) | Alcohol and/or substance abuse services; family/couple counseling (pregnant/parenting women's program) (per 30 minutes, one unit maximum per day | | T1006-TH | See 101 CMR 306.00: Rates for Mental Health Services Provided in Community Health Centers and Mental Health Centers (code 90847) | Alcohol and/or substance abuse services; family/couple counseling (pregnant/parenting women's program) (per 60 minutes, one unit maximum per day) | | Day Treatment | | | | H1005 | $104.44 | Prenatal care, at-risk enhanced service package (includes H1001-H1004) (prenatal care, at-risk enhanced service, antepartum management, care coordination, education, follow-up home visit, individual counseling, per hour) | | H1005-HQ | $104.44 | Prenatal care, at-risk enhanced service package (includes H1001-H1004) (group setting) (prenatal care, at-risk enhanced service, antepartum management, care coordination, education, follow-up home visit, day treatment, per 3.5 hours) |

| Supportive Case Management Services | | | | --- | --- | --- | | Unit | Rate | Service | | Enrolled Client Day | $16.49 | Adult Housing Stability Support | | Enrolled Client Day | $33.18 | Family Housing Stability Support | | Enrolled Client Day | $43.82 | Youth Housing Stability Support | | Month | $3,316 | House Manager Add-on | | Month | $4,573 | Outreach and Staffing Supports | | Enrolled Client Day | $58.14 | Low Threshold | | N/A | I.C. | Extraordinary Circumstances/Flex Funding | | Month | $20,194 | School-based Targeted Prevention Program |

| Program | Model | Unit | Base Rate | Engagement Staffing Rate | Engagement Staffing Rate, Day Program only | | --- | --- | --- | --- | --- | --- | | Triage, Engagement, and | A | Monthly per slot | $1,112 | $630 | $324 | | Assessment Services | B | Monthly per slot | $1,337 | $816 | $515 |

| Triage, Engagement, and Assessment Services Add-on Rates | Unit | Rate | | --- | --- | --- | | Peer Service Coordinator Add-on Rate | Hourly | $26.09 | | Social Worker LCSW Add-on Rate | Hourly | $46.58 | | Care Coordinator Add-on Rate | Hourly | $26.09 | | Direct Care Staff Add-on Rate | Hourly | $26.09 | | Support Staff Add-on Rate | Hourly | $26.09 |

| Service | Unit | Monthly Rate | | --- | --- | --- | | Federally Qualified Health Centers (FQHCs) Services | Per Client | $66.69 | | Office-based Opioid Treatment Programs (OBOTs) Outpatient Clinic Services | Per Client | $86.60 | | Office-based Opioid Treatment Programs (OBOTs) Hospital Services | Per Client | $178.77 |

| Service | Level | Monthly Rate | | --- | --- | --- | | Federally Qualified Health Centers (FQHCs) Start-up | Level 1 | $9,915 | | Level 2 | $14,516 | |

| Service | Tier | Monthly Rate | | --- | --- | --- | | Recovery Support Centers | Tier 1 | $39,489 | | Tier 2 | $49,072 | | | Tier 3 | $59,844 | |

| Recovery Support Center Add-on Rates | FTE | Monthly Rate | | --- | --- | --- | | Direct Service Staff Add-on Rate | 1.0 | $4,131 | | Direct Service Staff Add-on Rate | 0.5 | $2,066 | | Recovery Coach Specialist Staff Add-on Rate | 1.0 | $5,168 | | Recovery Coach Specialist Staff Add-on Rate | 0.5 | $2,584 |

(6) Pay for Performance ('P4P) Incentive Payments. Subject to a purchasing governmental unit's determination of the availability of funds, P4P providers receive incentive payments through the Pay for Performance (P4P) Program as defined by the purchasing governmental unit and as follows.

(a) Performance Indicators. Each performance indicator is calculated to produce aggregate numbers that will be used to establish baseline information, attainment thresholds, and performance benchmarks, relative to the distribution of P4P eligible providers. Performance indicator rates are calculated by dividing the numerator by the denominator for each measure to obtain a percentage. A measure's denominator is the number of clients served by a P4P eligible provider who are eligible for the performance measure and the numerator is the subset of the denominator who meet the measure's specific performance criteria.

(b) Payment Eligibility. To be eligible for payment for a performance indicator, a P4P eligible provider must

be an eligible provider as of a certain date, the date to be established by the purchasing governmental unit on an annual basis; and
have a minimum number (minimum to be established by the purchasing governmental unit) of clients who must meet specific performance indicator criteria during the date range for which performance is being measured.

(c) Performance Score. For each performance indicator for which the P4P eligible provider is eligible per 101 CMR 346.04(6), P4P eligible providers will earn points for either achieving a benchmark or for improving their performance over their previous year's performance. Points will be awarded to a P4P eligible provider for each indicator, according to the methodologies in 101 CMR 346.04(6)(c).

Attainment Points. P4P eligible providers may earn points based on where the P4P eligible provider's performance falls, relative to the attainment threshold and to the benchmark set for each performance indicator. The attainment threshold is set at the median of all P4P eligible providers' performance rates. The benchmark is set at the 75^th percentile of all P4P eligible providers' performance rates. P4P eligible providers will receive attainment points between the range of zero and ten for each performance indicator, as noted in 101 CMR 346.04(6)(c).

a. If a P4P eligible provider's performance rate is below the attainment threshold, it will receive zero attainment points.

b. If a P4P eligible provider's performance rate is greater than or equal to the benchmark, it will receive ten attainment points.

c. If a P4P eligible provider's performance rate is below the benchmark, but at or above the attainment threshold, the P4P eligible provider will receive anywhere from one to up to but less than ten attainment points, as calculated using the following formula.

P4P Eligible Provider's Attainment Points = Click to view image

Improvement Points. P4P eligible providers may earn improvement points if the P4P eligible provider has demonstrated improvement from its previous year's performance rate. The P4P eligible provider's improvement points will be calculated based on the following formula.

P4P Eligible Provider's Improvement Points =

Click to view image

P4P Eligible Provider Awarded Points. For each performance indicator, the awarded points are the higher of the attainment or improvement points earned by the P4P eligible provider. In no event will the number of points awarded exceed ten for each performance indicator. Each performance indicator's awarded points are then summed across all the indicators a P4P eligible provider is eligible for to determine the total awarded points for a P4P eligible provider.

Click to view image

P4P Eligible Provider Potential Points. The total potential points for a P4P eligible provider is determined by multiplying the number of performance indicators the P4P eligible provider is eligible for ( see 101 CMR 346.04(6)) by the maximum number of points per performance indicator (10).

Click to view image

P4P Eligible Provider Performance Score. The P4P eligible provider's performance score reflects a percentage between 0% and 100%. The P4P eligible provider awarded points is divided by the P4P eligible provider potential points to obtain the P4P eligible provider performance score based on the following formula.

Click to view image

(d) Per Client Payment Amount. The per client payment amount is determined as follows. The per client payment amount is determined by dividing the aggregate dollar figure determined by the purchasing governmental unit(s) to be available for incentive payments by the statewide adjusted clients calculated as described below.

Click to view image

Statewide Adjusted Clients. The statewide adjusted clients figure is calculated by summing over all P4P eligible providers, each P4P eligible provider's adjusted clients number.

Click to view image

P4P Eligible Provider Adjusted Clients. Each P4P eligible provider's number of clients served during the measurement period is multiplied by the P4P eligible provider's performance score to derive the "adjusted clients" figure.

(e) P4P Eligible Provider Total Performance Indicator Payment Amount. A P4P eligible provider's performance indicator incentive payment is calculated as the product of

the P4P eligible provider's performance score calculated as per 101 CMR 346.04(6)(c);
the number of P4P eligible provider clients served during the measurement period; and
the per client payment amount that is calculated as per 101 CMR 346.04(6)(d).

P4P Eligible Provider Total Performance Indicator Payment Amount = (P4P Eligible Provider Performance Score) x (number of P4P Eligible Provider clients served) x (Per Client Payment Amount)

(7) Publicly Assisted Client Mix Factor for Certain Services with Rates Established at 101 CMR 346.00. The publicly assisted client mix factor described in 101 CMR 346.04(7) is effective for dates of service on and after January 1, 2024, and applies as described in 101 CMR 346.04(7)(a) through (d).

(a) Calculation of Publicly Assisted Client Mix. The publicly assisted client mix is an individual provider's bed days attributable to publicly assisted clients divided by the total bed days for clinically managed detoxification services and medically monitored inpatient detoxification services described at 101 CMR 346.04(7)(c) and expressed as a percentage of publicly assisted client bed days. For the purposes of 101 CMR 346.04(7), "bed day" means a date of service, or portion thereof, during which a service recipient is inpatient and on which the provider furnishes the inpatient services described at 101 CMR 346.04(7)(c).

(b) Applicable Provider Rate. The applicable rate for each provider of services described at 101 CMR 346.04(7)(c) is based on each provider's publicly assisted client mix calculated in accordance with 101 CMR 346.04(7)(a) and as determined by EOHHS. Applicable provider rates are as follows:

Base Rate: the rate established at 101 CMR 346.04(5)
Tier 1 Rate: the base rate multiplied by a publicly assisted client mix factor of 1.10
Tier 2 Rate: the base rate multiplied by a publicly assisted client mix factor of 1.15

(c) Rates for Certain Inpatient Services Subject to Publicly Assisted Client Mix Factor. The publicly assisted client mix factors with associated applicable provider rates described at 101 CMR 346.04(7)(b) apply to the following inpatient services with rates established at 101 CMR 346.04(5):

H0011 (medically monitored inpatient detoxification services facility); and
H0010 (clinically managed detoxification services).

(d) Administrative Bulletins. EOHHS may issue administrative bulletins to establish the period and source of data used by EOHHS to determine the publicly assisted client mix in accordance with 101 CMR 346.04(7)(a); the criteria for the applicable provider rate, including the publicly assisted client mix that is attributable to each applicable provider rate in accordance with 101 CMR 346.04(7)(b); and to clarify substantive provisions of 101 CMR 346.04(7).

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 346.05 Severability

The provisions of 101 CMR 346.00 are severable. If any provision of 101 CMR 346.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 346.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

Rates for Freestanding Ambulatory Surgery Center Services Rates for Freestanding Ambulatory Surgery Center Services

101 CMR, § 347.01 General Provisions

(1) Scope and Purpose. 101 CMR 347.00 governs the rates of payment to eligible freestanding ambulatory surgery centers (FASCs) to be used by all governmental units for services provided to publicly aided individuals. Rates for services provided to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act), are not set forth in 101 CMR 347.00, but are at 114.3 CMR 40.00: Rates for Services Under M.G.L. c. 152, Workers' Compensation Act .

(2) Applicable Dates of Service. Rates contained in 101 CMR 347.00 apply for dates of service provided on or after February 2, 2024, unless otherwise indicated.

(3) Coverage. 101 CMR 347.00 and the rates of payment contained in 101 CMR 347.00 are full compensation for facility services furnished in connection with surgical procedures that can be performed safely on an ambulatory basis in an FASC, are within the scope of covered services, and meet the purchasing governmental unit's conditions of payment for such facility services. Payment from any other sources will be used to offset the amount of the purchasing governmental unit's obligation for such services rendered to publicly aided individuals. 101 CMR 347.00 does not cover professional services that are billed by a physician, dentist, or podiatrist separately from the surgery center and who receives no other compensation for the professional services rendered. Covered freestanding ambulatory surgery center services do not include services performed in a hospital-based facility or medical, dental, or podiatric surgical procedures that are customarily performed in an office setting.

(4) Disclaimer of Authorization of Services. 101 CMR 347.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 347.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of the care and services extended to publicly aided individuals.

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's CPT 2023 Professional Edition . The publication of such updates and corrections will list

(b) deleted codes for which there are no corresponding new codes;

(c) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) reimbursement for these codes until appropriate rates can be developed, unless 101 CMR 347.01(5)(d) is applied; and

(d) for entirely new codes that require new pricing and that have Medicare rates, EOHHS may list these codes and price them according to the rate methodology used in setting FASC facility component rates.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, to clarify its policy on and understanding of substantive provisions of 101 CMR 347.00, and otherwise as specified in 101 CMR 347.00.

History

Adopted by Mass Register Issue 1379, eff. 11/30/2018.

101 CMR, § 347.02 Definitions

The terms used in 101 CMR 347.00 have the meanings set forth in 101 CMR 347.02, unless the context requires otherwise. The five-digit codes included in 101 CMR 347.00 utilize the Healthcare Common Procedural Coding System (HCPCS) for Level I and Level II coding.

Level 1 CPT-4 codes are obtained from the American Medical Association's CPT 2023 Professional Edition , unless otherwise specified. Level II codes are obtained from the 2023 HCPCS maintained jointly by the Centers for Medicare and Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and the Health Insurance Association of America. HCPCS is a listing of descriptive terms and identifying codes and two-digit modifiers for reporting medical services and procedures performed by physicians and other healthcare professionals, as well as associated non-physician services. 101 CMR 347.00 includes only HCPCS numeric and alpha-numeric identifying codes and modifiers for reporting medical services and procedures that were selected by EOHHS. Any use of CPT outside the fee schedule should refer to the American Medical Association's CPT 2023 Professional Edition . For code descriptions, see the FASC service code spreadsheet at:

www.mass.gov/regulations/101-CMR-34700-rates-for-freestanding-ambulatory-surgery-center-services.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Eligible Provider. A licensed FASC that meets the conditions of participation adopted by a governmental unit, and to the extent specified by such governemental unit.

Facility Component. Rate of payment for an FASC's facility costs. The facility component does not include payment for a physician's, dentist's, or podiatrist's services in performing a surgical procedure.

Freestanding Ambulatory Surgery Center (FASC). A distinct entity that operates exclusively for the purpose of providing surgical services that do not require the availability of hospital facilities, is licensed by the Massachusetts Department of Public Health (or, if out-of-state, the applicable licensing authority of that state), and meets the conditions for payment by the governmental unit for facility services.

Governmental Unit. The Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

Individual Consideration (I.C.). Freestanding ambulatory surgery center services that are authorized but not listed in 101 CMR 347.00, FASC services performed in unusual circumstances, and services whose fees are designated by the letters "I.C." are individually considered items. The governmental unit or purchaser analyzes the eligible provider's operative report, which must contain a diagnosis, a pertinent medical history, a description of the services rendered, and the length of time spent with the patient. In making the determination of whether the service is appropriately classified as an individually considered item, and in determining appropriate payment for services designated as I.C., the governmental unit considers standards and criteria including the following, subject to any documentation requirements of the governmental unit:

(a) policies, procedures, and practices of other third-party purchasers of care, both governmental and private;

(b) the severity and complexity of the patient's disorder or disability;

(d) time, degree of skill, and cost including equipment cost required to perform the procedure(s).

Modifiers. Listed services may be modified under certain circumstances. When applicable, the modifying circumstances must be identified by the addition of the appropriate two-digit number or letters to the service code.

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Separate Procedure. Some of the listed procedures are commonly carried out as an integral part of a total service and as such, do not warrant a separate identification. When, however, such a procedure is performed independently of, and is not immediately related to, other services, it may be listed as a separate procedure in the service description. Thus, when a procedure that is ordinarily a component of a larger procedure is performed alone for a specific purpose, it may be considered to be a separate procedure.

History

Adopted by Mass Register Issue 1379, eff. 11/30/2018.

101 CMR, § 347.03 General Rate Provisions and Payment

(1) Rate Determination. Rates of payment for authorized FASC services to which 101 CMR 347.00 applies are the lowest of

(a) the eligible provider's usual fee to the general public;

(b) the eligible provider's actual charge submitted; and

(2) Maximum Allowable Rates. Rates of payment are for the facility component only. The maximum allowable payment rate for each FASC service is listed next to the HCPCS code in the fee schedule set forth in 101 CMR 347.03(6). Service codes listed in 101 CMR 347.03(6) with $0 rates are packaged services for which no separate payment is made.

(3) Individual Consideration and Nonlisted Services. Rates of payment to eligible providers for FASC services that are authorized but not listed in 101 CMR 347.00, services performed in unusual circumstances, and services whose fees are designated by the letters "I.C." are determined on an individual consideration basis.

(4) Terminated Procedures. The purchasing governmental unit determines payment on an individual consideration (I.C.) basis for any procedure that has been terminated after the procedure has been initiated.

(5) Modifiers.

(a) -50: Bilateral Procedure. Unless otherwise identified in the listings, bilateral procedures that are performed at the same session should be identified by adding the modifier 50 to the appropriate five-digit code. (Only one claim line is billed for both procedures. If a reimbursable surgical procedure provided in a single operative session is performed bilaterally, the full maximum fee is 150% of the payment group contained in 101 CMR 347.00 for the operative procedure.)

(b) -51: Multiple Procedures. When multiple procedures, other than E/M services, physical medicine and rehabilitation services or provision of supplies ( e.g ., vaccines), are performed at the same session by the same individual, the primary procedure or services may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). Note: This modifier should not be appended to designated "add-on" codes. (The addition of the modifier -51 to the second and subsequent service codes allows 50% of the allowable fee contained in 101 CMR 347.00 to be paid to the eligible provider.)

(c) -73: Discountinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia. Due to extenuating circumstances or those that threaten the well-being of the patient, the physician may cancel a surgical or diagnostic procedure subsequent to the patient's surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia (local, regional block(s), or general). Under these circumstances, the intended service that is prepared for, but cancelled, can be reported by its usual service code and the addition of the modifier -73. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported.

(d) -74: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia. Due to extenuating circumstances or those that threaten the well-being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started ( e.g. , incision made, intubation started, scope inserted). Under these circumstances, the procedure started, but terminated, can be reported by its usual service code and the addition of the modifier -74. Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported.

(e) Modifiers for Provider Preventable Conditions. Modifiers for reporting "provider preventable conditions" that are National Coverage Determinations, in accordance with 42 CFR 447.26, are listed in 101 CMR 347.03(5)(e).

(6) Fee Schedule: Surgical Services. For code descriptions, see the FASC service code spreadsheet at:

www.mass.gov/regulations/101-CMR-34700-rates-for-freestanding-ambulatory-surgery-center-services.

| Code | Fee | Description ( see FASC services code spreadsheet at www.mass.gov/regulations/101-CMR-34700-rates-for-freestanding-ambulatory-surgery-center-services ) | | --- | --- | --- | | 10004 | $0.00 | | | 10005 | $63.81 | | | 10006 | $0.00 | | | 10007 | $197.56 | | | 10008 | $0.00 | | | 10009 | $262.00 | | | 10010 | $0.00 | | | 10011 | $262.00 | | | 10012 | $0.00 | | | 10021 | $50.31 | | | 10030 | $262.00 | | | 10035 | $0.00 | | | 10036 | $0.00 | | | 10040 | $0.00 | | | 10060 | $64.12 | | | 10061 | $98.17 | | | 10080 | $140.50 | | | 10081 | $177.31 | | | 10120 | $90.81 | | | 10121 | $489.93 | | | 10140 | $93.56 | | | 10160 | $70.86 | | | 10180 | $845.19 | | | 11000 | $29.15 | | | 11001 | $0.00 | | | 11010 | $262.00 | | | 11011 | $262.00 | | | 11012 | $845.19 | | | 11042 | $137.23 | | | 11043 | $213.47 | | | 11044 | $489.93 | | | 11045 | $0.00 | | | 11046 | $0.00 | | | 11047 | $0.00 | | | 11055 | $0.00 | | | 11056 | $0.00 | | | 11057 | $49.39 | | | 11102 | $64.42 | | | 11103 | $0.00 | | | 11104 | $75.05 | | | 11105 | $0.00 | | | 11106 | $98.78 | | | 11107 | $0.00 | | | 11200 | $0.00 | | | 11201 | $0.00 | | | 11300 | $0.00 | | | 11301 | $0.00 | | | 11302 | $0.00 | | | 11303 | $0.00 | | | 11305 | $0.00 | | | 11306 | $0.00 | | | 11307 | $75.05 | | | 11308 | $0.00 | | | 11310 | $73.63 | | | 11311 | $75.05 | | | 11312 | $94.49 | | | 11313 | $104.61 | | | 11400 | $78.53 | | | 11401 | $89.57 | | | 11402 | $97.86 | | | 11403 | $106.14 | | | 11404 | $489.93 | | | 11406 | $489.93 | | | 11420 | $75.46 | | | 11421 | $88.66 | | | 11422 | $98.17 | | | 11423 | $106.45 | | | 11424 | $489.93 | | | 11426 | $845.19 | | | 11440 | $86.20 | | | 11441 | $96.93 | | | 11442 | $104.92 | | | 11443 | $116.26 | | | 11444 | $489.93 | | | 11446 | $845.19 | | | 11450 | $845.19 | | | 11451 | $845.19 | | | 11462 | $845.19 | | | 11463 | $845.19 | | | 11470 | $845.19 | | | 11471 | $845.19 | | | 11600 | $115.65 | | | 11601 | $128.84 | | | 11602 | $137.23 | | | 11603 | $149.09 | | | 11604 | $262.00 | | | 11606 | $489.93 | | | 11620 | $115.96 | | | 11621 | $129.15 | | | 11622 | $140.19 | | | 11623 | $153.99 | | | 11624 | $489.93 | | | 11626 | $845.19 | | | 11640 | $119.33 | | | 11641 | $133.14 | | | 11642 | $145.72 | | | 11643 | $159.52 | | | 11644 | $489.93 | | | 11646 | $845.19 | | | 11719 | $0.00 | | | 11720 | $0.00 | | | 11721 | $0.00 | | | 11730 | $0.00 | | | 11732 | $0.00 | | | 11740 | $0.00 | | | 11750 | $84.36 | | | 11755 | $65.34 | | | 11760 | $213.47 | | | 11762 | $158.90 | | | 11765 | $0.00 | | | 11770 | $845.19 | | | 11771 | $845.19 | | | 11772 | $845.19 | | | 11900 | $0.00 | | | 11901 | $0.00 | | | 11920 | $105.53 | | | 11921 | $116.88 | | | 11922 | $0.00 | | | 11950 | $39.58 | | | 11951 | $50.92 | | | 11952 | $65.65 | | | 11954 | $72.70 | | | 11960 | $1,278.72 | | | 11970 | $2,382.86 | | | 11971 | $845.19 | | | 11976 | $64.12 | | | 11980 | $0.00 | | | 11981 | $0.00 | | | 11982 | $0.00 | | | 11983 | $0.00 | | | 12001 | $0.00 | | | 12002 | $0.00 | | | 12004 | $0.00 | | | 12005 | $137.23 | | | 12006 | $137.23 | | | 12007 | $75.05 | | | 12011 | $0.00 | | | 12013 | $0.00 | | | 12014 | $0.00 | | | 12015 | $75.05 | | | 12016 | $137.23 | | | 12017 | $137.23 | | | 12018 | $75.05 | | | 12020 | $213.47 | | | 12021 | $137.23 | | | 12031 | $137.23 | | | 12032 | $137.23 | | | 12034 | $137.23 | | | 12035 | $137.23 | | | 12036 | $213.47 | | | 12037 | $696.96 | | | 12041 | $137.23 | | | 12042 | $137.23 | | | 12044 | $213.47 | | | 12045 | $213.47 | | | 12046 | $137.23 | | | 12047 | $696.96 | | | 12051 | $137.23 | | | 12052 | $137.23 | | | 12053 | $137.23 | | | 12054 | $137.23 | | | 12055 | $137.23 | | | 12056 | $137.23 | | | 12057 | $137.23 | | | 13100 | $213.47 | | | 13101 | $213.47 | | | 13102 | $0.00 | | | 13120 | $213.47 | | | 13121 | $213.47 | | | 13122 | $0.00 | | | 13131 | $137.23 | | | 13132 | $213.47 | | | 13133 | $0.00 | | | 13151 | $213.47 | | | 13152 | $213.47 | | | 13153 | $0.00 | | | 13160 | $696.96 | | | 14000 | $696.96 | | | 14001 | $696.96 | | | 14020 | $696.96 | | | 14021 | $696.96 | | | 14040 | $696.96 | | | 14041 | $696.96 | | | 14060 | $696.96 | | | 14061 | $696.96 | | | 14301 | $1,278.72 | | | 14302 | $0.00 | | | 14350 | $696.96 | | | 15002 | $696.96 | | | 15003 | $0.00 | | | 15004 | $213.47 | | | 15005 | $0.00 | | | 15040 | $696.96 | | | 15050 | $213.47 | | | 15100 | $696.96 | | | 15101 | $0.00 | | | 15110 | $696.96 | | | 15111 | $0.00 | | | 15115 | $696.96 | | | 15116 | $0.00 | | | 15120 | $1,278.72 | | | 15121 | $0.00 | | | 15130 | $696.96 | | | 15131 | $0.00 | | | 15135 | $1,278.72 | | | 15136 | $0.00 | | | 15150 | $696.96 | | | 15151 | $0.00 | | | 15152 | $0.00 | | | 15155 | $1,278.72 | | | 15156 | $0.00 | | | 15157 | $0.00 | | | 15200 | $696.96 | | | 15201 | $0.00 | | | 15220 | $696.96 | | | 15221 | $0.00 | | | 15240 | $696.96 | | | 15241 | $0.00 | | | 15260 | $696.96 | | | 15261 | $0.00 | | | 15271 | $696.96 | | | 15272 | $0.00 | | | 15273 | $1,278.72 | | | 15274 | $0.00 | | | 15275 | $696.96 | | | 15276 | $0.00 | | | 15277 | $696.96 | | | 15278 | $0.00 | | | 15570 | $696.96 | | | 15572 | $1,278.72 | | | 15574 | $696.96 | | | 15576 | $696.96 | | | 15600 | $1,278.72 | | | 15610 | $696.96 | | | 15620 | $696.96 | | | 15630 | $696.96 | | | 15650 | $696.96 | | | 15730 | $1,278.72 | | | 15731 | $1,278.72 | | | 15733 | $1,278.72 | | | 15734 | $1,278.72 | | | 15736 | $696.96 | | | 15738 | $1,278.72 | | | 15740 | $696.96 | | | 15750 | $1,278.72 | | | 15760 | $696.96 | | | 15769 | $1,278.72 | | | 15770 | $1,278.72 | | | 15771 | $1,278.72 | | | 15773 | $696.96 | | | 15775 | $137.23 | | | 15776 | $137.23 | | | 15777 | $0.00 | | | 15780 | $481.00 | | | 15781 | $262.00 | | | 15782 | $321.79 | | | 15783 | $137.23 | | | 15786 | $0.00 | | | 15787 | $0.00 | | | 15788 | $0.00 | | | 15789 | $213.47 | | | 15792 | $0.00 | | | 15793 | $0.00 | | | 15819 | $696.96 | | | 15820 | $696.96 | | | 15821 | $696.96 | | | 15822 | $696.96 | | | 15823 | $696.96 | | | 15824 | $696.96 | | | 15825 | $1,278.72 | | | 15826 | $1,278.72 | | | 15828 | $1,278.72 | | | 15829 | $1,278.72 | | | 15830 | $1,864.28 | | | 15832 | $845.19 | | | 15833 | $845.19 | | | 15834 | $845.19 | | | 15835 | $845.19 | | | 15836 | $845.19 | | | 15837 | $845.19 | | | 15838 | $845.19 | | | 15839 | $845.19 | | | 15840 | $1,278.72 | | | 15841 | $1,278.72 | | | 15842 | $696.96 | | | 15845 | $1,278.72 | | | 15847 | $0.00 | | | 15851 | $213.47 | | | 15852 | $0.00 | | | 15860 | $0.00 | | | 15876 | $1,278.72 | | | 15877 | $1,278.72 | | | 15878 | $696.96 | | | 15879 | $1,278.72 | | | 15920 | $845.19 | | | 15922 | $1,278.72 | | | 15931 | $845.19 | | | 15933 | $845.19 | | | 15934 | $1,278.72 | | | 15935 | $1,278.72 | | | 15936 | $696.96 | | | 15937 | $696.96 | | | 15940 | $845.19 | | | 15941 | $845.19 | | | 15944 | $1,278.72 | | | 15945 | $696.96 | | | 15946 | $696.96 | | | 15950 | $489.93 | | | 15951 | $845.19 | | | 15952 | $696.96 | | | 15953 | $1,278.72 | | | 15956 | $696.96 | | | 15958 | $1,278.72 | | | 16000 | $0.00 | | | 16020 | $0.00 | | | 16025 | $75.05 | | | 16030 | $137.23 | | | 16035 | $137.23 | | | 17000 | $0.00 | | | 17003 | $0.00 | | | 17004 | $91.72 | | | 17106 | $137.23 | | | 17107 | $213.47 | | | 17108 | $300.32 | | | 17110 | $0.00 | | | 17111 | $0.00 | | | 17250 | $0.00 | | | 17260 | $0.00 | | | 17261 | $0.00 | | | 17262 | $0.00 | | | 17263 | $0.00 | | | 17264 | $112.28 | | | 17266 | $123.62 | | | 17270 | $75.05 | | | 17271 | $75.05 | | | 17272 | $0.00 | | | 17273 | $110.74 | | | 17274 | $124.85 | | | 17276 | $137.23 | | | 17280 | $0.00 | | | 17281 | $96.02 | | | 17282 | $107.98 | | | 17283 | $122.09 | | | 17284 | $134.67 | | | 17286 | $160.44 | | | 17311 | $213.47 | | | 17312 | $0.00 | | | 17313 | $213.47 | | | 17314 | $0.00 | | | 17315 | $0.00 | | | 17340 | $0.00 | | | 17360 | $0.00 | | | 17380 | $213.47 | | | 19000 | $66.26 | | | 19001 | $0.00 | | | 19020 | $489.93 | | | 19030 | $0.00 | | | 19081 | $489.93 | | | 19082 | $0.00 | | | 19083 | $489.93 | | | 19084 | $0.00 | | | 19085 | $489.93 | | | 19086 | $0.00 | | | 19100 | $489.93 | | | 19101 | $950.67 | | | 19105 | $950.67 | | | 19110 | $950.67 | | | 19112 | $950.67 | | | 19120 | $950.67 | | | 19125 | $950.67 | | | 19126 | $0.00 | | | 19281 | $0.00 | | | 19282 | $0.00 | | | 19283 | $0.00 | | | 19284 | $0.00 | | | 19285 | $0.00 | | | 19286 | $0.00 | | | 19287 | $0.00 | | | 19288 | $0.00 | | | 19294 | $0.00 | | | 19296 | $3,549.47 | | | 19297 | $0.00 | | | 19298 | $1,864.28 | | | 19300 | $950.67 | | | 19301 | $950.67 | | | 19302 | $1,864.28 | | | 19303 | $1,864.28 | | | 19307 | $2,047.63 | | | 19316 | $1,864.28 | | | 19318 | $1,864.28 | | | 19325 | $2,277.55 | | | 19328 | $950.67 | | | 19330 | $950.67 | | | 19340 | $1,864.28 | | | 19342 | $2,277.55 | | | 19350 | $950.67 | | | 19355 | $950.67 | | | 19357 | $3,981.15 | | | 19370 | $950.67 | | | 19371 | $950.67 | | | 19380 | $1,864.28 | | | 19396 | $950.67 | | | 20103 | $262.00 | | | 20150 | $1,093.32 | | | 20200 | $489.93 | | | 20205 | $845.19 | | | 20206 | $489.93 | | | 20220 | $489.93 | | | 20225 | $489.93 | | | 20240 | $845.19 | | | 20245 | $845.19 | | | 20250 | $1,093.32 | | | 20251 | $2,382.86 | | | 20500 | $56.44 | | | 20501 | $0.00 | | | 20520 | $118.10 | | | 20525 | $845.19 | | | 20526 | $35.28 | | | 20527 | $38.34 | | | 20550 | $22.08 | | | 20551 | $23.32 | | | 20552 | $25.77 | | | 20553 | $30.06 | | | 20555 | $1,093.32 | | | 20600 | $21.17 | | | 20604 | $36.51 | | | 20605 | $22.08 | | | 20606 | $39.58 | | | 20610 | $26.38 | | | 20611 | $44.48 | | | 20612 | $29.76 | | | 20615 | $137.73 | | | 20650 | $1,093.32 | | | 20662 | $606.05 | | | 20663 | $1,093.32 | | | 20665 | $156.16 | | | 20670 | $489.93 | | | 20680 | $845.19 | | | 20690 | $3,192.86 | | | 20692 | $6,917.51 | | | 20693 | $2,382.86 | | | 20694 | $606.05 | | | 20696 | $10,090.37 | | | 20697 | $606.05 | | | 20700 | $0.00 | | | 20822 | $606.05 | | | 20900 | $2,382.86 | | | 20902 | $2,382.86 | | | 20910 | $213.47 | | | 20912 | $1,278.72 | | | 20920 | $696.96 | | | 20922 | $696.96 | | | 20924 | $2,382.86 | | | 20930 | $0.00 | | | 20931 | $0.00 | | | 20932 | $0.00 | | | 20933 | $0.00 | | | 20934 | $0.00 | | | 20936 | $0.00 | | | 20937 | $0.00 | | | 20938 | $0.00 | | | 20939 | $0.00 | | | 20950 | $262.00 | | | 20972 | $2,382.86 | | | 20973 | $2,382.86 | | | 20975 | $0.00 | | | 20979 | $0.00 | | | 20982 | $2,382.86 | | | 20983 | $3,226.69 | | | 20985 | $0.00 | | | 21010 | $896.80 | | | 21011 | $210.13 | | | 21012 | $489.93 | | | 21013 | $271.79 | | | 21014 | $845.19 | | | 21015 | $845.19 | | | 21016 | $845.19 | | | 21025 | $1,909.57 | | | 21026 | $1,909.57 | | | 21029 | $896.80 | | | 21030 | $266.88 | | | 21031 | $230.68 | | | 21032 | $229.46 | | | 21034 | $1,909.57 | | | 21040 | $896.80 | | | 21044 | $1,909.57 | | | 21046 | $1,909.57 | | | 21047 | $1,909.57 | | | 21048 | $1,909.57 | | | 21050 | $1,909.57 | | | 21060 | $1,909.57 | | | 21070 | $1,909.57 | | | 21073 | $218.72 | | | 21076 | $346.94 | | | 21077 | $842.06 | | | 21079 | $594.20 | | | 21080 | $693.59 | | | 21081 | $642.97 | | | 21082 | $607.08 | | | 21083 | $598.49 | | | 21084 | $671.19 | | | 21085 | $87.46 | | | 21086 | $633.16 | | | 21087 | $633.16 | | | 21088 | $896.80 | | | 21100 | $1,909.57 | | | 21110 | $456.11 | | | 21116 | $0.00 | | | 21120 | $1,909.57 | | | 21121 | $896.80 | | | 21122 | $1,909.57 | | | 21123 | $896.80 | | | 21125 | $1,909.57 | | | 21127 | $1,909.57 | | | 21137 | $896.80 | | | 21138 | $1,909.57 | | | 21139 | $1,909.57 | | | 21150 | $1,909.57 | | | 21181 | $1,909.57 | | | 21198 | $1,909.57 | | | 21199 | $1,909.57 | | | 21206 | $1,909.57 | | | 21208 | $2,504.67 | | | 21209 | $1,909.57 | | | 21210 | $1,909.57 | | | 21215 | $1,909.57 | | | 21230 | $1,909.57 | | | 21235 | $1,909.57 | | | 21240 | $1,909.57 | | | 21242 | $1,909.57 | | | 21243 | $10,292.37 | | | 21244 | $1,909.57 | | | 21245 | $1,909.57 | | | 21246 | $1,909.57 | | | 21248 | $1,909.57 | | | 21249 | $1,909.57 | | | 21260 | $1,909.57 | | | 21267 | $1,909.57 | | | 21270 | $1,909.57 | | | 21275 | $1,909.57 | | | 21280 | $896.80 | | | 21282 | $896.80 | | | 21295 | $456.11 | | | 21296 | $896.80 | | | 21315 | $456.11 | | | 21320 | $896.80 | | | 21325 | $896.80 | | | 21330 | $1,909.57 | | | 21335 | $896.80 | | | 21336 | $1,093.32 | | | 21337 | $896.80 | | | 21338 | $2,787.92 | | | 21339 | $1,909.57 | | | 21340 | $896.80 | | | 21345 | $456.11 | | | 21355 | $896.80 | | | 21356 | $1,909.57 | | | 21360 | $1,909.57 | | | 21365 | $2,703.14 | | | 21390 | $1,909.57 | | | 21400 | $189.71 | | | 21401 | $456.11 | | | 21406 | $1,909.57 | | | 21407 | $1,909.57 | | | 21421 | $896.80 | | | 21440 | $433.76 | | | 21445 | $1,909.57 | | | 21450 | $189.71 | | | 21451 | $456.11 | | | 21452 | $1,909.57 | | | 21453 | $1,909.57 | | | 21454 | $1,909.57 | | | 21461 | $2,680.59 | | | 21462 | $2,625.26 | | | 21465 | $1,909.57 | | | 21480 | $92.62 | | | 21485 | $456.11 | | | 21490 | $896.80 | | | 21497 | $456.11 | | | 21501 | $845.19 | | | 21502 | $1,093.32 | | | 21550 | $489.93 | | | 21552 | $845.19 | | | 21554 | $845.19 | | | 21555 | $489.93 | | | 21556 | $845.19 | | | 21557 | $845.19 | | | 21558 | $845.19 | | | 21600 | $2,382.86 | | | 21610 | $1,093.32 | | | 21685 | $1,909.57 | | | 21700 | $2,382.86 | | | 21720 | $1,093.32 | | | 21725 | $262.00 | | | 21820 | $92.62 | | | 21920 | $151.23 | | | 21925 | $489.93 | | | 21930 | $489.93 | | | 21931 | $489.93 | | | 21932 | $845.19 | | | 21933 | $845.19 | | | 21935 | $845.19 | | | 21936 | $845.19 | | | 22102 | $2,382.86 | | | 22103 | $0.00 | | | 22310 | $92.62 | | | 22315 | $1,093.32 | | | 22505 | $606.05 | | | 22510 | $1,093.32 | | | 22511 | $1,093.32 | | | 22512 | $0.00 | | | 22513 | $2,382.86 | | | 22514 | $2,382.86 | | | 22515 | $0.00 | | | 22551 | $7,156.77 | | | 22552 | $0.00 | | | 22554 | $7,162.97 | | | 22585 | $0.00 | | | 22612 | $7,316.44 | | | 22614 | $0.00 | | | 22840 | $0.00 | | | 22842 | $0.00 | | | 22845 | $0.00 | | | 22853 | $0.00 | | | 22854 | $0.00 | | | 22856 | $10,035.74 | | | 22858 | $0.00 | | | 22859 | $0.00 | | | 22867 | $10,408.62 | | | 22868 | $0.00 | | | 22869 | $8,393.60 | | | 22870 | $0.00 | | | 22900 | $845.19 | | | 22901 | $845.19 | | | 22902 | $489.93 | | | 22903 | $845.19 | | | 22904 | $845.19 | | | 22905 | $845.19 | | | 23000 | $845.19 | | | 23020 | $1,093.32 | | | 23030 | $845.19 | | | 23031 | $845.19 | | | 23035 | $606.05 | | | 23040 | $1,093.32 | | | 23044 | $1,093.32 | | | 23065 | $115.65 | | | 23066 | $845.19 | | | 23071 | $489.93 | | | 23073 | $845.19 | | | 23075 | $489.93 | | | 23076 | $845.19 | | | 23077 | $845.19 | | | 23078 | $845.19 | | | 23100 | $1,093.32 | | | 23101 | $1,093.32 | | | 23105 | $2,382.86 | | | 23106 | $1,093.32 | | | 23107 | $2,382.86 | | | 23120 | $1,093.32 | | | 23125 | $1,093.32 | | | 23130 | $1,093.32 | | | 23140 | $1,093.32 | | | 23145 | $1,093.32 | | | 23146 | $2,382.86 | | | 23150 | $1,093.32 | | | 23155 | $2,382.86 | | | 23156 | $3,690.96 | | | 23170 | $1,093.32 | | | 23172 | $1,093.32 | | | 23174 | $2,382.86 | | | 23180 | $2,382.86 | | | 23182 | $2,382.86 | | | 23184 | $2,382.86 | | | 23190 | $1,093.32 | | | 23195 | $2,382.86 | | | 23330 | $262.00 | | | 23333 | $845.19 | | | 23334 | $845.19 | | | 23350 | $0.00 | | | 23395 | $2,382.86 | | | 23397 | $2,382.86 | | | 23400 | $2,382.86 | | | 23405 | $2,382.86 | | | 23406 | $3,415.90 | | | 23410 | $2,382.86 | | | 23412 | $2,382.86 | | | 23415 | $2,382.86 | | | 23420 | $2,382.86 | | | 23430 | $2,382.86 | | | 23440 | $2,382.86 | | | 23450 | $2,382.86 | | | 23455 | $2,382.86 | | | 23460 | $2,382.86 | | | 23462 | $2,382.86 | | | 23465 | $2,382.86 | | | 23466 | $2,382.86 | | | 23480 | $2,382.86 | | | 23485 | $6,679.21 | | | 23490 | $2,382.86 | | | 23491 | $6,804.08 | | | 23500 | $92.62 | | | 23505 | $606.05 | | | 23515 | $3,269.86 | | | 23520 | $606.05 | | | 23525 | $92.62 | | | 23530 | $2,382.86 | | | 23532 | $2,382.86 | | | 23540 | $92.62 | | | 23545 | $92.62 | | | 23550 | $2,382.86 | | | 23552 | $3,248.86 | | | 23570 | $92.62 | | | 23575 | $606.05 | | | 23585 | $2,382.86 | | | 23600 | $92.62 | | | 23605 | $606.05 | | | 23615 | $7,046.20 | | | 23616 | $9,920.13 | | | 23620 | $92.62 | | | 23625 | $606.05 | | | 23630 | $3,150.64 | | | 23650 | $92.62 | | | 23655 | $606.05 | | | 23660 | $2,382.86 | | | 23665 | $606.05 | | | 23670 | $2,382.86 | | | 23675 | $606.05 | | | 23680 | $7,116.26 | | | 23700 | $606.05 | | | 23800 | $2,382.86 | | | 23802 | $4,868.06 | | | 23921 | $696.96 | | | 23930 | $845.19 | | | 23931 | $489.93 | | | 23935 | $1,093.32 | | | 24000 | $1,093.32 | | | 24006 | $1,093.32 | | | 24065 | $153.38 | | | 24066 | $845.19 | | | 24071 | $845.19 | | | 24073 | $845.19 | | | 24075 | $489.93 | | | 24076 | $845.19 | | | 24077 | $845.19 | | | 24079 | $845.19 | | | 24100 | $1,093.32 | | | 24101 | $1,093.32 | | | 24102 | $1,093.32 | | | 24105 | $1,093.32 | | | 24110 | $1,093.32 | | | 24115 | $2,382.86 | | | 24116 | $2,382.86 | | | 24120 | $1,093.32 | | | 24125 | $1,093.32 | | | 24126 | $3,631.00 | | | 24130 | $1,093.32 | | | 24134 | $2,382.86 | | | 24136 | $1,093.32 | | | 24138 | $2,382.86 | | | 24140 | $1,093.32 | | | 24145 | $2,382.86 | | | 24147 | $1,093.32 | | | 24149 | $2,382.86 | | | 24152 | $2,382.86 | | | 24155 | $1,093.32 | | | 24160 | $1,093.32 | | | 24164 | $1,093.32 | | | 24200 | $125.16 | | | 24201 | $845.19 | | | 24220 | $0.00 | | | 24300 | $606.05 | | | 24301 | $2,382.86 | | | 24305 | $1,093.32 | | | 24310 | $1,093.32 | | | 24320 | $2,382.86 | | | 24330 | $2,382.86 | | | 24331 | $2,382.86 | | | 24332 | $1,093.32 | | | 24340 | $2,382.86 | | | 24341 | $2,382.86 | | | 24342 | $2,382.86 | | | 24343 | $1,093.32 | | | 24344 | $2,382.86 | | | 24345 | $2,382.86 | | | 24346 | $4,868.06 | | | 24357 | $1,093.32 | | | 24358 | $1,093.32 | | | 24359 | $1,093.32 | | | 24360 | $2,382.86 | | | 24361 | $10,381.94 | | | 24362 | $4,868.06 | | | 24363 | $10,374.32 | | | 24365 | $7,298.81 | | | 24366 | $7,759.69 | | | 24370 | $7,168.21 | | | 24371 | $9,297.61 | | | 24400 | $2,382.86 | | | 24410 | $4,868.06 | | | 24420 | $2,382.86 | | | 24430 | $6,820.76 | | | 24435 | $6,869.84 | | | 24470 | $1,093.32 | | | 24495 | $2,382.86 | | | 24498 | $6,725.91 | | | 24500 | $92.62 | | | 24505 | $606.05 | | | 24515 | $6,643.46 | | | 24516 | $6,738.30 | | | 24530 | $92.62 | | | 24535 | $606.05 | | | 24538 | $2,382.86 | | | 24545 | $6,974.71 | | | 24546 | $9,323.66 | | | 24560 | $92.62 | | | 24565 | $606.05 | | | 24566 | $606.05 | | | 24575 | $6,300.77 | | | 24576 | $92.62 | | | 24577 | $606.05 | | | 24579 | $6,408.48 | | | 24582 | $2,382.86 | | | 24586 | $4,868.06 | | | 24587 | $7,021.42 | | | 24600 | $92.62 | | | 24605 | $606.05 | | | 24615 | $2,382.86 | | | 24620 | $606.05 | | | 24635 | $3,325.62 | | | 24640 | $47.55 | | | 24650 | $92.62 | | | 24655 | $606.05 | | | 24665 | $2,382.86 | | | 24666 | $7,720.13 | | | 24670 | $92.62 | | | 24675 | $606.05 | | | 24685 | $3,130.81 | | | 24800 | $2,382.86 | | | 24802 | $4,868.06 | | | 24925 | $1,093.32 | | | 25000 | $606.05 | | | 25001 | $1,093.32 | | | 25020 | $606.05 | | | 25023 | $1,093.32 | | | 25024 | $1,093.32 | | | 25025 | $606.05 | | | 25028 | $1,093.32 | | | 25031 | $606.05 | | | 25035 | $2,382.86 | | | 25040 | $1,093.32 | | | 25065 | $155.22 | | | 25066 | $845.19 | | | 25071 | $489.93 | | | 25073 | $845.19 | | | 25075 | $489.93 | | | 25076 | $489.93 | | | 25077 | $845.19 | | | 25078 | $845.19 | | | 25085 | $1,093.32 | | | 25100 | $1,093.32 | | | 25101 | $1,093.32 | | | 25105 | $1,093.32 | | | 25107 | $1,093.32 | | | 25109 | $1,093.32 | | | 25110 | $606.05 | | | 25111 | $606.05 | | | 25112 | $606.05 | | | 25115 | $606.05 | | | 25116 | $1,093.32 | | | 25118 | $606.05 | | | 25119 | $1,093.32 | | | 25120 | $1,093.32 | | | 25125 | $606.05 | | | 25126 | $1,093.32 | | | 25130 | $1,093.32 | | | 25135 | $2,382.86 | | | 25136 | $3,156.93 | | | 25145 | $1,093.32 | | | 25150 | $1,093.32 | | | 25151 | $1,093.32 | | | 25210 | $1,093.32 | | | 25215 | $1,093.32 | | | 25230 | $1,093.32 | | | 25240 | $1,093.32 | | | 25246 | $0.00 | | | 25248 | $606.05 | | | 25250 | $606.05 | | | 25251 | $1,093.32 | | | 25259 | $606.05 | | | 25260 | $1,093.32 | | | 25263 | $2,382.86 | | | 25265 | $1,093.32 | | | 25270 | $1,093.32 | | | 25272 | $1,093.32 | | | 25274 | $1,093.32 | | | 25275 | $1,093.32 | | | 25280 | $1,093.32 | | | 25290 | $1,093.32 | | | 25295 | $1,093.32 | | | 25300 | $1,093.32 | | | 25301 | $1,093.32 | | | 25310 | $1,093.32 | | | 25312 | $1,093.32 | | | 25315 | $2,382.86 | | | 25316 | $2,382.86 | | | 25320 | $2,382.86 | | | 25332 | $1,093.32 | | | 25335 | $1,093.32 | | | 25337 | $2,382.86 | | | 25350 | $3,691.42 | | | 25355 | $1,093.32 | | | 25360 | $2,382.86 | | | 25365 | $4,868.06 | | | 25370 | $1,093.32 | | | 25375 | $1,093.32 | | | 25390 | $3,355.01 | | | 25391 | $6,834.58 | | | 25392 | $2,382.86 | | | 25393 | $2,382.86 | | | 25394 | $1,093.32 | | | 25400 | $3,361.31 | | | 25405 | $3,323.75 | | | 25415 | $3,439.00 | | | 25420 | $2,382.86 | | | 25425 | $2,382.86 | | | 25426 | $1,093.32 | | | 25430 | $1,093.32 | | | 25431 | $2,382.86 | | | 25440 | $2,382.86 | | | 25441 | $7,937.47 | | | 25442 | $10,861.53 | | | 25443 | $3,322.34 | | | 25444 | $8,002.77 | | | 25445 | $3,357.34 | | | 25446 | $10,925.06 | | | 25447 | $1,093.32 | | | 25449 | $2,382.86 | | | 25450 | $1,093.32 | | | 25455 | $1,093.32 | | | 25490 | $2,382.86 | | | 25491 | $4,868.06 | | | 25492 | $1,093.32 | | | 25500 | $92.62 | | | 25505 | $606.05 | | | 25515 | $3,198.47 | | | 25520 | $606.05 | | | 25525 | $2,382.86 | | | 25526 | $3,167.44 | | | 25530 | $92.62 | | | 25535 | $92.62 | | | 25545 | $3,137.34 | | | 25560 | $92.62 | | | 25565 | $606.05 | | | 25574 | $3,374.37 | | | 25575 | $3,280.82 | | | 25600 | $92.62 | | | 25605 | $606.05 | | | 25606 | $1,093.32 | | | 25607 | $3,431.54 | | | 25608 | $3,416.84 | | | 25609 | $3,430.83 | | | 25622 | $92.62 | | | 25624 | $606.05 | | | 25628 | $2,382.86 | | | 25630 | $92.62 | | | 25635 | $606.05 | | | 25645 | $1,093.32 | | | 25650 | $92.62 | | | 25651 | $1,093.32 | | | 25652 | $2,382.86 | | | 25660 | $92.62 | | | 25670 | $2,382.86 | | | 25671 | $1,093.32 | | | 25675 | $92.62 | | | 25676 | $2,382.86 | | | 25680 | $92.62 | | | 25685 | $2,382.86 | | | 25690 | $606.05 | | | 25695 | $2,382.86 | | | 25800 | $3,465.13 | | | 25805 | $3,445.53 | | | 25810 | $6,760.23 | | | 25820 | $3,239.06 | | | 25825 | $3,220.40 | | | 25830 | $3,157.87 | | | 25907 | $1,093.32 | | | 25922 | $606.05 | | | 25929 | $696.96 | | | 25931 | $1,093.32 | | | 26010 | $75.05 | | | 26011 | $489.93 | | | 26020 | $1,093.32 | | | 26025 | $1,093.32 | | | 26030 | $1,093.32 | | | 26034 | $606.05 | | | 26035 | $1,093.32 | | | 26037 | $1,093.32 | | | 26040 | $606.05 | | | 26045 | $1,093.32 | | | 26055 | $606.05 | | | 26060 | $606.05 | | | 26070 | $606.05 | | | 26075 | $1,093.32 | | | 26080 | $606.05 | | | 26100 | $1,093.32 | | | 26105 | $1,093.32 | | | 26110 | $606.05 | | | 26111 | $489.93 | | | 26113 | $489.93 | | | 26115 | $489.93 | | | 26116 | $489.93 | | | 26117 | $845.19 | | | 26118 | $845.19 | | | 26121 | $1,093.32 | | | 26123 | $1,093.32 | | | 26125 | $0.00 | | | 26130 | $1,093.32 | | | 26135 | $1,093.32 | | | 26140 | $606.05 | | | 26145 | $606.05 | | | 26160 | $606.05 | | | 26170 | $606.05 | | | 26180 | $606.05 | | | 26185 | $606.05 | | | 26200 | $606.05 | | | 26205 | $2,382.86 | | | 26210 | $606.05 | | | 26215 | $1,093.32 | | | 26230 | $1,093.32 | | | 26235 | $606.05 | | | 26236 | $606.05 | | | 26250 | $1,093.32 | | | 26260 | $1,093.32 | | | 26262 | $606.05 | | | 26320 | $489.93 | | | 26340 | $606.05 | | | 26341 | $60.74 | | | 26350 | $1,093.32 | | | 26352 | $2,382.86 | | | 26356 | $1,093.32 | | | 26357 | $1,093.32 | | | 26358 | $2,382.86 | | | 26370 | $1,093.32 | | | 26372 | $2,382.86 | | | 26373 | $1,093.32 | | | 26390 | $3,161.84 | | | 26392 | $2,382.86 | | | 26410 | $606.05 | | | 26412 | $1,093.32 | | | 26415 | $1,093.32 | | | 26416 | $1,093.32 | | | 26418 | $606.05 | | | 26420 | $1,093.32 | | | 26426 | $1,093.32 | | | 26428 | $1,093.32 | | | 26432 | $606.05 | | | 26433 | $1,093.32 | | | 26434 | $1,093.32 | | | 26437 | $1,093.32 | | | 26440 | $606.05 | | | 26442 | $1,093.32 | | | 26445 | $1,093.32 | | | 26449 | $1,093.32 | | | 26450 | $1,093.32 | | | 26455 | $606.05 | | | 26460 | $606.05 | | | 26471 | $1,093.32 | | | 26474 | $606.05 | | | 26476 | $1,093.32 | | | 26477 | $1,093.32 | | | 26478 | $1,093.32 | | | 26479 | $1,093.32 | | | 26480 | $1,093.32 | | | 26483 | $1,093.32 | | | 26485 | $1,093.32 | | | 26489 | $1,093.32 | | | 26490 | $1,093.32 | | | 26492 | $1,093.32 | | | 26494 | $1,093.32 | | | 26496 | $1,093.32 | | | 26497 | $1,093.32 | | | 26498 | $1,093.32 | | | 26499 | $1,093.32 | | | 26500 | $2,382.86 | | | 26502 | $1,093.32 | | | 26508 | $1,093.32 | | | 26510 | $1,093.32 | | | 26516 | $1,093.32 | | | 26517 | $1,093.32 | | | 26518 | $2,382.86 | | | 26520 | $1,093.32 | | | 26525 | $606.05 | | | 26530 | $2,382.86 | | | 26531 | $3,418.00 | | | 26535 | $1,093.32 | | | 26536 | $3,162.77 | | | 26540 | $1,093.32 | | | 26541 | $1,093.32 | | | 26542 | $1,093.32 | | | 26545 | $1,093.32 | | | 26546 | $2,382.86 | | | 26548 | $1,093.32 | | | 26550 | $1,093.32 | | | 26555 | $2,382.86 | | | 26560 | $606.05 | | | 26561 | $1,093.32 | | | 26562 | $1,093.32 | | | 26565 | $1,093.32 | | | 26567 | $1,093.32 | | | 26568 | $2,382.86 | | | 26580 | $1,093.32 | | | 26587 | $1,093.32 | | | 26590 | $606.05 | | | 26591 | $1,093.32 | | | 26593 | $1,093.32 | | | 26596 | $1,093.32 | | | 26600 | $92.62 | | | 26605 | $92.62 | | | 26607 | $1,093.32 | | | 26608 | $1,093.32 | | | 26615 | $1,093.32 | | | 26641 | $92.62 | | | 26645 | $606.05 | | | 26650 | $1,093.32 | | | 26665 | $1,093.32 | | | 26670 | $92.62 | | | 26675 | $606.05 | | | 26676 | $1,093.32 | | | 26685 | $1,093.32 | | | 26686 | $1,093.32 | | | 26700 | $92.62 | | | 26705 | $606.05 | | | 26706 | $1,093.32 | | | 26715 | $1,093.32 | | | 26720 | $92.62 | | | 26725 | $92.62 | | | 26727 | $1,093.32 | | | 26735 | $1,093.32 | | | 26740 | $92.62 | | | 26742 | $606.05 | | | 26746 | $1,093.32 | | | 26750 | $92.62 | | | 26755 | $92.62 | | | 26756 | $1,093.32 | | | 26765 | $1,093.32 | | | 26770 | $92.62 | | | 26775 | $98.70 | | | 26776 | $1,093.32 | | | 26785 | $1,093.32 | | | 26820 | $3,267.76 | | | 26841 | $2,382.86 | | | 26842 | $2,382.86 | | | 26843 | $2,382.86 | | | 26844 | $2,382.86 | | | 26850 | $2,382.86 | | | 26852 | $2,382.86 | | | 26860 | $1,093.32 | | | 26861 | $0.00 | | | 26862 | $1,093.32 | | | 26863 | $0.00 | | | 26910 | $1,093.32 | | | 26951 | $1,093.32 | | | 26952 | $1,093.32 | | | 26990 | $1,093.32 | | | 26991 | $606.05 | | | 27000 | $606.05 | | | 27001 | $1,093.32 | | | 27003 | $2,382.86 | | | 27033 | $2,382.86 | | | 27035 | $1,093.32 | | | 27040 | $489.93 | | | 27041 | $489.93 | | | 27043 | $845.19 | | | 27045 | $845.19 | | | 27047 | $845.19 | | | 27048 | $845.19 | | | 27049 | $845.19 | | | 27050 | $606.05 | | | 27052 | $606.05 | | | 27059 | $845.19 | | | 27060 | $2,382.86 | | | 27062 | $1,093.32 | | | 27065 | $2,382.86 | | | 27066 | $1,093.32 | | | 27067 | $2,382.86 | | | 27080 | $1,093.32 | | | 27086 | $489.93 | | | 27087 | $1,093.32 | | | 27093 | $0.00 | | | 27095 | $0.00 | | | 27097 | $1,093.32 | | | 27098 | $1,093.32 | | | 27100 | $2,382.86 | | | 27105 | $1,093.32 | | | 27110 | $2,382.86 | | | 27111 | $1,093.32 | | | 27130 | $7,671.16 | | | 27197 | $92.62 | | | 27198 | $92.62 | | | 27200 | $92.62 | | | 27202 | $1,093.32 | | | 27220 | $92.62 | | | 27230 | $92.62 | | | 27238 | $606.05 | | | 27246 | $92.62 | | | 27250 | $92.62 | | | 27252 | $606.05 | | | 27256 | $92.62 | | | 27257 | $606.05 | | | 27265 | $92.62 | | | 27266 | $606.05 | | | 27267 | $1,093.32 | | | 27275 | $606.05 | | | 27279 | $11,034.95 | | | 27301 | $845.19 | | | 27305 | $1,093.32 | | | 27306 | $1,093.32 | | | 27307 | $1,093.32 | | | 27310 | $1,093.32 | | | 27323 | $489.93 | | | 27324 | $845.19 | | | 27325 | $677.27 | | | 27326 | $677.27 | | | 27327 | $489.93 | | | 27328 | $845.19 | | | 27329 | $845.19 | | | 27330 | $1,093.32 | | | 27331 | $1,093.32 | | | 27332 | $1,093.32 | | | 27333 | $1,093.32 | | | 27334 | $1,093.32 | | | 27335 | $2,382.86 | | | 27337 | $845.19 | | | 27339 | $845.19 | | | 27340 | $1,093.32 | | | 27345 | $1,093.32 | | | 27347 | $1,093.32 | | | 27350 | $2,382.86 | | | 27355 | $1,093.32 | | | 27356 | $4,868.06 | | | 27357 | $2,382.86 | | | 27358 | $0.00 | | | 27360 | $1,093.32 | | | 27364 | $845.19 | | | 27369 | $0.00 | | | 27372 | $845.19 | | | 27380 | $2,382.86 | | | 27381 | $2,382.86 | | | 27385 | $2,382.86 | | | 27386 | $2,382.86 | | | 27390 | $1,093.32 | | | 27391 | $1,093.32 | | | 27392 | $1,093.32 | | | 27393 | $2,382.86 | | | 27394 | $2,382.86 | | | 27395 | $1,093.32 | | | 27396 | $2,382.86 | | | 27397 | $2,382.86 | | | 27400 | $2,382.86 | | | 27403 | $3,148.08 | | | 27405 | $2,382.86 | | | 27407 | $2,382.86 | | | 27409 | $2,382.86 | | | 27412 | $4,088.71 | | | 27415 | $7,998.96 | | | 27416 | $2,382.86 | | | 27418 | $2,382.86 | | | 27420 | $2,382.86 | | | 27422 | $2,382.86 | | | 27424 | $2,382.86 | | | 27425 | $1,093.32 | | | 27427 | $3,086.25 | | | 27428 | $6,559.57 | | | 27429 | $8,596.64 | | | 27430 | $2,382.86 | | | 27435 | $1,093.32 | | | 27437 | $2,382.86 | | | 27438 | $6,686.36 | | | 27440 | $7,190.13 | | | 27441 | $4,868.06 | | | 27442 | $7,203.95 | | | 27443 | $7,026.66 | | | 27446 | $7,149.15 | | | 27447 | $7,318.35 | | | 27475 | $2,382.86 | | | 27479 | $2,382.86 | | | 27496 | $1,093.32 | | | 27497 | $1,093.32 | | | 27498 | $606.05 | | | 27499 | $2,382.86 | | | 27500 | $92.62 | | | 27501 | $92.62 | | | 27502 | $606.05 | | | 27503 | $606.05 | | | 27508 | $92.62 | | | 27509 | $2,382.86 | | | 27510 | $606.05 | | | 27516 | $92.62 | | | 27517 | $606.05 | | | 27520 | $92.62 | | | 27524 | $2,382.86 | | | 27530 | $92.62 | | | 27532 | $1,093.32 | | | 27538 | $92.62 | | | 27550 | $92.62 | | | 27552 | $606.05 | | | 27560 | $92.62 | | | 27562 | $92.62 | | | 27566 | $2,382.86 | | | 27570 | $606.05 | | | 27594 | $1,093.32 | | | 27600 | $1,093.32 | | | 27601 | $1,093.32 | | | 27602 | $1,093.32 | | | 27603 | $845.19 | | | 27604 | $1,093.32 | | | 27605 | $606.05 | | | 27606 | $1,093.32 | | | 27607 | $1,093.32 | | | 27610 | $1,093.32 | | | 27612 | $1,093.32 | | | 27613 | $144.79 | | | 27614 | $845.19 | | | 27615 | $845.19 | | | 27616 | $845.19 | | | 27618 | $489.93 | | | 27619 | $845.19 | | | 27620 | $1,093.32 | | | 27625 | $1,093.32 | | | 27626 | $1,093.32 | | | 27630 | $1,093.32 | | | 27632 | $845.19 | | | 27634 | $845.19 | | | 27635 | $1,093.32 | | | 27637 | $2,382.86 | | | 27638 | $2,382.86 | | | 27640 | $1,093.32 | | | 27641 | $1,093.32 | | | 27647 | $1,093.32 | | | 27648 | $0.00 | | | 27650 | $2,382.86 | | | 27652 | $2,382.86 | | | 27654 | $2,382.86 | | | 27656 | $1,093.32 | | | 27658 | $1,093.32 | | | 27659 | $2,382.86 | | | 27664 | $2,382.86 | | | 27665 | $2,382.86 | | | 27675 | $1,093.32 | | | 27676 | $2,382.86 | | | 27680 | $1,093.32 | | | 27681 | $1,093.32 | | | 27685 | $1,093.32 | | | 27686 | $1,093.32 | | | 27687 | $1,093.32 | | | 27690 | $2,382.86 | | | 27691 | $2,382.86 | | | 27692 | $0.00 | | | 27695 | $2,382.86 | | | 27696 | $2,382.86 | | | 27698 | $2,382.86 | | | 27700 | $2,382.86 | | | 27704 | $1,093.32 | | | 27705 | $3,432.00 | | | 27707 | $1,093.32 | | | 27709 | $4,868.06 | | | 27720 | $3,270.55 | | | 27726 | $3,331.68 | | | 27730 | $1,093.32 | | | 27732 | $1,093.32 | | | 27734 | $1,093.32 | | | 27740 | $1,093.32 | | | 27742 | $1,093.32 | | | 27745 | $3,319.55 | | | 27750 | $92.62 | | | 27752 | $606.05 | | | 27756 | $3,481.46 | | | 27758 | $6,878.91 | | | 27759 | $6,791.69 | | | 27760 | $92.62 | | | 27762 | $606.05 | | | 27766 | $2,382.86 | | | 27767 | $92.62 | | | 27768 | $606.05 | | | 27769 | $2,382.86 | | | 27780 | $92.62 | | | 27781 | $606.05 | | | 27784 | $2,382.86 | | | 27786 | $92.62 | | | 27788 | $92.62 | | | 27792 | $3,149.24 | | | 27808 | $92.62 | | | 27810 | $606.05 | | | 27814 | $3,199.16 | | | 27816 | $92.62 | | | 27818 | $606.05 | | | 27822 | $3,185.63 | | | 27823 | $3,175.14 | | | 27824 | $92.62 | | | 27825 | $606.05 | | | 27826 | $3,328.41 | | | 27827 | $6,814.56 | | | 27828 | $6,933.71 | | | 27829 | $2,382.86 | | | 27830 | $92.62 | | | 27831 | $1,093.32 | | | 27832 | $2,382.86 | | | 27840 | $92.62 | | | 27842 | $606.05 | | | 27846 | $2,382.86 | | | 27848 | $3,510.39 | | | 27860 | $1,093.32 | | | 27870 | $7,181.08 | | | 27871 | $6,920.84 | | | 27884 | $1,093.32 | | | 27889 | $2,382.86 | | | 27892 | $1,093.32 | | | 27893 | $2,382.86 | | | 27894 | $1,093.32 | | | 28001 | $153.69 | | | 28002 | $606.05 | | | 28003 | $1,093.32 | | | 28005 | $1,093.32 | | | 28008 | $1,093.32 | | | 28010 | $105.83 | | | 28011 | $606.05 | | | 28020 | $1,093.32 | | | 28022 | $1,093.32 | | | 28024 | $606.05 | | | 28035 | $677.27 | | | 28039 | $845.19 | | | 28041 | $845.19 | | | 28043 | $489.93 | | | 28045 | $845.19 | | | 28046 | $845.19 | | | 28047 | $845.19 | | | 28050 | $1,093.32 | | | 28052 | $1,093.32 | | | 28054 | $1,093.32 | | | 28055 | $677.27 | | | 28060 | $1,093.32 | | | 28062 | $1,093.32 | | | 28070 | $2,382.86 | | | 28072 | $1,093.32 | | | 28080 | $606.05 | | | 28086 | $1,093.32 | | | 28088 | $1,093.32 | | | 28090 | $606.05 | | | 28092 | $606.05 | | | 28100 | $1,093.32 | | | 28102 | $2,382.86 | | | 28103 | $2,382.86 | | | 28104 | $1,093.32 | | | 28106 | $2,382.86 | | | 28107 | $2,382.86 | | | 28108 | $606.05 | | | 28110 | $1,093.32 | | | 28111 | $1,093.32 | | | 28112 | $1,093.32 | | | 28113 | $1,093.32 | | | 28114 | $1,093.32 | | | 28116 | $1,093.32 | | | 28118 | $1,093.32 | | | 28119 | $1,093.32 | | | 28120 | $1,093.32 | | | 28122 | $1,093.32 | | | 28124 | $256.45 | | | 28126 | $1,093.32 | | | 28130 | $3,556.11 | | | 28140 | $1,093.32 | | | 28150 | $1,093.32 | | | 28153 | $1,093.32 | | | 28160 | $1,093.32 | | | 28171 | $1,093.32 | | | 28173 | $1,093.32 | | | 28175 | $606.05 | | | 28190 | $154.91 | | | 28192 | $489.93 | | | 28193 | $489.93 | | | 28200 | $1,093.32 | | | 28202 | $2,382.86 | | | 28208 | $1,093.32 | | | 28210 | $2,382.86 | | | 28220 | $242.34 | | | 28222 | $1,093.32 | | | 28225 | $1,093.32 | | | 28226 | $1,093.32 | | | 28230 | $238.97 | | | 28232 | $223.01 | | | 28234 | $606.05 | | | 28238 | $2,382.86 | | | 28240 | $1,093.32 | | | 28250 | $1,093.32 | | | 28260 | $1,093.32 | | | 28261 | $606.05 | | | 28262 | $3,768.88 | | | 28264 | $606.05 | | | 28270 | $1,093.32 | | | 28272 | $215.35 | | | 28280 | $1,093.32 | | | 28285 | $1,093.32 | | | 28286 | $1,093.32 | | | 28288 | $1,093.32 | | | 28289 | $1,093.32 | | | 28291 | $3,655.50 | | | 28292 | $1,093.32 | | | 28295 | $1,093.32 | | | 28296 | $1,093.32 | | | 28297 | $3,417.77 | | | 28298 | $2,382.86 | | | 28299 | $2,382.86 | | | 28300 | $3,187.03 | | | 28302 | $2,382.86 | | | 28304 | $2,382.86 | | | 28305 | $3,431.54 | | | 28306 | $2,382.86 | | | 28307 | $2,382.86 | | | 28308 | $1,093.32 | | | 28309 | $2,382.86 | | | 28310 | $2,382.86 | | | 28312 | $1,093.32 | | | 28313 | $1,093.32 | | | 28315 | $1,093.32 | | | 28320 | $7,546.16 | | | 28322 | $3,250.26 | | | 28340 | $1,093.32 | | | 28341 | $1,093.32 | | | 28344 | $1,093.32 | | | 28345 | $606.05 | | | 28400 | $92.62 | | | 28405 | $92.62 | | | 28406 | $2,382.86 | | | 28415 | $3,293.66 | | | 28420 | $7,012.84 | | | 28430 | $92.62 | | | 28435 | $606.05 | | | 28436 | $2,382.86 | | | 28445 | $3,092.08 | | | 28446 | $2,382.86 | | | 28450 | $92.62 | | | 28455 | $142.65 | | | 28456 | $2,382.86 | | | 28465 | $3,256.55 | | | 28470 | $92.62 | | | 28475 | $92.62 | | | 28476 | $1,093.32 | | | 28485 | $3,172.11 | | | 28490 | $84.06 | | | 28495 | $92.62 | | | 28496 | $1,093.32 | | | 28505 | $1,093.32 | | | 28510 | $66.56 | | | 28515 | $89.88 | | | 28525 | $1,093.32 | | | 28530 | $63.81 | | | 28531 | $2,382.86 | | | 28540 | $92.62 | | | 28545 | $1,093.32 | | | 28546 | $606.05 | | | 28555 | $2,382.86 | | | 28570 | $92.62 | | | 28575 | $1,093.32 | | | 28576 | $2,382.86 | | | 28585 | $3,514.35 | | | 28600 | $92.62 | | | 28605 | $92.62 | | | 28606 | $1,093.32 | | | 28615 | $3,107.24 | | | 28630 | $75.77 | | | 28635 | $606.05 | | | 28636 | $1,093.32 | | | 28645 | $1,093.32 | | | 28660 | $58.59 | | | 28665 | $98.70 | | | 28666 | $1,093.32 | | | 28675 | $1,093.32 | | | 28705 | $9,842.00 | | | 28715 | $7,512.80 | | | 28725 | $6,900.83 | | | 28730 | $7,424.63 | | | 28735 | $7,498.98 | | | 28737 | $7,128.65 | | | 28740 | $3,522.99 | | | 28750 | $3,458.36 | | | 28755 | $2,382.86 | | | 28760 | $2,382.86 | | | 28810 | $1,093.32 | | | 28820 | $1,093.32 | | | 28825 | $1,093.32 | | | 28890 | $166.57 | | | 29000 | $98.70 | | | 29010 | $98.70 | | | 29015 | $98.70 | | | 29035 | $98.70 | | | 29040 | $98.70 | | | 29044 | $57.44 | | | 29046 | $98.70 | | | 29049 | $52.76 | | | 29055 | $98.70 | | | 29058 | $59.20 | | | 29065 | $51.23 | | | 29075 | $46.94 | | | 29085 | $50.92 | | | 29086 | $46.33 | | | 29105 | $42.33 | | | 29125 | $0.00 | | | 29126 | $0.00 | | | 29130 | $0.00 | | | 29131 | $0.00 | | | 29200 | $15.95 | | | 29240 | $0.00 | | | 29260 | $0.00 | | | 29280 | $0.00 | | | 29305 | $98.70 | | | 29325 | $98.70 | | | 29345 | $66.88 | | | 29355 | $68.10 | | | 29358 | $85.89 | | | 29365 | $63.19 | | | 29405 | $41.11 | | | 29425 | $38.65 | | | 29435 | $57.06 | | | 29440 | $18.71 | | | 29445 | $52.76 | | | 29450 | $55.52 | | | 29505 | $49.39 | | | 29515 | $35.89 | | | 29520 | $0.00 | | | 29530 | $0.00 | | | 29540 | $11.96 | | | 29550 | $0.00 | | | 29580 | $35.89 | | | 29581 | $57.44 | | | 29584 | $57.44 | | | 29700 | $34.36 | | | 29705 | $29.15 | | | 29710 | $57.37 | | | 29720 | $48.16 | | | 29730 | $27.61 | | | 29740 | $45.09 | | | 29750 | $47.24 | | | 29800 | $1,093.32 | | | 29804 | $1,093.32 | | | 29805 | $1,093.32 | | | 29806 | $2,382.86 | | | 29807 | $2,382.86 | | | 29819 | $1,093.32 | | | 29820 | $2,382.86 | | | 29821 | $1,093.32 | | | 29822 | $1,093.32 | | | 29823 | $1,093.32 | | | 29824 | $1,093.32 | | | 29825 | $1,093.32 | | | 29826 | $0.00 | | | 29827 | $2,382.86 | | | 29828 | $2,382.86 | | | 29830 | $1,093.32 | | | 29834 | $1,093.32 | | | 29835 | $1,093.32 | | | 29836 | $2,382.86 | | | 29837 | $1,093.32 | | | 29838 | $1,093.32 | | | 29840 | $1,093.32 | | | 29843 | $1,093.32 | | | 29844 | $1,093.32 | | | 29845 | $1,093.32 | | | 29846 | $1,093.32 | | | 29847 | $2,382.86 | | | 29848 | $606.05 | | | 29850 | $606.05 | | | 29851 | $606.05 | | | 29855 | $3,657.36 | | | 29856 | $6,666.81 | | | 29860 | $2,382.86 | | | 29861 | $2,382.86 | | | 29862 | $2,382.86 | | | 29863 | $1,093.32 | | | 29866 | $2,382.86 | | | 29867 | $7,212.54 | | | 29870 | $1,093.32 | | | 29871 | $1,093.32 | | | 29873 | $1,093.32 | | | 29874 | $1,093.32 | | | 29875 | $1,093.32 | | | 29876 | $1,093.32 | | | 29877 | $1,093.32 | | | 29879 | $1,093.32 | | | 29880 | $1,093.32 | | | 29881 | $1,093.32 | | | 29882 | $1,093.32 | | | 29883 | $1,093.32 | | | 29884 | $1,093.32 | | | 29885 | $2,382.86 | | | 29886 | $1,093.32 | | | 29887 | $2,382.86 | | | 29888 | $3,292.25 | | | 29889 | $6,512.39 | | | 29891 | $1,093.32 | | | 29892 | $2,382.86 | | | 29893 | $1,093.32 | | | 29894 | $1,093.32 | | | 29895 | $1,093.32 | | | 29897 | $1,093.32 | | | 29898 | $1,093.32 | | | 29899 | $3,089.51 | | | 29900 | $1,093.32 | | | 29901 | $1,093.32 | | | 29902 | $606.05 | | | 29904 | $1,093.32 | | | 29905 | $2,382.86 | | | 29906 | $1,093.32 | | | 29907 | $6,682.54 | | | 29914 | $2,382.86 | | | 29915 | $2,382.86 | | | 29916 | $2,382.86 | | | 30000 | $87.46 | | | 30020 | $170.26 | | | 30100 | $91.11 | | | 30110 | $150.31 | | | 30115 | $896.80 | | | 30117 | $896.80 | | | 30118 | $896.80 | | | 30120 | $896.80 | | | 30124 | $456.11 | | | 30125 | $1,909.57 | | | 30130 | $896.80 | | | 30140 | $896.80 | | | 30150 | $1,909.57 | | | 30160 | $1,909.57 | | | 30200 | $70.25 | | | 30210 | $90.81 | | | 30220 | $456.11 | | | 30300 | $0.00 | | | 30310 | $896.80 | | | 30320 | $456.11 | | | 30400 | $1,909.57 | | | 30410 | $1,909.57 | | | 30420 | $1,909.57 | | | 30430 | $1,909.57 | | | 30435 | $1,909.57 | | | 30450 | $1,909.57 | | | 30460 | $1,909.57 | | | 30462 | $1,909.57 | | | 30465 | $1,909.57 | | | 30468 | $2,956.50 | | | 30469 | $2,785.37 | | | 30520 | $896.80 | | | 30540 | $1,909.57 | | | 30545 | $1,909.57 | | | 30560 | $189.71 | | | 30580 | $1,909.57 | | | 30600 | $1,909.57 | | | 30620 | $1,909.57 | | | 30630 | $896.80 | | | 30801 | $456.11 | | | 30802 | $456.11 | | | 30901 | $0.00 | | | 30903 | $46.83 | | | 30905 | $46.83 | | | 30906 | $87.46 | | | 30915 | $1,140.05 | | | 30920 | $1,140.05 | | | 30930 | $896.80 | | | 31000 | $87.46 | | | 31002 | $456.11 | | | 31020 | $896.80 | | | 31030 | $1,909.57 | | | 31032 | $1,909.57 | | | 31040 | $1,909.57 | | | 31050 | $1,909.57 | | | 31051 | $1,909.57 | | | 31070 | $1,909.57 | | | 31075 | $1,909.57 | | | 31080 | $1,909.57 | | | 31081 | $1,909.57 | | | 31084 | $1,909.57 | | | 31085 | $1,909.57 | | | 31086 | $1,909.57 | | | 31087 | $1,909.57 | | | 31090 | $1,909.57 | | | 31200 | $1,909.57 | | | 31201 | $456.11 | | | 31205 | $896.80 | | | 31231 | $67.24 | | | 31233 | $162.31 | | | 31235 | $519.94 | | | 31237 | $519.94 | | | 31238 | $519.94 | | | 31239 | $1,052.05 | | | 31240 | $519.94 | | | 31253 | $1,611.51 | | | 31254 | $1,611.51 | | | 31255 | $1,611.51 | | | 31256 | $1,052.05 | | | 31257 | $1,611.51 | | | 31259 | $1,611.51 | | | 31267 | $1,611.51 | | | 31276 | $1,611.51 | | | 31287 | $1,611.51 | | | 31288 | $1,611.51 | | | 31295 | $1,548.22 | | | 31296 | $1,556.51 | | | 31297 | $1,544.24 | | | 31298 | $1,611.51 | | | 31300 | $896.80 | | | 31400 | $1,909.57 | | | 31420 | $1,909.57 | | | 31500 | $87.46 | | | 31502 | $87.46 | | | 31505 | $54.60 | | | 31510 | $1,052.05 | | | 31511 | $67.24 | | | 31512 | $1,052.05 | | | 31513 | $162.31 | | | 31515 | $162.31 | | | 31520 | $162.31 | | | 31525 | $519.94 | | | 31526 | $519.94 | | | 31527 | $1,052.05 | | | 31528 | $1,052.05 | | | 31529 | $1,052.05 | | | 31530 | $519.94 | | | 31531 | $1,052.05 | | | 31535 | $1,052.05 | | | 31536 | $1,052.05 | | | 31540 | $1,052.05 | | | 31541 | $1,052.05 | | | 31545 | $1,052.05 | | | 31546 | $1,611.51 | | | 31551 | $1,909.57 | | | 31552 | $1,909.57 | | | 31553 | $1,909.57 | | | 31554 | $1,909.57 | | | 31560 | $1,611.51 | | | 31561 | $1,611.51 | | | 31570 | $1,052.05 | | | 31571 | $1,052.05 | | | 31572 | $1,052.05 | | | 31573 | $155.52 | | | 31574 | $519.94 | | | 31575 | $67.24 | | | 31576 | $519.94 | | | 31577 | $162.31 | | | 31578 | $1,052.05 | | | 31579 | $101.85 | | | 31580 | $1,909.57 | | | 31590 | $1,909.57 | | | 31591 | $1,909.57 | | | 31592 | $1,909.57 | | | 31603 | $456.11 | | | 31605 | $87.46 | | | 31611 | $896.80 | | | 31612 | $896.80 | | | 31613 | $896.80 | | | 31614 | $1,909.57 | | | 31615 | $189.71 | | | 31622 | $519.94 | | | 31623 | $519.94 | | | 31624 | $519.94 | | | 31625 | $519.94 | | | 31626 | $1,611.51 | | | 31627 | $0.00 | | | 31628 | $1,052.05 | | | 31629 | $1,052.05 | | | 31630 | $1,052.05 | | | 31631 | $1,611.51 | | | 31632 | $0.00 | | | 31633 | $0.00 | | | 31634 | $1,611.51 | | | 31635 | $519.94 | | | 31636 | $2,358.10 | | | 31637 | $0.00 | | | 31638 | $1,611.51 | | | 31640 | $1,052.05 | | | 31641 | $1,052.05 | | | 31643 | $519.94 | | | 31645 | $519.94 | | | 31646 | $162.31 | | | 31647 | $2,100.61 | | | 31648 | $1,052.05 | | | 31649 | $519.94 | | | 31651 | $0.00 | | | 31652 | $1,052.05 | | | 31653 | $1,052.05 | | | 31654 | $0.00 | | | 31717 | $162.31 | | | 31720 | $0.00 | | | 31730 | $519.94 | | | 31750 | $1,909.57 | | | 31755 | $1,909.57 | | | 31820 | $896.80 | | | 31825 | $896.80 | | | 31830 | $896.80 | | | 32400 | $489.93 | | | 32408 | $505.04 | | | 32550 | $1,170.63 | | | 32552 | $270.80 | | | 32553 | $534.87 | | | 32554 | $270.80 | | | 32555 | $270.80 | | | 32556 | $563.60 | | | 32557 | $492.92 | | | 32960 | $270.80 | | | 32994 | $1,864.96 | | | 32998 | $1,864.96 | | | 33016 | $492.92 | | | 33206 | $6,277.95 | | | 33207 | $6,488.87 | | | 33208 | $6,644.59 | | | 33210 | $3,232.10 | | | 33211 | $4,986.79 | | | 33212 | $5,271.28 | | | 33213 | $6,554.32 | | | 33214 | $6,431.30 | | | 33215 | $1,140.05 | | | 33216 | $4,649.14 | | | 33217 | $5,672.53 | | | 33218 | $1,281.61 | | | 33220 | $1,807.87 | | | 33221 | $9,968.88 | | | 33222 | $696.96 | | | 33223 | $696.96 | | | 33224 | $6,662.33 | | | 33225 | $0.00 | | | 33226 | $1,140.05 | | | 33227 | $5,152.61 | | | 33228 | $6,489.66 | | | 33229 | $10,036.97 | | | 33230 | $16,958.41 | | | 33231 | $22,646.02 | | | 33233 | $4,550.09 | | | 33234 | $1,281.61 | | | 33235 | $1,658.81 | | | 33240 | $16,781.20 | | | 33241 | $1,281.61 | | | 33249 | $22,696.48 | | | 33262 | $16,578.41 | | | 33263 | $16,812.47 | | | 33264 | $22,729.28 | | | 33270 | $22,493.38 | | | 33271 | $5,320.96 | | | 33273 | $1,281.61 | | | 33274 | $9,459.41 | | | 33275 | $1,140.05 | | | 33285 | $5,657.66 | | | 33286 | $262.00 | | | 33419 | $0.00 | | | 33508 | $0.00 | | | 33866 | $0.00 | | | 33900 | $5,002.87 | | | 33901 | $5,002.87 | | | 33902 | $8,314.00 | | | 33903 | $5,002.87 | | | 34490 | $1,140.05 | | | 34713 | $0.00 | | | 34714 | $0.00 | | | 34715 | $0.00 | | | 34716 | $0.00 | | | 35188 | $1,973.54 | | | 35207 | $1,140.05 | | | 35572 | $0.00 | | | 35875 | $1,973.54 | | | 35876 | $1,973.54 | | | 36000 | $0.00 | | | 36002 | $270.80 | | | 36005 | $0.00 | | | 36010 | $0.00 | | | 36011 | $0.00 | | | 36012 | $0.00 | | | 36013 | $0.00 | | | 36014 | $0.00 | | | 36015 | $0.00 | | | 36100 | $0.00 | | | 36140 | $0.00 | | | 36160 | $0.00 | | | 36200 | $0.00 | | | 36215 | $0.00 | | | 36216 | $0.00 | | | 36217 | $0.00 | | | 36218 | $0.00 | | | 36221 | $0.00 | | | 36222 | $0.00 | | | 36223 | $0.00 | | | 36224 | $0.00 | | | 36225 | $0.00 | | | 36226 | $0.00 | | | 36227 | $0.00 | | | 36228 | $0.00 | | | 36245 | $0.00 | | | 36246 | $0.00 | | | 36247 | $0.00 | | | 36248 | $0.00 | | | 36251 | $0.00 | | | 36252 | $0.00 | | | 36253 | $0.00 | | | 36254 | $0.00 | | | 36260 | $1,973.54 | | | 36261 | $2,234.00 | | | 36262 | $1,281.61 | | | 36400 | $0.00 | | | 36405 | $0.00 | | | 36406 | $0.00 | | | 36410 | $0.00 | | | 36416 | $0.00 | | | 36420 | $0.00 | | | 36425 | $0.00 | | | 36430 | $29.76 | | | 36440 | $166.66 | | | 36450 | $166.66 | | | 36455 | $166.66 | | | 36465 | $696.96 | | | 36466 | $696.96 | | | 36468 | $0.00 | | | 36470 | $68.10 | | | 36471 | $116.88 | | | 36473 | $1,112.01 | | | 36474 | $0.00 | | | 36475 | $1,140.05 | | | 36476 | $0.00 | | | 36478 | $1,140.05 | | | 36479 | $0.00 | | | 36481 | $0.00 | | | 36482 | $1,529.52 | | | 36483 | $0.00 | | | 36500 | $0.00 | | | 36510 | $0.00 | | | 36511 | $568.49 | | | 36512 | $568.49 | | | 36513 | $166.66 | | | 36514 | $568.49 | | | 36516 | $1,639.96 | | | 36522 | $1,639.96 | | | 36555 | $492.92 | | | 36556 | $492.92 | | | 36557 | $1,973.54 | | | 36558 | $1,140.05 | | | 36560 | $1,140.05 | | | 36561 | $1,140.05 | | | 36563 | $1,973.54 | | | 36565 | $1,140.05 | | | 36566 | $1,973.54 | | | 36568 | $270.80 | | | 36569 | $492.92 | | | 36570 | $1,140.05 | | | 36571 | $1,140.05 | | | 36572 | $270.80 | | | 36573 | $492.92 | | | 36575 | $270.80 | | | 36576 | $492.92 | | | 36578 | $1,140.05 | | | 36580 | $492.92 | | | 36581 | $1,140.05 | | | 36582 | $1,140.05 | | | 36583 | $3,558.93 | | | 36584 | $492.92 | | | 36585 | $1,140.05 | | | 36589 | $270.80 | | | 36590 | $270.80 | | | 36591 | $0.00 | | | 36592 | $0.00 | | | 36593 | $26.69 | | | 36595 | $1,140.05 | | | 36596 | $492.92 | | | 36597 | $492.92 | | | 36598 | $78.91 | | | 36600 | $0.00 | | | 36620 | $0.00 | | | 36625 | $0.00 | | | 36640 | $1,140.05 | | | 36680 | $0.00 | | | 36800 | $1,973.54 | | | 36810 | $1,140.05 | | | 36815 | $1,973.54 | | | 36818 | $1,973.54 | | | 36819 | $1,973.54 | | | 36820 | $1,973.54 | | | 36821 | $1,140.05 | | | 36825 | $1,973.54 | | | 36830 | $1,973.54 | | | 36831 | $1,973.54 | | | 36832 | $1,973.54 | | | 36833 | $1,973.54 | | | 36835 | $1,699.70 | | | 36836 | $8,798.77 | | | 36837 | $9,734.34 | | | 36860 | $270.80 | | | 36861 | $1,973.54 | | | 36901 | $487.44 | | | 36902 | $1,820.48 | | | 36903 | $5,371.24 | | | 36904 | $2,443.95 | | | 36905 | $3,555.50 | | | 36906 | $8,654.90 | | | 36907 | $0.00 | | | 36908 | $0.00 | | | 36909 | $0.00 | | | 37184 | $5,465.23 | | | 37185 | $0.00 | | | 37186 | $0.00 | | | 37187 | $2,637.52 | | | 37188 | $1,140.05 | | | 37193 | $1,227.21 | | | 37197 | $1,140.05 | | | 37200 | $1,973.54 | | | 37211 | $1,973.54 | | | 37212 | $1,140.05 | | | 37220 | $1,820.48 | | | 37221 | $5,252.88 | | | 37222 | $0.00 | | | 37223 | $0.00 | | | 37224 | $2,651.96 | | | 37225 | $5,674.09 | | | 37226 | $5,478.11 | | | 37227 | $9,300.44 | | | 37228 | $4,819.83 | | | 37229 | $8,743.73 | | | 37230 | $8,586.45 | | | 37231 | $9,052.07 | | | 37232 | $0.00 | | | 37233 | $0.00 | | | 37234 | $0.00 | | | 37235 | $0.00 | | | 37236 | $5,053.41 | | | 37237 | $0.00 | | | 37238 | $5,265.06 | | | 37239 | $0.00 | | | 37241 | $3,555.50 | | | 37242 | $5,182.21 | | | 37243 | $3,555.50 | | | 37246 | $1,820.48 | | | 37247 | $0.00 | | | 37248 | $1,820.48 | | | 37249 | $0.00 | | | 37252 | $0.00 | | | 37253 | $0.00 | | | 37500 | $1,973.54 | | | 37607 | $1,140.05 | | | 37609 | $489.93 | | | 37650 | $1,140.05 | | | 37700 | $1,140.05 | | | 37718 | $1,140.05 | | | 37722 | $1,140.05 | | | 37735 | $1,140.05 | | | 37760 | $1,140.05 | | | 37761 | $492.92 | | | 37765 | $210.75 | | | 37766 | $232.22 | | | 37780 | $492.92 | | | 37785 | $1,140.05 | | | 37790 | $1,170.42 | | | 38200 | $0.00 | | | 38204 | $0.00 | | | 38206 | $568.49 | | | 38220 | $103.99 | | | 38221 | $95.10 | | | 38222 | $845.19 | | | 38230 | $568.49 | | | 38232 | $1,639.96 | | | 38241 | $568.49 | | | 38242 | $568.49 | | | 38243 | $568.49 | | | 38300 | $845.19 | | | 38305 | $845.19 | | | 38308 | $950.67 | | | 38500 | $950.67 | | | 38505 | $489.93 | | | 38510 | $950.67 | | | 38520 | $950.67 | | | 38525 | $950.67 | | | 38530 | $950.67 | | | 38531 | $1,103.89 | | | 38542 | $1,864.96 | | | 38550 | $950.67 | | | 38555 | $1,864.28 | | | 38570 | $1,864.96 | | | 38571 | $3,050.29 | | | 38572 | $3,050.29 | | | 38573 | $3,050.29 | | | 38700 | $1,864.28 | | | 38740 | $1,864.96 | | | 38745 | $1,864.96 | | | 38760 | $1,864.28 | | | 38790 | $0.00 | | | 38792 | $0.00 | | | 38794 | $0.00 | | | 38900 | $0.00 | | | 40490 | $68.10 | | | 40500 | $896.80 | | | 40510 | $896.80 | | | 40520 | $896.80 | | | 40525 | $896.80 | | | 40527 | $1,909.57 | | | 40530 | $896.80 | | | 40650 | $189.71 | | | 40652 | $189.71 | | | 40654 | $456.11 | | | 40700 | $1,909.57 | | | 40701 | $1,909.57 | | | 40702 | $1,909.57 | | | 40720 | $896.80 | | | 40761 | $1,909.57 | | | 40800 | $141.41 | | | 40801 | $189.71 | | | 40804 | $0.00 | | | 40805 | $167.19 | | | 40806 | $76.08 | | | 40808 | $103.68 | | | 40810 | $137.73 | | | 40812 | $170.56 | | | 40814 | $896.80 | | | 40816 | $896.80 | | | 40818 | $189.71 | | | 40819 | $456.11 | | | 40820 | $182.52 | | | 40830 | $87.46 | | | 40831 | $189.71 | | | 40840 | $1,909.57 | | | 40842 | $1,909.57 | | | 40843 | $1,909.57 | | | 40844 | $1,909.57 | | | 40845 | $1,909.57 | | | 41000 | $93.25 | | | 41005 | $87.46 | | | 41006 | $456.11 | | | 41007 | $456.11 | | | 41008 | $896.80 | | | 41009 | $189.71 | | | 41010 | $456.11 | | | 41015 | $189.71 | | | 41016 | $1,909.57 | | | 41017 | $896.80 | | | 41018 | $456.11 | | | 41019 | $1,909.57 | | | 41100 | $104.30 | | | 41105 | $104.30 | | | 41108 | $98.17 | | | 41110 | $138.65 | | | 41112 | $896.80 | | | 41113 | $896.80 | | | 41114 | $896.80 | | | 41115 | $159.83 | | | 41116 | $896.80 | | | 41120 | $1,909.57 | | | 41250 | $0.00 | | | 41251 | $87.46 | | | 41252 | $87.46 | | | 41510 | $896.80 | | | 41512 | $1,909.57 | | | 41520 | $896.80 | | | 41530 | $709.84 | | | 41800 | $0.00 | | | 41805 | $214.43 | | | 41806 | $257.37 | | | 41820 | $896.80 | | | 41821 | $456.11 | | | 41822 | $215.96 | | | 41823 | $310.75 | | | 41825 | $142.65 | | | 41826 | $193.26 | | | 41827 | $1,909.57 | | | 41828 | $192.34 | | | 41830 | $276.70 | | | 41850 | $456.11 | | | 41870 | $456.11 | | | 41872 | $284.67 | | | 41874 | $235.90 | | | 42000 | $87.46 | | | 42100 | $82.82 | | | 42104 | $131.60 | | | 42106 | $160.74 | | | 42107 | $1,909.57 | | | 42120 | $1,909.57 | | | 42140 | $896.80 | | | 42145 | $1,909.57 | | | 42160 | $141.72 | | | 42180 | $189.71 | | | 42182 | $1,909.57 | | | 42200 | $1,909.57 | | | 42205 | $896.80 | | | 42210 | $1,909.57 | | | 42215 | $1,909.57 | | | 42220 | $1,909.57 | | | 42225 | $1,909.57 | | | 42226 | $1,909.57 | | | 42227 | $1,909.57 | | | 42235 | $1,909.57 | | | 42260 | $1,909.57 | | | 42280 | $103.07 | | | 42281 | $1,909.57 | | | 42300 | $456.11 | | | 42305 | $896.80 | | | 42310 | $189.71 | | | 42320 | $189.71 | | | 42330 | $124.85 | | | 42335 | $235.59 | | | 42340 | $896.80 | | | 42400 | $63.81 | | | 42405 | $456.11 | | | 42408 | $896.80 | | | 42409 | $896.80 | | | 42410 | $1,909.57 | | | 42415 | $1,909.57 | | | 42420 | $1,909.57 | | | 42425 | $1,909.57 | | | 42440 | $1,909.57 | | | 42450 | $1,909.57 | | | 42500 | $1,909.57 | | | 42505 | $1,909.57 | | | 42507 | $1,909.57 | | | 42509 | $1,909.57 | | | 42510 | $896.80 | | | 42550 | $0.00 | | | 42600 | $896.80 | | | 42650 | $42.02 | | | 42660 | $64.12 | | | 42665 | $896.80 | | | 42700 | $87.46 | | | 42720 | $896.80 | | | 42725 | $1,909.57 | | | 42800 | $87.74 | | | 42804 | $896.80 | | | 42806 | $896.80 | | | 42808 | $896.80 | | | 42809 | $0.00 | | | 42810 | $896.80 | | | 42815 | $1,909.57 | | | 42820 | $1,909.57 | | | 42821 | $896.80 | | | 42825 | $1,909.57 | | | 42826 | $896.80 | | | 42830 | $896.80 | | | 42831 | $896.80 | | | 42835 | $896.80 | | | 42836 | $896.80 | | | 42860 | $896.80 | | | 42870 | $1,909.57 | | | 42890 | $1,909.57 | | | 42892 | $1,909.57 | | | 42900 | $456.11 | | | 42950 | $1,909.57 | | | 42955 | $456.11 | | | 42960 | $189.71 | | | 42962 | $896.80 | | | 42970 | $87.46 | | | 42972 | $896.80 | | | 42975 | $72.40 | | | 43030 | $1,909.57 | | | 43130 | $1,909.57 | | | 43180 | $1,909.57 | | | 43191 | $563.60 | | | 43192 | $563.60 | | | 43193 | $563.60 | | | 43194 | $563.60 | | | 43195 | $1,110.22 | | | 43196 | $1,110.22 | | | 43197 | $115.04 | | | 43198 | $122.71 | | | 43200 | $337.55 | | | 43201 | $563.60 | | | 43202 | $563.60 | | | 43204 | $563.60 | | | 43205 | $563.60 | | | 43206 | $563.60 | | | 43210 | $3,050.29 | | | 43211 | $563.60 | | | 43212 | $2,655.89 | | | 43213 | $563.60 | | | 43214 | $563.60 | | | 43215 | $563.60 | | | 43216 | $563.60 | | | 43217 | $563.60 | | | 43220 | $563.60 | | | 43226 | $563.60 | | | 43227 | $563.60 | | | 43229 | $1,110.22 | | | 43231 | $563.60 | | | 43232 | $563.60 | | | 43233 | $563.60 | | | 43235 | $337.55 | | | 43236 | $337.55 | | | 43237 | $563.60 | | | 43238 | $563.60 | | | 43239 | $337.55 | | | 43240 | $1,672.41 | | | 43241 | $563.60 | | | 43242 | $563.60 | | | 43243 | $563.60 | | | 43244 | $563.60 | | | 43245 | $563.60 | | | 43246 | $563.60 | | | 43247 | $337.55 | | | 43248 | $337.55 | | | 43249 | $563.60 | | | 43250 | $563.60 | | | 43251 | $563.60 | | | 43252 | $1,110.22 | | | 43253 | $563.60 | | | 43254 | $563.60 | | | 43255 | $563.60 | | | 43257 | $1,110.22 | | | 43259 | $563.60 | | | 43260 | $1,110.22 | | | 43261 | $1,110.22 | | | 43262 | $1,110.22 | | | 43263 | $1,110.22 | | | 43264 | $1,110.22 | | | 43265 | $1,666.48 | | | 43266 | $2,690.49 | | | 43270 | $563.60 | | | 43273 | $0.00 | | | 43274 | $1,666.48 | | | 43275 | $1,110.22 | | | 43276 | $1,666.48 | | | 43277 | $1,110.22 | | | 43278 | $1,110.22 | | | 43284 | $4,353.58 | | | 43285 | $1,864.96 | | | 43290 | $639.57 | | | 43291 | $365.32 | | | 43450 | $337.55 | | | 43453 | $563.60 | | | 43653 | $1,864.96 | | | 43752 | $156.16 | | | 43753 | $0.00 | | | 43754 | $0.00 | | | 43755 | $59.42 | | | 43756 | $337.55 | | | 43757 | $337.55 | | | 43761 | $100.89 | | | 43762 | $100.89 | | | 43763 | $100.89 | | | 43774 | $1,276.03 | | | 43870 | $1,110.22 | | | 43886 | $1,278.72 | | | 43887 | $696.96 | | | 43888 | $1,278.72 | | | 44100 | $337.55 | | | 44312 | $1,278.72 | | | 44340 | $1,278.72 | | | 44360 | $563.60 | | | 44361 | $563.60 | | | 44363 | $563.60 | | | 44364 | $563.60 | | | 44365 | $563.60 | | | 44366 | $563.60 | | | 44369 | $563.60 | | | 44370 | $2,693.26 | | | 44372 | $563.60 | | | 44373 | $563.60 | | | 44376 | $563.60 | | | 44377 | $563.60 | | | 44378 | $563.60 | | | 44379 | $1,666.48 | | | 44380 | $337.55 | | | 44381 | $563.60 | | | 44382 | $337.55 | | | 44384 | $1,110.22 | | | 44385 | $328.08 | | | 44386 | $328.08 | | | 44388 | $328.08 | | | 44389 | $431.31 | | | 44390 | $328.08 | | | 44391 | $431.31 | | | 44392 | $431.31 | | | 44394 | $431.31 | | | 44401 | $431.31 | | | 44402 | $2,502.03 | | | 44403 | $431.31 | | | 44404 | $431.31 | | | 44405 | $431.31 | | | 44406 | $431.31 | | | 44407 | $431.31 | | | 44408 | $328.08 | | | 44500 | $337.55 | | | 44701 | $0.00 | | | 45000 | $431.31 | | | 45005 | $431.31 | | | 45020 | $935.17 | | | 45100 | $935.17 | | | 45108 | $935.17 | | | 45150 | $431.31 | | | 45160 | $935.17 | | | 45171 | $935.17 | | | 45172 | $935.17 | | | 45190 | $935.17 | | | 45300 | $80.06 | | | 45303 | $431.31 | | | 45305 | $431.31 | | | 45307 | $935.17 | | | 45308 | $935.17 | | | 45309 | $431.31 | | | 45315 | $431.31 | | | 45317 | $431.31 | | | 45320 | $935.17 | | | 45321 | $935.17 | | | 45327 | $2,156.79 | | | 45330 | $123.62 | | | 45331 | $328.08 | | | 45332 | $431.31 | | | 45333 | $328.08 | | | 45334 | $431.31 | | | 45335 | $328.08 | | | 45337 | $328.08 | | | 45338 | $431.31 | | | 45340 | $431.31 | | | 45341 | $328.08 | | | 45342 | $431.31 | | | 45346 | $431.31 | | | 45347 | $2,760.15 | | | 45349 | $935.17 | | | 45350 | $431.31 | | | 45378 | $328.08 | | | 45379 | $431.31 | | | 45380 | $431.31 | | | 45381 | $431.31 | | | 45382 | $431.31 | | | 45384 | $431.31 | | | 45385 | $431.31 | | | 45386 | $431.31 | | | 45388 | $431.31 | | | 45389 | $2,662.75 | | | 45390 | $935.17 | | | 45391 | $431.31 | | | 45392 | $431.31 | | | 45393 | $431.31 | | | 45398 | $431.31 | | | 45500 | $935.17 | | | 45505 | $935.17 | | | 45520 | $0.00 | | | 45541 | $935.17 | | | 45560 | $935.17 | | | 45900 | $328.08 | | | 45905 | $431.31 | | | 45910 | $431.31 | | | 45915 | $431.31 | | | 45990 | $935.17 | | | 46020 | $935.17 | | | 46030 | $431.31 | | | 46040 | $431.31 | | | 46045 | $935.17 | | | 46050 | $328.08 | | | 46060 | $935.17 | | | 46070 | $935.17 | | | 46080 | $935.17 | | | 46083 | $100.89 | | | 46200 | $935.17 | | | 46220 | $431.31 | | | 46221 | $158.29 | | | 46230 | $935.17 | | | 46250 | $935.17 | | | 46255 | $935.17 | | | 46257 | $935.17 | | | 46258 | $935.17 | | | 46260 | $935.17 | | | 46261 | $935.17 | | | 46262 | $935.17 | | | 46270 | $935.17 | | | 46275 | $935.17 | | | 46280 | $935.17 | | | 46285 | $935.17 | | | 46288 | $935.17 | | | 46320 | $114.42 | | | 46500 | $200.32 | | | 46505 | $431.31 | | | 46600 | $0.00 | | | 46601 | $0.00 | | | 46604 | $431.31 | | | 46606 | $181.60 | | | 46607 | $431.31 | | | 46608 | $328.08 | | | 46610 | $935.17 | | | 46611 | $328.08 | | | 46612 | $935.17 | | | 46614 | $93.87 | | | 46615 | $935.17 | | | 46700 | $935.17 | | | 46706 | $935.17 | | | 46707 | $935.17 | | | 46750 | $935.17 | | | 46753 | $935.17 | | | 46754 | $935.17 | | | 46760 | $935.17 | | | 46761 | $935.17 | | | 46900 | $137.23 | | | 46910 | $158.90 | | | 46916 | $75.05 | | | 46917 | $935.17 | | | 46922 | $935.17 | | | 46924 | $935.17 | | | 46930 | $131.60 | | | 46940 | $134.36 | | | 46942 | $134.05 | | | 46945 | $935.17 | | | 46946 | $935.17 | | | 46947 | $935.17 | | | 46948 | $935.17 | | | 47000 | $489.93 | | | 47001 | $0.00 | | | 47382 | $1,864.96 | | | 47383 | $2,637.15 | | | 47531 | $0.00 | | | 47532 | $0.00 | | | 47533 | $1,170.63 | | | 47534 | $1,170.63 | | | 47535 | $1,170.63 | | | 47536 | $1,170.63 | | | 47537 | $337.55 | | | 47538 | $2,829.97 | | | 47539 | $1,864.96 | | | 47540 | $2,651.40 | | | 47541 | $1,170.63 | | | 47542 | $0.00 | | | 47543 | $0.00 | | | 47544 | $0.00 | | | 47552 | $1,170.63 | | | 47553 | $1,170.63 | | | 47554 | $1,864.96 | | | 47555 | $1,170.63 | | | 47556 | $2,764.23 | | | 47562 | $1,864.96 | | | 47563 | $1,864.96 | | | 47564 | $1,864.96 | | | 48102 | $489.93 | | | 49082 | $337.55 | | | 49083 | $337.55 | | | 49084 | $337.55 | | | 49180 | $489.93 | | | 49250 | $1,170.63 | | | 49320 | $1,864.96 | | | 49321 | $1,864.96 | | | 49322 | $1,864.96 | | | 49324 | $1,864.96 | | | 49325 | $1,864.96 | | | 49326 | $0.00 | | | 49327 | $0.00 | | | 49400 | $0.00 | | | 49402 | $1,170.63 | | | 49406 | $489.93 | | | 49407 | $489.93 | | | 49411 | $308.30 | | | 49418 | $1,170.63 | | | 49419 | $1,973.54 | | | 49421 | $1,170.63 | | | 49422 | $1,140.05 | | | 49423 | $563.60 | | | 49424 | $0.00 | | | 49426 | $1,170.63 | | | 49427 | $0.00 | | | 49429 | $1,140.05 | | | 49435 | $0.00 | | | 49436 | $563.60 | | | 49440 | $563.60 | | | 49441 | $563.60 | | | 49442 | $431.31 | | | 49446 | $563.60 | | | 49450 | $337.55 | | | 49451 | $337.55 | | | 49452 | $337.55 | | | 49460 | $337.55 | | | 49465 | $100.09 | | | 49495 | $1,170.63 | | | 49496 | $1,170.63 | | | 49500 | $1,170.63 | | | 49501 | $1,170.63 | | | 49505 | $1,170.63 | | | 49507 | $1,170.63 | | | 49520 | $1,170.63 | | | 49521 | $1,170.63 | | | 49525 | $1,170.63 | | | 49540 | $1,864.96 | | | 49550 | $1,170.63 | | | 49553 | $1,170.63 | | | 49555 | $1,170.63 | | | 49557 | $1,170.63 | | | 49591 | $1,170.63 | | | 49592 | $1,170.63 | | | 49593 | $1,170.63 | | | 49594 | $1,170.63 | | | 49595 | $1,170.63 | | | 49600 | $1,170.63 | | | 49613 | $1,864.96 | | | 49614 | $1,864.96 | | | 49615 | $1,864.96 | | | 49650 | $1,864.96 | | | 49651 | $1,864.96 | | | 50080 | $3,396.30 | | | 50081 | $3,396.30 | | | 50200 | $489.93 | | | 50382 | $671.25 | | | 50384 | $671.25 | | | 50385 | $671.25 | | | 50386 | $543.58 | | | 50387 | $671.25 | | | 50389 | $239.03 | | | 50390 | $262.00 | | | 50391 | $41.72 | | | 50396 | $239.03 | | | 50430 | $0.00 | | | 50431 | $0.00 | | | 50432 | $671.25 | | | 50433 | $1,170.42 | | | 50434 | $899.31 | | | 50435 | $671.25 | | | 50436 | $671.25 | | | 50437 | $1,170.42 | | | 50551 | $1,679.83 | | | 50553 | $1,679.83 | | | 50555 | $3,396.30 | | | 50557 | $3,396.30 | | | 50561 | $1,679.83 | | | 50562 | $3,396.30 | | | 50570 | $1,170.42 | | | 50572 | $239.03 | | | 50574 | $671.25 | | | 50575 | $1,679.83 | | | 50576 | $1,679.83 | | | 50580 | $1,679.83 | | | 50590 | $1,170.42 | | | 50592 | $1,864.96 | | | 50593 | $4,179.17 | | | 50606 | $0.00 | | | 50684 | $0.00 | | | 50686 | $59.42 | | | 50688 | $671.25 | | | 50690 | $0.00 | | | 50693 | $1,170.42 | | | 50694 | $1,170.42 | | | 50695 | $1,170.42 | | | 50705 | $0.00 | | | 50706 | $0.00 | | | 50727 | $1,170.42 | | | 50947 | $1,864.96 | | | 50948 | $3,050.29 | | | 50951 | $1,170.42 | | | 50953 | $1,170.42 | | | 50955 | $1,679.83 | | | 50957 | $1,679.83 | | | 50961 | $1,679.83 | | | 50970 | $1,170.42 | | | 50972 | $1,170.42 | | | 50974 | $1,679.83 | | | 50976 | $1,679.83 | | | 50980 | $1,679.83 | | | 51020 | $1,170.42 | | | 51030 | $1,170.42 | | | 51040 | $671.25 | | | 51045 | $671.25 | | | 51050 | $1,679.83 | | | 51065 | $1,170.42 | | | 51080 | $845.19 | | | 51100 | $33.13 | | | 51101 | $89.57 | | | 51102 | $671.25 | | | 51500 | $1,864.96 | | | 51520 | $1,170.42 | | | 51535 | $1,170.42 | | | 51600 | $0.00 | | | 51605 | $0.00 | | | 51610 | $0.00 | | | 51700 | $44.48 | | | 51701 | $0.00 | | | 51702 | $0.00 | | | 51703 | $59.42 | | | 51705 | $52.15 | | | 51710 | $239.03 | | | 51715 | $1,552.24 | | | 51720 | $43.56 | | | 51725 | $100.89 | | | 51726 | $100.89 | | | 51727 | $207.99 | | | 51728 | $213.50 | | | 51729 | $214.43 | | | 51736 | $0.00 | | | 51741 | $0.00 | | | 51784 | $24.85 | | | 51785 | $100.89 | | | 51792 | $0.00 | | | 51797 | $0.00 | | | 51798 | $0.00 | | | 51880 | $1,170.42 | | | 51992 | $2,485.42 | | | 52000 | $239.03 | | | 52001 | $1,170.42 | | | 52005 | $671.25 | | | 52007 | $1,170.42 | | | 52010 | $239.03 | | | 52204 | $671.25 | | | 52214 | $671.25 | | | 52224 | $671.25 | | | 52234 | $1,170.42 | | | 52235 | $1,170.42 | | | 52240 | $1,679.83 | | | 52250 | $1,170.42 | | | 52260 | $671.25 | | | 52265 | $230.99 | | | 52270 | $671.25 | | | 52275 | $671.25 | | | 52276 | $671.25 | | | 52277 | $1,170.42 | | | 52281 | $671.25 | | | 52282 | $1,170.42 | | | 52283 | $671.25 | | | 52285 | $239.03 | | | 52287 | $671.25 | | | 52290 | $671.25 | | | 52300 | $1,170.42 | | | 52301 | $1,170.42 | | | 52305 | $1,679.83 | | | 52310 | $671.25 | | | 52315 | $671.25 | | | 52317 | $1,170.42 | | | 52318 | $1,170.42 | | | 52320 | $1,170.42 | | | 52325 | $1,679.83 | | | 52327 | $2,284.74 | | | 52330 | $1,170.42 | | | 52332 | $1,170.42 | | | 52334 | $1,170.42 | | | 52341 | $1,170.42 | | | 52342 | $1,170.42 | | | 52343 | $671.25 | | | 52344 | $1,170.42 | | | 52345 | $1,170.42 | | | 52346 | $1,679.83 | | | 52351 | $1,170.42 | | | 52352 | $1,170.42 | | | 52353 | $1,679.83 | | | 52354 | $1,679.83 | | | 52355 | $1,679.83 | | | 52356 | $1,679.83 | | | 52400 | $1,170.42 | | | 52402 | $1,170.42 | | | 52450 | $1,170.42 | | | 52500 | $1,170.42 | | | 52601 | $1,679.83 | | | 52630 | $1,679.83 | | | 52640 | $1,170.42 | | | 52647 | $1,679.83 | | | 52648 | $1,679.83 | | | 52649 | $1,679.83 | | | 52700 | $1,170.42 | | | 53000 | $671.25 | | | 53010 | $1,679.83 | | | 53020 | $671.25 | | | 53025 | $671.25 | | | 53040 | $671.25 | | | 53060 | $69.63 | | | 53080 | $239.03 | | | 53085 | $671.25 | | | 53200 | $671.25 | | | 53210 | $1,170.42 | | | 53215 | $1,679.83 | | | 53220 | $1,170.42 | | | 53230 | $1,679.83 | | | 53235 | $1,679.83 | | | 53240 | $1,170.42 | | | 53250 | $1,170.42 | | | 53260 | $671.25 | | | 53265 | $671.25 | | | 53270 | $671.25 | | | 53275 | $671.25 | | | 53400 | $1,679.83 | | | 53405 | $1,679.83 | | | 53410 | $1,679.83 | | | 53420 | $1,679.83 | | | 53425 | $1,679.83 | | | 53430 | $1,679.83 | | | 53431 | $1,679.83 | | | 53440 | $5,564.69 | | | 53442 | $1,679.83 | | | 53444 | $11,645.96 | | | 53445 | $12,696.73 | | | 53446 | $1,679.83 | | | 53447 | $12,310.92 | | | 53449 | $1,679.83 | | | 53450 | $1,170.42 | | | 53451 | $8,653.91 | | | 53452 | $3,004.56 | | | 53453 | $1,214.33 | | | 53454 | $117.04 | | | 53460 | $1,170.42 | | | 53502 | $1,170.42 | | | 53505 | $1,679.83 | | | 53510 | $1,679.83 | | | 53515 | $1,679.83 | | | 53520 | $1,679.83 | | | 53600 | $33.44 | | | 53601 | $0.00 | | | 53605 | $671.25 | | | 53620 | $74.24 | | | 53621 | $76.08 | | | 53660 | $37.43 | | | 53661 | $0.00 | | | 53665 | $671.25 | | | 53850 | $1,170.42 | | | 53852 | $1,116.92 | | | 53854 | $671.25 | | | 53855 | $590.83 | | | 53860 | $671.25 | | | 54000 | $1,170.42 | | | 54001 | $671.25 | | | 54015 | $489.93 | | | 54050 | $0.00 | | | 54055 | $67.80 | | | 54056 | $0.00 | | | 54057 | $696.96 | | | 54060 | $696.96 | | | 54065 | $696.96 | | | 54100 | $489.93 | | | 54105 | $845.19 | | | 54110 | $1,170.42 | | | 54111 | $1,679.83 | | | 54112 | $3,396.30 | | | 54115 | $845.19 | | | 54120 | $1,170.42 | | | 54150 | $671.25 | | | 54160 | $239.03 | | | 54161 | $671.25 | | | 54162 | $671.25 | | | 54163 | $671.25 | | | 54164 | $671.25 | | | 54200 | $59.51 | | | 54205 | $1,679.83 | | | 54220 | $100.89 | | | 54230 | $0.00 | | | 54231 | $54.91 | | | 54235 | $37.12 | | | 54240 | $32.21 | | | 54250 | $10.43 | | | 54300 | $1,170.42 | | | 54304 | $1,170.42 | | | 54308 | $1,679.83 | | | 54312 | $1,170.42 | | | 54316 | $1,679.83 | | | 54318 | $1,170.42 | | | 54322 | $1,170.42 | | | 54324 | $1,170.42 | | | 54326 | $671.25 | | | 54328 | $1,170.42 | | | 54340 | $1,170.42 | | | 54344 | $1,679.83 | | | 54348 | $1,679.83 | | | 54352 | $1,679.83 | | | 54360 | $1,170.42 | | | 54380 | $671.25 | | | 54385 | $671.25 | | | 54400 | $12,288.26 | | | 54401 | $12,634.62 | | | 54405 | $12,698.92 | | | 54406 | $1,170.42 | | | 54408 | $1,679.83 | | | 54410 | $12,519.91 | | | 54415 | $1,170.42 | | | 54416 | $12,440.25 | | | 54420 | $671.25 | | | 54435 | $1,170.42 | | | 54437 | $1,170.42 | | | 54440 | $1,170.42 | | | 54450 | $100.89 | | | 54500 | $845.19 | | | 54505 | $1,170.42 | | | 54512 | $1,170.42 | | | 54520 | $1,170.42 | | | 54522 | $1,170.42 | | | 54530 | $1,170.63 | | | 54550 | $1,170.63 | | | 54560 | $671.25 | | | 54600 | $1,170.42 | | | 54620 | $1,170.42 | | | 54640 | $1,170.63 | | | 54650 | $1,223.51 | | | 54660 | $2,330.79 | | | 54670 | $671.25 | | | 54680 | $1,170.42 | | | 54690 | $1,864.96 | | | 54692 | $1,864.96 | | | 54700 | $671.25 | | | 54800 | $489.93 | | | 54830 | $671.25 | | | 54840 | $671.25 | | | 54860 | $671.25 | | | 54861 | $1,170.42 | | | 54865 | $1,170.42 | | | 54900 | $671.25 | | | 54901 | $1,170.42 | | | 55000 | $54.60 | | | 55040 | $1,170.63 | | | 55041 | $1,170.63 | | | 55060 | $1,170.42 | | | 55100 | $489.93 | | | 55110 | $1,170.42 | | | 55120 | $671.25 | | | 55150 | $1,170.42 | | | 55175 | $1,170.42 | | | 55180 | $1,679.83 | | | 55200 | $1,170.42 | | | 55250 | $671.25 | | | 55300 | $0.00 | | | 55400 | $1,170.42 | | | 55500 | $1,170.42 | | | 55520 | $1,170.42 | | | 55530 | $1,170.42 | | | 55535 | $1,170.63 | | | 55540 | $1,170.63 | | | 55550 | $1,864.96 | | | 55600 | $671.25 | | | 55680 | $1,170.42 | | | 55700 | $671.25 | | | 55705 | $671.25 | | | 55706 | $1,170.42 | | | 55720 | $671.25 | | | 55725 | $1,170.42 | | | 55860 | $1,679.83 | | | 55870 | $65.95 | | | 55873 | $5,265.42 | | | 55874 | $1,679.83 | | | 55875 | $1,679.83 | | | 55876 | $69.02 | | | 55880 | $1,753.87 | | | 55920 | $1,543.91 | | | 56405 | $59.51 | | | 56420 | $71.32 | | | 56440 | $1,050.01 | | | 56441 | $1,050.01 | | | 56442 | $1,050.01 | | | 56501 | $88.04 | | | 56515 | $696.96 | | | 56605 | $40.49 | | | 56606 | $0.00 | | | 56620 | $1,050.01 | | | 56625 | $1,050.01 | | | 56700 | $1,050.01 | | | 56740 | $1,050.01 | | | 56800 | $1,050.01 | | | 56805 | $1,050.01 | | | 56810 | $1,050.01 | | | 56820 | $51.84 | | | 56821 | $67.49 | | | 57000 | $1,050.01 | | | 57010 | $1,050.01 | | | 57020 | $1,543.91 | | | 57022 | $845.19 | | | 57023 | $845.19 | | | 57061 | $77.92 | | | 57065 | $1,050.01 | | | 57100 | $42.33 | | | 57105 | $1,050.01 | | | 57120 | $1,543.91 | | | 57130 | $1,050.01 | | | 57135 | $1,050.01 | | | 57150 | $0.00 | | | 57155 | $1,543.91 | | | 57156 | $116.27 | | | 57160 | $28.83 | | | 57170 | $30.06 | | | 57180 | $71.32 | | | 57200 | $1,050.01 | | | 57210 | $1,050.01 | | | 57220 | $1,543.91 | | | 57230 | $1,050.01 | | | 57240 | $1,543.91 | | | 57250 | $1,543.91 | | | 57260 | $1,543.91 | | | 57265 | $1,543.91 | | | 57267 | $0.00 | | | 57268 | $1,543.91 | | | 57282 | $2,419.10 | | | 57283 | $2,419.10 | | | 57287 | $1,050.01 | | | 57288 | $2,084.00 | | | 57289 | $2,320.78 | | | 57291 | $1,543.91 | | | 57295 | $1,050.01 | | | 57300 | $1,050.01 | | | 57310 | $2,320.78 | | | 57320 | $1,543.91 | | | 57400 | $1,050.01 | | | 57410 | $1,050.01 | | | 57415 | $1,050.01 | | | 57420 | $53.69 | | | 57421 | $70.86 | | | 57425 | $3,304.38 | | | 57426 | $2,320.78 | | | 57452 | $52.45 | | | 57454 | $61.66 | | | 57455 | $65.65 | | | 57456 | $62.58 | | | 57460 | $169.02 | | | 57461 | $180.38 | | | 57500 | $83.44 | | | 57505 | $71.17 | | | 57510 | $65.34 | | | 57511 | $84.06 | | | 57513 | $1,050.01 | | | 57520 | $1,050.01 | | | 57522 | $1,050.01 | | | 57530 | $1,543.91 | | | 57550 | $1,543.91 | | | 57556 | $1,543.91 | | | 57558 | $1,050.01 | | | 57700 | $1,050.01 | | | 57720 | $1,050.01 | | | 57800 | $34.36 | | | 58100 | $42.95 | | | 58110 | $0.00 | | | 58120 | $1,050.01 | | | 58145 | $1,050.01 | | | 58260 | $1,543.91 | | | 58262 | $1,543.91 | | | 58301 | $44.48 | | | 58321 | $37.12 | | | 58322 | $39.26 | | | 58323 | $5.22 | | | 58340 | $0.00 | | | 58345 | $1,050.01 | | | 58346 | $1,543.91 | | | 58350 | $1,543.91 | | | 58353 | $1,543.91 | | | 58356 | $1,368.77 | | | 58541 | $1,864.96 | | | 58542 | $3,050.29 | | | 58543 | $3,050.29 | | | 58544 | $3,050.29 | | | 58545 | $1,864.96 | | | 58546 | $3,050.29 | | | 58550 | $1,864.96 | | | 58552 | $3,050.29 | | | 58553 | $3,050.29 | | | 58554 | $3,050.29 | | | 58555 | $1,050.01 | | | 58558 | $1,050.01 | | | 58559 | $1,543.91 | | | 58560 | $1,543.91 | | | 58561 | $1,543.91 | | | 58562 | $1,050.01 | | | 58563 | $1,543.91 | | | 58565 | $1,543.91 | | | 58570 | $3,050.29 | | | 58571 | $3,050.29 | | | 58572 | $3,050.29 | | | 58573 | $3,050.29 | | | 58600 | $1,050.01 | | | 58615 | $1,050.01 | | | 58660 | $1,864.96 | | | 58661 | $1,864.96 | | | 58662 | $1,864.96 | | | 58670 | $1,864.96 | | | 58671 | $1,864.96 | | | 58672 | $1,864.96 | | | 58673 | $1,864.96 | | | 58674 | $3,050.29 | | | 58800 | $1,050.01 | | | 58805 | $1,050.01 | | | 58820 | $1,050.01 | | | 58900 | $1,050.01 | | | 58970 | $274.22 | | | 58974 | $274.22 | | | 58976 | $116.27 | | | 59000 | $55.83 | | | 59001 | $116.27 | | | 59012 | $116.27 | | | 59015 | $52.45 | | | 59020 | $28.22 | | | 59025 | $15.95 | | | 59070 | $116.27 | | | 59072 | $162.54 | | | 59074 | $116.27 | | | 59076 | $116.27 | | | 59100 | $1,543.91 | | | 59150 | $1,864.96 | | | 59151 | $1,864.96 | | | 59160 | $1,050.01 | | | 59200 | $47.86 | | | 59300 | $95.10 | | | 59320 | $1,050.01 | | | 59412 | $1,050.01 | | | 59414 | $1,050.01 | | | 59812 | $1,050.01 | | | 59820 | $1,050.01 | | | 59821 | $1,050.01 | | | 59840 | $1,050.01 | | | 59841 | $1,050.01 | | | 59866 | $116.27 | | | 59870 | $1,050.01 | | | 59871 | $1,050.01 | | | 60000 | $456.11 | | | 60100 | $45.70 | | | 60200 | $1,864.96 | | | 60210 | $1,864.96 | | | 60212 | $1,864.96 | | | 60220 | $1,864.96 | | | 60225 | $1,864.96 | | | 60240 | $1,864.96 | | | 60280 | $1,864.96 | | | 60281 | $1,864.96 | | | 60300 | $66.88 | | | 60500 | $1,909.57 | | | 60512 | $0.00 | | | 61000 | $268.46 | | | 61001 | $268.46 | | | 61020 | $348.77 | | | 61026 | $268.46 | | | 61050 | $112.43 | | | 61055 | $112.43 | | | 61070 | $268.46 | | | 61215 | $1,844.70 | | | 61330 | $896.80 | | | 61770 | $1,844.70 | | | 61781 | $0.00 | | | 61782 | $0.00 | | | 61783 | $0.00 | | | 61790 | $677.27 | | | 61791 | $677.27 | | | 61880 | $1,569.06 | | | 61885 | $14,711.53 | | | 61886 | $20,027.75 | | | 61888 | $3,806.91 | | | 62160 | $0.00 | | | 62194 | $677.27 | | | 62225 | $1,844.70 | | | 62230 | $1,844.70 | | | 62252 | $29.76 | | | 62263 | $348.77 | | | 62264 | $348.77 | | | 62267 | $262.00 | | | 62268 | $348.77 | | | 62269 | $489.93 | | | 62270 | $268.46 | | | 62272 | $268.46 | | | 62273 | $268.46 | | | 62280 | $348.77 | | | 62281 | $348.77 | | | 62282 | $348.77 | | | 62284 | $0.00 | | | 62287 | $677.27 | | | 62290 | $0.00 | | | 62291 | $0.00 | | | 62292 | $677.27 | | | 62294 | $348.77 | | | 62302 | $0.00 | | | 62303 | $0.00 | | | 62304 | $0.00 | | | 62305 | $0.00 | | | 62320 | $268.46 | | | 62321 | $268.46 | | | 62322 | $268.46 | | | 62323 | $268.46 | | | 62324 | $348.77 | | | 62325 | $348.77 | | | 62326 | $348.77 | | | 62327 | $348.77 | | | 62328 | $268.46 | | | 62329 | $268.46 | | | 62350 | $2,463.29 | | | 62355 | $677.27 | | | 62360 | $11,751.22 | | | 62361 | $12,105.69 | | | 62362 | $11,617.56 | | | 62365 | $1,844.70 | | | 62367 | $11.65 | | | 62368 | $16.26 | | | 62369 | $60.44 | | | 62370 | $56.44 | | | 62380 | $2,382.86 | | | 63001 | $2,382.86 | | | 63003 | $2,382.86 | | | 63005 | $2,382.86 | | | 63020 | $2,382.86 | | | 63030 | $2,382.86 | | | 63042 | $2,382.86 | | | 63044 | $0.00 | | | 63045 | $2,382.86 | | | 63046 | $2,382.86 | | | 63047 | $2,382.86 | | | 63055 | $2,382.86 | | | 63056 | $2,382.86 | | | 63600 | $677.27 | | | 63610 | $1,000.93 | | | 63650 | $3,837.63 | | | 63655 | $13,552.09 | | | 63661 | $677.27 | | | 63662 | $1,569.06 | | | 63663 | $3,751.47 | | | 63664 | $12,344.99 | | | 63685 | $19,948.00 | | | 63688 | $1,569.06 | | | 63744 | $1,844.70 | | | 63746 | $677.27 | | | 64400 | $65.03 | | | 64405 | $28.22 | | | 64408 | $34.66 | | | 64415 | $348.77 | | | 64416 | $348.77 | | | 64417 | $348.77 | | | 64418 | $36.81 | | | 64420 | $268.46 | | | 64421 | $348.77 | | | 64425 | $63.81 | | | 64430 | $348.77 | | | 64435 | $37.73 | | | 64445 | $76.08 | | | 64446 | $348.77 | | | 64447 | $41.11 | | | 64448 | $348.77 | | | 64449 | $348.77 | | | 64450 | $41.11 | | | 64451 | $268.46 | | | 64454 | $134.36 | | | 64455 | $17.48 | | | 64461 | $268.46 | | | 64462 | $0.00 | | | 64463 | $268.46 | | | 64479 | $348.77 | | | 64480 | $0.00 | | | 64483 | $348.77 | | | 64484 | $0.00 | | | 64486 | $0.00 | | | 64487 | $0.00 | | | 64488 | $0.00 | | | 64489 | $0.00 | | | 64490 | $348.77 | | | 64491 | $0.00 | | | 64492 | $0.00 | | | 64493 | $348.77 | | | 64494 | $0.00 | | | 64495 | $0.00 | | | 64505 | $60.74 | | | 64510 | $348.77 | | | 64517 | $348.77 | | | 64520 | $348.77 | | | 64530 | $348.77 | | | 64553 | $4,388.55 | | | 64555 | $3,983.23 | | | 64561 | $3,981.22 | | | 64566 | $88.96 | | | 64568 | $20,355.26 | | | 64569 | $4,645.52 | | | 64570 | $1,844.70 | | | 64575 | $13,321.61 | | | 64580 | $14,483.39 | | | 64581 | $4,117.58 | | | 64582 | $21,103.08 | | | 64583 | $6,877.15 | | | 64584 | $2,121.37 | | | 64585 | $1,569.06 | | | 64590 | $14,699.02 | | | 64595 | $1,569.06 | | | 64600 | $348.77 | | | 64605 | $677.27 | | | 64610 | $677.27 | | | 64611 | $64.12 | | | 64612 | $65.65 | | | 64615 | $57.98 | | | 64616 | $55.52 | | | 64617 | $75.46 | | | 64620 | $348.77 | | | 64624 | $270.87 | | | 64625 | $677.27 | | | 64628 | $8,005.16 | | | 64630 | $348.77 | | | 64632 | $36.20 | | | 64633 | $677.27 | | | 64634 | $0.00 | | | 64635 | $677.27 | | | 64636 | $0.00 | | | 64640 | $150.01 | | | 64642 | $67.18 | | | 64643 | $0.00 | | | 64644 | $82.82 | | | 64645 | $0.00 | | | 64646 | $67.49 | | | 64647 | $74.24 | | | 64650 | $45.70 | | | 64653 | $52.76 | | | 64680 | $348.77 | | | 64681 | $348.77 | | | 64702 | $677.27 | | | 64704 | $677.27 | | | 64708 | $677.27 | | | 64712 | $677.27 | | | 64713 | $677.27 | | | 64714 | $677.27 | | | 64716 | $677.27 | | | 64718 | $677.27 | | | 64719 | $677.27 | | | 64721 | $677.27 | | | 64722 | $677.27 | | | 64726 | $677.27 | | | 64727 | $0.00 | | | 64732 | $677.27 | | | 64734 | $677.27 | | | 64736 | $677.27 | | | 64738 | $677.27 | | | 64740 | $677.27 | | | 64742 | $677.27 | | | 64744 | $677.27 | | | 64746 | $677.27 | | | 64763 | $677.27 | | | 64766 | $677.27 | | | 64771 | $677.27 | | | 64772 | $677.27 | | | 64774 | $677.27 | | | 64776 | $677.27 | | | 64778 | $0.00 | | | 64782 | $677.27 | | | 64783 | $0.00 | | | 64784 | $677.27 | | | 64786 | $1,844.70 | | | 64787 | $0.00 | | | 64788 | $677.27 | | | 64790 | $677.27 | | | 64792 | $1,844.70 | | | 64795 | $677.27 | | | 64802 | $677.27 | | | 64820 | $677.27 | | | 64821 | $1,093.32 | | | 64822 | $1,093.32 | | | 64823 | $1,093.32 | | | 64831 | $677.27 | | | 64832 | $0.00 | | | 64834 | $1,844.70 | | | 64835 | $1,844.70 | | | 64836 | $1,844.70 | | | 64837 | $0.00 | | | 64840 | $1,844.70 | | | 64856 | $1,844.70 | | | 64857 | $1,844.70 | | | 64858 | $677.27 | | | 64859 | $0.00 | | | 64861 | $677.27 | | | 64862 | $1,844.70 | | | 64864 | $1,844.70 | | | 64865 | $1,844.70 | | | 64872 | $0.00 | | | 64874 | $0.00 | | | 64876 | $0.00 | | | 64885 | $1,844.70 | | | 64886 | $1,844.70 | | | 64890 | $1,844.70 | | | 64891 | $2,404.59 | | | 64892 | $1,844.70 | | | 64893 | $1,844.70 | | | 64895 | $1,844.70 | | | 64896 | $1,844.70 | | | 64897 | $1,844.70 | | | 64898 | $1,844.70 | | | 64901 | $0.00 | | | 64902 | $0.00 | | | 64905 | $1,844.70 | | | 64907 | $1,844.70 | | | 64910 | $2,662.86 | | | 64912 | $2,908.67 | | | 64913 | $0.00 | | | 65091 | $1,152.29 | | | 65093 | $1,152.29 | | | 65101 | $1,152.29 | | | 65103 | $1,152.29 | | | 65105 | $1,152.29 | | | 65110 | $1,152.29 | | | 65112 | $1,152.29 | | | 65114 | $1,152.29 | | | 65125 | $711.40 | | | 65130 | $1,152.29 | | | 65135 | $1,152.29 | | | 65140 | $1,152.29 | | | 65150 | $1,152.29 | | | 65155 | $1,152.29 | | | 65175 | $1,152.29 | | | 65205 | $0.00 | | | 65210 | $0.00 | | | 65220 | $0.00 | | | 65222 | $0.00 | | | 65235 | $860.81 | | | 65260 | $860.81 | | | 65265 | $860.81 | | | 65270 | $711.40 | | | 65272 | $711.40 | | | 65275 | $1,152.29 | | | 65280 | $1,560.46 | | | 65285 | $1,560.46 | | | 65286 | $393.27 | | | 65290 | $1,152.29 | | | 65400 | $346.59 | | | 65410 | $711.40 | | | 65420 | $711.40 | | | 65426 | $711.40 | | | 65430 | $0.00 | | | 65435 | $40.80 | | | 65436 | $177.62 | | | 65450 | $116.18 | | | 65600 | $221.18 | | | 65710 | $1,560.46 | | | 65730 | $1,560.46 | | | 65750 | $1,560.46 | | | 65755 | $1,560.46 | | | 65756 | $1,560.46 | | | 65757 | $0.00 | | | 65770 | $7,552.47 | | | 65772 | $346.59 | | | 65775 | $711.40 | | | 65778 | $0.00 | | | 65779 | $0.00 | | | 65780 | $1,152.29 | | | 65781 | $1,560.46 | | | 65782 | $1,152.29 | | | 65785 | $1,560.46 | | | 65800 | $860.81 | | | 65810 | $860.81 | | | 65815 | $860.81 | | | 65820 | $1,560.46 | | | 65850 | $860.81 | | | 65855 | $115.35 | | | 65860 | $150.62 | | | 65865 | $860.81 | | | 65870 | $860.81 | | | 65875 | $860.81 | | | 65880 | $1,560.46 | | | 65900 | $860.81 | | | 65920 | $860.81 | | | 65930 | $860.81 | | | 66020 | $860.81 | | | 66030 | $860.81 | | | 66130 | $711.40 | | | 66150 | $1,560.46 | | | 66155 | $1,560.46 | | | 66160 | $860.81 | | | 66170 | $860.81 | | | 66172 | $860.81 | | | 66174 | $1,560.46 | | | 66175 | $1,560.46 | | | 66179 | $1,560.46 | | | 66180 | $2,092.90 | | | 66183 | $2,203.21 | | | 66184 | $860.81 | | | 66185 | $860.81 | | | 66225 | $1,560.46 | | | 66250 | $711.40 | | | 66500 | $860.81 | | | 66505 | $860.81 | | | 66600 | $1,560.46 | | | 66605 | $860.81 | | | 66625 | $860.81 | | | 66630 | $860.81 | | | 66635 | $860.81 | | | 66680 | $860.81 | | | 66682 | $860.81 | | | 66700 | $860.81 | | | 66710 | $711.40 | | | 66711 | $860.81 | | | 66720 | $711.40 | | | 66740 | $711.40 | | | 66761 | $161.36 | | | 66762 | $217.72 | | | 66770 | $217.72 | | | 66820 | $860.81 | | | 66821 | $217.72 | | | 66825 | $860.81 | | | 66830 | $860.81 | | | 66840 | $860.81 | | | 66850 | $860.81 | | | 66852 | $1,560.46 | | | 66920 | $860.81 | | | 66930 | $1,560.46 | | | 66940 | $860.81 | | | 66982 | $860.81 | | | 66983 | $860.81 | | | 66984 | $860.81 | | | 66985 | $860.81 | | | 66986 | $860.81 | | | 66987 | $2,034.08 | | | 66988 | $2,034.08 | | | 66989 | $2,757.89 | | | 66990 | $0.00 | | | 66991 | $2,757.89 | | | 67005 | $860.81 | | | 67010 | $860.81 | | | 67015 | $860.81 | | | 67025 | $860.81 | | | 67027 | $1,384.87 | | | 67028 | $40.19 | | | 67030 | $860.81 | | | 67031 | $217.72 | | | 67036 | $1,560.46 | | | 67039 | $1,560.46 | | | 67040 | $1,560.46 | | | 67041 | $1,560.46 | | | 67042 | $1,560.46 | | | 67043 | $1,560.46 | | | 67101 | $172.40 | | | 67105 | $145.72 | | | 67107 | $1,560.46 | | | 67108 | $1,560.46 | | | 67110 | $432.23 | | | 67113 | $1,560.46 | | | 67115 | $1,560.46 | | | 67120 | $860.81 | | | 67121 | $860.81 | | | 67141 | $116.18 | | | 67145 | $217.72 | | | 67208 | $116.18 | | | 67210 | $217.72 | | | 67218 | $1,152.29 | | | 67220 | $217.72 | | | 67221 | $130.07 | | | 67225 | $0.00 | | | 67227 | $139.88 | | | 67228 | $152.15 | | | 67229 | $217.72 | | | 67250 | $711.40 | | | 67255 | $860.81 | | | 67311 | $711.40 | | | 67312 | $1,152.29 | | | 67314 | $711.40 | | | 67316 | $711.40 | | | 67318 | $711.40 | | | 67320 | $0.00 | | | 67331 | $0.00 | | | 67332 | $0.00 | | | 67334 | $0.00 | | | 67335 | $0.00 | | | 67340 | $0.00 | | | 67343 | $711.40 | | | 67345 | $107.36 | | | 67346 | $1,152.29 | | | 67400 | $1,152.29 | | | 67405 | $711.40 | | | 67412 | $711.40 | | | 67413 | $711.40 | | | 67414 | $1,152.29 | | | 67415 | $711.40 | | | 67420 | $1,152.29 | | | 67430 | $1,152.29 | | | 67440 | $1,152.29 | | | 67445 | $1,152.29 | | | 67450 | $1,152.29 | | | 67500 | $116.18 | | | 67505 | $33.13 | | | 67515 | $30.68 | | | 67550 | $1,152.29 | | | 67560 | $1,152.29 | | | 67570 | $1,152.29 | | | 67700 | $116.18 | | | 67710 | $169.33 | | | 67715 | $711.40 | | | 67800 | $65.03 | | | 67801 | $78.84 | | | 67805 | $100.92 | | | 67808 | $711.40 | | | 67810 | $116.18 | | | 67820 | $0.00 | | | 67825 | $68.41 | | | 67830 | $346.59 | | | 67835 | $711.40 | | | 67840 | $173.63 | | | 67850 | $130.37 | | | 67875 | $346.59 | | | 67880 | $711.40 | | | 67882 | $711.40 | | | 67900 | $711.40 | | | 67901 | $711.40 | | | 67902 | $1,152.29 | | | 67903 | $711.40 | | | 67904 | $711.40 | | | 67906 | $1,152.29 | | | 67908 | $711.40 | | | 67909 | $711.40 | | | 67911 | $711.40 | | | 67912 | $711.40 | | | 67914 | $711.40 | | | 67915 | $198.78 | | | 67916 | $711.40 | | | 67917 | $711.40 | | | 67921 | $711.40 | | | 67922 | $192.03 | | | 67923 | $711.40 | | | 67924 | $711.40 | | | 67930 | $200.01 | | | 67935 | $711.40 | | | 67938 | $116.18 | | | 67950 | $711.40 | | | 67961 | $711.40 | | | 67966 | $711.40 | | | 67971 | $711.40 | | | 67973 | $711.40 | | | 67974 | $1,152.29 | | | 67975 | $711.40 | | | 68020 | $58.28 | | | 68040 | $27.00 | | | 68100 | $110.43 | | | 68110 | $143.57 | | | 68115 | $711.40 | | | 68130 | $711.40 | | | 68135 | $74.85 | | | 68200 | $0.00 | | | 68320 | $711.40 | | | 68325 | $1,152.29 | | | 68326 | $1,152.29 | | | 68328 | $711.40 | | | 68330 | $860.81 | | | 68335 | $1,152.29 | | | 68340 | $711.40 | | | 68360 | $1,152.29 | | | 68362 | $711.40 | | | 68371 | $711.40 | | | 68400 | $197.25 | | | 68420 | $208.90 | | | 68440 | $56.44 | | | 68500 | $1,152.29 | | | 68505 | $1,152.29 | | | 68510 | $711.40 | | | 68520 | $1,152.29 | | | 68525 | $711.40 | | | 68530 | $116.18 | | | 68540 | $711.40 | | | 68550 | $1,152.29 | | | 68700 | $711.40 | | | 68705 | $116.18 | | | 68720 | $1,152.29 | | | 68745 | $1,152.29 | | | 68750 | $1,152.29 | | | 68760 | $116.18 | | | 68761 | $82.82 | | | 68770 | $711.40 | | | 68801 | $0.00 | | | 68810 | $116.18 | | | 68811 | $711.40 | | | 68815 | $711.40 | | | 68816 | $711.40 | | | 68840 | $70.86 | | | 68850 | $0.00 | | | 69000 | $110.74 | | | 69005 | $113.81 | | | 69020 | $147.25 | | | 69100 | $57.98 | | | 69105 | $93.25 | | | 69110 | $845.19 | | | 69120 | $1,909.57 | | | 69140 | $1,909.57 | | | 69145 | $845.19 | | | 69150 | $1,909.57 | | | 69200 | $0.00 | | | 69205 | $489.93 | | | 69209 | $0.00 | | | 69210 | $0.00 | | | 69220 | $0.00 | | | 69222 | $133.75 | | | 69300 | $896.80 | | | 69310 | $1,909.57 | | | 69320 | $1,909.57 | | | 69420 | $87.46 | | | 69421 | $896.80 | | | 69424 | $81.60 | | | 69433 | $117.49 | | | 69436 | $456.11 | | | 69440 | $896.80 | | | 69450 | $896.80 | | | 69501 | $1,909.57 | | | 69502 | $1,909.57 | | | 69505 | $1,909.57 | | | 69511 | $1,909.57 | | | 69530 | $1,909.57 | | | 69540 | $134.97 | | | 69550 | $1,909.57 | | | 69552 | $1,909.57 | | | 69601 | $1,909.57 | | | 69602 | $1,909.57 | | | 69603 | $1,909.57 | | | 69604 | $1,909.57 | | | 69610 | $173.63 | | | 69620 | $896.80 | | | 69631 | $1,909.57 | | | 69632 | $1,909.57 | | | 69633 | $1,909.57 | | | 69635 | $1,909.57 | | | 69636 | $1,909.57 | | | 69637 | $1,909.57 | | | 69641 | $1,909.57 | | | 69642 | $1,909.57 | | | 69643 | $1,909.57 | | | 69644 | $1,909.57 | | | 69645 | $1,909.57 | | | 69646 | $1,909.57 | | | 69650 | $896.80 | | | 69660 | $1,909.57 | | | 69661 | $1,909.57 | | | 69662 | $1,909.57 | | | 69666 | $896.80 | | | 69667 | $896.80 | | | 69670 | $1,909.57 | | | 69676 | $896.80 | | | 69700 | $456.11 | | | 69705 | $3,033.36 | | | 69706 | $3,033.36 | | | 69711 | $896.80 | | | 69714 | $8,038.99 | | | 69716 | $6,654.75 | | | 69717 | $3,718.95 | | | 69719 | $6,654.75 | | | 69720 | $1,909.57 | | | 69726 | $1,156.29 | | | 69727 | $1,156.29 | | | 69728 | $1,202.52 | | | 69729 | $7,029.64 | | | 69730 | $7,029.64 | | | 69740 | $1,909.57 | | | 69745 | $1,909.57 | | | 69801 | $113.81 | | | 69805 | $1,909.57 | | | 69806 | $1,909.57 | | | 69905 | $1,909.57 | | | 69910 | $1,909.57 | | | 69915 | $896.80 | | | 69930 | $26,093.23 | | | 69990 | $0.00 | | | 92920 | $2,568.37 | | | 92921 | $0.00 | | | 92928 | $5,149.14 | | | 92929 | $0.00 | | | 92974 | $0.00 | | | 92978 | $0.00 | | | 93451 | $1,168.21 | | | 93452 | $1,168.21 | | | 93453 | $1,168.21 | | | 93454 | $1,168.21 | | | 93455 | $1,168.21 | | | 93456 | $1,168.21 | | | 93457 | $1,168.21 | | | 93458 | $1,168.21 | | | 93459 | $1,168.21 | | | 93460 | $1,168.21 | | | 93461 | $1,168.21 | | | 93462 | $0.00 | | | 93463 | $0.00 | | | 93566 | $0.00 | | | 93567 | $0.00 | | | 93568 | $0.00 | | | 93571 | $0.00 | | | 93572 | $0.00 | | | 93985 | $100.09 | | | 93986 | $48.14 | | | C5271 | $213.47 | | | C5272 | $0.00 | | | C5273 | $696.96 | | | C5274 | $0.00 | | | C5275 | $213.47 | | | C5276 | $0.00 | | | C5277 | $213.47 | | | C5278 | $0.00 | | | C7500 | $911.52 | | | C7501 | $911.52 | | | C7502 | $911.52 | | | C7503 | $2,047.63 | | | C7504 | $2,667.04 | | | C7505 | $2,667.04 | | | C7506 | $2,667.04 | | | C7507 | $5,468.69 | | | C7508 | $5,468.69 | | | C7509 | $1,201.22 | | | C7510 | $1,201.22 | | | C7511 | $1,201.22 | | | C7512 | $1,201.22 | | | C7513 | $1,227.21 | | | C7514 | $1,227.21 | | | C7515 | $1,227.21 | | | C7516 | $1,977.77 | | | C7517 | $1,977.77 | | | C7518 | $1,977.77 | | | C7519 | $1,977.77 | | | C7520 | $1,977.77 | | | C7521 | $1,977.77 | | | C7522 | $1,977.77 | | | C7523 | $1,977.77 | | | C7524 | $1,977.77 | | | C7525 | $1,977.77 | | | C7526 | $1,977.77 | | | C7527 | $1,977.77 | | | C7528 | $1,977.77 | | | C7529 | $1,977.77 | | | C7530 | $3,891.98 | | | C7531 | $4,659.36 | | | C7532 | $4,495.47 | | | C7533 | $4,697.06 | | | C7534 | $8,573.55 | | | C7535 | $8,499.01 | | | C7537 | $8,582.65 | | | C7538 | $8,559.00 | | | C7539 | $8,722.67 | | | C7540 | $8,574.26 | | | C7541 | $1,932.16 | | | C7542 | $1,932.16 | | | C7543 | $1,932.16 | | | C7544 | $1,932.16 | | | C7545 | $1,932.16 | | | C7546 | $1,271.93 | | | C7547 | $1,474.07 | | | C7548 | $1,271.93 | | | C7549 | $1,271.93 | | | C7550 | $1,271.93 | | | C7551 | $2,236.61 | | | C7552 | $1,977.77 | | | C7553 | $1,977.77 | | | C7554 | $720.74 | | | C7555 | $3,637.66 | | | C9600 | $5,260.89 | | | C9601 | $0.00 | | | C9725 | $328.08 | | | C9726 | $0.00 | | | C9727 | $456.11 | | | C9728 | $534.87 | | | C9739 | $2,789.49 | | | C9740 | $5,872.60 | | | C9757 | $6,345.57 | | | C9759 | $0.00 | | | C9761 | $2,189.69 | | | C9764 | $3,709.81 | | | C9765 | $9,609.20 | | | C9766 | $6,142.47 | | | C9767 | $10,188.19 | | | C9769 | $2,189.69 | | | C9770 | $1,396.17 | | | C9771 | $1,199.19 | | | C9772 | $4,937.21 | | | C9773 | $8,830.90 | | | C9774 | $8,957.14 | | | C9775 | $8,988.26 | | | C9777 | $1,548.18 | | | C9778 | $2,112.18 | | | C9781 | $7,029.64 | | | G0104 | $123.62 | | | G0105 | $328.08 | | | G0121 | $328.08 | | | G0186 | $217.72 | | | G0260 | $268.46 | | | G0276 | $2,382.86 | | | G0278 | $0.00 | |

History

Adopted by Mass Register Issue 1379, eff. 11/30/2018.

101 CMR, § 347.04 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1379, eff. 11/30/2018.

101 CMR, § 347.05 Severability

The provisions of 101 CMR 347.00 are severable, and if any provision of 101 CMR 347.00 or application of such provision to any FASC or any circumstances are held to be invalid or unconstitutional, such invalidity will not be construed to affect the validity or constitutionality of any remaining provisions to eligible FASCs or circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1379, eff. 11/30/2018.

Rates for Day Habilitation Services Rates for Day Habilitation Services

101 CMR, § 348.01 General Provisions

(1) Scope, Purpose, and Effective Date. 101 CMR 348.00 governs the payment rates for day habilitation services rendered to publicly aided individuals. The rates set forth in 101 CMR 348.00 also apply to day habilitation services governed by 130 CMR 419.000: Day Habilitation Center Services and other comparable programs.

(2) Applicable Dates of Service. Rates contained in 101 CMR 348.00 apply for dates of service on and after August 1, 2024, unless otherwise indicated.

(3) Coverage. The payment rates in 101 CMR 348.00 are full compensation for day habilitation services provided to publicly aided individuals as well as for any related administrative or supervisory duties rendered in connection with the provision of day habilitation services.

(4) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an Administrative Bulletin. The publication of such updates and corrections will list:

(a) codes for which only the code numbers change, with the corresponding cross references between existing and new codes;

(b) codes for which the code number remains the same but the description has changed; and

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 348.00.

(6) Disclaimer of Authorization of Services. 101 CMR 348.00 is neither authorization for nor approval of the substantive programs for which rates are determined pursuant to 101 CMR 348.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care and services extended to covered individuals.

History

Amended by Mass Register Issue 1369, eff. 7/13/2018.

101 CMR, § 348.02 Definitions

Meaning of Terms. Terms used in 101 CMR 348.00, unless the context requires otherwise, have the meanings ascribed in 101 CMR 348.02.

Admission Services. Services provided to ensure safe and appropriate care planning for day habilitation members enrolling in day habilitation services for the first time. This is a one-time only claim per MassHealth member ID.

Approved Rates. The rates of payment that have been certified by EOHHS and filed with the Secretary of the Commonwealth. These rates govern payment for services under 101 CMR 348.00.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Day Habilitation Program. A structured, goal-oriented active treatment program of medically oriented, therapeutic, and habilitation services to raise recipients' levels of functioning and facilitate independent living and self-management in their communities.

Eligible Provider. Any individual, partnership, corporation, or other entity that offers services for purchase by a governmental unit and that meets the conditions of purchase or licensure established under 130 CMR 419.000: Day Habilitation Center Services .

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth.

Half Per Diem. Day habilitation services provided for a period equal to or less than three hours per day.

Monitor Transportation. Transportation services provided when the member is accompanied by an escort to ensure safety due to signs and symptoms related to medical needs, including Alzheimer's disease and related dementias, or due to other known and verified behaviors related to mental health or developmental disability diagnoses.

Per Diem. Day habilitation services provided for a period greater than three hours per day.

Publicly Aided Individual. A person whose medical and other services a governmental unit is in whole or in part liable for under a statutory program.

Quarter Per Diem. Day habilitation services provided for a period equal to or less than 1U hours per day.

Transportation. Method by which a member is brought from their home to the day habilitation provider or from the day habilitation provider to the member's home. Transportation service includes assisting the member while they enter and exit the vehicle, as appropriate. A member's home may include a temporary housing environment such as a shelter or transitional housing.

Wheelchair Transportation. Transportation service provided to a member who requires a wheelchair.

History

Amended by Mass Register Issue 1369, eff. 7/13/2018.

101 CMR, § 348.03 Rate Provisions

(1) Rate as Full Payment. Each eligible provider must, as a condition of receipt of payment from one or more purchasing governmental units for services rendered, accept the approved rates as full payment and discharge of all obligations for the services rendered, subject only to appellate rights as set forth in M.G.L. c. 118E. There will be no duplication or supplementation of payment from sources other than those expressly recognized or anticipated in the computation of the rate. Any client resources or third-party payments received on behalf of a publicly assisted client will reduce, by that amount, the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(2) Approved Day Habilitation Program Rates. For services provided in day habilitation programs in the community, the approved rates include payment for all care and services that are customarily part of the program of services of an eligible provider, subject only to the terms of the purchase agreement between the eligible provider and the purchasing governmental unit(s). The rate of payment for authorized services is the lower of the established charge or the rate listed in 101 CMR 348.03(5).

(3) Day Habilitation Services in Nursing Facilities. Certain residents of nursing facilities who qualify for day habilitation services may be unable to participate in these services in community settings. These individuals may qualify for day habilitation services to be provided at the nursing facility in which they reside. In order to be eligible for these nursing facility services, the individual must meet criteria established by the MassHealth agency. These members will be billed at the Level 4 rate. The approved rates cover all care and services associated with the provision of day habilitation services in a nursing facility.

(4) Payment Level for Nursing Facility Residents in Community Day Habilitation Programs. Certain qualifying individuals in nursing facilities may need supplemental services in the form of additional staff assistance to enable them to leave their nursing facility to participate in day habilitation services in the community. The MassHealth agency will pay the Level 4 rate for those individuals so they may participate in a community day habilitation program.

(5) Allowable Fees. The rates of payment for authorized day habilitation program services, unless otherwise noted in 101 CMR 348.03, must be the lower of the established charge or the rate listed in 101 CMR 348.03(5). Refer to purchasers' manuals for special coding instructions and limitations on number of units.

| Code | Per Diem Rate | Description | | --- | --- | --- | | S5102-U1 | $125.91 | Skills training and development, per diem , Level 1 (community program) | | S5102-U2 | $167.85 | Skills training and development per diem , Level 2 (community program) | | S5102-U3 | $290.97 | Skills training and development, per diem , Level 3 (community program) | | S5102-U4 | $414.09 | Skills training and development, per diem , Level 4 (community program & nursing facility residents) |

| Code | Half Per Diem Base Rate | Description | | --- | --- | --- | | S5101-U1 | $62.96 | Skills training and development, half per diem , Level 1 (community program) | | S5101-U2 | $83.93 | Skills training and development, half per diem , Level 2 (community program) | | S5101-U3 | $145.49 | Skills training and development, half per diem , Level 3 (community program) | | S5101-U4 | $207.05 | Skills training and development, half per diem , Level 4 (community program & nursing facility residents) |

| Code | Quarter Per Diem | Description | | --- | --- | --- | | S5100-U5-U1 | $31.48 | Skills training and development, quarter per diem , Level 1 (community program) | | S5100-U5-U2 | $41.96 | Skills training and development, quarter per diem , Level 2 (community program) | | S5100-U5-U3 | $72.74 | Skills training and development, quarter per diem , Level 3 (community program) | | S5100-U5-U4 | $103.52 | Skills training and development, quarter per diem , Level 4 (community program & nursing facility residents) |

| Code | One-time Only | Description | | --- | --- | --- | | S5105 | $2000.00 | Admission Services (one-time only on or after the 45^th day of service) | | S5105-KZ | $12,000.00 | Re-engagement Services (one-time only on or after the 45^th day of service) |

| Code | Per One-way Trip | Description | | --- | --- | --- | | T2003 | $28.56 | Non-wheelchair (ambulatory) transportation | | T2003-U6 | $34.98 | Wheelchair transportation (one-way trip) | | T2003-U7 | $34.98 | Monitor transportation (one-way trip) |

History

Amended by Mass Register Issue 1369, eff. 7/13/2018.

101 CMR, § 348.04 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Amended by Mass Register Issue 1369, eff. 7/13/2018.

101 CMR, § 348.05 Severability

The provisions of 101 CMR 348.00 are severable. If any provision of 101 CMR 348.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 348.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1369, eff. 7/13/2018.

Rates For Early Intervention Program Services Rates For Early Intervention Program Services

101 CMR, § 349.01 General Provisions

(1) Scope. 101 CMR 349.00 governs rates of payment to be used by all governmental units making payment to eligible providers for Early Intervention program services to publicly assisted clients. 101 CMR 349.00 does not govern the rates for specialty services, which are governed by 101 CMR 358.00: Rates of Payment for Applied Behavior Analysis .

(2) Applicable Dates of Service. Rates contained in 101 CMR 349.00 apply for dates of service provided on or after the dates as listed in 101 CMR 349.04(3).

(3) Disclaimer of Authorization of Services. 101 CMR 349.00 is not authorization for or approval of the substantive services for which rates are determined pursuant to 101 CMR 349.00. The Department of Public Health, which is designated as the lead agency, is responsible for the definition, authorization, and approval of services extended to publicly assisted clients by eligible providers.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 349.00.

History

Adopted by Mass Register Issue 1269, eff. 9/12/2014.

101 CMR, § 349.02 Definitions

As used in 101 CMR 349.00, unless the context requires otherwise, terms have the meanings in 101 CMR 349.02.

Approved Program Rates. The rates per service unit approved by EOHHS. The rates of payment that have been certified by the Commonwealth and filed with the Secretary of the Commonwealth are to be used for services governed by 101 CMR 349.00.

Assessment. A comprehensive evaluation of the child's developmental status and family situation, involving the use of a normed developmental assessment tool and measuring fine and gross motor skills, cognitive ability, communication skills, affect and temperament, self-care and feeding skills, socialization, family interactions, and social and economic support systems available to the family. An assessment is limited to ten working hours per 12-month period.

Biological Risk. The presence of a documented history of prenatal, perinatal, neonatal, or early developmental events or conditions suggestive of damage to the central nervous system or of later atypical development.

Center-based Individual Visit. A face-to-face meeting at an Early Intervention program's site, of one client or one client's caregiver, or both, with professional staff member(s) for the purpose of furthering the client's developmental progress. Center-based individual visits must be provided for a scheduled period of time ranging from one to two hours. Center-based individual visits provided in conjunction with group services, however, may be provided for a period of time that is less than one hour.

Child Visit. A face-to-face meeting at the client's home or at an approved setting outside of the center-based site, with the client, the client's caregiver, or both, and professional staff member(s) for the purpose of furthering the client's developmental progress. A child visit must be provided for a scheduled period of time not to exceed two hours.

Client Resources. Revenue received in cash or in-kind from publicly assisted clients to defray all or a portion of the cost of program services.

Clients. Recipients of services provided by an Early Intervention program.

Co-treatment. A child visitor center-based individual visit that involves two professional staff members and the client, the client's caregiver, or both. Co-treatment sessions are billed on the basis of working hours and are limited to four working hours per session.

Community Child Group. A face-to-face meeting at a community site, as defined in 101 CMR 349.02, facilitated or co-facilitated by professional staff members and designed to further the client's developmental progress. The meeting must include both children enrolled and not enrolled in Early Intervention. Community child groups will be provided for a scheduled period of time ranging from one to 21/2 hours, not more than two times weekly.

Community Site. Any location where all young children are welcome and typically spend time, and where services are provided in natural environments, as defined in federal law and regulation, in which children without disabilities participate. This may include, but is not limited to, child-care settings, playgrounds, libraries, and community centers.

Complete Filing. A filing of the cost report, containing no major deficiencies.

Cost Report. The document used to report cost and other financial and statistical data, the Uniform Financial Statements and Independent Auditor's Report, when required.

Early Intervention (EI) Program. A program that shows evidence of having met the Early Intervention Operational Standards of the Department of Public Health and that provides services such as medical, therapeutic, educational, developmental, and social services for children and their families. Services are provided to children from birth through three years old, who are at biological, environmental, or established risk.

EI-only Child Group. A face-to-face meeting of a group of children enrolled in Early Intervention, facilitated or co-facilitated by professional staff members and designed to further the client's developmental progress. EI-only child groups will be provided for a scheduled period of time ranging from one to 2U hours, not more than two times weekly.

Eligible Provider. Any partnership, corporation, trust, or other legal entity that meets the conditions established for Early Intervention programs by the Department of Public Health.

Environmental Risk. The presence of an environmental factor that may pose a serious threat to a child's development such as, but not restricted to, limited maternal and family care, inadequate health care, poor nutrition, limited opportunities for expression of adaptive behaviors, and a lack of physical and social stimulation.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Established Risk. The presence of a developmental delay or deviation of unknown etiology, or the likelihood of a developmental delay or deviation due to a diagnosed medical disorder of known etiology.

Governmental Unit. The Commonwealth, any department, agency, board, or division of the Commonwealth, and any political subdivision of the Commonwealth.

Parent-focused Group. A face-to-face meeting of a group of clients' parents and persons filling the role of parents (for example, a grandparent, foster parent, or guardian, but not a day-care worker) with professional staff members, for the purpose of support and guidance. A parent-focused group must be provided for a scheduled period of time not to exceed two hours per session and one session per week.

Professional Staff Member. Any certified Early Intervention specialist defined in M.G.L. c. 175, § 47C, and in the Early Intervention Operational Standards published by the Department of Public Health.

Publicly Assisted Client. A person who receives program services for which a governmental unit is responsible in whole or in part, under a statutory program of financial assistance.

Screening. An initial face-to-face meeting of a client and client's caregiver with a professional staff member to determine whether the client would be appropriately placed in two working hours.

Specialty Services. Specialty services are a subgroup of Early Intervention services for children with a confirmed diagnosis of an autism spectrum disorder. These services are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child's development around the core characteristics of autism spectrum disorder, and are selected in collaboration with the family in conformity with an individualized family service plan. The services are provided by qualified personnel working in a specialty service provider program.

Specialty Services Provider. A specialty service provider serves children with conditions like autism spectrum disorder, and their families, and may be either a supervisor-level clinician with an appropriate graduate degree or a bachelor's-level clinician with at least two years of supervised experience, or a bachelor's-level associate clinician with a preferred one year of supervised experience. These providers must satisfy the certification requirements of the Department of Public Health.

Unit. Fifteen minutes of service provided to a client. In the case of a community child group, EI-only child group, and/or a parent-focused group, one unit is 15 minutes of service provided to an individual client. In the case of a child visit and/or a center-based individual visit, one unit is 15 minutes of service provided to an individual client, except for situations defined under cotreatment. In the case of a screening and/or assessment, one unit is 15 minutes of service provided by one professional staff member.

Working Hours. One hour worked on a screening, assessment, or co-treatment session by one professional staff member. For example, if three professionals work together for one hour to complete the assessment, the assessment lasts three working hours.

History

Adopted by Mass Register Issue 1269, eff. 9/12/2014.

101 CMR, § 349.03 Filing and Reporting Requirements

(1) Reporting for Annual Review. Unless exempted, each operating agency must, on or before the 15^th day of the fifth month after the end of its fiscal year, file a

(a) Uniform Financial Statements and Independent Auditor's Report completed in accordance with the filing requirements of the Operational Services Division, Executive Office for Administration and Finance; and

(b) supplemental program questionnaire or any other data collection form if requested by EOHHS.

(2) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the executive director or chief financial officer of the operating agency.

(b) Examination of Records. Each operating agency must make available all records relating to its operation and all records relating to a realty service or holding company or any entity in which there may be a common ownership or interrelated directorate upon request of EOHHS for examination.

(c) Field Audits. EOHHS may conduct field audits. EOHHS will attempt to schedule an audit at a convenient time for both parties.

History

Adopted by Mass Register Issue 1269, eff. 9/12/2014.

101 CMR, § 349.04 Rate Provisions

(1) Services Included in the Rate. The approved rates include payment for all care and services that are or have been customarily part of the Early Intervention program of the eligible provider, including necessary administration, supervision, travel, transportation, and support services, subject only to the terms of the purchase agreement between the eligible provider and the purchasing governmental units.

(2) Payment Terms.

(a) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by one or more purchasing governmental units for services rendered, accept the approved program rates as full payment and discharge of all obligations for the services rendered, subject only to appellate rights as set forth in M.G.L. c. 118E. There must be no duplication of or supplemental payment in excess of the approved program rates from sources other than those expressly recognized or anticipated in the computation of the rates. Any client resources not expressly recognized or anticipated in the computation of the rate will reduce, by that amount, the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(b) Payment Limitations. Except as provided in 101 CMR 349.03(3), 349.04(2)(a), and 349.04(3), no purchasing governmental unit may pay less than, or more than, the approved program rate.

(3) Approved Program Rates. The rates of payment for authorized services are the lowest of the eligible provider's usual charge to the general public for Early Intervention services, the amount accepted as payment from another payer, or the rate listed in 101 CMR 349.04(3).

(a) Early Intervention Program Service Rates Effective July 1, 2022.

| Service Code | Service Description | Per Unit | | --- | --- | --- | | H2015 | Child visit - day care | $27.05 | | H2015 | Child visit - hospital | $27.05 | | H2015 | Child visit | $27.05 | | T1015 | Center-based individual | $22.63 | | 96165-U1 | EI-only child group (15 minutes) | $7.88 | | 96164-U1 | EI-only child group (30 minutes) | $15.77 | | 96165-U2 | Community child group (15 minutes) | $10.36 | | 96164-U2 | Community child group (30 minutes) | $20.72 | | T1027 | Parent-focused group | $10.12 | | T1023 | Screening | $31.54 | | T1024 | Assessment | $36.21 |

(b) Early Intervention Program Service Rates Effective July 1, 2024.

| Service Code | Service Description | Per Unit | | --- | --- | --- | | H2015 | Child visit - day care | $35.95 | | H2015 | Child visit - hospital | $35.95 | | H2015 | Child visit | $35.95 | | T1015 | Center-based individual | $30.07 | | 96165-U1 | El-only child group (15 minutes) | $10.48 | | 96164-U1 | El-only child group (30 minutes) | $20.96 | | 96165-U2 | Community child group (15 minutes) | $13.77 | | 96164-U2 | Community child group (30 minutes) | $27.53 | | T1027 | Parent-focused group | $13.44 | | T1023 | Screening | $41.92 | | T1024 | Assessment | $48.12 |

(c) Specialty Services. For therapeutic behavioral services, refer to 101 CMR 358.00: Rates of Payment for Applied Behavior Analysis for the appropriate rate schedule.

History

Adopted by Mass Register Issue 1269, eff. 9/12/2014.

101 CMR, § 349.05 Severability

The provisions of 101 CMR 349.00 are severable. If any provision of 101 CMR 349.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 349.00, or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1269, eff. 9/12/2014.

Rates for Home Health Services Rates for Home Health Services

101 CMR, § 350.01 General Provisions

(1) Scope. 101 CMR 350.00 establishes rates of payment for home health services described in 130 CMR 403.000: Home Health Agency that are provided by eligible providers to publicly aided individuals. The rates set forth in 101 CMR 350.00 also apply to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act). For rates applicable to continuous skilled nursing services provided by a home health agency or an independent nurse to publicly aided individuals, see 101 CMR 361.00: Rates for Continuous Skilled Nursing Services .

(2) Applicable Dates of Service. Rates contained in 101 CMR 350.00 apply for dates of service provided on or after July 1, 2023.

(3) Coverage. The allowable fees established pursuant to 101 CMR 350.00 for services provided to publicly aided individuals apply to all home health services, as defined in 101 CMR 350.02, regardless of the type of program under which MassHealth is purchasing the services. The allowable fees are full compensation for the home health services rendered, including but not limited to administrative or supervisory duties and costs in connection with service provision.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 350.00 and to specify the information and documentation necessary to implement 101 CMR 350.00.

(5) Disclaimer of Authorization of Services. 101 CMR 350.00 is not authorization for or approval of the substantive services, or lengths of time, for which rates are paid pursuant to 101 CMR 350.00. Governmental units or workers compensation insurers that purchase services from eligible providers are responsible to define, authorize, and approve the services extended to covered individuals and the length of time for which the approval is applicable.

History

Adopted by Mass Register Issue 1335, eff. 3/24/2017.

101 CMR, § 350.02 General Definitions

As used in 101 CMR 350.00, unless the context requires otherwise, terms have the meanings set forth in 101 CMR 350.02.

Activities of Daily Living (ADL). Activities related to personal care, specifically bathing, grooming, dressing, toileting/continence, transferring/ambulation, and eating.

ADL Support Visit. A home visit performed by an eligible provider to a member for assistance with ADLs when the member is not receiving concurrent home health skilled nursing or therapy services.

Eligible Provider. An organization certified as a provider of services under the Medicare Health Insurance Program for the Aged (Title XVIII) and that meets such conditions of participation as have been or may be adopted by a governmental unit purchasing home health services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth of Massachusetts and any department, agency, board, commission, division, or political subdivision of the Commonwealth.

Home Health Agency. An organization that meets the requirements of 130 CMR 403.000: Home Health Agency to provide home health services.

Home Health Aide Service. The provision of personal care and other health-related services in the home, as described in 130 CMR 403.416(B) through (D) by a home health aide as defined in 130 CMR 403.402: Home Health Aide.

Home Health Services. Skilled nursing visits, physical therapy, occupational therapy, speech therapy, and home health aide services provided in the individual's home.

Home Visit. A morbidity visit rendered in the home by a qualified employee of a home health agency.

Medication Administration Visit. A skilled nursing visit for the purpose of administration of medications when the member is unable to perform the task due to impaired physical, cognitive, behavioral, and/or emotional issues; no able caregiver is present; or the member has a history of failed medication compliance resulting in a documented exacerbation of the member's condition, and/or the task including the route of administration of medication requires a licensed nurse to provide the service. A medication administration visit may include administration of oral, intramuscular, and/or subcutaneous medication or administration of medications other than oral, intramuscular and/or subcutaneous medication, but does not include intravenous administration.

Nursing Services. Services as defined in 130 CMR 403.402: Nursing Services and described at 130 CMR 403.415: Nursing Services .

Occupational Therapy. Services as defined in 130 CMR 403.402: Occupational Therapy provided by an occupational therapist as defined in 130 CMR 403.402: Occupational Therapist and occupational therapy assistant as defined in 130 CMR 403.402: Occupational Therapy Assistant.

Office Visit. A health promotion or therapeutic visit rendered in a home health agency's office.

Physical Therapy. Services as defined in 130 CMR 403.402: Physical Therapy provided by a physical therapist or physical therapy assistant as defined in 130 CMR 403.402: Definitions .

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or part liable under a statutory program.

Reasonable Costs. Those reasonable and necessary costs incurred by an eligible provider of home health services, subject to the requirements and limitations of 101 CMR 350.00. In determining the reasonableness of costs, EOHHS may consider the particular services offered, the introduction of efficiency measures, the requirements for staffing, and the costs of providing comparable service.

Security/Escorts. The provision of security services to direct care personnel in the performance of a reimbursable home health visit.

Speech/Language Therapy. Services as defined in 130 CMR 403.402: Speech/Language Therapy provided by a qualified speech/language therapist (speech/language pathologist) as defined in 130 CMR 403.402: Speech/Language Therapist (Speech/Language Pathologist).

Therapeutic or Morbidity Home Visit. A home visit rendered by an eligible provider to an individual and/or family for the purpose of treating one or more diagnosed illnesses or disabilities.

Visit. A visit as defined in 130 CMR 403.402: Visit that is up to eight 15-minute units.

Weekday. The hours from 7:00 A.M. to 3:00 P.M., Monday through Friday.

Weekend and Nights.

(a) Weekend. The hours from 3:00 P.M., Friday, to 7:00 A.M., Monday.

(b) Nights. The hours from 3:00 P.M. to 7:00 A.M., Monday through Friday.

(c) Holidays. All official Commonwealth of Massachusetts holidays. For purposes of 101 CMR 350.00, holidays that occur on a weekend are observed on that day and not the preceding Friday or following Monday.

New Year's Day

Martin Luther King Jr. Day

Presidents' Day

Patriots' Day

Memorial Day

Juneteenth

Independence Day

Labor Day

Indigenous Peoples Day

Veterans Day

Thanksgiving Day

Christmas Day

History

Adopted by Mass Register Issue 1335, eff. 3/24/2017.

101 CMR, § 350.03 General Rate Provisions

Rates of payment for authorized home health services to which 101 CMR 350.00 applies will be the lower of

(a) the eligible provider's usual fee to patients other than publicly aided patients; or

(b) the schedule of rates set forth in 101 CMR 350.04.

History

Adopted by Mass Register Issue 1335, eff. 3/24/2017.

101 CMR, § 350.04 Rates of Payment for Home Health Services in the Home

For dates of service on or after July 1, 2023, the base rate for home health services is the lower of the established charge or the rate listed in 101 CMR 350.04(1).

| Code | Rate | Unit | Service | | --- | --- | --- | --- | | G0299 | $107.88 | Per Visit | Services of an RN in home health setting (one through 30 calendar days) | | G0300 | $107.88 | Per Visit | Services of an LPN in home health setting (one through 30 calendar days) | | G0299 UD | $87.43 | Per Visit | Services of an RN in home health setting (31+ calendar days) | | G0300 UD | $87.43 | Per Visit | Services of an LPN in home health setting (31+ calendar days) | | T1502 | $71.52 | Per Visit | Administration of oral, intramuscular, and/or subcutaneous medication by health care agency/professional per visit (RN or LPN) (Use only for medication administration visit.) | | T1503 | $71.52 | Per Visit | Administration of medication other than oral, intramuscular, and/or subcutaneous medication by health care agency/professional per visit (RN or LPN) (Use only for medication administration visit.) | | 99058 | $28.99 | Per Visit | Office services provided on an emergency basis | | G0151 | $94.05 | Per Visit | Services of physical therapist in the home health setting | | G0152 | $97.06 | Per Visit | Services of occupational therapist in the home health setting | | G0153 | $99.55 | Per Visit | Services of speech/language therapist in the home health setting | | G0156 | $10.18 | Per 15 Minutes | Services of home health aide in the home health setting | | G0156 UD | $10.18 | Per 15 Minutes | Services of home health aide in the home health setting for ADL support | | G0493 | $107.88 | Per Visit | Services of an RN for the observation and assessment of the patient's condition provided every 60 days to members utilizing home health aide services for ADL support |

History

Adopted by Mass Register Issue 1335, eff. 3/24/2017.

101 CMR, § 350.05 Administrative Adjustment

(1) A certified home health agency may apply for a change in rate(s) of payment due to costs associated with providing interpreter and security/escort services as defined in 101 CMR 350.02.

(2) Administrative adjustment may be provided on a prospective basis only.

(3) Administrative relief will consist of an adjustment to the rate calculated by dividing the costs from the most recently filed and reviewed cost report by the number of service units reported for that corresponding period. The costs allowed will be limited to reasonable costs as defined in 101 CMR 350.02.

(4) An administrative adjustment that an agency was awarded in a prior period may be updated by EOHHS using data from the most recent Cost Report filed pursuant to 101 CMR 350.06.

History

Adopted by Mass Register Issue 1335, eff. 3/24/2017.

101 CMR, § 350.06 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1335, eff. 3/24/2017.

101 CMR, § 350.07 Severability

The provisions of 101 CMR 350.00 are severable. If any provision of 101 CMR 350.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 350.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1335, eff. 3/24/2017.

Rates for Certain Adult Foster Care Services Rates for Certain Adult Foster Care Services

101 CMR, § 351.01 General Provisions

(1) Scope and Purpose. 101 CMR 351.00 governs the MassHealth payment rates for adult foster care services and group adult foster care services described in 130 CMR 408.000: Adult Foster Care that are provided by participating providers to eligible publicly aided individuals.

(2) Applicable Dates of Service. The rates contained in 101 CMR 351.00 apply for dates of service provided on or after September 20, 2024.

(3) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify provisions of 101 CMR 351.00.

(4) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin if the coding system adds, deletes, or changes relevant codes.

(5) Disclaimer of Authorization of Services. 101 CMR 351.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 351.00. Governmental units that purchase services described in 101 CMR 351.00 are responsible for the definition, authorization, and approval of services provided to publicly aided individuals.

History

Amended by Mass Register Issue 1338, eff. 5/5/2017.

101 CMR, § 351.02 Definitions

As used in 101 CMR 351.00, unless the context requires otherwise, terms have the meanings in 101 CMR 351.02.

Activities of Daily Living (ADLs). Fundamental personal care tasks as defined in 130 CMR 408.402: Activities of Daily Living (ADLs) performed as part of an individual's routine of self-care. ADLs include, but are not limited to, eating, toileting, dressing, bathing, transferring, and ambulation.

Adult Foster Care (AFC). Services as defined in 130 CMR 408.402: Adult Foster Care.

Adult Foster Care (AFC) Caregiver. A person selected, supervised, and paid by the provider for the provision of direct care in accordance with 130 CMR 408.415(A): Direct Care .

AFC Level I. A level of payment for adult foster care services provided to a member who meets the clinical criteria of 130 CMR 408.419(D)(1): AFC Level I Service Payment .

AFC Level II. A level of payment for adult foster care services provided to a member who meets the clinical criteria of 130 CMR 408.419(D)(2): AFC Level II Service Payment .

Alternative Caregiver Days. A short-term placement during which a member receives adult foster care from an alternative care provider when the AFC caregiver is temporarily unavailable or unable to provide care.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth.

Group Adult Foster Care (GAFC). Services as defined in 130 CMR 408.402: Adult Foster Care.

Intake and Assessment Services. Services as defined in 130 CMR 408.402: AFC Intake and Assessment Services and outlined in 130 CMR 408.431(A): Preadmission Procedures provided to a MassHealth member referred to a provider for AFC services.

MassHealth. A program of medical care and assistance that includes, but is not limited to, payment for certain health care services to eligible residents of the Commonwealth established under M.G.L. c. 118E and administered by the Executive Office of Health and Human Services through its Office of Medicaid.

Medical Leave of Absence (MLOA). A short-term absence during which a member does not receive AFC from the AFC caregiver because the member is temporarily admitted to a hospital or nursing facility. Member. A MassHealth eligible member who has received clinical authorization by either MassHealth or its designated screening agent for payment of adult foster care.

Member. A MassHealth eligible member who has received clinical authorization by either MassHealth or its designated screening agent for payment of adult foster care.

Nonmedical Leave of Absence (NMLOA). A short-term absence during which a member does not receive AFC from the AFC caregiver because the member is away from the AFC-qualified setting for nonmedical reasons.

Provider. An organization that meets the requirements of 130 CMR 408.000: Adult Foster Care and that contracts with MassHealth to provide adult foster care or group adult foster care to eligible MassHealth members.

Publicly Aided Individual. A person who receives health care and other services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Service Code. The standardized code from the Healthcare Common Procedure Coding System (HCPCS).

History

Amended by Mass Register Issue 1338, eff. 5/5/2017.

101 CMR, § 351.03 Rate Provisions

(1) Reimbursement as Full Payment. The payment rates in 101 CMR 351.00 are full compensation for all adult foster care services or group adult foster care services rendered to members, including any related administrative or supervisory duties in connection with the provision of AFC services or GAFC services outlined in 130 CMR 408.000: Adult Foster Care .

(2) Payment Rates. The rates for AFC services, including GAFC services, are set forth in 101 CMR 351.03(2).

| Service Code-Modifier | Rate | Unit | Service Description | | --- | --- | --- | --- | | S5140 | $54.37 | Per Diem | AFC Level I | | S5140-TG | $91.31 | Per Diem | AFC Level II | | S5140-TF | $54.37 | Per Diem | AFC Level I Alternative Caregiver Day | | S5140-U5 | $91.31 | Per Diem | AFC Level II Alternative Caregiver Day | | S5140-U6 | $54.37 | Per Diem | AFC Level I MLOA Day | | S5140-TG-U6 | $91.31 | Per Diem | AFC Level II MLOA Day | | S5140-U7 | $54.37 | Per Diem | AFC Level I NMLOA Day | | S5140-TG-U7 | $91.31 | Per Diem | AFC Level II NMLOA Day | | T1028 | $266.62 | Per Admission | AFC Intake and Assessment Services | | H0043 | $50.00 | Per Diem | GAFC |

History

Amended by Mass Register Issue 1338, eff. 5/5/2017.

101 CMR, § 351.04 Filing and Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00 : Cost Reporting Requirements .

History

Amended by Mass Register Issue 1338, eff. 5/5/2017.

101 CMR, § 351.05 Severability

The provisions of 101 CMR 351.00 are severable. If any provision of 101 CMR 351.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 351.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1338, eff. 5/5/2017.

Rates of Payment for Certain Children's Behavioral Health Services Rates of Payment for Certain Children's Behavioral Health Services

101 CMR, § 352.01 General Provisions

(1) Scope and Purpose. 101 CMR 352.00 governs the rates to be used by all governmental units for certain outpatient children's behavioral health services provided by community service agencies and other eligible providers. 101 CMR 352.00 does not govern rates for psychological testing services, which are governed by 101 CMR 329.00: Rates for Psychological and Independent Clinical Social Work Services , or rates for mental health services, which are governed by 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health Centers and Mental Health Centers . In addition, 101 CMR 352.00 does not govern rates for other services, care, and supplies provided to publicly aided patients including, but not limited to, psychiatric day treatment services, early intervention services, and medical services provided in community health centers.

(2) Applicable Dates of Service. Rates contained in 101 CMR 352.00 apply for dates of service provided on or after August 1, 2023, or as indicated in 101 CMR 352.03(3).

(3) Disclaimer of Authorization of Services. 101 CMR 352.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 352.00. Purchasing agencies and insurers are responsible for the definition, authorization, and approval of care and services extended to publicly aided clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 352.00.

History

Amended by Mass Register Issue 1303, eff. 7/1/2015.

101 CMR, § 352.02 General Definitions

Meaning of Terms. Terms used in 101 CMR 352.00 have the meaning ascribed in 101 CMR 352.02.

Behavior Management Monitoring. This service includes implementation of the behavior treatment plan; monitoring the youth's behavior; reinforcing implementation of the treatment plan by the parents, guardians, and caregivers; and reporting to the behavior management therapist on implementation of the treatment plan and progress toward behavioral objectives or performance goals. Phone contact and consultation may be provided as part of the intervention. Behavior management monitoring is provided by eligible providers.

Behavioral Management Therapy. This service includes a behavioral assessment (including observing the youth's behavior, antecedents of behaviors, and identification of motivators); development of a highly specific behavior treatment plan; supervision and coordination of interventions; and training other interveners to address specific behavioral objectives or performance goals. This service is designed to treat challenging behaviors that interfere with the child's successful functioning. The behavior management therapist develops specific behavioral objectives and interventions that are designed to diminish, extinguish, or improve specific behaviors related to the child's behavioral health condition(s) and that are incorporated into the behavior management treatment plan and the risk management/safety plan. Behavior management therapy is provided by eligible providers.

Care Manager. A single care manager who works with the child's parents and guardians to provide targeted case management.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Clinic. A clinic that is licensed by the Department of Mental Health as a provider of mental health clinic services that is not a community health center or a community mental health center.

Community-based Sites of Service. A service provided to a member located outside of a hospital.

Community Behavioral Health Center (CBHC). An entity that serves as a hub of coordinated and integrated behavioral health disorder treatment for individuals of all ages, including routine and urgent outpatient behavioral health services, mobile crisis services for adults and youth, and community crisis stabilization services for adults and youth.

Community Health Center. A clinic that provides comprehensive ambulatory services and that is not financially or physically an integral part of a hospital.

Community Mental Health Center. A clinic that provides comprehensive ambulatory mental health services and that is not financially or physically an integral part of a hospital.

Community Service Agency (CSA). A clinic, community health center, community mental health center, or other provider entity that meets all other requirements established by MassHealth.

Day. As used in 101 CMR 352.00 as a unit of payment, refers to a billable day in which the child is enrolled in the program.

Eligible Provider. Eligible providers of targeted case management are designated CSAs. Eligible providers of parent/caregiver peer-to-peer support, in-home behavior management services, in-home behavior monitoring services, in-home therapy services, therapeutic training and support, therapeutic mentoring, mobile crisis intervention, and crisis stabilization are providers that meet the conditions of participation established by MassHealth.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A: Executive Offices .

Family Partner. A family partner must have experience as a caregiver of youth with special needs, preferably youth with mental health needs, experience in navigating any of the youth-and family-serving systems, and either a bachelor's degree in a human services field from an accredited academic institution, or an associate's degree in a human services field from an accredited academic institution and one year of experience working with children, adolescents, or transition-age youth and families, or a high school diploma or equivalent and a minimum of two years of experience working with children, adolescents, or transition-age youth and families. If the bachelor's or associate's degree is not in a human services field, additional life or work experience may be considered in place of the human services degree.

Governmental Unit. The Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

Individual Consideration (I.C.). Payment rates to eligible providers for services authorized in accordance with 101 CMR 352.03(2), but not listed in 101 CMR 352.00 or authorized services performed in exceptional circumstances are determined on an individual consideration basis by the governmental unit or purchaser under M.G.L. c. 152: Workers' Compensation upon receipt of a bill that describes the services rendered. The determination of rates of payment for authorized individual consideration procedures are in accordance with the following criteria:

(a) time required to perform the service;

(b) degree of skill required for service rendered;

(d) policies, procedures, and practices of other third party purchasers of care; and

(e) such other standards and criteria as may be adopted from time to time by EOHHS pursuant to 101 CMR 352.03(4).

In-home Therapy. This service is a structured, consistent, therapeutic relationship between a licensed clinician and the youth and family for the purpose of treating the youth's behavioral health needs, including improving the family's ability to provide effective support for the youth to promote healthy functioning of the youth within the family. In-home therapy is provided by eligible providers.

Mobile Crisis Intervention. A behavioral health service available 24/7/365 providing short-term mobile, on-site, face-to-face crisis assessment, intervention, and stabilization to individuals younger than 21 years old experiencing a behavioral health crisis. Transition-aged youth older than 17 years of age and younger than 21 years old may be served by adult-trained clinicians with a certified peer specialist instead of a family partner based on an individual's clinical needs. Services may be provided in community-based settings, or in emergency department sites of services to support stabilization for transition into the community. Services may be provided via telehealth. The purpose is to identify, assess, treat, and stabilize the situation and reduce the immediate risk of danger to the youth or others consistent with the youth's risk management/safety plan, if any.

Parent-caregiver Peer-to-peer Support. This service provides a structured one-to-one relationship between a family partner and a parent or caregiver for the purpose of resolving or ameliorating the child's emotional and behavioral needs by improving the capacity of the parent or caregiver to parent the child with a serious emotional disturbance. Services may include education, support, and training for the parent or caregiver. Family partners do not provide respite care or babysitting services.

Per Diem. A unit of payment that refers to a billable day in which the member is enrolled in the program.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

Targeted Case Management (TCM). This service is for individuals younger than 21 years old with serious emotional disturbance and includes assessment of the member, development of an individualized care plan, referral and coordination of other services and supports, and monitoring and follow-up on the implementation of the care plan. Targeted case management is also referred to as intensive care coordination (ICC).

Therapeutic Mentoring. Therapeutic mentoring services are designed to support age-appropriate social functioning or ameliorate deficits in the youth's age-appropriate social functioning. Therapeutic mentoring offers structured, one-to-one, strength-based support services between a therapeutic mentor and a youth for the purpose of addressing daily living, social, and communication needs. Therapeutic mentoring services include supporting, coaching, and training the youth in age-appropriate behaviors, interpersonal communication, problem-solving and conflict resolution, and relating appropriately to other youth and adults. Therapeutic mentoring is provided by eligible providers.

Therapeutic Training and Support. This service is provided by a therapeutic training and support staff working under the supervision of an in-home therapist to support implementation of the licensed clinician's treatment plan to achieve the goals of that plan. The therapeutic training and support staff assists the in-home therapist in implementing the therapeutic objectives of the treatment plan designed to address the youth's emotional, behavioral, and mental health needs. This service includes teaching the youth to understand, direct, interpret, manage, and control feelings and emotional responses to situations, and to assist the family to address the youth's emotional, behavioral, and mental health needs. Therapeutic training and support is provided by eligible providers.

History

Amended by Mass Register Issue 1303, eff. 7/1/2015.

101 CMR, § 352.03 Rate Provisions

(1) Rates as Full Compensation. The rates under 101 CMR 352.03 constitute full compensation for children's behavioral health services provided by community service agencies to publicly aided patients, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Payment rates under 101 CMR 352.03 are the lowest of

(a) the eligible provider's usual charge to the general public;

(b) the amount accepted as payment from another payer; or

(3) Fee Schedule.

(a) Unit of service is per 15 minutes, unless otherwise indicated. Allowable fee for dates of service on or after August 1, 2023.

| H0038 | $24.69 | Self-help/peer services, per 15 minutes (parent-caregiver peer-to-peer support service provided by a family partner) | | --- | --- | --- | | H2011-HN | $30.57 | Crisis intervention service, per 15 minutes (mobile crisis intervention service provided by a paraprofessional, hospital emergency department) | | H2011-HO | $39.70 | Crisis intervention service, per 15 minutes (mobile crisis intervention service provided by a master-level clinician, hospital emergency department.) | | H2014-HN | $20.15 | Skills training and development, per 15 minutes (behavior management monitoring provided by a bachelor-level clinician) | | H2014-HO | $33.86 | Skills training and development, per 15 minutes (behavior management therapy provided by a master-level clinician) | | H2019-HN | $22.67 | Therapeutic behavioral services, per 15 minutes (therapeutic training and support services provided by a bachelor-level clinician) | | H2019-HO | $32.33 | Therapeutic behavioral services, each 15 minutes (in-home therapy provided by a master-level clinician) | | T1027-EP | $23.24 | Family training and counseling for child development, per 15 minutes (therapeutic mentoring service) | | H0023-HT | $66.99 | Behavioral Health Outreach Service (Targeted Case Management (multi-disciplinary team) that includes family support and training and intensive care coordination per day) |

(b) For mobile crisis intervention services at community-based sites of service, refer to 101 CMR 305.00: Rates for Behavioral Health Services Provided in Community Behavioral Health Centers .

(4) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list

(a) codes for which only the code numbers changed, with the corresponding cross-walk;

(b) codes for which the code number remains the same but the description has changed; and

(c) deleted codes for which there is no cross-walk. In addition, for entirely new codes that require new pricing, EOHHS will list these codes and apply individual consideration in reimbursing these new codes until rates are established.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on, and understanding of, substantive provisions of 101 CMR 352.00.

(6) Billing. Each eligible provider must bill the governmental unit according to the appropriate fee schedule on a prescribed form. Each specific service must be separately enumerated on the bill.

History

Amended by Mass Register Issue 1303, eff. 7/1/2015.

101 CMR, § 352.04 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to the Center pursuant to M.G.L. c. 12C, § 22, shall be certified under pains and penalties of perjury as true, correct, and accurate by the executive director or chief financial officer of the provider.

(b) Examination of Records. Each provider must make available to the Center or purchasing governmental unit upon request all records relating to its reported costs, including costs of any entity related by common ownership or control.

(2) Required Reports. Each provider must file

(a) an annual uniform financial statement and independent auditor's report completed in accordance with the filing requirements of Division of Purchased Services regulation 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services ;

(b) any cost report supplemental schedule as issued by the Center; and

History

Amended by Mass Register Issue 1303, eff. 7/1/2015.

101 CMR, § 352.05 Severability

The provisions of 101 CMR 352.00 are severable. If any provision of 101 CMR 352.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 352.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1303, eff. 7/1/2015.

Payment for Primary Care Clinician Plan Services and Primary Care ACO Participating Primary Care Provider Services Payment for Primary Care Clinician Plan Services and Primary Care ACO Participating Primary Care Provider Services

101 CMR, § 353.01 General Provisions

(1) Scope and Purpose. 101 CMR 353.00 governs certain payments to Primary Care Clinicians (PCCs) for Primary Care Clinician (PCC) services provided to MassHealth members as part of the MassHealth PCC Plan, and to Primary Care ACO-participating Primary Care Providers (participating PCPs) for participating PCP services provided to members enrolled in MassHealth Primary Care ACOs. The enhancement rate payments described in 101 CMR 353.00 are in addition to payments issued under the Acute Hospital Request for Applications, and 101 CMR 304.00: Rates for Community Health Centers ; 101 CMR 316.00: Surgery and Anesthesia Services ; 101 CMR 317.00: Medicine ; and 101 CMR 318.00: Radiology .

(2) Disclaimer of Authorization of Services. 101 CMR 353.00 is not authorization for or approval of the procedures for which payments are determined pursuant to 101 CMR 353.00. Purchasing agencies and insurers are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals.

(3) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 353.00.

History

Adopted by Mass Register Issue 1361, eff. 3/23/2018.

101 CMR, § 353.02 General Definitions

Meaning of Terms. Terms used in 101 CMR 353.00 will have the meaning ascribed in 101 CMR 353.02.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Primary Care ACO. A type of ACO with which the MassHealth agency contracts under its ACO program.

Primary Care Clinician (PCC) . Any MassHealth provider that participates as a primary care provider for MassHealth members enrolled in the PCC Plan, as described in 130 CMR 450.118: Primary Care Clinician (PCC) Plan .

Publicly Aided Individual. A person whose medical and other services is paid for in whole or in part by the Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

History

Adopted by Mass Register Issue 1361, eff. 3/23/2018.

101 CMR, § 353.03 General Payment Provisions

(A) Primary Care Clinicians (PCCs) receive an enhanced rate for certain types of primary and preventive care visits provided to PCC Plan members enrolled with the PCC on the date of service. Ten dollars is added to the fee for the procedure code billed. The MassHealth agency pays PCCs an enhanced fee for delivering primary care services in accordance with the terms of the PCC provider contract.

(B) Primary Care ACO-participating Primary Care Providers (participating PCPs) receive an enhanced rate for certain types of primary and preventive care visits provided to Primary Care ACO members enrolled with the participating PCP on the date of service. Ten dollars is added to the fee for the procedure code for the procedure code billed. The MassHealth agency pays participating PCPs an enhanced fee for delivering primary care services in accordance with the terms of the participating PCP contract.

History

Adopted by Mass Register Issue 1361, eff. 3/23/2018.

101 CMR, § 353.04 Penalty for Noncompliance with Filing and Reporting Requirements

The purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 353.04.

History

Adopted by Mass Register Issue 1361, eff. 3/23/2018.

101 CMR, § 353.05 Severability

The provisions of 101 CMR 353.00 are severable, and if any provision of 101 CMR 353.00 or application of such provision to any community service agency or any circumstances shall be held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 353.00 or application of such provisions to community service agencies or circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1361, eff. 3/23/2018.

Rates for Freestanding Birth Center Services Rates for Freestanding Birth Center Services

101 CMR, § 355.01 General Provisions

(1) Scope and Purpose. 101 CMR 355.00 governs the rates of payment to eligible freestanding birth centers to be used by all governmental units for services provided to publicly aided individuals.

(2) Applicable Dates of Service. Rates contained in 101 CMR 355.00 apply for dates of service provided on and after January 19, 2024, unless otherwise indicated.

(3) Coverage. 101 CMR 355.00 and the rates of payment contained in 101 CMR 355.00 are full compensation for the facility component of services furnished in connection with prenatal, labor, delivery, newborn nursery, and postpartum care for low-risk births that can be performed safely in a freestanding birth center under the scope of covered services and that meet the conditions for payment for such services by the governmental purchaser. Payment from any other sources is used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly aided individuals. 101 CMR 355.00 does not cover professional services billed separately from the birth center facility component fee by either the facility or by the clinical staff.

(4) Disclaimer of Authorization of Services. 101 CMR 355.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 355.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided individuals.

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology® (CPT). The publication of such updates and corrections will list

(b) codes for which the code number remains the same but the description has changed;

(d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (I.C.) payment for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, to clarify its policy on and understanding of substantive provisions of 101 CMR 355.00, and as otherwise specified in 101 CMR 355.00.

History

Adopted by Mass Register Issue 1409, eff. 1/24/2020.

101 CMR, § 355.02 Definitions

As used in 101 CMR 355.00, unless the content requires otherwise, terms have the meanings in 101 CMR 355.02. The descriptions and five-digit codes included in 101 CMR 355.00 utilize the Healthcare Common Procedure Code System (HCPCS) for Level I and Level II coding. Level 1 CPT-4 codes are obtained from the Physicians' 2022 Current Procedural Terminology® by the American Medical Association, unless otherwise specified. Level II codes are obtained from 2022 HCPCS maintained jointly by the Centers for Medicare & Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and the Health Insurance Association of America.

HCPCS is a listing of descriptive terms and identifying codes and modifiers for reporting medical services and procedures performed by physicians and other healthcare professionals, as well as associated non-physician services. 101 CMR 355.00 includes only HCPCS numeric and alpha-numeric identifying codes and modifiers for reporting medical services and procedures that were selected by EOHHS. Any use of CPT outside the fee schedule should refer to the Physicians' 2022 Current Procedural Terminology®.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Certified Nurse-midwife (CNM). An advanced practice registered nurse (APRN) who has completed a program of study and clinical experience for nurse-midwives, and is licensed by the Board of Registration in Nursing to practice as a certified nurse-midwife, whose eligibility is limited to those procedures specified by the governmental unit purchasing such services, and who also meets such conditions of participation as may have been or may be adopted from time to time by a governmental unit.

Certified Nurse Practitioner (CNP). An APRN who has completed a program of study and clinical experience for nurse practitioners, and is licensed by the Board of Registration in Nursing to practice as a certified nurse practitioner, whose eligibility is limited to those procedures specified by the governmental unit purchasing such services, and who also meets such conditions of participation as may be adopted by a governmental unit.

Clinical Staff. The physician, certified nurse-midwife, certified nurse practitioner, registered nurse, licensed practical nurse, and other licensed health care practitioners appointed by the governing authority to practice within the birthing center and governed by rules approved by the governing body.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Facility Component. Rates of payment for a freestanding birth center's facility component costs. The facility component does not include payment for physician, certified nurse-midwife, or certified nurse practitioner services in performing a procedure or service. The facility component does include payment for the services of other clinical staff, e.g ., registered nurses and licensed practical nurses. The facility component also includes payment for the component of a service or procedure representing the cost of rent, equipment, utilities, supplies, drugs and biologicals, clinical laboratory services, malpractice insurance, administrative and technical salaries and benefits, all related administrative or supervisory duties performed in connection with the provision of the service or procedure, and all other overhead expenses of the service or procedure.

Freestanding. Existing independently or physically separated from another health care facility and administered by separate staff with separate records.

Freestanding Birth Center (FBC). A health facility not operated under a hospital license that is licensed by the Department of Public Health (DPH) as a birth center, pursuant to 105 CMR 140.000: Licensure of Clinics .

Governmental Unit. The Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

Individual Consideration (I.C.). Freestanding birth center services that are authorized but not listed in 101 CMR 355.00, freestanding birth center services performed in unusual circumstances, and services whose fees are designated by the letters "I.C." are individually considered items. The governmental unit or purchaser analyzes the eligible provider's operative report, which must contain a diagnosis, a pertinent medical history, a description of the services rendered, and the length of time spent with the patient. In making the determination of whether the service is appropriately classified as an individually considered item, the following criteria are used:

(a) policies, procedures, and practices of other third-party purchasers of care, both governmental and private;

(b) the severity and complexity of the patient's disorder or disability;

(d) time, degree of skill, and cost including equipment cost required to perform the procedure(s).

Modifiers. Listed services may be modified under certain circumstances. When applicable, the modifying circumstances must be identified by the addition of the appropriate two-digit number or letters.

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

History

Adopted by Mass Register Issue 1409, eff. 1/24/2020.

101 CMR, § 355.03 General Rate Provisions and Payment

(1) Rate Determination. Rates of payment for the facility component of authorized freestanding birth center facility services to which 101 CMR 355.00 applies are the lowest of

(a) the eligible provider's usual fee to the general public;

(b) the eligible provider's actual charge submitted; and

(2) Individual Consideration and Non-listed Procedures. Rates of payment for freestanding birth center services that are authorized, but not listed in 101 CMR 355.00, services performed in unusual circumstances, and services whose fees are designated by the letters "I.C." are determined on an individual consideration basis.

(3) Terminated Procedures. The purchasing governmental unit determines payment on an individual consideration (I.C.) basis for any procedure that has been terminated after the procedure was initiated.

(4) Services and Payments Covered under Other Regulations. Rules and payment rates for professional services of physicians, certified nurse-midwives, and certified nurse practitioners performed in freestanding birth centers are contained in 101 CMR 355.03(4).

| Regulation Title | Regulation Number | | --- | --- | | Rates for Surgery and Anesthesia Services | 101 CMR 316.00 | | Rates for Medicine Services | 101 CMR 317.00 | | Rates for Radiology Services | 101 CMR 318.00 |

(5) Fee Schedule.

| HCPCS Code | Fee | Description | | --- | --- | --- | | 59400-TC | $4,589.24 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care (payment for the mother's length of stay for an all-inclusive global facility obstetrical service without use of forceps) | | 99460-TC | $1,422.31 | Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant (all-inclusive global facility payment for newborn's length of stay) | | S4005 | I.C. | Interim labor facility global (labor occurring, but not resulting in delivery) (global facility payment for prepartum services when delivery occurs at another facility) |

(6) Provider Preventable Conditions. The following modifiers are used to report provider preventable conditions in accordance with 42 CFR 447.26, and result in nonpayment for services.

| Modifier | Description | | --- | --- | | PA | Surgical or other invasive procedure on wrong body part | | PB | Surgical or other invasive procedure on wrong patient | | PC | Wrong surgery or other invasive procedure on patient |

History

Adopted by Mass Register Issue 1409, eff. 1/24/2020.

101 CMR, § 355.04 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1409, eff. 1/24/2020.

101 CMR, § 355.05 Severability

The provisions of 101 CMR 355.00 are severable. If any provision of 101 CMR 355.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 355.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1409, eff. 1/24/2020.

Rates For Money Follows The Person Demonstration Services Rates For Money Follows The Person Demonstration Services

101 CMR, § 356.01 General Provisions

(1) Scope and Purpose. 101 CMR 356.00 governs the payment rates for Money Follows the Person Demonstration (MFP Demo) services purchased by all governmental units.

(2) Applicable Dates of Service. Rates contained in 101 CMR 356.00 apply for dates of service on and after March 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 356.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 356.00. Governmental units that purchase MFP Demo services are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 356.00.

History

Amended by Mass Register Issue 1511, eff. 12/22/2023.

101 CMR, § 356.02 Definitions

As used in 101 CMR 356.00, unless the context requires otherwise, terms have the meanings in 101 CMR 356.02.

Assistive Technology. Assistive technology includes:

(a) devices, controls, or appliances, that enable an individual to increase their ability to perform activities of daily living;

(b) devices, controls, or appliances that enable an individual to perceive, control, or communicate with the community environment in which they live;

(c) items necessary for life support or to address physical conditions along with ancillary supplies and equipment necessary to the proper functioning of such items;

(d) such other durable and non-durable medical equipment that is necessary to address an individual's functional limitations; and

(e) necessary medical supplies.

Service may also include: evaluations necessary for the selection, design, fitting or customization of assistive technology to meet the needs of the individual; customization, adaptation, fitting, set-up, maintenance or repairs of assistive technology; the temporary replacement of assistive technology; and, training or technical assistance with the use of assistive technology.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Community Engagement Navigation. Outreach and support services to MFP Demonstration participants both as they prepare to transition out of facilities and after they have transitioned. Services may include:

(a) accompaniment and transportation from facilities to community housing and service options;

(b) supporting service exploration and linkage; and

Demonstration Case Management. A service that provides an individual with care coordination and assistance with obtaining necessary MFP Demonstration and MassHealth services, as well as other medical social, or educational services, regardless of the funding source, and that support the individual's ability to reside in a community setting. Demonstration Case Management includes:

(a) comprehensive assessments and periodic reassessments of an individual to determine the need for any medical, educational, social, or other services;

(b) development of a care plan that is based on the comprehensive assessments;

(c) referral and related activities (such as scheduling appointments) to help the individual obtain necessary services and identified needs specified in his or her care plan;

(d) development of a back-up plan of care; and

(e) monitoring and follow-up activities that are necessary to ensure that the individual's care plan is effectively implemented and adequately addresses the needs of the individual.

Executive Office of Health and Human Services (EOHHS). The executive agency within Massachusetts government that is the single state agency responsible for the administration of the MassHealth program (Medicaid), pursuant to M.G.L. c. 118E, Titles XIX and XXI of the Social Security Act, and other applicable laws and waivers thereto.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration (I.C). Payment rates for certain services are designated as Individual Consideration (I.C.). Where I.C. rates are designated, the purchasing governmental unit will determine the appropriate payment rate in accordance with the following standards and criteria:

(a) the amount of time required to complete the service or item;

(b) the degree of skill required to complete the service or item;

(d) the lowest price charged or accepted from any payer for the same or similar service or item, including, but not limited to any shelf price, sale price, advertised price, or other price reasonably obtained by a competitive market for the service or item; and

(e) the established rates, policies, procedures, and practices of any other purchasing governmental unit in purchasing the same or similar services or items.

MassHealth. The Medicaid program of the Commonwealth of Massachusetts, administered by EOHHS pursuant to M.G.L. c. 118E, Titles XIX and XXI of the Social Security Act, and other applicable laws and waivers thereto.

Money Follows the Person Demonstration. A MassHealth demonstration program authorized pursuant to a federal grant received by EOHHS that seeks to assist eligible MassHealth members residing in facility-based long term care settings to transition to a community-based setting, where they can receive home and community-based services.

Money Follows the Person Demonstration Services. Services that are either allowable Medicaid services not currently included in the state's array of home and community-based services (HCBS) or qualified services above what would be available to non-MFP Demonstration Medicaid beneficiaries, and which include assistive technology, Community Engagement Navigation, and transitional assistance.

Money Follows the Person Demonstration Supplemental Services. One-time services to support the transition of MFP Demonstration participants that are otherwise not allowable under the Medicaid program. Services address critical barriers to transition for MFP Demonstration participants, including the lack of affordable and accessible housing, food insecurity, and financial and administrative barriers to transitions.

Orientation and Mobility Services (O&M Services). Services that teach an individual with vision impairment or legal blindness how to move or travel safely and independently in his/her home and community and which include direct training, environmental evaluations and caregiver/direct care staff training on sensitivity to blindness/low vision. O&M Services are tailored to the individual's need and may extend beyond residential settings to other community settings as well as public transportation systems. There are three rates for Orientation and Mobility services. The three rates are based on the one-way distance traveled to initiate provision of the service: Level I for distances of one-30 miles; Level II for distances 31-60 miles and Level III for distances over 61 miles.

Provider. Any individual, group, partnership, trust, corporation or other legal entity that offers services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been adopted by a purchasing governmental unit.

Reporting Year. The Provider's fiscal year for which costs incurred are reported to the appropriate entity, as determined by EOHHS.

Transitional Assistance. Non-recurring set-up expenses and short-term services necessary to facilitate an individual's transition from a facility-based long term care setting to the community. Allowable expenses are those that are necessary to enable a person to establish a basic household and do not constitute room and board.

History

Amended by Mass Register Issue 1511, eff. 12/22/2023.

101 CMR, § 356.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment for services included in the scope of this regulation from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. Except as provided in 101 CMR 356.03(3), no purchasing governmental unit may pay less than, or more than, the approved program rate.

(4) Rates of Payment. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed below:

| Service | Rate | | --- | --- | | Assistive Technology | See 101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment | | Community Engagement Navigation | See 101 CMR 423.00: Rates for Certain In-home Basic Living Supports | | Transitional Assistance | I.C. |

History

Amended by Mass Register Issue 1511, eff. 12/22/2023.

101 CMR, § 356.04 Filing and Reporting Requirements

(1) Cost Reporting Requirements. All providers must comply with the requirements of 957 CMR 6.00: Cost Reporting Requirements .

(2) Penalties for Noncompliance. The purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing government unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 356.04(2).

History

Amended by Mass Register Issue 1511, eff. 12/22/2023.

101 CMR, § 356.05 Severability

The provisions of 101 CMR 356.00 are severable. If any provision of 101 CMR 356.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 356.00 or application of those provisions to applicable individuals, entities, or circumstances

History

Amended by Mass Register Issue 1511, eff. 12/22/2023.

101 CMR, 101 CMR 357.00 REPEALED

History

Repealed by Mass Register Issue S1331, eff. 1/27/2017.
REGULATORY AUTHORITY 101 CMR 357.00: M.G.L. chs. 118E and 12C.

RATES FOR APPLIED BEHAVIOR ANALYSIS RATES FOR APPLIED BEHAVIOR ANALYSIS

101 CMR, § 358.01 General Provisions

(1) Scope and Purpose. 101 CMR 358.00 governs the rates to be used by all governmental units in making payments to eligible providers of applied behavior analysis to publicly aided individuals.

(2) Applicable Dates of Service. Rates contained in 101 CMR 358.00 apply for dates of service on or after October 1, 2024, except as otherwise noted.

(3) Disclaimer of Authorization of Services. 101 CMR 358.00 is not authorization for or approval of the services for which rates are determined pursuant to 101 CMR 358.00. Governmental units that purchase care and services are responsible for the definition, authorization, and approval of care and services provided to publicly aided individuals.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 358.00.

History

Adopted by Mass Register Issue 1306, eff. 2/12/2016.

101 CMR, § 358.02 General Definitions

Terms used in 101 CMR 358.00 have the meanings in 101 CMR 358.02.

Applied Behavior Analysis. A MassHealth service that focuses on the analysis, design, implementation, and evaluation of social and other environmental modifications to produce meaningful changes in human behavior. This service provides for the performance of behavioral assessments; interpretation of behavior analytic data; development of a highly specific treatment plan; supervision and coordination of interventions; and training other interveners to address specific objectives or performance goals in order to support the acquisition of socially significant adaptive skills and reduction of challenging behaviors that interfere with a youth's successful functioning.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Eligible Provider. Any person, partnership, corporation, or other entity that is authorized to provide Applied Behavior Analysis services in the Commonwealth of Massachusetts and who meets such conditions of participation as have been adopted by a governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

History

Adopted by Mass Register Issue 1306, eff. 2/12/2016.

101 CMR, § 358.03 Rate Provisions

(1) Rates as Full Compensation. The rates under 101 CMR 358.03 constitute full compensation for applied behavior analysis services provided by eligible providers to publicly aided individuals, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Payment rates under 101 CMR 358.03 are the lowest of

(a) the eligible provider's usual charge to the general public; or

(b) the schedule of allowable rates for services as set forth in 101 CMR 358.03(3).

(3) Fee Schedule.

| Code | Payment Rate | Service Description | | --- | --- | --- | | 97151 | $30.73 | Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan. (Initial functional behavior assessment and reassessment.) | | 97153 | $16.37 | Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes. (Adaptive behavior treatment.) | | 97154 | $13.91 | Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes. (Social skills group, up to eight participants.) | | 97155 | $30.73 | Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes. (Adaptive behavior treatment.) | | 97156 | $30.73 | Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes. (Parent training with or without child present.) | | 97157 | $26.12 | Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes. (Multiple group parent training, up to eight participants.) | | H0031-U2 | $30.73 | Mental health assessment by physician or other qualified health professional (Assessment and case planning for home services by a licensed professional. 15-minute rate.) |

(4) Coding Updates and Corrections.

(a) EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list

codes for which only the code numbers changed, with the corresponding crosswalk;

codes for which the code number remains the same but the description has changed; and
deleted codes for which there is no crosswalk.

(b) In addition, for entirely new codes that require new pricing, EOHHS will list these codes and apply individual consideration in reimbursing these new codes until rates are established.

(5) Billing. Each eligible provider must bill the governmental unit according to the appropriate fee schedule on a prescribed form. Each specific service must be separately enumerated on the bill.

History

Adopted by Mass Register Issue 1306, eff. 2/12/2016.

101 CMR, § 358.04 Reporting Requirements

(1) An eligible provider that was paid by a governmental unit for applied behavior analysis services provided in a prior fiscal year, and whose program operated for the entire prior fiscal year must submit the following information to the Operational Services Division or to the Center, as applicable:

(a) an annual Uniform Financial Statements and Independent Auditor's Report (UFR) completed in accordance with

the filing requirements and schedule of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services ; and
any special instructions appearing in the UFR Audit & Preparation Manual, which may require that certain providers distinguish certain cost centers or programs by filing separate UFR-Schedule Bs for each cost center or program; and

(b) any cost report supplemental schedule or any additional information requested by the Center within the timeframe specified by the Center on the request.

History

Adopted by Mass Register Issue 1306, eff. 2/12/2016.

101 CMR, § 358.05 Severability

The provisions of 101 CMR 358.00 are severable. If any provision of 101 CMR 358.00 or application of such provision to any eligible provider or circumstances is held to be invalid or unconstitutional, such invalidity will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 358.00 or application of such provisions to eligible providers or circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1306, eff. 2/12/2016.

Rates for Home and Community Based Services Rates for Home and Community Based Services

101 CMR, § 359.01 General Provisions

(1) Scope. 101 CMR 359.00 governs the payment rates, effective as provided under 101 CMR 359.03 for services in four Home and Community-based Services (HCBS) Waivers purchased by a governmental unit. The four HCBS Waivers are: Acquired Brain Injury Non-residential Habilitation (ABI-N) Waiver, Acquired Brain Injury Residential Habilitation (ABI-RH) Waiver, Moving Forward Plan Community Living (MFP-CL) Waiver, and Moving Forward Plan Residential Supports (MFP-RS) Waiver. Listed in 101 CMR 359.01(1)(a) through (d) are the waiver services available in each waiver.

(a) ABI-N Waiver Services:

Adult Companion
Assistive Technology
Chore Services
Community-based Day Supports
Community Family Training
Community Support & Navigation
Day Services
Home Accessibility Adaptations
Home Delivered Meals
Home Health Aide
Homemaker
Independent Living Supports
Individual Support and Community Habilitation
Laundry
Occupational Therapy
Orientation and Mobility Services
Peer Support
Personal Care
Physical Therapy
Prevocational Services
Respite Services
Shared Home Supports
Skilled Nursing
Specialized Medical Equipment
Speech Therapy
Supported Employment
Supportive Home Care Aide
Transitional Assistance
Vehicle Modification
Transportation

(b) ABI-RH Waiver Services:

Assisted Living Services
Assistive Technology
Community-based Day Supports
Community Support & Navigation
Day Services
Home Accessibility Adaptations (available only in Shared Living - 24-hour Supports)
Individual Support and Community Habilitation
Occupational Therapy
Orientation and Mobility Services
Peer Support
Physical Therapy
Prevocational Services
Residential Family Training
Residential Habilitation
Shared Living - 24-Hour Supports
Skilled Nursing
Specialized Medical Equipment
Speech Therapy
Supported Employment
Transitional Assistance

Transportation

Adult Companion
Assistive Technology
Chore Services
Community-based Day Supports
Community Family Training
Community Support and Navigation
Day Services
Home Accessibility Adaptations
Home Delivered Meals
Home Health Aide
Homemaker
Independent Living Supports
Individual Support and Community Habilitation
Laundry
Occupational Therapy
Orientation and Mobility Services
Peer Support
Personal Care
Physical Therapy
Prevocational Services
Respite Services
Shared Home Supports
Skilled Nursing
Specialized Medical Equipment
Speech Therapy
Supported Employment
Supportive Home Care Aide
Transportation
Transitional Assistance
Vehicle Modification

(d) MFP-RS Waiver Services:

Assisted Living Services
Assistive Technology
Community-based Day Supports
Community Support and Navigation
Day Services
Home Accessibility Adaptations (available only in Shared Living - 24-hour Supports)
Individual Support and Community Habilitation
Occupational Therapy
Orientation and Mobility Services
Peer Support
Physical Therapy
Prevocational Services
Residential Family Training
Residential Habilitation
Shared Living - 24-hour Supports
Skilled Nursing
Specialized Medical Equipment
Speech Therapy
Supported Employment
Transitional Assistance

Transportation

(2) Applicable Dates of Service. Rates contained in 101 CMR 359.00 apply for dates of service on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 359.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 359.00. Governmental units that purchase MFP Waiver Services and/or ABI Waiver Services are responsible for the definition, authorization, and approval of services extended to participants.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 359.00.

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections by administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) maintained by the Centers for Medicare and Medicaid Services (CMS). The publication of such updates and corrections will list

(a) codes for which only the code numbers change, with the corresponding cross references between existing and new codes;

(b) deleted codes for which there are no corresponding new codes; and

(c) codes for entirely new services that require pricing. These codes will be paid on an individual consideration basis until rates are established.

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

101 CMR, § 359.02 Definitions

As used in 101 CMR 359.00, unless the context requires otherwise, terms will have the meanings in 101 CMR 359.02.

Acquired Brain Injury Home- and Community-based Service Waiver (ABI Waiver). Two Massachusetts home- and community-based services waivers approved by the Centers for Medicare and Medicaid Services (CMS) under the Social Security Act, § 1915(c) for persons with acquired brain injury who are transitioning from long-stay facilities. The two separate ABI Waivers each with different covered services and eligibility requirements, are the Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver and the Acquired Brain Injury Nonresidential Habilitation (ABI-N) Waiver.

Activities of Daily Living (ADL). Certain basic tasks required for daily living, including the ability to bathe, dress/undress, eat, toilet, transfer in and out of bed or chair, get around inside the home, and manage incontinence.

Adult Companion Service. Nonmedical care, supervision, and socialization provided to a participant. Companions may assist or supervise the participant with such light household tasks as meal preparation, laundry, and shopping.

Agency Rate. The fee for services performed by a person whose wage is paid by a corporation or partnership that is a MassHealth provider.

Assisted Living Services. Services consist of personal care and supportive services (homemaker, chore, personal care services, meal preparation) that are furnished to participants who reside in a qualified assisted living residence (ALR) that includes 24-hour on-site response capability to meet scheduled or unpredictable resident needs and to provide supervision, safety, and security. Services may also include social and recreational programs, and medication assistance (consistent with ALR certification and to the extent permitted under State law). Nursing and skilled therapy services are incidental rather than integral to the provision of Assisted Living Services. Intermittent skilled nursing services and therapy services may be provided to the extent allowed by applicable regulations.

Assistive Technology. This service has two components: Assistive Technology devices and Assistive Technology evaluation and training. These components are defined as follows:

(a) Assistive Technology devices - an item, piece of equipment, or product system that is used to develop, increase, maintain, or improve functional capabilities of participants, and to support the participant to achieve goals identified in their Plan of Care.

(b) Assistive Technology evaluation and training - the evaluation of the Assistive Technology needs of the participant, i.e . functional evaluation of the impact of the provision of appropriate Assistive Technology devices and services to the participant in the customary environment of the participant; the selection, customization and acquisition of Assistive Technology devices for participants; selection, design, fitting, customization, adaption, maintenance, repair, and/or replacement of Assistive Technology devices; coordination and use of necessary therapies, interventions, or services with Assistive Technology devices that are associated with other services contained in the Plan of Care; training and technical assistance for the participant, and, where appropriate, the family members, guardians, advocates, or authorized representatives of the participant; and training or technical assistance for professionals or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of participants.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Chore. An unusual or infrequent household maintenance task that is needed to maintain the participant's home in a clean, sanitary, and safe environment. Chore includes heavy household chores such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture in order to provide safe access and egress.

Community-based Day Supports (CBDS). A service designed to enable an individual to enrich his or her life and enjoy a full range of community activities by providing opportunities for developing, enhancing, and maintaining competency in personal and social interactions and community engagement. Community-based Day Supports uses a small group model to provide a flexible array of individualized supports through activities primarily in non-center-based settings, separate from the participant's private residence or other residential living arrangement. The service may include career exploration, including assessment of interests through volunteer experiences or situational assessments; participant-driven experiences to support fuller participation in community life; development and support of activities of daily living and independent living skills, socialization experiences, and enhancement of interpersonal skills; and pursuit of personal interests and hobbies.

Community Family Training. A service designed to provide training and instruction about the treatment regimes, behavior plans, and the use of specialized equipment that support a participant in the community. Community family training may also include training in family leadership, support of self-advocacy, and independence for the family member. The service enhances the skills of the family to assist the waiver participant to function in the community and at home.

Community Support and Navigation. A service that provides outreach and support services to enable participants to access and utilize clinical behavioral health treatment services and other supports. These services are staffed by paraprofessionals, supported by clinical supervision, and are designed to be maximally flexible in supporting participants to implement the goals in their plan of care and attain the skills and resources needed to successfully maintain community tenure. Such services may include:

(a) Fostering empowerment, recovery, and wellness, including developing recovery strategies, identifying and assisting participants in accessing self-help options, and creating crisis prevention plans and relapse prevention plans;

(b) Assisting participants in improving skills that enhance independence or accessing services to support them in enhancing independence;

(d) Providing temporary assistance with transportation to essential medical and behavioral health appointments while transitioning to community-based transportation resources ( e.g ., public transportation resources, PT-1 forms, etc .)

(e) Assisting with connecting the participant to necessary behavioral health and other health care services (including, as applicable, supporting initial engagement with coordination provided by the participant's ACO or MCO);

(f) Providing linkages to recovery-oriented peer supports and/or self-help supports and services;

(g) Assisting with self-advocacy skills to improve communication and participation in treatment/service planning discussions and meetings; and

(h) Collaborating with Emergency Services Programs/Mobile Crisis Intervention (ESP/ MCIs) and/or outpatient providers, including working with ESP/MCIs to develop, revise, or utilize participant crisis prevention plans or safety plans.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) are used when required.

Day Services. A structured, site-based, group program for participants that fosters community integration and offers assistance with the acquisition, retention, or improvement in self-help, socialization, and adaptive skills, and that takes place in a nonresidential setting separate from the participant's private residence or other residential living arrangement. Services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive and other strategies; interpersonal skills; prevocational skills; and recreational and socialization skills.

Employer Expense Component (EEC). The portion of the Self-directed Service rate that is designated for the mandated employer share of the Federal Insurance Contributions Act (FICA), federal and state unemployment taxes, Medicare, and Workers' Compensation premiums.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Home Accessibility Adaptations. Physical modifications to the participant's home that are necessary to ensure the health, welfare, and safety of the participant or that enable the participant to function with greater independence in the home.

Home and Community-based Services (HCBS) Waiver. A federally approved program operated under the Social Security Act, § 1915(c) that authorizes the U.S. Secretary of Health and Human Services to grant waivers of certain Medicaid statutory requirements so that a state may furnish home- and community-based services to certain Medicaid beneficiaries who need a level of care that is provided in a hospital, nursing facility, or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/ID). For purposes of 101 CMR 359.00, Home- and Community-based Service Waiver refers to the two ABI waivers and the two MFP waivers.

Home Delivered Meals. Services to a participant which provides well-balanced meals and maintains optimal nutritional and health status. Home Delivered Meals service includes the preparation, packaging, and delivery of meals by trained and supervised staff.

Home Health Aide. A person who performs certain personal care and other health-related services as described in 130 CMR 403.000: Home Health Agency .

Homemaker. A person who performs light housekeeping duties (for example: cooking, cleaning, laundry, and shopping) for the purpose of maintaining a household.

Independent Living Supports. A service that ensures 24-hour seven days per week access to supportive services for participants who have intermittent, scheduled and unscheduled needs for various forms of assistance, but who do not require 24-hour supervision. It provides participants with services and supports in a variety of activities such as: ADLs and instrumental activities of daily living (IADLs), support and companionship, emotional support, and socialization. This service is provided by a site-based provider, and is available to participants who choose to reside in locations where a critical mass of individuals reside who require such support and where providers of such supports are available.

(a) the amount of time required to complete the service or item;

(b) the degree of skill required to complete the service or item;

(d) the lowest price charged or accepted from any payer for the same or similar service or item including, but not limited to, any shelf price, sale price, advertised price, or other price reasonably obtained by a competitive market for the service or item; and

(e) the established rates, policies, procedures, and practices of any other purchasing governmental unit in purchasing the same or similar services or items.

Individual Provider (Self-employed Provider) Rate. The fee for services performed by a person that is a Provider and is not paid a wage by another person or entity for services performed.

Individual Support and Community Habilitation. Regular or intermittent services designed to develop, maintain, and/or maximize the participant's independent functioning in self-care, physical and emotional growth, socialization, communication, and vocational skills, to achieve objectives of improved health and welfare and to support the ability of the participant to establish and maintain a residence and live in the community.

Laundry. Services provided to a participant which includes pick up, washing, drying, folding, wrapping, and returning of laundry.

Moving Forward Plan Waivers (MFP Waivers). Two Massachusetts Home- and Community-based Services Waivers approved by the CMS under the Social Security Act, § 1915(c) for persons with disabilities who are transitioning from long-stay facilities. Massachusetts operates two separate MFP Waivers - the Moving Forward Plan Residential Supports (MFP-RS) waiver, and the Moving Forward Plan Community Living (MFP-CL) waiver, each with different covered services and eligibility requirements.

Non-agency Rate. The fee for services performed by Individual Providers (Self-employed Providers) or Self-directed Workers.

Occupational Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of functions that affect the activities of daily living that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Occupational therapy programs are designed to improve quality of life by recovering competence and preventing further injury or disability, and to improve the individual's ability to perform tasks required for independent functioning, so that the individual can engage in activities of daily living.

Orientation and Mobility Services. Services that teach an individual with vision impairment or legal blindness how to move or travel safely and independently in his or her home and community, and which includes assessment, training and education provided to participants, environmental evaluations, caregiver/direct care staff training on sensitivity to blindness/low vision, and information resource on community living for persons with vision impairment or legal blindness. Orientation and Mobility Services are tailored to the individual's need and may extend beyond the home setting to other community settings as well as public transportation systems.

Participant. A MassHealth member determined by the MassHealth agency to be eligible for enrollment in one of the HCBS waivers, who chooses to receive HCBS waiver services, and for whom a service plan has been developed that includes one or more HCBS waiver services.

Peer Support. Ongoing services and supports designed to assist participants to acquire, maintain or improve the skills necessary to live in a community setting. This service provides supports necessary for the participant to develop the skills that enable them to become more independent, integrated into, and productive in their communities. The service enables the participant to retain or improve skills related to personal finance, health, shopping, use of community resources, community safety, and other adaptive skills needed to live in the community.

Personal Care. Services provided to a participant, which may include physical assistance, supervision or cueing of participants, for the purpose of assisting the participant to accomplish activities of daily living (ADLs) including, but not limited to, eating, toileting, dressing, bathing, transferring, and ambulation.

Physical Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of physical functions that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Physical therapy emphasizes a form of rehabilitation focused on treatment of dysfunctions involving neuromuscular, musculoskeletal, cardiovascular/pulmonary, or integumentary systems through the use of therapeutic interventions to optimize functioning levels.

Prevocational Services. A service that consists of a range of learning and experimental type activities that prepares a participant for paid or unpaid employment in an integrated, community setting. Services are not job-task oriented, but instead aimed at a generalized result ( e.g ., attention span, motor skills). The service may include teaching such concepts as attendance, task completion, problem solving and safety as well as social skills training, improving attention span, and developing or improving motor skills. Basic skill-building activities are expected to specifically involve strategies to enhance a participant's employability in integrated, community settings.

Reporting Year. The Provider's fiscal year.

Residential Family Training. A service designed to provide training and instruction about treatment regimes, behavior plans, and the use of specialized equipment that supports the participant to participate in the community. Residential family training may also include training in family leadership, support of self-advocacy, and independence for their family member. The service enhances the skill of the family to assist the waiver participant to function in the community and at home when the waiver participant visits his or her family.

Residential Habilitation Room and Board. The amount paid by a governmental unit purchasing Residential Habilitation services for the costs of building, maintenance, upkeep, improvements, and meals, which are not covered as part of the Residential Habilitation Waiver service.

Residential Habilitation Service. Ongoing services and supports provided to a participant in a provider-operated residential setting that are designed to assist participants in acquiring, maintaining, or improving the skills necessary to live in a community setting. Residential habilitation provides participants with daily staff intervention including care, supervision, and skills training in activities of daily living, home management, and community integration in a qualified residential setting with 24-hour staffing. This service may include the provision of medical and health-care services that are integral to meeting the daily needs of participants.

Respite. Services provided to individuals unable to care for themselves; furnished on a short-term basis because of the absence or need for relief of unpaid caregivers.

Self-directed Services. A model of service delivery in which a waiver participant has decisionmaking authority over certain aspects of the delivery of their care.

Self-directed Worker. Participants who choose to self-direct waiver services have the authority and responsibility for recruiting and hiring workers to provide their Self-directed Services. These workers are referred to as self-directed workers and are subject to the standards, requirements, policies, and procedures for such workers under the participant's Home- and Community-based Services (HCBS) Waiver.

Shared Home Supports. An individually tailored supportive service that assists with the acquisition, retention, or improvement in skills related to living in the community. A participant is matched with a Shared Home Supports caregiver. This arrangement is overseen by a residential support agency. Shared Home Supports does not include 24-hour care. Shared Home Supports includes such supports as: adaptive skill development, assistance with ADLs and IADLs, adult educational supports, social and leisure skill development, and supervision.

Shared Living - 24-hour Supports. A residential option that matches a participant with a Shared Living caregiver. This arrangement is overseen by a residential support agency. Shared Living is an individually tailored 24 hours/seven days per week, supportive service available to a participant who needs daily structure and supervision. Shared Living includes supportive services that assist with the acquisition, retention, or improvement of skills related to living in the community. This includes such supports as: adaptive skill development, assistance with ADLs and IADLs, adult educational supports, social and leisure skill development, protective oversight and supervision.

Skilled Nursing Services. The assessment, planning, provision, and evaluation of goal-oriented nursing care that requires specialized knowledge and skills acquired under the established curriculum of a school of nursing approved by a board of registration in nursing. Such services include only those services that require the skills of a nurse. Skilled Nursing Services are provided by a person licensed as a registered nurse or a licensed practical nurse by a state's board of registration in nursing.

Specialized Medical Equipment and Supplies. Devices, controls, or appliances to increase abilities in activities of daily living, or to control or communicate with the environment.

Speech Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, that are designed to improve, develop, correct, rehabilitate, or prevent the worsening of speech/language communication and swallowing disorders that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Speech and language disorders are those that affect articulation of speech, sounds, fluency, voice, swallowing (regardless of presence of a communication disability), and those that impair comprehension, spoken, written, or other symbol systems used for communication.

Supported Employment. Regularly scheduled services that enable participants, through training and support, to work in integrated work settings in which individuals are working toward compensated work, consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals.

Supportive Home Care Aide. Services provided to participants with Alzheimer's/dementia or behavioral health needs to assist with ADLs and IADLs. These services include personal care, shopping, menu planning, meal preparation including special diets, laundry, light housekeeping, escort, and socialization/emotional support.

Transitional Assistance. Nonrecurring residential set-up expenses for participants who are transitioning from a nursing facility or hospital to a community living arrangement where the participant is directly responsible for his or her own set-up expenses. Allowable expenses are those that are necessary to enable a person to establish a basic household and do not constitute room and board.

Transportation Services. Conveyance of participants by vehicle from their residence to and from the site of HCBS waiver services and other community services, activities, and resources, including physical assistance to participants while entering and exiting the vehicle.

Vehicle Modification. Necessary adaptations or alterations to an automobile or van that is the waiver participant's primary means of transportation and that is not owned or leased by an entity providing services to the participant. Vehicle modifications are necessary when they are required to accommodate the special needs of the participant. Examples of vehicle modifications include: van lift, tie downs, ramp, specialized seating equipment and seating/safety restraint.

Waiver Services. Home- and community-based services that are covered in accordance with the requirements of 130 CMR 630.000: Home- and Community-based Services Waivers for participants enrolled under an ABI or MFP waiver.

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

101 CMR, § 359.03 Rate Provisions

(1) Services Included in the Rate. The approved rate will include payment for all care and services that are part of the program of services of a Provider, as explicitly set forth in the terms of the purchase agreement between the Provider and the purchasing governmental unit(s).

(2) Reimbursement as Full Payment. Each Provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment for services included in the scope of 101 CMR 359.00 from any other source must be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the participant.

(3) Payment Limitations.

(a) No purchasing governmental unit may pay less than or more than the approved program rate, except that a participant contribution may be applied towards the Residential Habilitation room and board payment in accordance with policies and procedures established by the purchasing governmental unit.

(b) Where more than one payment rate is available for a covered service, the service is covered at the lowest available payment rate, unless a higher rate is approved by the purchasing governmental unit, except as provided in 101 CMR 359.03(3)(c).

(c) Notwithstanding the requirement of 101 CMR 359.03(3)(b), payment rates for certain HCBS waiver services will be determined as follows:

Residential Habilitation rates will be determined in the following manner:

a. Service Model Rate. The purchasing Governmental Unit will designate the applicable rate from among the basic lower intensity, basic, or Intermediate categories, or at medical/clinical level 1, medical/clinical level 2, or medical/clinical level 3 as outlined and defined in 101 CMR 420.00: Rates for Adult Long-term Residential Services .

b. Room and Board. The purchasing Governmental Unit will designate the applicable rate for room and board from among the site rates outlined in 101 CMR 420.00: Rates for Adult Long-term Residential Services .

Orientation and Mobility. Orientation and Mobility rates will be determined: based on one-way distance traveled to initiate the service in the following manner:

a. Level I: one to 30 miles;

b. Level II: 31 to 60 miles; and

c. Level III: over 60 miles.

Shared Home Supports. The purchasing Governmental Unit will designate the applicable stipend rate at level 1, 2 or 3, as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services .

Shared Living - 24 Hour Supports. Shared Living - 24-hour support rates will be determined in the following manner

a. Operational Rate: The purchasing Governmental Unit will designate the applicable rate from among the available operational rate levels as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services .

b. Stipend Rate: The purchasing Governmental Unit will designate the applicable rate from among the available Stipend Levels, corresponding to the designated operational rate Level as outlined and defined in 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services .

(4) Approved Rates. The approved rate will be the lowest of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 359.03(4).

| Service | HCBS Waiver | Units | Agency Rate | Non-agency Rate | | | --- | --- | --- | --- | --- | --- | | Individual Provider (Self-employed Provider) | Self-directed Service | | | | | | Adult Companion | ABI-N, MFP-CL | Per 15 Min. | $6.50 | 89.75% of Agency Rate | 89.75% of Agency Rate | | Assisted Living | ABI-RH, MFP-RS | Per Diem | $112.02 | N/A | N/A | | Assistive Technology - devices | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per Device | I.C. | N/A | N/A | | Assistive Technology - evaluation and training | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per 15 Min. | See 101 CMR 423.00 Rates for Certain In-Home Basic Living Supports | | | | Chore | ABI-N, MFP-CL | Per 15 Min. | $10.13 | 89.75% of Agency Rate | 89.75% of Agency Rate | | Community-based Day Supports | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per 15 Min. | See 101 CMR 415.00: Rates for Community based Day Support Services; Levels A, B, C, & I | N/A | N/A | | Community Support and Navigation | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per 15 Min. | See 101 CMR 444.00: Rates for Certain Substance Use Disorder Services: Recovery Support Navigator Service | N/A | N/A | | Community Family Training | ABI-N, MFP-CL | Per 15 Min. | See 101 CMR 414.00: Rates for Family Stabilization Services (Family Training rate divided by 4 to determine rate per 15-minute increments) | 89.75% of Agency Rate | N/A | | Day Services | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per Diem, | Per Diem : $115.72 | N/A | N/A | | Day Services - partial per diem | ABI-N, ABI-RH, MFP-CL, MFP-RS | Partial Per Diem | Partial Per Diem : $57.86 | N/A | N/A | | Home Accessibility Adaptations | ABI-N, ABI-RH MFP-CL, MFP-RS | Item | I.C. | N/A | N/A | | Home Delivered Meals | ABI-N, MFP-CL | Meal | $10 | N/A | N/A | | Home Health Aide | ABI-N, MFP-CL | Per 15 Min. | See 101 CMR 350.00: Home Health Services | N/A | N/A | | Homemaker | ABI-N, MFP-CL | Per 15 Min. | $8.22 | 89.75% of Agency Rate | 89.75% of Agency Rate | | Independent Living Supports | ABI-N, MFP-CL | Per Diem | $88.02 | N/A | N/A | | Individual Support and Community Habilitation | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per 15 Min. | See 101 CMR 423.00: Rates for Certain Inhome Basic Living Sup-ports ; Levels G-H & I | 89.69% of Agency Rate | 89.69% of Agency Rate | | Laundry | ABI-N, MFP-CL | Per Order | $30.17 | N/A | N/A | | Occupational Therapy | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per Visit | See 101 CMR 350.00: Home Health Services | See 101 CMR 339.00: Restorative Services (out-of-office visit rate) | N/A | | Orientation and Mobility Services | MFP-CL, MFP-RS | Per 15 Min | Level I: $33.58 Level II: $37.12 Level III: $40.66 | Level I: $33.58 Level II: $37.12 Level III: $40.66 | N/A | | Peer Support | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per 15 Min. | See 101 CMR 414.00: Rates for Family Stabilization Services (rate divided by 4 to determine rate per 15-minute increments) | 89.75% of Agency Rate | 89.75% of Agency Rate | | Personal Care | ABI-N, MFP-CL | Per 15 Min. | $8.22 | See 101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program | See 101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program | | Physical Therapy | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per Visit | See 101 CMR 350.00: Home Health Services | See 101 CMR 339.00: Restorative Services (out-of-office visit rate) | N/A | | Prevocational Services | ABI-N, ABI-RH, MFP-CL, MFP- RS | Per 15 Min. | See 101 CMR 419.00: Rates for Supported Employment Services (rate for Individual Supported Employment) | N/A | N/A | | Residential Family Training | ABI-RH, MFP-RS | Per 15 Min. | See 101 CMR 414.00: Rates for Family Stabilization Services (Family Training rate divided by 4 to determine rate per 15-minute increments) | 89.75% of Agency Rate | N/A | | Residential Habilitation Room and Board | ABI-RH, MFP-RS | Per Diem | See 101 CMR 420.00: Rates for Adult Long-term Residential Services (Site Rates) | N/A | N/A | | Residential Habilitation Services | ABI-RH, MFP-RS | Per Diem | See 101 CMR 420.00: Rates for Adult Long-term Residential Services (Basic Lower Intensity, Basic, or Intermediate categories, Medical/Clinical Level 1, Medical/Clinical Level 2, or Medical/Clinical Level 3 | N/A | N/A | | Respite | ABI-N, MFP-CL | Per Diem | I.C. | N/A | N/A | | Shared Home Supports | ABI-N, MFP-CL | Per Diem | See 101 CMR 411.00 : Rates for Certain Placement, Support, and Shared Living Services (Operational Rate Level A, Stipend Levels 1, 2, or 3) | N/A | N/A | | Shared Living - 24 Hour Supports | ABI-RH, MFP-RS | Per Diem | See 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services | N/A | N/A | | Skilled Nursing - LPN | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per Visit | See 101 CMR 350.00: Home Health Services (Rates for Skilled Nursing Services) | N/A | N/A | | Skilled Nursing - RN | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per Visit | See 101 CMR 350.00: Home Health Services (Rates for Skilled Nursing Services) | N/A | N/A | | Specialized Medical Equipment | ABI-N, ABI-RH, MFP-CL, MFP-RS | Item | See 101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment | See 101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment | N/A | | Speech Therapy | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per Visit | See 101 CMR 350.00: Home Health Services | See 101 CMR 339.00: Restorative Services (out-of-office visit rate) | N/A | | Supported Employment | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per 15 Min. | See 101 CMR 419.00: Rates for Supported Employment Services (rate for Individual Supported Employment) | N/A | N/A | | Supportive Home Care Aide | ABI-N, MFP-CL | Per 15 Min. | See 101 CMR 350.00: Home Health Services (13.12% above the rate for Home Health Aide) | N/A | N/A | | Transitional Assistance | ABI-N, ABI-RH, MFP-CL, MFP-RS | Per Episode | I.C. | N/A | N/A | | Transportation | ABI-N, ABI-RH, MFP-CL, MFP-RS | One-way Trip | See 101 CMR 327.00: Rates of Payment for Ambulance and Wheelchair Van Services | N/A | N/A | | Vehicle Modification | ABI-N, MFP-CL | Item | I.C. | N/A | N/A |

(5) Self-directed Service Rates.

(a) Employer Expense Component. The rates for Self-directed Services consists of two components: the Self-directed Worker rate and the Employer Expense Component (EEC).

| Service | Unit | Self-directed Worker Rate | Employer Expense Component | Self-directed Service Rate | | --- | --- | --- | --- | --- | | Adult Companion | Per 15 Min. | $5.23 | $0.60 | $5.83 | | Chore | Per 15 Min. | $8.16 | $0.93 | $9.09 | | Homemaker | Per 15 Min. | $6.63 | $0.75 | $7.38 | | Individual Supports and Community Habilitation: Level G | Per 15 Min. | $9.32 | $1.06 | $10.38 | | Individual Supports and Community Habilitation: Level H | Per 15 Min. | $10.04 | $1.14 | $11.18 | | Individual Supports and Community Habilitation: Level I | Per 15 Min. | $12.27 | $1.40 | $13.67 | | Peer Support | Per 15 Min. | $6.32 | $0.72 | $7.04 | | Personal Care | Per 15 Min. | See 101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program (rate divided by four to determine rate per 15-minute increments) | | |

(b) Overtime Calculation. Overtime payments for self-directed services will be made in accordance with the federal Fair Labor Standards Act. Such payments will be made to self-directed workers at rate of one and a half times that of the rate for the service or services provided. For self-directed workers that provide services paid at different rates, such overtime rate will consist of the blended weighted rate based on the number of hours for which each service was provided during a single work week. For the purposes of 101 CMR 359.03(5)(b), the term overtime will mean self-directed services provided to one or more participants in excess of 40 hours per work week, where work week consists of a seven-day period beginning Sunday at 12:00 A.M. and ending the consecutive Saturday at 11:59 P.M.

(6) Approved Modifiers. Below are the approved modifiers for all four HCBS Waiver programs:

(a) Modifier Classification. Below are the classification descriptions for modifiers associated with both the ABI and MFP Waivers.

| Modifier | Description | | --- | --- | | U1 | Agency Provider | | U2 | Individual/Self-employed Provider | | U4 | ABI Nonresidential Habitation (ABI-N) Waiver | | U5 | ABI Residential Habitation (ABI-RH) Waiver | | U8 | MFP Community Living (MFP-CL) Waiver | | U9 | MFP Residential Supports (MFP-RS) Waiver | | UB | Self-directed Service |

(b) Service Codes and Modifiers by Service. The list of approved service codes and modifiers for all four ABI and MFP Waivers are as follows.

| Service | Agency | Individual Provider (Self-employed Provider) | Self-directed Service | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Code | 1^st Position Modifier | 2^nd Position Modifier | Code | 1^st Position Modifier | 2^nd Position Modifier | Code | 1^st Position Modifier | 2^nd Position Modifier | | | Adult Companion | - | - | - | S5125 | U4 | - | S5125 | U4 | UB | | - | - | - | S5125 | U8 | - | S5125 | U8 | UB | | | S5135 | U4 | - | - | - | - | - | - | - | | | S5135 | U8 | - | - | - | - | - | - | - | | | Assisted Living | T2031 | U5 | - | - | - | - | - | - | - | | T2031 | U9 | - | - | - | - | - | - | - | | | Assistive Technology -devices | T2029 | U4 | - | - | - | - | - | - | | | T2029 | U5 | - | - | - | - | - | - | | | | T2029 | U8 | - | - | - | - | - | - | | | | T2029 | U9 | - | - | - | - | - | - | | | | Assistive Technology -evaluation and training | 97755 | U4 | | | | | | | | | 97755 | U5 | | | | | | | | | | 97755 | U8 | | | | | | | | | | 97755 | U9 | | | | | | | | | | Chore Services | S5120 | U4 | U1 | S5120 | U4 | U2 | S5120 | U4 | UB | | S5120 | U8 | U1 | S5120 | U8 | U2 | S5120 | U8 | UB | | | Community-based Day Supports | S5100 | U4 | - | - | - | - | - | - | | | S5100 | U4 | U1 | - | - | - | - | - | | | | S5100 | U4 | U2 | | | | | | | | | S5100 | U4 | U3 | | | | | | | | | S5100 | U5 | - | - | - | - | - | - | - | | | S5100 | U5 | U1 | - | - | - | - | - | - | | | S5100 | U5 | U2 | - | - | - | - | - | - | | | S5100 | U5 | U3 | - | - | - | - | - | - | | | S5100 | U8 | - | - | - | - | - | - | - | | | S5100 | U8 | U1 | - | - | - | - | - | - | | | S5100 | U8 | U2 | - | - | - | - | - | - | | | S5100 | U8 | U3 | - | - | - | - | - | - | | | S5100 | U9 | - | - | - | - | - | - | - | | | S5100 | U9 | U1 | - | - | - | - | - | - | | | S5100 | U9 | U2 | - | - | - | - | - | - | | | S5100 | U9 | U3 | - | - | - | - | - | - | | | Community Support and Navigation | H2015 | U4 | - | - | - | - | - | - | - | | H2015 | U5 | - | - | - | - | - | - | - | | | H2015 | U8 | - | - | - | - | - | - | - | | | H2015 | U9 | - | - | - | - | - | - | - | | | Community Family Training | S5110 | U4 | U1 | S5110 | U4 | U2 | | | | | S5110 | U8 | U1 | S5110 | U8 | U2 | - | - | - | | | Day Services | S5102 | U4 | - | - | - | - | - | - | | | S5102 | U5 | - | - | - | - | - | - | - | | | S5102 | U8 | - | - | - | - | - | - | - | | | S5102 | U9 | - | - | - | - | - | - | - | | | Day Services -partial per diem | S5102 | U4 | | | | | | | | | S5102 | U5 | | | | | | | | | | S5102 | U8 | - | | | | | | | | | S5102 | U9 | - | | | | | | | | | Home Accessibility Adaptations | S5165 | U4 | - | - | - | - | - | | | | S5165 | U5 | - | - | - | - | - | | | | | S5165 | U8 | - | S5165 | U8 | | | | | | | S5165 | U9 | - | S5165 | U9 | - | - | - | - | | | Home Delivered Meals | S5170 | U4 | - | - | - | - | - | - | - | | S5170 | U8 | | | | | | | | | | Homemaker | S5130 | U4 | U1 | S5130 | U4 | U2 | S5130 | U4 | UB | | S5130 | U8 | U1 | S5130 | U8 | U2 | S5130 | U8 | UB | | | Home Health Aide | G0156 | U4 | | | | | | | | | G0156 | U8 | - | - | - | - | - | - | - | | | Independent Living Supports | H0043 | U4 | | | | | | | | | H0043 | U8 | - | - | - | - | - | - | - | | | Individual Support and Community Habilitation (Individual Provider/Self-directed Worker) | - | - | - | H2014 | U4 | U1, U2, U3 | H2014 | U4 | U1, UB U2, UB U3, UB | | - | - | - | H2014 | U8 | U1, U2, U3 | H2014 | U8 | U1, UB U2, UB U3, UB | | | H2014 | U9 | U1, U2, U3 | H2014 | U9 | - | | | | | | Individual Support and Community Habilitation (Agency) | S5108 | U4 | U1, U2, U3 | - | - | - | - | - | - | | S5108 | U8 | U1, U2, U3 | - | - | - | - | - | - | | | S5108 | U9 | U1, U2, U3 | - | - | - | - | - | - | | | Laundry | S5175 | U4 | - | - | - | - | - | - | - | | S5175 | U8 | - | | | | | | | | | Occupational Therapy | S9129 | U4 | U1 | S9129 | U4 | U2 | - | - | - | | S9129 | U5 | U1 | S9129 | U5 | U2 | - | - | - | | | S9129 | U8 | U1 | S9129 | U8 | U2 | - | - | - | | | S9129 | U9 | U1 | S9129 | U9 | U2 | - | - | - | | | Orientation and Mobility Services | H2021 | U4 | U1, U2, U3 | H2021 | U4 | U1, U2, U3 | | | | | H2021 | U5 | U1, U2, U3 | H2021 | U5 | U1, U2, U3 | | | | | | H2021 | U8 | U1, U2, U3 | H2021 | U8 | U1, U2, U3 | - | - | - | | | H2021 | U9 | U1, U2, U3 | H2021 | U9 | U1, U2, U3 | - | - | - | | | Peer Support | H0038 | U4 | U1 | H0038 | U4 | U2 | H0038 | U4 | UB | | H0038 | U5 | U1 | H0038 | U5 | U2 | H0038 | U5 | UB | | | H0038 | U8 | U1 | H0038 | U8 | U2 | H0038 | U8 | UB | | | H0038 | U9 | U1 | H0038 | U9 | U2 | H0038 | U9 | UB | | | Personal Care | T1019 | U4 | - | - | - | - | - | - | - | | T1019 | U8 | U1 | T1019 | U8 | U2 | T1019 | U8 | UB | | | Physical Therapy | S9131 | U4 | U1 | S9131 | U4 | U2 | - | - | - | | S9131 | U5 | U1 | S9131 | U5 | U2 | - | - | - | | | S9131 | U8 | U1 | S9131 | U8 | U2 | - | - | - | | | S9131 | U9 | U1 | S9131 | U9 | U2 | - | - | - | | | Prevocational Services | T2019 | U4 | | | | | | | | | T2019 | U5 | - | - | - | - | - | - | - | | | T2019 | U8 | - | - | - | - | - | - | - | | | T2019 | U9 | - | - | - | - | - | - | - | | | Residential Family Training | S5110 | U5 | U1 | S5110 | U5 | U2 | | | | | S5110 | U9 | U1 | S5110 | U9 | U2 | - | - | - | | | Residential Habilitation | T2016 | U5 | - | - | - | - | - | - | - | | T2016 | U9 | - | - | - | - | - | - | - | | | Respite | H0045 | U4 | - | - | - | - | - | - | - | | H0045 | U8 | - | - | - | - | - | - | - | | | Shared Home Supports | H2016 | U4 | U1 | | | | | | | | H2016 | U4 | U2 | | | | | | | | | H2016 | U4 | U3 | | | | | | | | | H2016 | U8 | U1- | - | - | - | - | - | - | | | H2016 | U8 | U2 | - | - | - | - | - | - | | | H2016 | U8 | U3 | - | - | - | - | - | - | | | Shared Living -24-hour Supports | T2033 | U5 | - | - | - | - | - | - | - | | T2033 | U9 | - | - | - | - | - | - | - | | | Skilled Nursing - RN | G0299 | U4 | | | | | | | | | G0299 | U5 | | | | | | | | | | G0299 | U8 | - | - | - | - | - | - | - | | | G0299 | U9 | - | - | - | - | - | - | - | | | Skilled Nursing - LPN | G0300 | U4 | | | | | | | | | G0300 | U5 | | | | | | | | | | G0300 | U8 | - | - | - | - | - | - | - | | | G0300 | U9 | - | - | - | - | - | - | - | | | Specialized Medical Equipment | T2029 | U4 | - | T2029 | U4 | - | - | - | - | | T2029 | U5 | - | T2029 | U4 | - | - | - | - | | | T2029 | U8 | - | - | - | - | - | - | - | | | T2029 | U9 | - | - | - | - | - | - | - | | | Speech Therapy | S9128 | U4 | U1 | S9128 | U4 | U2 | - | - | - | | S9128 | U5 | U1 | S9128 | U5 | U2 | - | - | - | | | S9128 | U8 | U1 | S9128 | U8 | U2 | - | - | - | | | S9128 | U9 | U1 | S9128 | U9 | U2 | - | - | - | | | Supported Employment | H2023 | U4 | - | - | - | - | - | - | - | | H2023 | U5 | - | - | - | - | - | - | - | | | H2023 | U8 | - | - | - | - | - | - | - | | | H2023 | U9 | - | - | - | - | - | - | - | | | Supportive Home Care Aide | T1004 | U4 | | | | | | | | | T1004 | U8 | - | - | - | - | - | - | - | | | Transportation | T2003 | U4 | - | - | - | - | - | - | - | | T2003 | U5 | - | - | - | - | - | - | - | | | T2003 | U8 | - | - | - | - | - | - | - | | | T2003 | U9 | - | - | - | - | - | - | - | | | Transitional Assistance | T2038 | U4 | - | - | - | - | - | - | - | | T2038 | U5 | - | - | - | - | - | - | - | | | T2038 | U8 | - | - | - | - | - | - | - | | | T2038 | U9 | - | - | - | - | - | - | - | | | Vehicle Modification | T2039 | U4 | | | | | | | | | T2039 | U8 | - | - | - | - | - | - | - | |

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

101 CMR, § 359.04 Filing and Reporting Requirements

(1) General Provisions. Providers must satisfy the applicable reporting requirements of 957 CMR 6.00: Cost Reporting Requirements , and 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services .

(2) Penalty for Noncompliance. The purchasing governmental unit may impose a penalty of up to 15% for any provider that fails to submit required information to the Center. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 359.04(2).

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

101 CMR, § 359.05 Severability

The provisions of 101 CMR 359.00 are severable. If any provision of 101 CMR 359.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 359.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

Rates for Continuous Skilled Nursing Agency and Independent Nursing Services Rates for Continuous Skilled Nursing Agency and Independent Nursing Services

101 CMR, § 361.01 General Provisions

(1) Scope. 101 CMR 361.00 establishes rates of payment for continuous skilled nursing agency services and independent nursing services rendered by eligible providers to publicly aided individuals. The rates set forth in 101 CMR 361.00 also apply to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act).

(2) Applicable Dates of Service. Rates contained in 101 CMR 361.00 apply for dates of service on or after August 1, 2024, unless otherwise specifically noted.

(3) Coverage.

(a) Separate rates are specified for the following situations.

The eligible provider bills as an individual practitioner for professional services rendered, and the services are not covered by a facility rate.
The eligible provider bills as a provider agency and employs, either through contractual agreement or salary, qualified professionals who do not bill independently for professional services rendered and whose services are not covered by a facility rate.

(b) The allowable fees established pursuant to 101 CMR 361.00 for services provided to publicly aided individuals apply to all continuous skilled nursing services, registered nurse (RN) supervisory visits, and complex care assistant services, as defined in 101 CMR 361.02, regardless of the type of program under which MassHealth is purchasing the services. The allowable fees are full compensation for the continuous skilled nursing services, RN supervisory visits, and complex care assistant services rendered including, but not limited to, administrative or supervisory duties and costs in connection with service provision.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 361.00 and to specify the information and documentation necessary to implement 101 CMR 361.00.

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and/or the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list:

(b) codes for which the code number remains the same, but the description has changed; and

(6) Disclaimer of Authorization of Services. 101 CMR 361.00 is not authorization for or approval of the substantive services, or lengths of time, for which rates are paid pursuant to 101 CMR 361.00. Governmental units or workers' compensation insurers that purchase services from eligible providers are responsible to define, authorize, and approve the services extended to covered individuals and the length of time for which the approval is applicable.

History

Adopted by Mass Register Issue 1395, eff. 7/12/2019.

101 CMR, § 361.02 General Definitions

As used in 101 CMR 361.00, terms have the meanings set forth in 101 CMR 361.02, unless the context requires otherwise.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Complex Care Assistant. A person who is employed or contracted by a CSN agency and meets the qualifications of a complex care assistant to perform certain health-related services as described in 130 CMR 438.415(C): Recordkeeping .

Continuous Skilled Nursing (CSN) Agency. A public or private organization that meets the requirements of 130 CMR 438.000: Continuous Skilled Nursing Agency and provides CSN agency services to complex care members within the member's home.

Continuous Skilled Nursing (CSN) Agency Services. CSN services and complex care assistant services as described in 130 CMR 438.402: Definitions and delivered to MassHealth-eligible members. For details on requirements, see 130 CMR 438.000: Continuous Skilled Nursing Agency .

Continuous Skilled Nursing (CSN) Services. Skilled nursing care provided by a licensed nurse to complex care members who require more than two continuous hours of nursing services per day and as defined in 130 CMR 438.000: Continuous Skilled Nursing Agency .

Eligible Provider. An individual practitioner or an organization that meets such conditions of participation as have been or may be adopted by a governmental unit purchasing CSN or CSN agency services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth of Massachusetts and any department, agency, board, commission, division, or political subdivision of the Commonwealth.

Home Health Agency. An organization that meets the requirements of 130 CMR 403.000: Home Health Agency to provide home health services, including continuous skilled nursing.

Individual Practitioner. An RN or licensed practical nurse (LPN), who directly provides authorized continuous skilled nursing services and who bills independently for professional services rendered as defined in 130 CMR 414.402: Independent Nurse .

Provider Agency. A partnership, corporation, or other entity, other than an individual, that provides authorized CSN agency services, as defined in 101 CMR 361.02: Continuous Skilled Nursing (CSN) Agency Services , by an RN, LPN, or complex care assistant (as applicable) who is its employee.

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or part liable under a statutory program.

Reasonable Costs. Those reasonable and necessary costs incurred by an eligible provider of CSN, subject to the requirements and limitations of 101 CMR 361.00. In determining the reasonableness of costs, EOHHS may consider the particular services offered, the introduction of efficiency measures, the requirements for staffing, and the costs of providing comparable service.

Security/Escorts. The provision of security services to direct care personnel in the performance of a reimbursable home health visit.

Sixty-day Supervisory Visit (60-day Supervisory Visit). The 60-day supervisory visit conducted by an RN and described in 130 CMR 438.415(C)(5)(c), made to the member's home in order to observe and assess the complex care assistant while they are performing care. A reassessment of the member's needs may be done at this time.

Weekday. The hours from 7:00 A.M. to 3:00 P.M., Monday through Friday.

Weekend and Nights.

(a) Weekend. The hours from 3:00 P.M., Friday, to 7:00 A.M., Monday.

(b) Nights. The hours from 3:00 P.M. to 7:00 A.M., Monday through Friday.

(c) Holidays. All official Commonwealth of Massachusetts holidays. For purposes of 101 CMR 361.00, holidays that occur on a weekend are observed on that day and not the preceding Friday or following Monday.

New Year's Day

Martin Luther King Jr. Day

Presidents' Day

Patriots' Day

Memorial Day

Juneteenth Independence Day

Independence Day

Labor Day

Indigenous Peoples' Day

Veterans Day

Thanksgiving Day

Christmas Day

History

Adopted by Mass Register Issue 1395, eff. 7/12/2019.

101 CMR, § 361.03 General Rate Provisions

Rates of payment for authorized continuous skilled nursing services to which 101 CMR 361.00 applies will be the lower of

(a) the eligible provider's usual fee to patients other than publicly aided patients; or

(b) the schedule of rates set forth in 101 CMR 361.04.

History

Adopted by Mass Register Issue 1395, eff. 7/12/2019.

101 CMR, § 361.04 Rates of Payment

(1) Continuous Skilled Nursing Services.

(a) Single Patient, per Straight-time Hour. Weekend rates are the same as night rates.

| Rates per 15 Minutes: Single Patient, per Straight-time Hour | | | | | | --- | --- | --- | --- | --- | | Code | Modifier | Agency | Individual Practitioner | Description | | T1002 | | $23.61 | $19.46 | RN Services, Weekday | | T1002 | UJ | $25.14 | $20.88 | RN Services, Nights | | T1002 | | $33.12 | $28.22 | RN Services, Holidays | | T1003 | | $16.35 | $13.47 | LPN Services, Weekday | | T1003 | UJ | $17.41 | $14.46 | LPN Services, Nights | | T1003 | | $23.01 | $19.60 | LPN Services, Holidays |

(b) Multiple-patient Nursing.

(1) Two Individuals, per Straight-time Hour. When only one of the individuals is publicly aided, the fee for services to the publicly aided individual will be U of the appropriate rate listed in the table "Two Individuals, per Straight-time Hour." Weekend rates are the same as night rates.

| Rates per 15 Minutes: Two Individuals, per Straight-time Hour | | | | | | --- | --- | --- | --- | --- | | Code | Modifier | Agency | Individual Practitioner | Description | | T1002 | TT | $33.21 | $28.13 | RN Services, Weekday | | T1002 | U1 | $35.36 | $30.18 | RN Services, Nights | | T1002 | TT | $46.59 | $40.80 | RN Services, Holidays | | T1003 | TT | $23.10 | $19.56 | LPN Services, Weekday | | T1003 | U1 | $24.61 | $20.99 | LPN Services, Nights | | T1003 | TT | $32.52 | $28.46 | LPN Services, Holidays |

Three Individuals, per Straight-time Hour. When only one of the individuals is publicly aided, the fee for services to the publicly aided individual will be a of the appropriate rate listed. When two of the individuals are publicly aided, the fee for services to the publicly aided individuals will be % of the appropriate rate listed. Weekend rates are the same as night rates.

| Rates per 15 Minutes: Three Individuals, per Straight-time Hour | | | | | | --- | --- | --- | --- | --- | | Code | Modifier | Agency | Individual Practitioner | Description | | T1002 | U2 | $39.68 | $32.62 | RN Services, Weekday | | T1002 | U3 | $42.24 | $35.00 | RN Services, Nights | | T1002 | U2 | $55.66 | $47.31 | RN Services, Holidays | | T1003 | U2 | $28.04 | $22.68 | LPN Services, Weekday | | T1003 | U3 | $29.87 | $24.34 | LPN Services, Nights | | T1003 | U2 | $39.47 | $33.00 | LPN Services, Holidays |

| Rates per 15 Minutes: Overtime | | | | | | --- | --- | --- | --- | --- | | Code | Modifier | Agency | Individual Practitioner | Description | | T1002 | TU | $32.66 | $27.88 | RN Services, Weekday | | T1002 | U4 | $34.77 | $29.91 | RN Services, Nights | | T1002 | TU | $48.77 | $40.43 | RN Services, Holidays | | T1003 | TU | $22.74 | $19.41 | LPN Services, Weekday | | T1003 | U4 | $24.22 | $20.83 | LPN Services, Nights | | T1003 | TU | $32.01 | $28.25 | LPN Services, Holidays |

(d) Complex Care Assistant and RN Supervisory Visits.

| Rate per 15 Minutes: Complex Care Assistant and RN Supervisory Visits | | | | | --- | --- | --- | --- | | Code | Modifier | Agency | Description | | T1002 | U5 | $23.61 | 60-day Supervisory Visit (RN) | | T1004 | | $11.25 | Complex Care Assistant Visit |

History

Adopted by Mass Register Issue 1395, eff. 7/12/2019.

101 CMR, § 361.05 Administrative Adjustment

(1) A certified home health agency or CSN agency may apply for a change in rate(s) of payment due to costs associated with providing interpreter and security/escort services as defined in 101 CMR 361.02.

(2) Administrative adjustment may be provided on a prospective basis only.

(3) Administrative relief will consist of an adjustment to the rate calculated by dividing the costs from the most recently filed and reviewed Cost Report filed pursuant to 101 CMR 361.06, by the number of service units reported for that corresponding period. The costs allowed will be limited to reasonable costs as defined in 101 CMR 361.02.

(4) An administrative adjustment that an agency was awarded in a prior period may be updated by EOHHS using data from the most recent Cost Report.

History

Adopted by Mass Register Issue 1395, eff. 7/12/2019.

101 CMR, § 361.06 Filing and Reporting Requirements

(1) Required Cost Reports. Cost reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

History

Adopted by Mass Register Issue 1395, eff. 7/12/2019.

101 CMR, § 361.07 Severability

The provisions of 101 CMR 361.00 are severable. If any provision of 101 CMR 361.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 361.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1395, eff. 7/12/2019.

Rates for Community Support Program Services Rates for Community Support Program Services

101 CMR, § 362.01 General Provision

(1) Scope and Purpose. 101 CMR 362.00 governs the rates to be used by all governmental units and worker's compensation insurers for community support program services provided by community support programs.

(2) Applicable Dates of Service. Rates contained in 101 CMR 362.00 apply for dates of service provided on or after April 1, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 362.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 362.00. Governmental units that purchase the services described in 101 CMR 362.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 362.00.

History

Adopted by Mass Register Issue 1494, eff. 4/28/2023.

101 CMR, § 362.02 General Definitions

As used in 101 CMR 362.00, terms have the meanings set forth in 101 CMR 362.02 unless stated otherwise.

Community Support Program (CSP or the Program). Behavioral health diversionary services through community-based, mobile, paraprofessional staff to members, as set forth in 130 CMR 461.000: Community Support Program Services .

Community Support Program for Homeless Individuals (CSP-HI). A specialized CSP service to address the health-related social needs of members who are experiencing

(a) homelessness and are frequent users of acute health MassHealth services, as defined by EOHHS; or

(b) chronic homelessness, as defined by the U.S. Department of Housing and Urban Development.

Community Support Program for Individuals with Justice Involvement (CSP-JI). A specialized CSP service to address the health-related social needs of members with justice involvement and have a barrier to accessing or consistently utilizing medical and behavioral health services, as defined by EOHHS. CSP-JI includes behavioral health and community tenure sustainment supports.

Community Support Program-Tenancy Preservation Program (CSP-TPP). A specialized CSP service to address the health-related social needs of members who are at risk of homelessness and facing eviction as a result of behavior related to a disability. CSP-TPP works with the member, the Housing Court, and the member's landlord to preserve tenancies by connecting the member to community-based services in order to address the underlying issues causing the lease violation.

Eligible Provider. A community support program that meets the conditions of participation that have been adopted by a governmental unit purchasing community support program services.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c.6A.

Eviction. The process of obtaining a court order to remove a tenant and other occupants from a rental property including serving either a Notice to Quit or a request for temporary, preliminary, or permanent relief. Eviction may also refer to any instance in which such relief has been granted.

Governmental Unit. The Commonwealth, any department, agency, board, commission, division, or political subdivision of the Commonwealth.

Homelessness. The condition of any member who lacks a fixed, regular, and adequate nighttime residence, and who has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings including a car, park, abandoned building, bus or train station, airport, or camping group, or who is living in a supervised publicly or privately operated emergency shelter designated to provide temporary living arrangements, including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low-income individuals. This includes those members who are exiting an institution ( e.g ., jail, hospital) where they resided for 90 days or less and were residing in an emergency shelter or place not meant for human habitation immediately before entering the institution.

Justice Involvement or Justice Involved. A member who is a former inmate or detainee of a correctional institution who has been released from a correctional institution within the past year; or an individual under the supervision of the Massachusetts Probation Service, Massachusetts Parole Board, or both, as determined by the Massachusetts Probation Service or the Massachusetts Parole Board.

Per Diem . A unit of payment that refers to a billable day in which the member is enrolled in the program.

Publicly Aided Individual. A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program.

Telehealth. The use of synchronous or asynchronous audio, video, electronic media, or other telecommunications technology including, but not limited to:

(a) interactive audio-video technology;

(b) remote patient monitoring devices;

(d) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring a patient's physical health, oral health, mental health, or substance use disorder condition.

History

Adopted by Mass Register Issue 1494, eff. 4/28/2023.

101 CMR, § 362.03 Rate Provisions

(1) Rates as Full Compensation. The rates under 101 CMR 362.00 constitute full compensation for community support program services provided by community support programs to publicly aided and industrial accident patients, including full compensation for necessary administration and professional supervision associated with patient care.

(2) Rates of Payment. Payment rates under 101 CMR 362.00 are the lower of

(a) the eligible provider's usual charge to the general public; or

(b) the schedule of allowable rates for services provided by community support programs as set forth in 101 CMR 362.03(4).

(3) Modifiers.

(a) -HK: Specialized mental health programs for high-risk populations (Community Support Program for Homeless Individuals).

(b) -HH: Integrated mental health/substance abuse program (Community Support Program for Individuals with Justice Involvement).

(4) Rates for Community Support Program Services. The payment rates for community support programs are as follows:

| Code | Rate | Service Description | | --- | --- | --- | | H2015 | $17.54 | Comprehensive community support services, per 15 minutes (Community Support Program) | | H2016-HE | $23.33 | Comprehensive community support services, per diem , mental health program (Community Support Program-Tenancy Preservation Program) | | H2016-HH | $21.93 | Comprehensive community support program, per diem , integrated mental health/substance abuse program (Community Support Program for Individuals with Justice Involvement) | | H2016-HK | $28.35 | Comprehensive community support services, per diem , specialized mental health programs for high-risk populations (Community Support Program for Homeless Individuals) |

History

Adopted by Mass Register Issue 1494, eff. 4/28/2023.

101 CMR, § 362.04 Reporting Requirements and Sanctions

(1) Required Reports.

(a) Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

(b) Additional Information. Eligible providers must file such additional information as EOHHS may from time to time reasonably require.

History

Adopted by Mass Register Issue 1494, eff. 4/28/2023.

101 CMR, § 362.05 Severability

The provisions of 101 CMR 362.00 are severable. If any provision of 101 CMR 362.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 362.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1544, eff. 4/1/2025.

Rates for Competitive Integrated Employment Services Rates for Competitive Integrated Employment Services

101 CMR, § 410.01 General Provisions

(1) Scope. 101 CMR 410.00 governs the payment rates for competitive integrated employment services (CIES) purchased by a governmental unit. CIES are provided to assist clients to obtain and retain competitive employment in an integrated, community-based work setting with wages and benefits that are comparable to those received by other workers in similar positions. CIES consist of five separate service components, each associated with a specific client outcome: intake, evaluation, and assessment; job-targeted educational and skills development activities; job development and placement; initial employment supports; and ongoing and interim supports. CIES are furnished under an Executive Office of Health and Human Services (EOHHS) Master Agreement (MA). Providers qualified to deliver CIES under the MA will be engaged separately by EOHHS departments to deliver specified services.

(2) Applicable Dates of Service. Rates contained in 101 CMR 410.00 apply for dates of service provided on or after July 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 410.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 410.00. Governmental units that purchase CIES are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 410.00.

History

Adopted, Mass Register Issue 1260, eff. 5/9/2014.

101 CMR, § 410.02 Definitions

As used in 101 CMR 410.00, unless the context requires otherwise, terms have the meanings in 101 CMR 410.02.

Client. An individual that receives CIES purchased by a governmental unit including, but not limited to, clients currently or formerly receiving services from the Department of Developmental Services: Employment Supports; the Massachusetts Rehabilitation Commission: Vocational Rehabilitation, Community-based Employment Services; the Department of Transitional Assistance: Supported Work Program, ESP-Workforce Investment Area (WIA), Community-based Employment Service, Supplemental Nutrition Assistance Program (SNAP), Employment and Training; Massachusetts Commission for the Blind: Personal Vocational Adjustment. A governmental unit may also purchase additional CIES at the rates set forth in 101 CMR 410.03(3).

Competitive Integrated Employment. A job in an integrated, community-based work setting where the client receives wages and benefits paid by an employer that are comparable to wages and benefits paid to workers in similar positions.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Extraordinary Circumstances/Flex Funding. A method whereby, subject to availability, a purchasing governmental unit may provide resource allocations to a client and/or a provider across the state. Flexible funding may be provided through a number of means including, but not limited to, reimbursement to the client for specific support services or funds directed to a qualified provider for extraordinary circumstances.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

History

Adopted, Mass Register Issue 1260, eff. 3/14/2014.

101 CMR, § 410.03 Rate Provisions

(1) Payment Methods.

(a) General. Purchasing governmental units will pay providers a total payment per completed service component as defined in 101 CMR 410.03(2).

Standard Progress Documentation. Providers must use a standard form to document initiation and completion of a service component for each client. Providers must submit all progress documentation, billing, and performance reporting through the Enterprise Invoice Management Service.

Initial Payment. The purchasing governmental unit pays the provider an initial payment based on a specified percentage of the total payment at the initiation of a service component for a client. For intake, evaluation, and assessment, the purchasing governmental unit makes an initial payment equal to 20% of the service component payment in 101 CMR 410.03(3). For all other service components, except ongoing and interim supports, the purchasing agency makes an initial payment equal to 40% of the service component payment in 101 CMR 410.03(3). EOHHS may revise these percentages by administrative bulletin.

Final Payment. The purchasing governmental unit pays the difference between the initial payment and the total service component payment upon completion of the service component and submission of required documentation.

Administrative Adjustment for Extraordinary Circumstances. A provider may petition the purchasing governmental unit for an administrative adjustment to reflect increases in operating costs due to unusual and unforeseen circumstances or extraordinary client service requirements not considered in the development of the current rates. Unusual and unforeseen circumstances are events of catastrophic nature ( e.g ., fire, flood, or earthquake) that are not covered by insurance that the prudent provider would carry. The provider must demonstrate that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(b) Services Provided in Dukes or Nantucket County. In accordance with the provisions of St. 2015, c. 46, payment for services provided in programs located in Dukes or Nantucket County will be the rate for the service contained in 101 CMR 410.03(3) times a factor of 1.07.

(2) Service Components. Payment is based on the following five separate service components.

(a) Intake, Evaluation, and Assessment. This service component requires the client to articulate initial goals, commit to a service plan, and engage in services. Provider activities included in this service component include, but are not limited to, solicitation of client referrals; review of applications; initial client screening; interview of applicants; assessment of client interests and skills; performance of a situational assessment; identification of recommended support services; and completion of a comprehensive service plan.

(b) Job-targeted Educational and Skills Training Activities. This service component is designed to ensure that the client has sufficient training and/or education to enter job search and placement for initial employment in a competitive environment in accordance with his or her job goals or to reach stabilization in a competitive work environment with additional supports, if necessary. Specific provider activities include, but are not limited to, depending on client skills and learning style, vocational English language training; "fast-track" HiSET testing; short-term "soft" or "technical" job skills training; and work adjustment, job search, and interviewing skills.

(c) Job Development and Placement. This service component is designed to assist the client to sustain initial employment for at least 30 days. Provider activities in this service component include, but are not limited to: employment exploration; career plan development; development of collaborative employer relationships; job try-outs; job matching; and job placement.

(d) Initial Employment Supports. This service component is designed to assist the client to sustain employment for at least 90 days and to demonstrate progress toward stability and confidence in job duties and workplace relationships. Provider activities in this service component include, but are not limited to, counseling, life, and community skills development; continued development of employer education; and collaboration, training, and conflict resolution.

(e) Ongoing and Interim Supports. This service component is designed to assist the client to maintain stable employment with additional supports if necessary. Provider activities in this service component include, but are not limited to, counseling, life, and community skills development; continued development of employer education; and collaboration, training, and conflict resolution, provided on an as-needed basis. This service component is paid on an hourly basis. Interim supports are used to assist a client who does not require full participation in another service component to achieve re-employment or a job upgrade.

(3) Approved Rates. Within each service component, there are two service levels that reflect the staff-to-client ratios necessary to meet client needs. The appropriate level is determined by the purchasing governmental unit.

| Description | Completed Component Rates | Hourly Rates | | | | --- | --- | --- | --- | --- | | Level A | Level B | Level A | Level B | | | Intake, Evaluation, and Assessment | $578 | $1,240 | $24.79 | $55.09 | | Job-targeted Educational and Skills Training Activities | $1,236 | $3,386 | $24.79 | $55.09 | | Job Development and Placement | $2,108 | $6,825 | $24.79 | $55.09 | | Initial Employment Supports | $764 | $2,473 | $24.79 | $55.09 | | Ongoing and Interim Supports | N/A | N/A | N/A | $55.09 | | Extraordinary Circumstances/Flex Funding Add-on | IC | IC | IC | IC |

History

Adopted, Mass Register Issue 1260, eff. 5/9/2014.

101 CMR, § 410.04 Filing and Reporting Requirements

(1) General Provisions.

(b) Examination of Records. Each provider must make available to EOHHS or the purchasing governmental unit upon request all records relating to its reported costs, including costs of any entity related by common ownership or control.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted, Mass Register Issue 1260, eff. 5/9/2014.

101 CMR, § 410.05 Severability

The provisions of 101 CMR 410.00 are severable. If any provision of 101 CMR 410.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 410.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted, Mass Register Issue 1260, eff. 5/9/2014.

Rates for Certain Placement, Support, and Shared Living Services Rates for Certain Placement, Support, and Shared Living Services

101 CMR, § 411.01 General Provisions

(1) Scope. 101 CMR 411.00 governs the payment rates for certain placement, support, and shared living services purchased by a governmental unit including, but not limited to, the Department of Developmental Services (DDS), the Massachusetts Commission for the Blind (MCB), MassAbility (formerly MRC), the Department of Children and Families (DCF), and the Department of Youth Services (DYS).

(2) Applicable Dates of Service. Rates contained in 101 CMR 411.00 apply for dates of service provided on or after July 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 411.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 411.00. Governmental units that purchase such services are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 411.00.

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

101 CMR, § 411.02 Definitions

As used in 101 CMR 411.00, unless the context requires otherwise, terms have the meanings in 101 CMR 411.02.

Add-on Rate. A rate that is intended to provide an additional, necessary service not included in the current programmatic model, which will be instituted at the discretion of the purchasing governmental unit.

Adoption Management Support Services (AMSS). Services that address specific client needs and provide specific services or full case management. Examples of AMSS include a provider's recruitment of an adoptive family for a specific child, the assessment of a child for adoption, the training and home study of prospective adoptive families, and the management of pre-adoptive homes. Purchasing governmental unit requests for responses contain specific definitions of AMSS. There are specific rates that are determined by the child's needs (mild, moderate, severe), or the placement of a specific number of siblings with the child in an adoptive family.

Child Home-based Rehabilitation. An IFC Other Model that provides IFC Placement and specialized, intensive foster care services for children with problem sexualized behavior and sexually abusive youth. In addition to placement in specially trained, intensive foster care homes, youth receive intensive case management, clinical, psychiatric, psychopharmacological, health care, educational, and recreational services supported by 24-hour per day, seven days per week emergency coverage.

Client. An individual who receives placement, support, and shared living services purchased by a governmental unit.

Community-based Alternative to Detention. Services that are an alternative to the juvenile locked secure detention component of the juvenile justice system.

Community-based Alternative to Detention Bed Hold. Services to retain Community-based Alternative to Detention caregivers while a Community-based Alternative to Detention bed is unoccupied.

Complex Medical Foster Care. A foster care program that is designed to provide care and treatment supports to children and youth who have medically complex or unstable conditions and require intensive medical care management and coordination. Care often involves multiple medical specialists.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Emergency Shelter Homes. An IFC Other Model that provides IFC placement for children from birth through 22 years of age for a duration not to exceed 45 days. IFC emergency foster care providers are responsible for facilitating emergency health care, emergency school placement, intensive family work to support reunification, and collaboration with community providers that have preexisting relationships with youth placed.

Enhanced Intensive Foster Care (EIFC). Services provided to a client at a higher level of intensity in accordance with specifications determined by the purchasing governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Family Residential Homes. Licensed foster homes with expertise sufficiently compatible with IFC Level One clients, where the caregiver is considered an employee of the agency and up to six IFC clients can reside within the same home.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth.

IFC Level One Homes. Licensed foster homes with expertise sufficient to meet the needs of children and youth referred for nonspecialized Intensive Foster Care.

IFC Level Two Homes. Licensed foster homes with expertise compatible with IFC Level One where caregivers have additional applicable training and extensive previous foster home experience.

Intensive Foster Care (IFC). Programs that provide therapeutic services and supports in a family-based placement setting to children and youth, from birth through 22 years of age, for whom a traditional foster care environment is not sufficiently supportive; who are transitioning from a residential/group home level of care and require the intensity of services available through this program; or who are discharging from a hospital setting. Referred children and youth come from diverse cultural, linguistic, religious, ethnic, or racial backgrounds and have varying sexual or gender orientations. They may have a range of behavioral, cognitive, and mental health strengths and needs. With the appropriate program strengths, safety planning, and supports, this range for IFC could include children with fire-setting, sexual offending and sexual reactive behaviors, or various medical needs. Ideally, and when appropriate, children remain in their communities, attend their school of origin, maintain their social network, and continue contact with their families. Some are teenage mothers who need support and guidance with their parenting skills.

Intensive Foster Care Other Models (IFC Other Models). Service models designed to meet the unique challenges that face a specialized population of foster care children and youth. These models represent an array of service requirements and program designs specified by the purchasing governmental unit.

Multiple Acute A. An IFC Other Model consisting of therapeutic foster care providing placement services that meet a combination of substantial medical, psychiatric, and cognitive needs of youth and their families. The placement population is more challenging than the children typically placed into IFC. It provides placement supports and family services that are specially designed to meet the complex challenges of children who have been abused and neglected and present with cognitive and physical impairments. Children and youth may also exhibit one or both of the following: a range of behavioral or emotional needs; or a wide range of disabilities including developmental disabilities, psychiatric disorders, chronic illnesses, and severe physical impairments.

Multiple Acute B. An IFC Other Model consisting of therapeutic foster care providing placement services that meet a combination of substantial medical, psychiatric, and cognitive needs of youth and their families. The placement population is more challenging than the children and youth typically placed into IFC. It provides placement supports and family services that are specially designed to meet the complex challenges of children and youth who have been abused and neglected and present with cognitive and physical impairments. These children and youth may also exhibit one or both of the following: a range of behavioral or emotional needs; or a wide range of disabilities including developmental disabilities, psychiatric disorders, chronic illnesses, and severe physical impairments. Additionally, it provides transportation and housing for children needing wheelchair accessibility.

Multiple Foster Parent Support Services. Services that represent a diverse set of services designed to support DCF foster parents. These services include trainings (pre- and post-approval), respite services, a helpline for weekends and after hours, emergency child care, a family resource liaison service (foster parents helping other foster parents), foster parent membership services, and satisfaction surveys shared with DCF.

Multiple Pre-adoption Services. Services that encompass a variety of adoption-related services, primarily a comprehensive recruitment effort for potential adoptive families. Other services include the provision of a central statewide clearing house for adoption information and referral, and events that facilitate the identification of new families and matches between children and approved families.

Multiple Post-adoption Services. A diverse set of services that are intended to provide a statewide program available to adoptive families in Massachusetts. The focus is on support and preservation services following the adoption. The services include family support groups (for the children or adoptive parents), respite services (an approved caregiver provides short term supervision of a child for the adoptive parents), support for families, therapeutic intervention through regional response teams trained to handle crises, and training for teachers, social workers, and mental health providers who work with adopted individuals and their families.

One-time Resource Purchase. Reimbursement to a provider for supplying a licensed pre-adoptive family with whom a child or sibling group has been placed. Payment is made after 60 days of placement. Payment is made when the responsibility for the operation of the provider's home on behalf of the child or sibling group is transferred to DCF for payment authorization of the adoption or guardianship subsidy. DCF makes a one-time product payment for the recruitment, home study, and use of a foster home, based on the same rate as AMSS Purchase of Home. The payment is made on successful completion of the foster home's six-month probationary period. No payment is made when the new home is a former DCF home.

Operational Service. The portion of the complete IFC or Shared Living service that reflects the various caregiver support services specified by the purchaser including, but not limited to, therapeutic services contributing to successful placement for a client. These rates are separate from caregiver stipends.

Remote Direct Supports. A service that provides for an off-site direct service provider to monitor and respond to an individual's health, safety, and other needs using live communication and non-invasive monitoring technologies.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the UFR.

Sexually Exploited Youth Services. An IFC Other Model consisting of placement services provided for the child welfare service needs of sexually exploited children including, but not limited to, services for sexually exploited children residing in the Commonwealth at the time they are taken into custody by law enforcement or who are identified by DCF or DY S as sexually exploited children. These services are provided for the duration of any legal or administrative proceeding in which they are either the complaining witness, the defendant, or the subject child. This includes appropriate services provided to a child reasonably believed to be a sexually exploited child in order to safeguard the child's welfare.

Shared Living. Programs that provide recruitment, placement, training, resources for clinical or behavioral consultative services, and oversight of caregivers and living situations for individuals who either live in the home of a designated care provider or live in their own homes with a designated care provider. These services are provided in one of three levels of intensity that are characterized by increasing levels of supervision and support to the caregiver by the contracting organization. Designated care providers are responsible for providing supervision and ongoing support in areas of daily living, maintaining optimal health care, creating and enhancing relationships with chosen family members and friends, and other areas of assistance specified in individuals' ISPs. Caregivers are paid a stipend and additional paid staff hours may be provided to augment the supports necessary to sustain an individual in the placement.

Sibling Rate. The payment for a client's sibling who does not need IFC services, but is placed in an IFC home in order to stay with a brother or sister who requires IFC-level services.

Stipend. Compensation paid to a caregiver for providing personal care services to an eligible client residing either in the caregiver's home or in the client's own home. For Shared Living services stipend rates and related information, see 101 CMR 411.03(5)(e)2.a.

Teen Parent Rate. The payment for the placement of a teen and the teen's child in an IFC home. The payment of the teen parent IFC rate is made only when both the teen and the teen's child are in the care or custody of DCF or DYS.

Transitions to Adult Services. An IFC Other Model involving IFC and the intensive support services package for children, youth, and adolescents leaving residential schools who have special cognitive, language, and behavioral needs. These individuals may have received diagnoses such as severe learning disabilities or developmental disabilities. This program seeks to find foster families who are committed to providing permanent homes that will eventually be funded under adult foster care, and who are able to implement highly technical behavioral treatment plans and use augmentative communication strategies in order to achieve safety and stability within the community.

Transitions to Adulthood Services. An IFC Other Model that provides IFC foster care services to young adults 18 through 22 years of age, assisting them in transitioning to adulthood, in order to assist the participants to develop lifelong family connections while gaining skills to lead self-sufficient, healthy, productive, and responsible adult lives. The program uses a Positive Youth Development Approach that focuses on safety, relationship building, youth participation, skill building, and community involvement and a team approach that includes the participant, the caregiver, and community professionals.

Youth Permanency Connections. A service that addresses the core need of helping youth who are transitioning from structured settings (residential, group home, foster care) toward independent living, by identifying committed responsible adults to help ensure the transitioning youth's success. The model focuses on identifying positive adults, connecting them with youth, and providing the youth with training and support, including youth support groups. Promoting permanency through task and goal-setting is a core principal, and regular team meetings (youth, adults, collateral individuals) are an integral component of the program. This service is established on a per diem rate basis.

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

101 CMR, § 411.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source is used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate, except as cited in 101 CMR 411.03.

(4) Blended Contract Rate Calculation. Purchasing governmental units may pay a Blended Contract Rate for the purchase of programs serving two or more clients. The blended rate will be calculated according to the following formula: {Sum of [(Operational Rate 1 * Units purchased of Operational Rate 1) plus (Stipend Rate 1 * Units Purchased of Stipend Rate 1)], plus [(Operational Rate 2 * Units purchased of Operational Rate 2) plus (Stipend Rate 2 * Units Purchased of Stipend Rate 2)], plus [(Operational Rate 3 * Units purchased of Operational Rate 3) plus (Stipend Rate 3) * (Units Purchased of Stipend Rate 3)],..., plus [Total funding for Add-ons] minus [Total Offsetting Revenue]} Divided by the sum of the Operational Rate Units purchased for all clients in the contract.

(5) Approved Program Rates. For all purchases, the approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 411.03(5).

(a) Intensive Foster Care.

| Service | Operational | Stipend | Total Rate | Unit | | --- | --- | --- | --- | --- | | Community-based Alternative to Detention Bed Hold | N/A | $36.79 | $36.79 | Per Day | | Sibling | $10.33 | $36.79 | $47.12 | Per Placement Per Day | | Intensive Foster Care One | $79.54 | $73.35 | $152.88 | Per Placement Per Day | | Intensive Foster Care Two | $79.54 | $84.74 | $164.27 | Per Placement Per Day | | Community-based Alternative to Detention | $82.09 | $100.23 | $182.32 | Per Placement Per Day | | Teen Parent | $90.23 | $110.14 | $200.38 | Per Placement Per Day | | Enhanced Intensive Foster Care | $143.03 | $107.49 | $250.52 | Per Placement Per Day |

(b) Intensive Foster Care Specialty.

| Service | Operational | Stipend | Total Rate | Unit | | --- | --- | --- | --- | --- | | Transitions to Adulthood | $110.49 | $82.45 | $192.94 | Per Placement Per Day | | Emergency Shelter Homes | $97.08 | $93.84 | $190.92 | Per Placement Per Day | | Child Home-based Rehabilitation | $97.08 | $96.27 | $193.35 | Per Placement Per Day | | Transitions to Adult Services | $201.19 | $74.80 | $275.99 | Per Placement Per Day | | Multiple Acute Level A | $166.81 | $125.80 | $292.61 | Per Placement Per Day | | Multiple Acute Level B | $282.94 | $125.80 | $408.75 | Per Placement Per Day | | Sexually Exploited Youth | $161.45 | $130.25 | $291.70 | Per Placement Per Day | | Family Residential | $243.14 | N/A | $243.14 | Per Placement Per Day |

| AMSS Product-based Services | Rate | | --- | --- | | 1. Adoption Consultation Services: | | | Adoption Assessment of a Child | $2,380.85 | | Adoption Assessment/Home Study of a Foster/relative family (with whom the child is placed) | $2,380.85 | | Adoption Assessment/Home Study of a relative (child is not in the home) | $2,994.56 | | MAPP training/Home Study of a referred person or couple | $2,994.56 | | Appearance fee | $359.82 | | MAPP Training only | $620.96 | | 2. Adoption Placement Case Management Services: | | | Case acceptance/assignment | $620.96 | | Adoption Assessment of a child | $2,380.85 | | Adoption Assessment/Home Study of a family with whom the child is placed | 2,380.85 | | Placement | | | Mild | $4,941.60 | | Moderate | $7,950.67 | | Severe | $12,015.96 | | Family Development | | | Mild | $3,968.08 | | Moderate | $6,363.44 | | Severe | $9,545.16 | | Reevaluations | | | Mild | $973.52 | | Moderate | $1,587.23 | | Severe | $2,380.85 | | Child(ren)/Legalization | | | Mild | $4,941.60 | | Moderate | $7,950.67 | | Severe | $12,015.96 | | Adjustment for a case held at least three years, but less than five. | $748.64 | | Sibling Bonus in Same Home/Legalization | | | Two siblings | $1,407.33 | | Three siblings | $2,994.56 | | Four siblings | $5,539.35 | | Five or more siblings | $1,767.14 | | Family Bonus for Provider's Home at Legalization per child, minimum of two children | $620.96 | | Closure | $1,587.23 | | Case Maintenance | $435.23 | | Delayed Adoption-legal Delay/Appeal | $539.72 | | Conflict of Interest Family Resource | $298.86 | | Transfer of case | $1,407.33 | | 3. Adoption Family Development Services: | | | Purchase of Home | $5,989.11 | | Reuse of a Closed Home | $2,118.25 | | 4. Recruitment: | | | Child-specific recruitment | $2,118.25 | | Child-specific recruitment renewal | $2,118.25 | | 5. Intervention Services (per hour) | $59.24 | | 6. Interstate Cases: | | | Home Study | $2,811.26 | | Assignment | $620.96 | | Case Supervision | $4,941.60 | | 7. Puerto Rico Cases: | | | Family Evaluation Home Study in Puerto Rico | $2,029.73 | | Family Evaluation Home Study in Puerto Rico (Daily Rate) | $34.24 | | 8. International Cases: | | | International Family Evaluation Home Study | IC |

(d) Additional Support Services.

| Support Contracts | Rate | Unit | | --- | --- | --- | | Youth Permanency Connections | $64.88 | Per Client Per Day Rate | | Multiple Pre-adoption Services | $83,386 | Accommodation Rate Per Month | | Complex Foster Care Medical | $383.58 | Per Client Per Day Rate | | Multiple Post-adoption Services | $173,430 | Accommodation Rate Per Month | | Multiple Foster Parent Support Services | $188,957 | Accommodation Rate Per Month |

(e) Shared Living.

Operational Rates.

| Service | Operational | Units | | --- | --- | --- | | A | $67.53 | Per Placement Per Day | | B | $103.60 | Per Placement Per Day | | C | $117.16 | Per Placement Per Day | | Direct Care Add-on Rate | $27.85 | Per Hour | | Clinician (LICSW) Add-on Rate | $59.84 | Per Hour | | Registered Nurse (RN) | $75.92 | Per Hour | | Licensed Practical Nurse (LPN) | $48.76 | Per Hour |

Stipend Rates.

a. Stipend amounts for caregivers are established at a rate within the applicable rate limit for a given Operational Rate tier, as noted in the chart in 101 CMR 411.403(5)(e)2.a.

| Operational Rate Level | Maximum Stipend Level | | --- | --- | | A | 9 | | B | 13 | | C | 17 |

b. Purchasing governmental units may approve exceptions to the maximum stipend level in 101 CMR 411.03(5)(e)2.a. for caregivers providing services as of September 30, 2016. In these cases, the stipend rate is no higher than the amount paid as of September 30, 2016, as may be adjusted to reflect applicable stipend inclusions and exclusions, in keeping with provisions contained in the procurement for these services. This payment level continues at the current level until such time as material changes in client circumstances occur to warrant a reassessment of the stipend level or a change in caregiver takes place, at which point revised stipend levels may not exceed applicable maximum amounts. Stipend levels 18 through 21 are available only by special application to the purchasing governmental unit.

| Shared Living Stipend Levels | | | | --- | --- | --- | | Level | Daily Stipend Rate | Stipend Level | | 1 | $79.59 | $27,618 | | 2 | $89.55 | $31,074 | | 3 | $99.49 | $34,523 | | 4 | $109.43 | $37,972 | | 5 | $119.39 | $41,428 | | 6 | $129.35 | $44,884 | | 7 | $139.28 | $48,330 | | 8 | $149.23 | $51,783 | | 9 | $159.19 | $55,239 | | 10 | $169.12 | $58,685 | | 11 | $179.08 | $62,141 | | 12 | $189.03 | $65,593 | | 13 | $198.99 | $69,050 | | 14 | $208.92 | $72,495 | | 15 | $218.88 | $75,951 | | 16 | $228.83 | $79,404 | | 17 | $238.78 | $82,857 | | 18 | $247.73 | $85,962 | | 19 | $258.68 | $89,762 | | 20 | $269.61 | $93,555 | | 21 | $278.58 | $96,667 |

| Remote Direct Supports | Per Hour | | --- | --- | | Remote Direct Supports | $20.15 |

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

101 CMR, § 411.04 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records 'that are filed or made available to EOHHS must be certified under pains and penalties of perjuryas true, correct, and accurate by the executive director or chief financial officer of the provider.

(2) Required Reports. Each provider must file

(a) an annual Uniform Financial Report completed in accordance with the filing requirements of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services ;

(b) any cost report supplemental schedule issued by EOHHS; and

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

101 CMR, § 411.05 Severability

The provisions of 101 CMR 411.00 are severable. If any provision of 101 CMR 411.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 411.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

Rates for Family Transitional Support Services Rates for Family Transitional Support Services

101 CMR, § 412.01 General Provisions

(1) Scope. 101 CMR 412.00 governs the payment rates for family transitional support (FTS) services purchased by a governmental unit.

(2) Applicable Dates of Service. Rates contained in 101 CMR 412.00 apply for dates of service provided on or after July 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 412.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 412.00. Governmental units that purchase the services described in 101 CMR 412.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 412.00.

(5) Services and Rates Covered by Other Regulations. Payment rates for the services listed in 101 CMR 412.01(5) are not included within the scope of 101 CMR 412.00 and are governed by other regulations promulgated by EOHHS as follows.

| Service | Regulation | | --- | --- | | Client Financial Assistance/Flex Funding Administration | 101 CMR 414.00: Rates for Family Stabilization Services |

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

101 CMR, § 412.02 Definitions

As used in 101 CMR 412.00, unless the context requires otherwise, terms have the meanings in 101 CMR 412.02.

Client. A family that receives family transitional support services purchased by a governmental unit.

Client Financial Assistance/Flexible Funding. A method whereby, subject to availability, a purchasing governmental unit may provide individual resource allocations to both families of children and adults across the state. Flexible funding may be provided through a number of means, including: a stipend issued directly to the family; reimbursement to the family for specific expenses and support services; or funds directed by the family to a qualified provider for specific services.

Client Financial Assistance/Flexible Funding Administration. A service in which the provider performs the function necessary to successfully administer flexible funding expenditures to families for permissible support services, services, or goods.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Domestic Violence, Substance Misuse, and Trauma (DVSMT) Services. Residential programs that help individuals who need to leave an unsafe situation due to domestic and/or sexual violence, and who need longer-term recovery support to address substance misuse and/or trauma. In addition to housing, DVSMT programs provide a range of activities and services designed to support the individual, familial, and social needs of survivors of domestic violence and their children and/or dependents. Service locations must be designed and furnished to offer families a welcoming and child-friendly environment, in addition to being physically accessible, safe, and secure. Providers who can shelter individuals and families in their own community are preferred.

Emergency Shelter. A program that provides individuals and families who need to leave an unsafe situation with timely and easy access to shelter within their own communities to help them achieve immediate safety while retaining access to school, work, and other supportive connections. The program must

(a) allow adults and children to remain connected to informal support from family, friends, counselors, pastors, and others they depend upon in the community; and

(b) demonstrate the capacity to shelter and serve children as well as adults, and be able to accommodate families requiring assistance with visitation and/or reunification.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Family Transitional Support (FTS) Services. A service class of programs that provide families with temporary housing in a specialized congregate or individual setting, to enable stabilization and transition to a safe, permanent, and self-sufficient home environment.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Housing Stabilization Advocacy and Supportive Services. A type of residential housing stabilization program that is either located in donated space or receives additional funding to cover facility costs from another funding source. This program provides supportive services to help survivors of domestic violence locate and maintain employment and/or complete their education, parent their children and establish routines with them, make it possible to be involved in a faith community of their choosing, provide opportunities for children and youth to be involved in after-school activities, prepare survivors for economic independence, and ultimately secure more permanent housing.

Individual Consideration (IC). Payment rates for certain services are designated as individual consideration (IC). If IC rates are designated, the purchasing governmental unit determines the appropriate payment as the actual cost of the item or service as evidenced by invoice, published tuition amount, or other price reasonably obtained by a competitive market for the product or service.

Lower Facility Cost Program. A program identified by the purchasing governmental unit as having nominal facility related costs due to either donated space or additional funding that covers the cost of the residence.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Residential Housing Stabilization. A program that helps victims and their families find stability within their communities, expand their networks of support, and build their capacity to live independently and securely. Support services help program participants access and maintain permanent housing, access employment and/or attend school, parent their children, and generally prepare for economic independence. Housing may be

(a) scattered site rental apartments in which families assume the lease once the program has provided the unit;

(b) condominiums or single family homes purchased by families through home buying assistance provided by the program; or

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

101 CMR, § 412.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of payment by any purchasing governmental unit, accept the approved rate as full payment and discharge of all obligations for the services rendered. Payment by the purchasing governmental unit for services rendered to the client are reduced by the amount of any payment by any other source.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved rate.

(4) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 412.03(4).

| Program/Service Type | Rate | Unit | | --- | --- | --- | | Emergency Shelter: Full program rate | $257.67 | Per room per day | | Emergency Shelter: Lower facility cost program | $240.11 | Per room per day | | Residential Housing Stabilization: Full program rate | $131.15 | Per room per day | | Residential Housing Stabilization: Lower facility cost program | $109.93 | Per room per day | | Housing Stabilization Advocacy and Supportive Services | $73.00 | Per room per day | | Domestic Violence, Substance Misuse, and Trauma: Full program rate | $295.25 | Per room per day | | Client Financial Assistance/Flex Funding | IC | N/A |

| Add-on Staff | | | | --- | --- | --- | | Title | Unit of Service | .25 FTE | | Direct Care Staff | Monthly | $1,264.87 |

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

101 CMR, § 412.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

101 CMR, § 412.05 Severability

The provisions of 101 CMR 412.00 are severable. If any provision of 101 CMR 412.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 412.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted, Mass Register Issue 1257, eff. 3/28/2014.

Payments for Youth Intermediate-term Stabilization Services Payments for Youth Intermediate-term Stabilization Services

101 CMR, § 413.01 General Provisions

(1) Scope. 101 CMR 413.00 governs the payment rates for youth intermediate-term stabilization services, as further described in 101 CMR 413.00, purchased by a governmental unit.

(2) Applicable Dates of Service. Rates contained in 101 CMR 413.00 apply for dates of service as described in 101 CMR 413.03(5).

(3) Disclaimer of Authorization of Services. 101 CMR 413.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 413.00. Governmental units that purchase the services described in 101 CMR 413.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 413.00.

(5) Services and Rates Covered by Other Regulations. Payment rates for the following services are not included within the scope of 101 CMR 413.00 and are governed by other regulations promulgated by EOHHS as follows.

| Service | Regulation | | --- | --- | | Enhanced Intensive Foster Care | 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services | | Medical Consultation | 101 CMR 317.00: Rates for Medicine Services |

History

Adopted by Mass Register Issue 1272, eff. 11/1/2014.

101 CMR, § 413.02 Definitions

As used in 101 CMR 413.00, unless the context requires otherwise, terms have the meanings in 101 CMR 413.02.

Add-on Rate. A rate that is intended to provide an additional, necessary programmatic or client specific service, not included in the current programmatic model, which will be instituted at the discretion of the purchasing governmental unit.

Adjudicated Youth Residential Treatment. Post-assessment programs that are either hardware-or staff-secure for clients 12 through 20 years of age committed by the juvenile court to the care and custody of the Department of Youth Services (DYS). These programs are characterized by physical (by means of both staffing and hardware) and behavior management, clinical and health services, education, recreation, and family support. These programs also undertake community transition assistance, among other services, in a fully integrated manner with the goal of reducing risk and/or need and preparing the client for reentry into the community.

Client. A child, adolescent, or young adult receiving youth intermediate-term stabilization services purchased by a governmental unit.

Clinically Intensive Residential Treatment Program (CIRT). Residential care that is a comprehensive strength-based, trauma-informed, skill-oriented treatment.

Clinically Intensive Youth Residential Substance Use Disorder Treatment. Residential programs for clients 13 through 17 years of age that include gender specific services for medically stable youth with substance use disorders. Each youth participates in highly structured, developmentally appropriate individual, group, and family clinical services in addition to having his or her medical and psychiatric needs addressed.

Community-based Services. Treatment options provided in a community setting where the client and his or her family typically live, work, or recreate.

Community Services Network (CSN). Regional community services teams that effectively integrate the DYS casework staff with provider agency support staff in a combined effort to deliver high quality, individualized, and culturally responsive services and supports to the youth and families served by DYS. CSN programs provide service locations for youth who have completed residential stays and are returning to their home communities. Services provided by CSN include education, clinical treatment, and accountability (rewards and sanctions), as well as recreational activities and community service.

Community Treatment Residence. A residential service that provides clients with moderate behavioral health needs a therapeutic milieu for receiving individualized treatment, rehabilitation, training in life skills, and supportive services to promote permanency in a family-based environment or, as developmentally appropriate, community living with permanency.

Continuum/Intensive Home-based Therapeutic Care. This program is an integrated and intensive array of community-based therapeutic interventions designed in partnership with youth and families to meet their unique needs. A goal of treatment is to support youth in their home and community, but when clinically indicated and authorized, short-term therapeutic group care is integrated into the Continuum/Intensive Home-based Therapeutic Care treatment plan. Continuum/Intensive Home-based Therapeutic Care treatment continues during periods of hospitalization or out-of-home placement.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Emergency Residence. A residential service, available for immediate 24/7 access, for clients requiring placement in a therapeutic milieu providing individualized treatment, rehabilitation, training in life skills, and supportive services to promote transition from the emergency setting to a treatment setting, to permanency in a family-based environment or, as developmentally appropriate, to community living with permanency.

Enhanced Residential Treatment Program (ERTP). The federal Family First Prevention Services Act of 2017 introduced this term. An ERTP meets the following five requirements:

(a) accreditation by an accrediting body named in the Family First Prevention Services Act of 2017 or subsequently approved by the U.S. Secretary of Health and Human Services;

(b) operation within a trauma-informed treatment model that creates a culture of delivering trauma-informed care and treatment;

(d) facilitation, in accordance with the child's best interest, of family members', including siblings', connections with the child and involvement in the child's treatment plan and programs; and

(e) provision of discharge planning and family-based aftercare support.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Extraordinary Circumstances/Flex Funding. A method whereby, subject to availability, a purchasing governmental unit may provide resource allocations to a client and/or provider across the state. Flexible funding may be provided through a number of means including, but not limited to, reimbursement to the client for specific support services or funds directed to a qualified provider for extraordinary circumstances.

Full-time Equivalent (FTE). A staff position equivalent to a full-time employee.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth.

Group Home Program. Residential services that provide flexible individualized treatment, rehabilitation, and support/supervision services that vary in intensity based upon individual youth and family needs. The Group Home Program includes the following four service models:

(a) Intensive Group Home programs with a 1:3 direct care staffing ratio;

(b) Group Home 1:4 programs with a 1:4 direct care staffing ratio;

(d) Independent Living programs with no live-in staff and that occur in an apartment setting

Individual Consideration (I.C.). Payment rates for certain services are designated as individual consideration (I.C.). Where I.C. rates are designated, the purchasing governmental unit will determine the appropriate payment as the actual cost of the item or service as evidenced by invoice, published tuition amount, or other price reasonably obtained by a competitive market for the product or service.

Intensive Emergency Residence. A residential service, available for immediate 24/7 access, for clients with severe behavioral health needs requiring placement in a therapeutic milieu providing individualized treatment, rehabilitation, training in life skills, and supportive services to promote transition from the emergency setting to a treatment setting, to permanency in a family-based environment or, as developmentally appropriate, to community living with permanency.

Intensive 1:1 Supported Living. A specialty community-based residential treatment service for young adults 18 through 22 years of age with a range of significant developmental needs. This service provides individualized 1:1 supervision and support services for all clients.

Intensive 1:2 Group Home. A specialty service that provides flexible individualized treatment, rehabilitation, and support/supervision services at a more intensive 1:2 direct care staff ratio, based upon individual youth and family needs.

Intensive Group Home with Expanded Nursing. Intensive Group Home with Expanded Nursing provides out-of-home treatment services that are integrated with community-based transitional support services. These services are designed for youth who present with complex medical needs and their families.

Intensive Residential Treatment Program (IRTP). Residential programs that are class VII facilities, licensed by the Department of Mental Health (DMH), and designed for adolescents who have completed a thorough and aggressive course of acute psychiatric care.

Intensive Transitional Independent Living. Programs for clients 16 through 20 years of age who are preparing to live independently upon release or who have been determined to need more intensive transitional and community support services as they return to the community. The programs are staff secure and provide monitoring and supervision, as well as individualized services that reduce risk and/or need and develop independent living skills and experiences in the community and community-based support systems.

Intensive Treatment Residence. A residential service that provides clients with severe behavioral health needs a therapeutic milieu that includes expertise about severe behavioral health conditions, individualized treatment, rehabilitation, training in life skills and self-regulation, and supportive services to promote permanency in a family-based environment or, as developmentally appropriate, to community living with permanency.

Intensive Treatment Residence Emergency Intake Add-on. An add-on service to support additional costs associated with achieving an emergency placement, within 24 to 48 hours of referral, into an Intensive Treatment Residence.

Medically Complex Behavioral Residence. A residential service for clients with complex medical needs that require out-of-home nursing services to meet their health-care needs and require individualized treatment to meet their behavioral health needs.

Medically Complex Needs Group Home. Specialty service for children/youth and young adults with complex medical needs that require intensive out-of-home nursing services in order to meet their health-care needs.

Medically Complex Residence. A residential service for clients with complex medical needs that require out-of-home nursing services to meet their health-care needs.

Non-enhanced Residential Treatment Program (Non-ERTP). A program that does not meet all five requirements of an Enhanced Residential Treatment Program (ERTP). See the definition of an Enhanced Residential Treatment Program.

Per Diem. Service unit based on a 24-hour period of care.

Programmatic Add-on Rate. A rate that is intended to provide an additional, necessary service to all clients, that is not included in the current programmatic model, and that will be instituted at the discretion of the purchasing governmental unit.

Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers youth intermediate-term stabilization services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been adopted by a purchasing governmental unit.

Provider Leased. The building housing an Adjudicated Youth Residential Treatment program that is leased by the provider.

Provider Owned. The building housing an Adjudicated Youth Residential Treatment program that is owned by the provider.

Recovery, Engagement, and Alliance with DYS Youth (READY, formerly MassSTART). A community-based program serving high-risk DYS-involved youth who are struggling with substance use and related behavioral health problems. Services provide ongoing engagement and psycho-education around substance use, increased support for education and employment, enhanced family engagement, expanded social support, out-of-school activities, one-on-one mentoring, behavioral incentives, and advocacy within DYS regarding the correlation between substance use and delinquent behavior.

Residential Schools. Special education programs with rates established by the Operational Services Division.

Residential Services. A setting away from the home that offers both housing and treatment.

Specialty Treatment Residence. A residential service that provides clients who would benefit from specialized treatment ( e.g ., individuals with intellectual disabilities; transgender individuals) with a therapeutic milieu that includes expertise about the specialty population, individualized treatment, rehabilitation, training in life skills, and supportive services to promote permanency in a family-based environment or, as developmentally appropriate, community living with permanency.

Specialty Treatment Residence for Commercially Sexually Exploited Children (CSEC). A residential service designed to meet the particular behavioral-health needs of clients who have been sexually exploited. Services are delivered within a therapeutic milieu that includes expertise about the CSEC population, individualized treatment, rehabilitation, training in life skills, and supportive services to promote permanency in a family-based environment or, as developmentally appropriate, to community living with permanency.

Short-term Assessment and Rapid Reintegration Program (STARR). A flexible, residential service designed to meet the service needs of the child/youth and family. All children/youth referred receive stabilization services, while some children/youth require additional assessment and treatment services.

Specialty Services. Specifically designed, low-incidence models of care.

State College Preparatory Program. A specialty service designed to serve as a crucial support in building permanency for young people by helping them achieve self-sufficiency, strengthen supportive relationships, and identify and access community support services and resources by combining intensive academic and support services that prepare the youth for college and adulthood.

State Funding. The aggregate state fiscal year amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 413.00. State funding does not include any amounts attributable to federal funding or grant funds.

State Owned Co-located. The building housing an Adjudicated Youth Residential Treatment program that is owned by the state and is connected in any way to or on the same campus as another state-owned building.

State Owned Separate. The building housing an Adjudicated Youth Residential Treatment program that is owned by the state and is a stand-alone structure in that it is not connected in any way to or on the same campus as another state-owned building.

Stepping Out Program. Community-based individualized support provided to youth who have transitioned to living independently after receiving pre-independent living and independent living services. Service continuity is a critical feature of Stepping Out. In order to ensure continuity, Stepping Out services are provided by the case manager who has already been working with the youth.

Summer Teacher Add-on Rate. An add-on rate for a licensed teaching position receiving a stipend to provide education in residential programs for the summer session, totaling six weeks during the months of July and August.

Teen Parenting Emergency Beds (E-beds) Program. An add-on rate to support additional costs associated with providing emergency beds (E-beds), which include transportation, food, diapers, and other emergency incidentals, and monthly assessment reimbursement for teen parents. The add-on rate is utilized for young parents needing an emergency bed and services until a regular placement can be made.

Teen Parenting Program. Programs designed to help teens develop a support system for themselves and their children including ensuring continuing contact with the baby's father, teen's parent(s), family members, paternal family members, and other supports through a residential setting. The Teen Parenting Program includes the following four service models:

(a) Enhanced programs with a 1:4 direct care staff ratio;

(b) Teen Living Programs (TLP) with a 1:5 direct care staff ratio;

(d) Supportive Teen Parent Education and Employment Program (STEP), which has no live-in staff and is provided in an apartment setting.

Therapeutic Group Care. A 24/7 out-of-home treatment service that provides flexible, individualized treatment and assessment with the goal of reintegrating youth to their families and communities; also provides short-term, planned respite.

Transition to Intensive Foster Care (IFC) Add-on. Specialty service for transition to Intensive Foster Care. Serves as an add-on to a residential model.

Transitional Age Youth Program. A specialty program for young adults, 18 through 25 years of age, designed to promote health and wellness and recovery through person-centered services and supports that enable individuals to live, work, and participate in their communities. The Transitional Age Youth Program includes the following two service models.

(a) The Transitional Aged Young Adult Continuum is an integrated array of services that includes both residential and community-based treatment.

(b) The Young Adult Group Living Environment includes services provided in a group home or supported housing residential setting.

Transitional Independent Living. Programs for clients 16 through 20 years of age who are preparing to live independently upon release or who have been determined to need more transitional and community support services as they return to the community. The programs provide monitoring and supervision, as well as individualized services that reduce risk and/or need and develop independent living skills and experiences in the community and in community-based support systems.

Utilization. The proportion of a program's capacity that is filled by clients on a regularly measured basis, expressed as a percentage.

Workforce Initiatives. Funds directed to a provider for workforce development.

Youth Intermediate-term Stabilization. Programs that provide a child, adolescent, or young adult temporary housing in a specialized residential or hospital setting to provide comprehensive services, and to promote stabilization and transition to

(a) a less-restrictive setting;

(b) a permanent family home;

(d) another type of adult program.

Youth Residential Substance Use Disorder Treatment. Residential programs for clients 16 through 19 years of age with moderate-to-severe substance use disorders that include intake and assessment, mental health counseling, case management and service coordination; psycho- and health education; life skills enhancement and vocational/educational support; recovery support and aftercare; and discharge planning.

Youth and Young Adult Group Residence . A residential service that provides older adolescents or young adults with a supportive environment where there are opportunities for individualized treatment, training in life skills development, vocational and career planning, linkages with community services, and supportive services to promote community living with permanency.

Youth and Young Adult Supported Living Community. Residential services offered to older adolescents or young adults living in multi-occupancy units ( e.g ., apartments, townhomes) that provide opportunities for linkages to community-based services, support with life skills development, vocational and career planning, and supportive services to promote community living with permanency.

Young Adult Supported Living. Services, with no live-in staff, offered to young adults living independently in scattered apartments that provide opportunities for linkages to community-based services, support with life skills, vocational and career planning, and supportive services to promote community living with permanency.

Young Parent Living Program. A residential service to support young parents in learning to care for themselves and their children, in developing positive support systems that include family members, extended kin, and friends, and in connecting with community-based supports.

Young Parent Residence Add-on. An add-on rate to support additional costs associated with a one-time assessment of young parents upon intake to a young parent residence.

Young Adult Therapeutic Care. This program is for young adults, 18 through 25 years of age, and is designed to promote health, wellness, and recovery through person-centered services and supports that enable individuals to live, work, and participate in their communities. This service provides multiple levels of intensity in order to meet the individual needs, including the following.

(a) Staffed Apartments. 24/7 group living with onsite staff support.

(b) Supported Apartments. 24/7 individual apartments with intermittent onsite staff support.

History

Adopted by Mass Register Issue 1272, eff. 11/1/2014.

101 CMR, § 413.03 Rate Provisions

(3) Payment Limitations. No purchasing governmental unit may pay less than, or more than, the approved rate, except as cited in 101 CMR 413.03(2), (4), and (5).

(5) Approved Rates. Except for the rates established for substance use disorder treatment, the rates set forth in 101 CMR 413.03 govern the payment rates for services purchased by the Department of Children and Families, DMH, and DYS provided pursuant to contracts executed under the departments' FY 2013 or subsequent procurements. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 413.03.

(a) Youth Residential Substance Use Disorder Treatment Rates Effective for Dates of Service Provided on or after January 1, 2024.

| Program Name | Rate | HCPCS Code/Description | | --- | --- | --- | | Youth Residential Substance Use Disorder Treatment | $397.89 | H0019-HF - Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (residential treatment service for transitional age youth and young adults: youth residential substance use disorder treatment). | | Clinically Intensive Youth Residential Substance Use Disorder Treatment | $523.57 | H0019-HA - Behavioral health; long-term residential (nonmedical, nonacute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem (residential treatment services for youth: clinically intensive youth residential substance use disorder treatment). |

(b) Adjudicated Youth Residential Treatment Base Rates Effective for Dates of Service Provided on or after January 1, 2024.

ADJUDICATED YOUTH RESIDENTIAL TREATMENT BASE RATES

| PROVIDER LEASED | Utilization % | # of Clients | | | | --- | --- | --- | --- | --- | | | 12-14 | 15-17 | 18-22 | 23-26 | | 90% | $627.83 | $525.21 | $425.63 | $386.26 | | 85% | $664.76 | $556.11 | $450.67 | $408.98 | | 80% | $706.31 | $590.86 | $478.83 | $434.54 | | 75% | $753.40 | $630.25 | $510.76 | $463.51 | | 70% | $807.21 | $675.27 | $547.24 | $496.62 | | 65% | $869.30 | $727.22 | $589.33 | $534.82 | | 60% | $941.74 | $787.82 | $638.45 | $579.39 | | 55% | $1,027.36 | $859.44 | $696.49 | $632.06 | | 50% | $1,130.09 | $945.38 | $766.13 | $695.26 |

| PROVIDER OWNED | Utilization % | # of Clients | | | | --- | --- | --- | --- | --- | | | 12-14 | 15-17 | 18-22 | 23-26 | | 90% | $587.40 | $484.78 | $385.20 | $345.83 | | 85% | $621.95 | $513.30 | $407.86 | $366.17 | | 80% | $660.83 | $545.38 | $433.35 | $389.06 | | 75% | $704.88 | $581.74 | $462.24 | $414.99 | | 70% | $755.23 | $623.29 | $495.26 | $444.64 | | 65% | $813.32 | $671.24 | $533.36 | $478.84 | | 60% | $881.10 | $727.18 | $577.80 | $518.74 | | 55% | $961.20 | $793.28 | $630.33 | $565.90 | | 50% | $1,057.32 | $872.61 | $693.36 | $622.49 |

| STATE OWNED - SEPARATE | Utilization % | # of Clients | | | | --- | --- | --- | --- | --- | | | 12-14 | 15-17 | 18-22 | 23-26 | | 90% | $579.70 | $477.08 | $377.50 | $357.80 | | 85% | $613.80 | $505.15 | $399.71 | $378.84 | | 80% | $652.16 | $536.72 | $424.69 | $402.52 | | 75% | $695.64 | $572.50 | $453.00 | $429.36 | | 70% | $745.33 | $613.39 | $485.36 | $460.02 | | 65% | $802.66 | $660.58 | $522.69 | $495.41 | | 60% | $869.55 | $715.62 | $566.25 | $536.69 | | 55% | $948.60 | $780.68 | $617.73 | $585.49 | | 50% | $1,043.46 | $858.75 | $679.50 | $644.03 |

| STATE OWNED - CO-LOCATED | Utilization % | # of Clients | | | | --- | --- | --- | --- | --- | | | 12-14 | 15-17 | 18-22 | 23-26 | | 90% | $543.96 | $451.26 | $357.43 | $338.74 | | 85% | $575.96 | $477.81 | $378.45 | $358.66 | | 80% | $611.96 | $507.67 | $402.11 | $381.08 | | 75% | $652.76 | $541.51 | $428.91 | $406.48 | | 70% | $699.38 | $580.19 | $459.55 | $435.52 | | 65% | $753.18 | $624.82 | $494.90 | $469.02 | | 60% | $815.95 | $676.89 | $536.14 | $508.11 | | 55% | $890.12 | $738.43 | $584.88 | $554.30 | | 50% | $979.14 | $812.27 | $643.37 | $609.73 |

| Intensive Trans. Indep. Living (A) | Utilization % | # of Clients | | | | --- | --- | --- | --- | --- | | | 5-11 | 12-14 | 15-17 | 18-22 | | 90% | $468.70 | $425.88 | $420.04 | $399.76 | | 85% | $496.27 | $450.93 | $444.75 | $423.28 | | 80% | $527.29 | $479.11 | $472.55 | $449.74 | | 75% | $562.44 | $511.06 | $504.05 | $479.72 | | 70% | $602.61 | $547.56 | $540.05 | $513.98 | | 65% | $648.97 | $589.68 | $581.59 | $553.52 | | 60% | $703.05 | $638.82 | $630.06 | $599.65 | | 55% | $766.96 | $696.89 | $687.34 | $654.16 | | 50% | $843.66 | $766.58 | $756.07 | $719.58 |

| Trans. Indep. Living (B) | Utilization % | # of Clients | | | | --- | --- | --- | --- | --- | | | 5-11 | 12-14 | 15-17 | 18-22 | | 90% | $183.69 | $131.16 | $145.15 | $129.30 | | 85% | $194.50 | $138.88 | $153.69 | $136.91 | | 80% | $206.66 | $147.56 | $163.29 | $145.46 | | 75% | $220.43 | $157.40 | $174.18 | $155.16 | | 70% | $236.18 | $168.64 | $186.62 | $166.25 | | 65% | $254.35 | $181.61 | $200.98 | $179.03 | | 60% | $275.54 | $196.74 | $217.73 | $193.95 | | 55% | $300.59 | $214.63 | $237.52 | $211.59 | | 50% | $330.65 | $236.09 | $261.27 | $232.74 |

| STATE OWNED - CO-LOCATED | Utilization % | # of Clients: | | | | --- | --- | --- | --- | --- | | | 12-14 | 15-17 | 18-22 | 23-26 | | 90% | $427.64 | $358.65 | $321.72 | $299.45 | | 85% | $452.80 | $379.75 | $340.63 | $317.07 | | 80% | $481.09 | $403.49 | $361.93 | $336.87 | | 75% | $513.17 | $430.39 | $386.06 | $359.34 | | 70% | $549.83 | $461.13 | $413.63 | $385.01 | | 65% | $592.12 | $496.60 | $445.45 | $414.61 | | 60% | $641.46 | $537.98 | $482.56 | $449.17 | | 55% | $699.77 | $586.89 | $526.44 | $490.00 | | 50% | $769.75 | $645.59 | $579.08 | $539.00 |

(c) Residential, Community-based, and Specialty Services (Formerly Known as Caring Together) Rates Effective for Dates of Service Provided on or after January 1, 2024.

RESIDENTIAL SERVICES (Formerly known as Caring Together)

| Program Type | Model | Rate per Month | | --- | --- | --- | | CIRT | Clinically Intensive Residential Treatment | $222,265 | | IRTP | Intensive Residential Treatment Program, co-located | $283,502 | | Intensive Residential Treatment Program, not co-located | $288,141 | | | STARR | Six Beds | $66,404 | | Nine Beds | $87,476 | | | 12 Beds | $116,238 | | | 15 Beds | $139,510 | | | Teen Parenting | TLP 1:5 (per slot) | $6,358 | | House Parent (per slot) | $6,420 | | | STEP (per slot) | $3,024 | |

RESIDENTIAL SERVICES (Formerly known as Caring Together)

| Program Type | Model | Rate per Diem | | --- | --- | --- | | Group Home | Intensive 1:3 | $354.02 | | Group Home 1:4 | $297.74 | | | Pre-independent Living | $255.54 | | | Independent Living | $110.35 | | | STARR | Six Bed | $418.50 | | Nine Beds | $367.73 | | | 12 Beds | $345.74 | | | 15 Beds | $332.25 | | | Teen Parenting | Enhanced 1:4 | $295.59 |

COMMUNITY-BASED SERVICES (Formerly known as Caring Together)

| Program Type | Model | Rate per Diem | | --- | --- | --- | | Continuum | Community Wrap | $119.02 | | Adjusted GH 1:3 | $357.77 | | | Adjusted GH 1:4 | $297.07 | | | Follow Along | $69.63 | | | Stepping Out | $48.45 | |

| Specialty Services (Formerly known as Caring Together) | | | --- | --- | | Service | Rate per Diem | | Transitional Age Youth: Adult Continuum | $164.03 | | Transitional Age Youth: Young Adult Group Living Environment | $355.74 | | Intensive 1:1 Supported Living | $697.09 | | Intensive 1:2 Group Home | $434.50 | | Intensive 1:3 Group Home with expanded nursing | $417.31 | | Medically Complex Needs GH, nine beds | $494.08 | | Medically Complex Needs GH, nine beds with expanded nursing | $585.04 | | Medically Complex Needs GH, six beds | $516.57 | | Medically Complex Needs GH, six beds with expanded nursing | $658.53 | | Medically Complex Needs GH, 12 beds | $462.24 | | Medically Complex Needs GH, 12 beds with expanded nursing | $523.59 | | Transition to IFC Add-on | $41.66 | | Teen Parenting Emergency Beds Add-on (per day) | $15.24 | | Teen Parenting Emergency Beds Add-on (per month) | $463.50 |

(d) Congregate Care Program Rates Effective for Dates of Service Provided on or after July 1, 2023.

| Congregate Care Program | Rate | Unit | | --- | --- | --- | | Clinically Intensive Residential Treatment | $388,523 | monthly program rate | | Community Treatment Residence (Non-ERTP) | $522.47 | per bed day | | Community Treatment Residence (ERTP) | $545.04 | per bed day | | Intensive Home Based Therapeutic Care | $189.18 | per day per person | | Emergency Residence | $636.00 | per bed day | | Intensive Emergency Residence | $755.87 | per bed day | | Intensive Residential Treatment Program | $497,888 | monthly program rate | | Intensive Treatment Residence (Non-ERTP) | $777.62 | per bed day | | Intensive Treatment Residence (ERTP) | $794.19 | per bed day | | Intensive Treatment Residence Emergency Intake-Add-on | $119.42 | per bed day | | Medically Complex & Behavioral Residence (Non-ERTP) | $737.48 | per bed day | | Medically Complex & Behavioral Residence (ERTP) | $754.05 | per bed day | | Medically Complex Residence (Non-ERTP) | $759.25 | per bed day | | Medically Complex Residence (ERTP) | $771.68 | per bed day | | Specialty Treatment Residence (Commercially Sexually Exploited Children) | $668.66 | per bed day | | Specialty Treatment Residence (Non-ERTP) | $660.85 | per bed day | | Specialty Treatment Residence (ERTP) | $674.03 | per bed day | | Therapeutic Group Care - 6 beds | $99,178 | monthly program rate | | Therapeutic Group Care - 9 beds | $135,891 | monthly program rate | | Therapeutic Group Care - 12 beds | $170,267 | monthly program rate | | Young Adult Supported Living | $195.39 | per bed day | | Young Adult Therapeutic Care -Outreach | $63.21 | daily slot rate | | Young Adult Therapeutic Care -Staffed Apartments | $87,633 | monthly program rate | | Young Adult Therapeutic Care -Staffed Apartments | $14,605 | monthly single apt. | | Young Adult Therapeutic Care -Supported Apartments | $6,236 | monthly single apt. | | Young Adult Therapeutic Care -Supported Apartments Hold | $65.52 | daily rate | | Young Parent Assessment | $406.33 | per assessment | | Young Parent Living Program | $9,481.57 | monthly bed rate | | Youth & Young Adult Group Residence | $408.96 | per bed day | | Youth & Young Adult Supported Living Community | $378.49 | per bed day |

(e) Add-on Rates Effective for Dates of Service Provided on or after January 1, 2024.

| Add-on Rates (Monthly) | | | | | | --- | --- | --- | --- | --- | | Position | 1.0 FTE | 0.75 FTE | 0.50 FTE | 0.25 FTE | | Direct Care | $4,244 | $3,183 | $2,122 | $1,061 | | Certified Nursing Assistant | $4,023 | $3,017 | $2,011 | $1,006 | | Direct Care III | $5,415 | $4,061 | $2,708 | $1,354 | | Occupational Therapist | $8,634 | $6,475 | $4,317 | $2,158 | | Occupational Therapist Assistant | $7,137 | $5,353 | $3,568 | $1,784 | | Case Manager, Social Worker, Clinician (MA level-not Independent Licensed) | $6,829 | $5,122 | $3,414 | $1,707 | | LPN | $6,497 | $4,873 | $3,248 | $1,624 | | Registered Nurse | $10,523 | $7,893 | $5,262 | $2,631 | | Clinician w/Independent License | $7,858 | $5,894 | $3,929 | $1,965 | | Social/Caseworker (BA Level) | $5,448 | $4,086 | $2,724 | $1,362 |

| Add-on Rates (Hourly) | | | --- | --- | | Position | Rate | | Direct Care | $26.10 | | Certified Nursing Assistant | $24.73 | | Direct Care III | $33.29 | | Occupational Therapist | $58.86 | | Occupational Therapist Assistant | $48.68 | | Case Manager, Social Worker, Clinician (MA level - not Independent Licensed) | $46.57 | | LPN | $44.30 | | Registered Nurse | $71.77 | | Clinician w/Independent License | $53.60 | | Social/Caseworker (BA Level) | $37.17 | | Nurse Practitioner/APRN | $94.45 | | Psychologist/Psychiatrist (PhD) | $152.17 | | Forensic Psychiatrist | $181.00 |

| Other Add-on Rates | | | --- | --- | | Service | Rate | | Canine Therapy | $10,000 per dog | | Extraordinary Circumstances/Flex Funding | Individual Consideration (I.C.) |

| Adjudicated Youth Residential Treatment Add-on Rates | | | | --- | --- | --- | | Position - Add-on | Unit | Rate | | Clinical Director | Per Youth, Per Day | $37.69 | | Clinician (LICSW) | Per Youth, Per Day | $29.96 | | Direct Care | Per Youth, Per Day | $15.46 |

(f) Community Service Network (CSN)/READY Rates Effective for Dates of Service Provided on or after January 1, 2024.

| Community Service Network (CSN)/READY Rates are based on region, and reflect per client per enrollment day. | | | --- | --- | | Model | Rate per Client per Enrollment Day | | Central Region | $44.05 | | Metro Boston Region | $62.81 | | Northeast Region | $32.22 | | Southeast Region | $38.65 | | West Region | $41.16 |

| Community Service Network (CSN) Add-on Rates | | | | --- | --- | --- | | Add-on | Unit | Rate | | Occupancy Add-on: | Monthly | $10,000.00 | | Youth Service Coordinator Add-on: 0.50 FTE | Monthly | $2,900 | | Youth Service Coordinator Add-on: 1.0 FTE | Monthly | $5,801 | | Administrative Assistant/Transporter Add-on: 0.50 FTE | Monthly | $2,268 | | Administrative Assistant/Transporter Add-on: 1.0 FTE | Monthly | $4,536 | | READY Program: 1.0 FTE | Enrolled Day | $19.61 |

(6) Geographic Regions for Community Service Network.

(a) Central: Ashburnham, Ashby, Ashland, Athol, Auburn, Ayer, Barre, Bellingham, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dover, Dudley, East Brookfield, Fitchburg, Framingham, Franklin, Gardner, Grafton, Groton, Hardwick, Harvard, Holden, Holliston, Hopedale, Hopkinton, Hubbardston, Hudson, Lancaster, Leicester, Leominster, Lunenburg, Marlborough, Medway, Mendon, Milford, Millbury, Millville, Natick, Needham, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Pepperell, Petersham, Phillipston, Princeton, Royalston, Rutland, Sherborn, Shirley, Shrewsbury, Southborough, Southbridge, Spencer, Sterling, Sturbridge, Sudbury, Sutton, Templeton, Townsend, Upton, Uxbridge, Warren, Wayland, Webster, Wellesley, West Boylston, West Brookfield, Westborough, Westminster, Weston, Winchendon, Worcester.

(b) Metropolitan Boston: Belmont, Boston, Brookline, Cambridge, Chelsea, Newton, Revere, Somerville, Waltham, Watertown, Winthrop.

(c) Northeast: Acton, Amesbury, Andover, Arlington, Bedford, Beverly, Billerica, Boxborough, Boxford, Burlington, Carlisle, Chelmsford, Concord, Danvers, Dracut, Dunstable, Essex, Everett, Georgetown, Gloucester, Groveland, Hamilton, Haverhill, Ipswich, Lawrence, Lexington, Lincoln, Littleton, Lowell, Lynn, Lynnfield, Malden, Manchester-by-the-Sea, Marblehead, Maynard, Medford, Melrose, Merrimac, Methuen, Middleton, Nahant, Newbury, Newburyport, North Andover, North Reading, Peabody, Reading, Rockport, Rowley, Salem, Salisbury, Saugus, Stoneham, Stow, Swampscott, Tewksbury, Topsfield, Tyngsborough, Wakefield, Wenham, Westford, West Newbury, Wilmington, Winchester, Woburn.

(d) Southeast: Abington, Acushnet, Aquinnah, Attleboro, Avon, Barnstable, Berkeley, Bourne, Braintree, Brewster, Bridgewater, Brockton, Canton, Carver, Chatham, Chilmark, Cohasset, Dartmouth, Dedham, Dennis, Dighton, Duxbury, East Bridgewater, Eastham, Easton, Edgartown, Fairhaven, Fall River, Falmouth, Foxborough, Freetown, Gosnold, Halifax, Hanover, Hanson, Harwich, Hingham, Holbrook, Hull, Kingston, Lakeville, Mansfield, Marion, Marshfield, Mashpee, Mattapoisett, Medfield, Middleborough, Millis, Milton, Nantucket, New Bedford, Norfolk, North Attleboro, Norton, Norwell, Norwood, Oak Bluffs, Orleans, Pembroke, Plainville, Plymouth, Plympton, Provincetown, Quincy, Randolph, Raynham, Rehoboth, Rochester, Rockland, Sandwich, Scituate, Seekonk, Sharon, Somerset, Stoughton, Swansea, Taunton, Tisbury, Truro, Walpole, Wareham, Wellfleet, West Bridgewater, Westport, West Tisbury, Westwood, Weymouth, Whitman, Wrentham, Yarmouth.

(e) West: Adams, Agawam, Alford, Amherst, Ashfield, Becket, Belchertown, Bernardston, Blandford, Brimfield, Buckland, Charlemont, Cheshire, Chester, Chesterfield, Chicopee, Clarksburg, Colrain, Conway, Cummington, Dalton, Deerfield, Easthampton, East Longmeadow, Egremont, Erving, Florida, Gill, Goshen, Granby, Granville, Great Barrington, Greenfield, Hadley, Hampden, Hancock, Hatfield, Hawley, Heath, Hinsdale, Holland, Holyoke, Huntington, Lanesborough, Lee, Lenox, Leverett, Leyden, Longmeadow, Ludlow, Middlefield, Monroe, Monson, Montague, Monterey, Montgomery, Mount Washington, New Ashford, New Marlborough, New Salem, North Adams, Northampton, Northfield, Orange, Otis, Palmer, Pelham, Peru, Pittsfield, Plainfield, Richmond, Rowe, Russell, Sandisfield, Savoy, Sheffield, Shelburne Falls, Shutesbury, Southampton, South Hadley, Southwick, Springfield, Stockbridge, Sunderland, Tolland, Tyringham, Wales, Ware, Warwick, Washington, Wendell, Westhampton, Westfield, West Springfield, West Stockbridge, Whately, Wilbraham, Williamsburg, Williamstown, Windsor, Worthington.

History

Adopted by Mass Register Issue 1272, eff. 11/1/2014.

101 CMR, § 413.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1272, eff. 11/1/2014.

101 CMR, § 413.05 Severability

The provisions of 101 CMR 413.00 are severable. If any provision of 101 CMR 413.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 413.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1272, eff. 11/1/2014.

Rates For Family Stabilization Services Rates For Family Stabilization Services

101 CMR, § 414.01 General Provisions

(1) Scope. 101 CMR 414.00 establishes the payment rates for family stabilization services that provide support to individuals and families to promote family stability and to prevent unnecessary out-of-home placements. These rates are established for the services listed in 101 CMR 414.03(6). The rates for other family stabilization services are established by other EOHHS regulations as listed in 101 CMR 414.01(3).

(2) Applicable Dates of Service. Rates contained in 101 CMR 414.00 apply for dates of service provided on or after January 1, 2025.

(3) Services and Rates Covered by Other Regulations. Payment rates for the following services are not included within the scope of 101 CMR 414.00 and are governed by other regulations promulgated by EOHHS as follows.

| Service | Regulation | | --- | --- | | Individual Support and Community Habilitation | 101 CMR 423.00: Rates for Certain In-home Basic Living Supports |

(4) Disclaimer of Authorization of Services. 101 CMR 414.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 414.00. Governmental units that purchase family stabilization services are responsible for the definition, authorization, and approval of services provided to participants.

(5) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 414.00.

History

Amended by Mass Register Issue 1272, eff. 10/24/2014.

101 CMR, § 414.02 Definitions

As used in 101 CMR 414.00, unless the context requires otherwise, terms have the meanings in 101 CMR 414.02.

Adolescent Support Network. This service provides young adults with a diverse range of supportive services offered within community advocacy centers. Services are provided by staff trained specifically in the issues of this population, six days per week, and with 24-hour emergency coverage. The service utilizes flexible supports within the community to better assist youth through life transitions in order to meet each person's needs and develop their capacity to make empowering choices that promote safety, well-being, and productivity.

Adult Companion and Adult Companion Group Services. Nonmedical care, supervision, and socialization services provided by a companion to a single participant or a small group of two or three participants. Companions may assist or supervise the participant with such light household tasks as meal preparation, laundry, and shopping.

After-school Respite. These services provide after-school supervision and activities for children and adolescents with developmental or behavioral challenges.

Agency Rate. The fee for services performed by a person whose wage is paid by a corporation or partnership that is a MassHealth provider or provider of human services purchased by any governmental unit of the Commonwealth.

Agency with Choice. The Agency with Choice program supports individual/family self-determination in managing the receipt of certain services. This program allows individuals/ families to have an increased level of self-determination when they share responsibility for the hiring and management of employees/workers who provide services to them. The Agency with Choice provider is the common law employer of record and the individual/family is the managing employer. Fees for these services are not to exceed the equivalent published rate.

Autism Support Center Services. The array of information and referral services, resources, and support services to children and young adults with autism spectrum disorders and their families, including information and referral, family clinics, support groups, access to the latest information on autism, family trainings, parent networking and mentoring, and social/recreational events, among other activities.

Behavioral Support Services. Services designed to remediate identified challenging behaviors or to help individuals acquire socially appropriate behaviors that are necessary to improve the individual's independence and integration into their community. Behavioral support services and consultation are provided by psychology, mental health, and special education professionals.

Center Size. The number of direct-care full-time equivalent employees (FTEs) required to staff a family support center or autism support center as determined by the Department of Developmental Services (DDS).

Child Requiring Assistance (CRA). A child who is having serious problems at home and at school, including runaways, truants, and sexually exploited children, as designated by St. 2012, c. 240.

Chore. An unusual or infrequent household maintenance task that is needed to maintain the participant's home in a clean, sanitary, and safe environment. This service includes heavy household chores such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture in order to provide safe access and egress.

Client Financial Assistance/Flexible Funding. A method whereby, subject to availability, a purchasing governmental unit may provide individual resource allocations to both families of children and adults across the state. Flexible funding may be provided through a number of means, including a stipend issued directly to the family; reimbursement to the family for specific expenses and support services; or funds directed by the family to a qualified provider for specific services.

Combined Hourly Services. These services, individual or group in nature, are based upon an hour's service time of direct-care staff. While most services are nonclinical, some may be clinical.

Community-based After-school Social and Recreation Program Services. After-school programs for blind children with the following elements: community-based recreation, social-skill development, peer support, and community integration.

Comprehensive Services. These family-oriented services reflect a range of either nonclinical or clinical, or blended models of the two, established on a per-full-day-of-service basis. Within model types, the client-to-staff ratio, or intensity of service, differentiates one from another.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Educational Coordination. This is an educational support service providing pre- and postadoption support for foster, adoptive, or guardianship families, and is based upon an enrolled day of service.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Family Navigation Services. Referral support services and expert advice designed to assist families to identify needs and to facilitate and gain access to local generic support services through coordination between family and other service providers. The family navigator acts as a guide and resource development expert to ensure that families have knowledge and access to a broad array of generic community resources, to provide assistance in navigating the system, and to recognize and promote the value of natural support services.

Family Navigation Administrative Services. A Massachusetts Commission for the Blind (MCB) specific service in which the provider performs all necessary accounting functions to successfully administer expenditures to families for permissible support services.

Family Resource Center (FRC). Community-based, culturally competent programs that provide evidence-based parent education groups, information and referral, mentoring, and other opportunities for children and families in need. FRCs also provide CRA-specific services such as intake, screening, and assessments.

Family Skills Development Program Model. A ten-to- 13-week curriculum-based program that engages multiple (ten to 12) families with children from newborn to adolescence, to participate in ten to 13, 2½ hour sessions led by a trained team of four facilitators and other volunteers. The goal is to develop strategies to increase communication skills, develop family rules, use positive discipline, address conflict, share feelings, and enjoy family fun. The program includes a full meal for all participants, and may include transportation for participants and child care for infants and other children.

Family Stabilization Services. Services that provide support to individuals and families to promote family stability and to prevent unnecessary out-of-home placements. Family stabilization services include adult companion group services, after-school respite, autism support center services, behavioral support services, case consultation services, chore services, client financial assistance/flexible funding, client financial assistance/flexible funding administration, combined hourly services, community-based after-school social and recreation program services, comprehensive services, educational coordination, family navigation services, family support centers, family systems intervention, family training, family training groups, homemaker services, individual support and community habilitation services, individual youth support services, intensive flexible family support services (IFFS), medically complex programs, occupational therapy, peer support services, physical therapy, planned facility-based respite for children, respite in the caregiver's home, respite in the client's home, site-based respite, specialized medical equipment, speech therapy, unbundled intensive foster care special support services, and youth support groups.

Family Support Centers. Programs that establish a local presence and act as a hub for offering a wide range of general family support services and activities to families of children and adults who are eligible for DDS services. Centers provide information, referral, and service navigation to DDS eligible families, connecting these families to services they may need, and host community activities such as guest speakers and trainings. Centers also play a role in the administration of client funds. Cultural/linguistic-specific family support centers have been created to respond to the unique needs of specific cultural and linguistic family groups in specified areas or regions of the state.

Family Training. Training and instruction for family members concerning the treatment regimes, behavior plans, and the use of specialized equipment that supports the individual waiver participant to participate in the community. Community family training may also include training in family leadership, support of self-advocacy, and independence for the family member.

Family Training Groups. These groups are designed to improve parenting skills. Of the three model types, two are multi-family in nature, and the third is designed for the parents alone. These groups run usually on a once-per-week basis, and generally range from ten to 16 weeks in duration. The most robust family model may include as many as 60 attendees, while parent groups typically include up to 20.

Flexible Support Services (FSS). An individualized and targeted set of interventions and services provided to children/youth/young adults with serious emotional disturbance (SED). Flexible support services strengthen the well-being of children/youth/young adults and their families; builds family cohesion; and prevents the need for more intensive services. Through this service, children/youth/young adults and their families develop the skills, strategies, and supports needed to live successfully in the community and to support the youth's ongoing development of age-appropriate social, emotional, academic, and pre-vocational competencies. FSS is designed to be highly flexible to meet the varying needs of those served. The FSS service array includes parent peer support, peer mentoring, therapeutic support, and clinical services delivered through one of three modalities: an interdisciplinary team, a group, or as an individual service.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth.

Homemaker. A person who performs light housekeeping duties (for example, cooking, cleaning, laundry, and shopping) for the purpose of maintaining a household.

Individual Consideration (IC) Payment rates for certain services are designated as individual consideration (IC). Where IC rates are designated, the purchasing governmental unit will determine the appropriate payment as the actual cost of the item or service as evidenced by invoice, published tuition amount, or other price reasonably obtained by a competitive market for the product or service.

Intensive Flexible Family Support Services (IFFS). Services that support families with one or more members with a disability who are experiencing significant challenges that put the child/individual at risk of out-of-home placement. This is a time-limited (six to 12 months) and goal-oriented service that provides more focused and intensive supports in response to identified areas of need and difficulty and that builds and strengthens the family's capacity to support their child at home.

Medically Complex Programs. Family-driven models of care that support families with children and young adults who have significant cognitive, physical, and complex health care needs and who are living at home. The goal is to provide comprehensive wrap-around support services, which consist of specialized case management activities that help families integrate the variety of resources and support services they are receiving in order to care for their family member at home.

Micro Family Resource Center. A reduced FRC staffing model, which may be affiliated with an FRC.

Micro Family Resource Center Add-on. Additional staff time allocated to an FRC or Micro FRC to increase its CRA staff capacity.

Occupational Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of functions that affect the activities of daily living that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Occupational therapy programs are designed to improve quality of life by recovering competence and preventing further injury or disability, and to improve the individual's ability to perform tasks required for independent functioning, so that the individual can engage in activities of daily living.

Parent Skill Development Program Model. A 12-to-14-week program based on curricula that promote positive parenting and skill building for parents and other care givers. Child care may be provided, but there are no children's groups. The program focuses on the specific needs of parents in their role in the family. The program includes a full meal for all participants, and may include transportation for participants and child care for infants and other children.

Peer Support Services. Services that are designed to provide training, instruction, and mentoring to individuals about self-advocacy, participant direction, civic participation, leadership, benefits, and participation in the community. These services may be provided either by an individual with an intellectual disability or an advisor or support person to a self-advocacy group.

Physical Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, designed to improve, develop, correct, rehabilitate, or prevent the worsening of physical functions that have been lost, impaired, or reduced as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Physical therapy emphasizes a form of rehabilitation focused on treatment of dysfunctions involving neuromuscular, musculoskeletal, cardiovascular/pulmonary, or integumentary systems through the use of therapeutic interventions to optimize functioning levels.

Planned Facility-based Respite for Children. Services that provide out-of-home supervision and care in a licensed respite home to provide relief for the parents/primary caregivers.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Respite in the Caregiver's Home. Supervision and care provided in the caregiver's home on a short-term basis, including on a short-term overnight basis, where there is an absence or need for relief of those persons who normally provide care for the participant. Since this service is provided in the caregiver's home, applicable license or certification is necessary.

Respite in the Recipient's Home. Supervision and care provided in the home of the client, by qualified staff that possess a high school diploma, GED, or equivalencies or relevant competencies, on a short-term basis, including on a short-term overnight basis, where there is an absence or need for relief of those persons who normally provide care for the participant.

Self-employed Provider Rate. The fee for services performed by a person that is a provider and is not paid a wage by another person or entity for services performed.

Session. A single group meeting.

Site-based Respite. Services provided by a licensed respite home designed to provide out-of-home supervision and care to provide relief for the parents/primary caregivers.

Specialized Medical Equipment and Supplies. Devices, controls, or appliances to increase abilities in activities of daily living, or to control or communicate with the environment.

Specialty Family Skills Development Program Model. A 14-to-16-week curriculum-based program that engages multiple (ten to 12) families with children from newborn to adolescence, to participate in 14 to 16, 2½ hour sessions led by a trained team of eight to 12 facilitators, professionals, specialty providers, and volunteers. These groups are designed to address families with unique and/or multiple challenges, and special support needs. The program includes a full meal for all participants, and may include transportation for participants and child care for infants and other children.

Speech/Language Therapy. Therapy services, including diagnostic evaluation and therapeutic intervention, that are designed to improve, develop, correct, rehabilitate, or prevent the worsening of speech/language communication and swallowing disorders that have resulted in lost, impaired, or reduced speech/language communication and swallowing abilities as a result of acute or chronic medical conditions, congenital anomalies, or injuries. Speech and language disorders are those that affect articulation of speech, sounds, fluency, voice, swallowing (regardless of presence of a communication disability), and those that impair comprehension, or spoken, written, or other symbol systems used for communication.

State Funding. The aggregate state fiscal year amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 414.00. State funding does not include any amounts attributable to federal funding or grant funds.

Unbundled Intensive Foster Care Special Support Services. This model of intensive foster care represents a modification of the model that is the basis for 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services . This model was requested by the Department of Children and Families (DCF) and eliminates the family resource worker because a DCF employee fulfills this role.

History

Amended by Mass Register Issue 1272, eff. 10/24/2014.

101 CMR, § 414.03 Rate Provisions

(2) Reimbursement as Full Payment. Each provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the participant.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Services Provided in Dukes or Nantucket County. In accordance with the provisions of St. 2016, c. 133, payment for services provided in programs located in Dukes or Nantucket County is the rate for the service contained in 101 CMR 414.03(6) times a factor of 1.07.

(5) Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(6) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 414.03(6).

(a) Family Support Services.

| Service | Center Size | Unit of Service | Agency Rate | | --- | --- | --- | --- | | Adolescent Support Network | | Enrolled day | $26.75 | | Adult Companion | | 15 minutes | $9.75 | | Adult Companion Group Services Group of 2 | | 15 minutes | $4.88 | | Adult Companion Group Services Group of 3 | | 15 minutes | $3.25 | | After-school Respite | | Half day | $64.30 | | After-school Respite | | Full day | $110.58 | | Autism Support Center/Family Support Center | 0.5 | Month | $5,827.56 | | Autism Support Center/Family Support Center | 1 | Month | $11,655.12 | | Autism Support Center/Family Support Center | 1.5 | Month | $17,482.68 | | Autism Support Center/Family Support Center | 2 | Month | $23,310.25 | | Autism Support Center/Family Support Center | 2.5 | Month | $27,676.70 | | Autism Support Center/Family Support Center | 3 | Month | $32,540.52 | | Autism Support Center/Family Support Center | 3.5 | Month | $37,348.43 | | Autism Support Center/Family Support Center | 4 | Month | $42,098.18 | | Autism Support Center/Family Support Center | 4.5 | Month | $46,797.24 | | Autism Support Center/Family Support Center | 5 | Month | $51,462.55 | | Autism Support Center/Family Support Center | 5.5 | Month | $56,101.18 | | Autism Support Center/Family Support Center | 6 | Month | $60,854.56 | | Autism Support Center/Family Support Center | 6.5 | Month | $65,610.75 | | Autism Support Center/Family Support Center | 7 | Month | $70,322.03 | | Autism Support Center/Family Support Center | 7.5 | Month | $75,044.46 | | Autism Support Center/Family Support Center | 8 | Month | $79,686.55 | | Autism Support Center/Family Support Center | 8.5 | Month | $84,218.28 | | Autism Support Center/Family Support Center | 9 | Month | $88,710.24 | | Autism Support Center/Family Support Center | 9.5 | Month | $93,202.21 | | Autism Support Center/Family Support Center | 10 | Month | $97,659.00 | | Autism Support Center/Family Support Center | 10.5 | Month | $102,123.03 | | Autism Support Center/Family Support Center | 11 | Month | $106,569.56 | | Autism Support Center/Family Support Center | 11.5 | Month | $111,034.12 | | Autism Support Center/Family Support Center | 12 | Month | $115,507.30 | | Agency with Choice | - | N/A | IC | | Agency with Choice Admin Fee | - | Month | $375.74 | | Behavioral Support Services Bachelor's | - | 15 minutes | $20.92 | | Behavioral Support Services Master's | - | 15 minutes | $33.14 | | Behavioral Support Services PhD | - | 15 minutes | $41.95 | | Client Financial Assistance/Flex Funding | - | N/A | IC | | Client Financial Assistance/Flex Funding Administration | - | Transaction | $18.65 | | Community-based After-school Social and Recreation Programs | - | Group Hour | $42.38 | | Combined Hourly Services: | | | | | Nonclinical | - | Hour | $68.84 | | Clinical | - | Hour | $103.65 | | Comprehensive Services: | | | | | Model A-1 Direct Care - Nonclinical, Less Intensive | - | Enrolled day | $47.98 | | Model A-2 Direct Care - Nonclinical, More Intensive | - | Enrolled day | $72.54 | | Model B Direct Care and Clinical, Less Intensive | - | Enrolled day | $91.20 | | Model C Direct Care and Clinical, More Intensive | - | Enrolled day | $92.52 | | Model D Clinical | - | Enrolled day | $91.29 | | Model E Direct Care and Clinical High Intensive | - | Enrolled day | $132.37 | | Model F Direct Care and Clinical Highest Intensive | - | Enrolled day | $220.98 | | Model G Direct Care and Clinical Higher Intensive | - | Enrolled day | $163.54 | | Educational Coordination | - | Enrolled day | $22.66 | | Family Navigation | - | 15 minutes | $18.70 | | Family Resource Center | - | Month | $61,097 | | Micro Family Resource Center | - | Month | $24,785 | | Micro Family Resource Center Add-on | - | Month | $7,105 | | Family Resource Center Per Diem Add-on: Family Support Worker | - | Per Diem | $266.24 | | Family Resource Center Per Diem Add-on: Clinician (LCSW) | - | Per Diem | $372.56 | | Family Resource Center Per Diem Add-on: Clinician (LICSW) | - | Per Diem | $428.56 | | Family Resource Center Per Diem Add-on: Family Partner | - | Per Diem | $208.67 | | Family Resource Center Per Diem Add-on: School Liaison | - | Per Diem | $296.93 | | Family Training Groups: | | | | | Specialty Family Skills Development Program Model | - | Session | $2,952.38 | | Add-ons for a Specialty Family Skills Development Program Model: | | | | | Occupancy Purchase of Space | - | Session | $140.77 | | Family Skills Development Program Model | - | Session | $2,059.32 | | Add-ons for a Family Skills Development Program Model: | | | | | Facilitator/Coordinator | - | Session | $70.58 | | Meals | - | Session | $173.10 | | Child Care | - | Session | $49.91 | | Occupancy Purchase of Space | - | Session | $140.77 | | Transportation | - | Session | $168.94 | | Parent Skill Development Program Model | - | Session | $1,532.93 | | Add-ons for a Parent Skill Development Program Model: | | | | | Facilitator/Coordinator | - | Session | $70.58 | | Meals | - | Session | $173.10 | | Child Care | - | Session | $49.91 | | Occupancy Purchase of Space | - | Session | $140.77 | | Transportation | - | Session | $168.94 | | Family Training | - | 15 minutes | $13.25 | | Family Training Group of 2 | - | 15 minutes | $6.63 | | Family Training Group of 5 | - | 15 minutes | $2.65 | | Intensive Flexible Family Support Services | - | Enrolled day | $25.39 | | Medically Complex Programs | - | Month | $415.30 | | Peer Support | - | 15 minutes | $9.75 | | Peer Support Group of 2 | - | 15 minutes | $4.88 | | Peer Support Group of 5 | - | 15 minutes | $1.95 | | Planned Site-based Respite for Children | - | Day | $437.82 | | Planned Site-based Respite for Children, High-intensity Support Needs | - | Day | $569.44 | | Planned Site-based Respite for Children | - | 30 minutes | $27.37 | | Planned Site-based Respite for Children, High-intensity Support Needs | - | 30 minutes | $35.59 | | Respite in Caregiver's Home, Level 1 | - | Day | $145.19 | | Respite in Caregiver's Home, Level 2 | - | Day | $176.03 | | Respite in Caregiver's Home, Level 3 | - | Day | $206.86 | | Respite in Recipient's Home, 1:1 | - | 15 minutes | $9.75 | | Respite in Recipient's Home, 1:2 | - | 15 minutes | $4.88 | | Respite in Recipient's Home, 1:3 | - | 15 minutes | $3.25 | | Respite in Recipient's Home | - | Day | $351.00 | | Site-based Respite | - | Day | $302.19 | | Site-based Respite with Nursing | - | Day | $380.96 | | Unbundled Intensive Foster Care Special Support | - | Child day | $63.32 | | Family Navigation Administrative Service | - | Transaction | $40.87 |

(b) Flexible Support Services.

| Flexible Supports Service | Level | Hourly Rate | Monthly Rate 1.0 FTE | Monthly Rate 0.75 FTE | Monthly Rate 0.5 FTE | Monthly Rate 0.25 FTE | | --- | --- | --- | --- | --- | --- | --- | | Program Manager | 1 | N/A | $11,053 | $8,290 | $5,527 | $2,763 | | Program Manager | 2 | N/A | $10,719 | $8,040 | $5,360 | $2,680 | | Clinician | 1 | $113.71 | $9,637 | $7,228 | $4,819 | $2,409 | | Clinician | 2 | $132.53 | $11,232 | $8,424 | $5,616 | $2,808 | | Clinician | 3 | $167.89 | $13,389 | $10,042 | $6,694 | $3,347 | | Family Partner | 1 | $84.16 | $6,614 | $4,960 | $3,307 | $1,653 | | Family Partner | 2 | $103.76 | $8,154 | $6,115 | $4,077 | $2,038 | | Peer Mentor/Therapeutic Support Specialist | 1 | $80.69 | $6,435 | $4,826 | $3,218 | $1,609 | | Peer Mentor/Therapeutic Support Specialist | 2 | $100.00 | $7,975 | $5,982 | $3,988 | $1,994 | | Support Specialist | 1 | $80.69 | $6,435 | $4,826 | $3,218 | $1,609 |

History

Amended by Mass Register Issue 1272, eff. 10/24/2014.

101 CMR, § 414.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Amended by Mass Register Issue 1272, eff. 10/24/2014.

101 CMR, § 414.05 Severability

The provisions of 101 CMR 414.00 are severable. If any provision of 101 CMR 414.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 414.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1272, eff. 10/24/2014.

Rates for Community-based Day Support Services Rates for Community-based Day Support Services

101 CMR, § 415.01 General Provisions

(1) Scope. 101 CMR 415.00 governs the payment rates for community-based day support services that assist individuals to participate in community activities by improving communication, self-care, and relationship-building skills.

(2) Applicable Dates of Service. The rates contained in 101 CMR 415.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 415.00 is neither authorization for nor approval of the services for which the regulation establishes payment rates. Purchasing agencies are responsible for the definition, authorization, and approval of services as specified in a contract between the provider and the purchasing agency.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 415.00.

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 415.02 Definitions

As used in 101 CMR 415.00, unless the context requires otherwise, terms have the meanings in 101 CMR 415.02.

Active Treatment. Care and services to improve and/or maintain the client's quality of life in a nursing facility by promoting the optimal level of functioning that allows as much self-determination as possible and strives to prevent a regression of current optimal status.

Client. An individual who receives services purchased by a governmental unit.

Community-based Day Support Services (Services). Community-based day support services assist clients to build and maintain their ability to participate in community activities by focusing on skill areas that include communication, self-care, relationship-building, and community involvement.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Nursing Facility. An inpatient health-care facility with the staff and equipment to provide skilled care, rehabilitation, and other related health services to patients who need nursing care, but do not require hospitalization.

Provider. Any individual, group, partnership, trust, corporation, or other legal entity that contracts with a purchasing agency to provide community-based day support services.

Purchasing Agency. A governmental unit that purchases community-based day support services.

State Funding. The aggregate state fiscal year amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 415.00. State funding does not include any amounts attributable to federal funding or grant funds.

Workforce Initiatives. Funds directed to a provider for workforce development.

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 415.03 Rate Provisions

(1) Services Included in the Rate. The payment rates in 101 CMR 415.00 are payment for all services provided to a client by a provider, subject to the terms of the contract between the provider and the purchasing agency.

(2) Reimbursement as Full Payment. Each provider must, as a condition of acceptance of payment by a purchasing agency for services provided to a client, accept the payment rates established by 101 CMR 415.00 as full payment and discharge of all obligations for the services provided. The provider may not seek additional or supplemental payment from clients or other third parties for services for which rates are established by 101 CMR 415.00. If a provider receives any client funds or third-party payments for services provided to a client, the purchasing agency's obligation for services to the client will be offset by the amount received.

(3) Payment Limitations. Except as provided in 101 CMR 415.03(2), each purchasing agency pays for services at the rates established in 101 CMR 415.03(5).

(5) Approved Rates. The payment rate for services is based on the intensity level assigned to each client by the purchasing agency.

| Level | Unit | Rate | | --- | --- | --- | | A | 15 Minutes | $15.02 | | B | 15 Minutes | $8.62 | | C | 15 Minutes | $6.16 | | D | 15 Minutes | $5.28 | | I | 15 Minutes | $11.32 | | W | 15 Minutes | $7.01 |

| Active Treatment | Unit | Rate | | --- | --- | --- | | Adult Nursing Facility Active Treatment | 15 Minutes | $17.82 | | Pediatric Nursing Facility Active Treatment | 15 Minutes | $21.02 |

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 415.04 Filing and Reporting Requirements

(1) General Provisions.

(b) Examination of Records. Each provider must make available to EOHHS or purchasing agency upon request all records relating to its reported costs, including costs of any entity related by common ownership or control.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 415.05 Severability

The provisions of 101 CMR 415.00 are severable. If any provision of 101 CMR 415.00 or the application of any provision of 101 CMR 415.00 is held invalid or unconstitutional, such provision will not be construed to affect the validity or constitutionality of any other provision of 101 CMR 415.00 or the application of any other provision.

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

Rates For Clubhouse Services Rates For Clubhouse Services

101 CMR, § 416.01 General Provisions

(1) Scope. 101 CMR 416.00 governs the payment rates for clubhouse services purchased by a governmental unit.

(2) Applicable Dates of Services. Rates contained in 101 CMR 416.00 apply for dates of service provided on or after January 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 416.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 416.00. The governmental unit that purchases the services is responsible for the definition, authorization, and approval of services provided to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 416.00.

History

Adopted by Mass Register Issue 1314, eff. 6/3/2016.

101 CMR, § 416.02 Definitions

As used in 101 CMR 416.00, unless the context requires otherwise, terms have the meanings in 101 CMR 416.02.

Average Daily Attendance. A measure of the average number of clients served each day by a program. The average daily attendance is assigned to the program based on prior fiscal year attendance data.

Client. An adult for whom a governmental unit purchases clubhouse services.

Clubhouse Services. Services provided under a clubhouse program to individuals with behavioral and/or mental health issues, including employment, educational, social, and support services. Clubhouse services assist individuals to develop social networking, independent living, budgeting, self-care, and other skills that will assist them to live in the community and to secure and retain employment.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth.

Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers clubhouse services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been or may be adopted by a purchasing governmental unit.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Service Day. A service day is the unit of service used to bill the governmental unit. In general, a service day is a day during which an enrolled client either participates in a clubhouse services activity or activities related to a specific goal or objective documented in the client's Action Plan. The governmental unit will determine the specific events and conditions that qualify as billable activity. A provider can invoice only one unit of service per member per day.

State Funding. The aggregate state fiscal year amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 416.00. State funding does not include any amounts attributable to federal funding or grant funds.

Workforce Initiatives. Funds directed to a provider for workforce development.

History

Adopted by Mass Register Issue 1314, eff. 6/3/2016.

101 CMR, § 416.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of payment by any purchasing governmental unit, accept the approved rate as full payment and discharge of all obligations for the services rendered. Payment by the purchasing governmental unit for services rendered to the client will be reduced by the amount of any payment from any other source.

(3) Payment Limitations. No purchasing governmental unit may pay less than, or more than, the approved rate.

(4) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer, or the rate listed in 101 CMR 416.03(4).

| Club House Services Rates | Unit | Rate | | --- | --- | --- | | Average Daily Attendance of 29 and under | Per Service Day | $80.06 | | Average Daily Attendance of 30 through 70 | Per Service Day | $76.72 | | Average Daily Attendance of 71 and above | Per Service Day | $57.16 | | Program located in Nantucket or Dukes County | Per Service Day | $99.92 |

| Add-on Rates | Unit | Rate | | --- | --- | --- | | Workforce Initiatives | Annual | 2.9% of the Provider's FY18 State Funding | | Workforce Initiatives | Half-year | 1.45% of the Provider's FY18 State Funding |

History

Adopted by Mass Register Issue 1314, eff. 6/3/2016.

101 CMR, § 416.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1314, eff. 6/3/2016.

101 CMR, § 416.05 Severability

The provisions of 101 CMR 416.00 are severable. If any provision of 101 CMR 416.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 416.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1314, eff. 6/3/2016.

Rates For Certain Elder Care Services Rates For Certain Elder Care Services

101 CMR, § 417.01 General Provisions

(1) Scope. 101 CMR 417.00 governs the payment rates for certain elder care services provided to clients of the Executive Office of Elder Affairs (EOEA) by Aging Services Access Points (ASAPs) and other designated providers.

(2) Applicable Dates of Service. Rates contained in 101 CMR 417.00 apply for dates of service provided on or after January 1, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 417.00 is neither authorization for, nor approval of, the services for which rates are determined pursuant to 101 CMR 417.00. Governmental units that purchase ASAP services are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 417.00.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 417.02 Definitions

As used in 101 CMR 417.00, unless the context requires otherwise, terms have the meanings in 101 CMR 417.02.

Aging Services Access Points (ASAPs). One or more nonprofit agencies, one or more home care providers as defined in M.G.L. c. 19A, § 4(c), a combination of said home care corporations acting jointly, or a state agency that is/are designated by and under contract with EOEA to provide services for Medicaid community-based long-term care pursuant to an interagency agreement between EOEA and the Office of Medicaid. ASAPs contract with EOEA to purchase community-based long-term-care services for certain clients, provide protective services (and in some cases provide nutrition services), provide information and referral services, provide case management services, coordinate and authorize the delivery of home care program services, and provide clinical screening for nursing facility and community-based long-term-care services. Each agency is organized to plan, develop, and implement the coordination and delivery of community-based long-term-care services.

ASAP Services. Those functions that are performed by the ASAP according to the terms of an ASAP contract. The functions include screenings, interdisciplinary case management, protective services, information and referral, and, in cases in which the ASAP elects to provide rather than subcontract the function, nutrition services.

Client. A person who receives community-based long-term-care services purchased by a governmental unit.

Congregate Housing Services Coordination. Services provided to eligible seniors and adults with disabilities living in a multi-unit housing setting in which residents have a private bedroom or apartment and share living space; and in which a congregate coordinator evaluates applicants, arranges for community-based support services that residents may need, and provides living support and social activities.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Enhanced Community Options Program (ECOP) Direct Services. A program administered by ASAPs for frail elders who are clinically eligible for nursing facility services under MassHealth and who meet criteria set forth by EOEA. ECOP provides a broad range of community services for these elders to remain in the community that includes services available under the Home Care Program.

EOEA. The Executive Office of Elder Affairs, also known as the Department of Elder Affairs, established under M.G.L. c. 19A.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Guardianship Services. A legal service administered by EOEA by which the Probate and Family Court appoints a guardian and grants the guardian authority to care for and to make decisions on behalf of an incapacitated person.

Home Care Program Case Management Services. Services under the Basic Home Care and ECOP programs to coordinate a variety of homemaker and assisted daily living services within the client's home and community. Services are provided by Basic Home Care and ECOP case managers, based on the needs and acuity level of the client.

Home Care Program Direct Services. Home Care Program services include homemaker, personal care, laundry, home-delivered meals, chores, home health, transportation, social day care services, adult day health, dementia day care, adaptive housing, personal emergency response, grocery shopping/delivery, companion, emergency shelter, respite care, and other Home Care Program services as set forth in 651 CMR 3.01: Scope and Purpose . Service definitions and service standards are established by EOEA in 651 CMR 3.00: Home Care Program .

Incapacitated Person. An adult who has a clinically diagnosed medical condition that results in an inability to receive and evaluate information or make or communicate decisions about his or her everyday personal care, health, and safety, and who has been determined to be an incapacitated person by the Massachusetts Probate and Family Court.

Money Management Program. Services that assist low-income elders who have difficulty with money management or bill paying and, as a result, are vulnerable to financial exploitation, or are at serious risk due to an inability to meet critical needs. Services under this program include representative payee and bill payer services.

Protective Services (PS). A statewide system administered by EOEA to receive and investigate reports of elder abuse, including physical, emotional, and sexual abuse, neglect by a caregiver, self-neglect, and financial exploitation, and to provide protective services as necessary. Services are provided by designated (PS) agencies to respond to reports of elder abuse, to remedy or alleviate the abusive situation, and to prevent the recurrence of abuse.

Protective Services Central Intake Unit. A live data entry, protective services call center that takes an elder abuse report directly from a reporter and enters the information into the EOEA web based Protective Services Case Management System. An elder abuse report submitted directly by a reporter through the EOEA online reporting system does not constitute a Protective Services Intake for billing purposes.

Protective Services Intake. The ancillary service, provided by an ASAP, of taking an elder abuse report directly from a reporter and entering the information into the EOEA web based Protective Services Case Management System. An Elder abuse report submitted directly by a reporter through the EOEA online reporting system does not constitute a Protective Services Intake for billing purposes.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

State Funding. The aggregate state fiscal year amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 417.00. State funding does not include any amounts attributable to federal funding or grant funds.

Supportive Senior Housing. A program administered by EOEA to develop supportive senior housing in public housing with the goal of promoting independence and aging in place. Supportive senior housing services include service coordination, 24-hour emergency coverage on-site or on call, social activities, and at least one congregate meal per weekday.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 417.03 Rate Provisions

(1) Services Included in the Rate. The approved rate includes payment for all care and services that are part of the program of services of an eligible provider set forth in the terms of the purchase agreement between the eligible provider and the purchasing governmental unit(s).

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 417.03(4).

| Service | Unit | Rate | | --- | --- | --- | | Enhanced Community Options Program (ECOP) Direct Services | Per client per month | $1,025.12 | | Home Care Program Services Direct Services | Per client per month | $457.41 | | Congregate Housing Services Coordination | Per client per month | $339.48 | | Central Intake and Assessment Program | Per client report | $78.37 | | Basic Home Care Case Management | Per client per month | $194.91 | | ECOP Case Management | Per client per month | $346.01 | | Protective Services | Per client per month | $605.86 | | Protective Services Intake | Per protective service report | $85.24 | | Supportive Senior Housing | Per site per month | $16,086 | | Money Management Services | Per client per month | $138.48 | | Guardianship Services | Per client per month | $892.78 |

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 417.04 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS will be certified under pains and penalties of perjury as true, correct, and accurate by the executive director or chief financial officer of the provider.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 417.05 Severability

The provisions of 101 CMR 417.00 are severable. If any provision of 101 CMR 417.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 417.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

Payments For Youth Short-Term Stabilization and Emergency Placement Services Payments For Youth Short-Term Stabilization and Emergency Placement Services

101 CMR, § 418.01 General Provisions

(1) Scope. 101 CMR 418.00 governs the payment rates for youth short-term stabilization and emergency placement services provided to clients of governmental units under the jurisdiction of the Executive Office of Health and Human Services (EOHHS).

(2) Disclaimer of Authorization of Services. 101 CMR 418.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 418.00. Governmental units that purchase the services described in 101 CMR 418.00 are responsible for the definition, authorization, and approval of services extended to clients.

(3) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 418.00.

(4) Applicable Dates of Service. Rates contained in 101 CMR 418.00 apply for dates of service provided on or after October 1, 2024.

History

Amended by Mass Register Issue 1273, eff. 11/7/2014.

101 CMR, § 418.02 Definitions

As used in 101 CMR 418.00, unless the context requires otherwise, terms have the meanings in 101 CMR 418.02.

Client. A child, adolescent, or young adult receiving youth short-term stabilization and emergency placement services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Full-time Equivalent (FTE). Staff position equivalent to a full-time employee.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth.

Per Diem. Service unit based on a 24-hour period of care.

Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers youth short-term stabilization and emergency placement services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been or may be adopted by a purchasing governmental unit.

Staffing Support. The additional staff members, with positions ranging from clinical to direct care and including varying levels of support staff from food services to secure transporters, who supplement DYS staff within the state-operated residential programs. The purchasing agency provides specific definitions for each position.

Utilization. The proportion of a program's capacity that is filled by clients on a regularly measured basis, expressed as a percentage.

Youth and Transition Age Youth Detoxification and Stabilization Programs. A short-term (generally less than 45 days) 24-hour addiction treatment program for adolescents or transition age youth who abuse or are dependent on alcohol or drugs, which may be accompanied by mental health issues. These programs provide stabilization/detoxification services for males and females 13 through 17, and 16 through 20 years of age. Services provide gender-specific medical, psychological, and behavioral stabilization; biopsychosocial assessment; treatment planning; referral to appropriate treatment and support services; and follow-up for the adolescents.

Youth Short-term Stabilization and Emergency Placement. Programs that provide a child or adolescent a place of overnight housing in a specialized residential setting for a short-term period, generally less than 45 days, to promote stabilization, determine appropriate long-term placement, or provide integration and ongoing services.

History

Amended by Mass Register Issue 1273, eff. 11/7/2014.

101 CMR, § 418.03 Rate Provisions

(3) Payment Limitations. Except as provided in 101 CMR 418.03(2), (4) and (5), each purchasing governmental unit pays for services at the rates established in 101 CMR 418.03(4).

(4) Approved Rates. The rates set forth in 101 CMR 418.03(4) govern payments for services provided pursuant to contracts executed under the FY 2013 or subsequent procurements of the governmental unit procuring the service. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed below.

RATES FOR STAFFING SUPPORT

| Positions | Per Diem Rate | Hourly Rate | 30-Minute Rate | | --- | --- | --- | --- | | Clinical Director | $557.68 | N/A | N/A | | Clinical (LICSW) | $441.55 | N/A | N/A | | Clinical (MA Level) | $352.40 | N/A | N/A | | Direct Care III | $339.56 | $38.49 | $19.25 | | Direct Care Staff | $261.22 | $29.61 | $14.81 | | Maintenance I General | $246.99 | $28.00 | $14.00 | | Maintenance II Skilled | $305.95 | $34.68 | $17.34 | | Maintenance III Licensed | $344.38 | $39.04 | $19.52 | | Food Service I | $261.22 | $29.61 | $14.81 | | Food Service II | $300.39 | $34.05 | $17.03 | | Food Service III | $339.56 | $38.49 | $19.25 | | Transporter | $261.22 | $29.61 | $14.81 | | Security | $261.22 | $29.61 | $14.81 | | Trainer | $339.56 | $38.49 | $19.25 | | Clerical Support | $261.22 | $29.61 | $14.81 |

RATES FOR YOUTH AND TRANSITION AGE YOUTH DETOXIFICATION AND STABILIZATION PROGRAMS

| Capacity | Per Diem Rate | | --- | --- | | 12 Beds | $775.85 |

(5) Administrative Adjustment for Extraordinary Circumstances. A purchasing governmental unit may request an adjustment to the published rates to reflect increases in per diem operating costs due to unusual and unforeseen circumstances or extraordinary client service requirements not considered in the development of the current rates. Unusual and unforeseen circumstances are events of a serious nature that affect program operations or viability to the extent that there exists a threat to the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit evaluates the need for the administrative adjustment, identifies the duration of the need, determines whether funding is available, and conveys that information to EOHHS for review to determine the amount of any adjustment.

History

Amended by Mass Register Issue 1273, eff. 11/7/2014.

101 CMR, § 418.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Amended by Mass Register Issue 1273, eff. 11/7/2014.

101 CMR, § 418.05 Severability

The provisions of 101 CMR 418.00 are severable. If any provision of 101 CMR 418.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 418.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1273, eff. 11/7/2014.

Rates For Supported Employment Services Rates For Supported Employment Services

101 CMR, § 419.01 General Provisions

(1) Scope. 101 CMR 419.00 governs the payment rates for supported employment services purchased by a governmental unit. Supported employment services provide individual and group employment in the community for clients that require provider support and/or supervision.

(2) Applicable Dates of Service. The rates contained in 101 CMR 419.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 419.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 419.00. Governmental units that purchase supported employment services are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 419.00.

History

Amended by Mass Register Issue 1306, eff. 2/12/2016.

101 CMR, § 419.02 Definitions

As used in 101 CMR 419.00, unless the context requires otherwise, terms have the meanings in 101 CMR 419.02.

Client. A person who receives supported employment services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Enhanced Staffing Rates for Higher Intensity Clients. These rates allow, under certain circumstances and based on assessed need, the targeted provision of one-to-one or one-to-three staffing ratio supports to individual program participants who require more staffing than the base rate provides in group supported employment services. These rates are not intended to be used to address typical program need fluctuations.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Group Supported Employment Services. Supports provided to a small group of clients working in a competitive environment, usually not at the provider site. The clients are usually employees of the provider agency and are often paid and receive benefits from that provider. These services emphasize work in integrated environments and may include small groups in industry (also called enclaves), mobile work crews, and provider-run businesses.

High-intensity/Specialized Program Rates. These rates are restricted in use for exceptional purposes for certain high-intensity programs supporting specialty populations receiving group supported employment services. These rates apply only in cases in which it is determined that programs require significant additional supervisory resources, staff with higher skill levels and qualifications, increased staffing ratios, and specialized consulting and/or clinical supports. Examples may include programs supporting individuals with forensic involvement or serious behavioral issues.

Individual Supported Employment Services. Supports provided to a client on a one-to-one basis to assist the client to obtain and maintain a job at a business in the community. The client is hired and paid by the employer at competitive wages. These services may include assessment, career planning, skills training, job development and placement, job coaching at the job site, and ongoing supportive services to assist the client to successfully maintain employment.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Supported Employment Services. Services that provide assistance to individuals or groups of individuals to help them prepare for, acquire, and maintain integrated employment in the community for clients that require provider support and/or supervision.

Transportation to Individual Job Sites. This service applies to individuals in individual supported employment services who are working at a business in the community and require ongoing rides/transportation from the provider to their job to maintain their employment, and are not able to transport themselves to and from work successfully. This service must be used only after all other public, para-transit, and private transportation options have been pursued.

History

Amended by Mass Register Issue 1306, eff. 2/12/2016.

101 CMR, § 419.03 Rate Provisions

(1) Services Included in the Rate. The approved rate includes payment for all care and services that are part of the program of services of a provider, as explicitly set forth in the terms of the purchase agreement between the provider and the purchasing governmental unit(s).

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate except as authorized by 101 CMR 419.03(2).

(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 419.03(5). Providers must bill for services in 15-minute units.

| Base Service | Rate (15 mins) per Client | | --- | --- | | Individual Supported Employment ($65.48 hourly) | $16.37 | | Ongoing Individual Supported Employment ($48.36 hourly) | $12.09 | | Group Supported Employment ($23.52 hourly) | $5.88 | | High-intensity Service/Specialized Program Rates | Rate (15 mins) per Client | | High-intensity Group Supported Employment ($30.96 hourly) $7.74 | | | Add-on Services | Rate (15 mins) per Client | | Direct Care ($26.08 hourly) | $6.52 | | Direct Care III ($33.28 hourly) | $8.32 | | Transportation to Individual Job Sites | Rate (15 mins) per Client | | Travel to and from ISE job sites up to one hour ($36.12 hourly) $9.03 | | | Enhanced Staffing for Higher Intensity Clients (Combined Add-on and Base Service Rates) | Rate (15 mins) per Client | | 1:1 Group Supported Employment ($49.04 hourly) | $12.26 | | 1:3 Group Supported Employment ($32.04 hourly) | $8.01 |

History

Amended by Mass Register Issue 1306, eff. 2/12/2016.

101 CMR, § 419.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Amended by Mass Register Issue 1306, eff. 2/12/2016.

101 CMR, § 419.05 Severability

The provisions of 101 CMR 419.00 are severable. If any provision of 101 CMR 419.00 or application of such provision to any provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 419.00 or application of such provisions to any provider or fiscal intermediary in circumstances other than those held invalid.

History

Amended by Mass Register Issue 1306, eff. 2/12/2016.

Rates for Adult Long-term Residential Services Rates for Adult Long-term Residential Services

101 CMR, § 420.01 General Provisions

(1) Scope. 101 CMR 420.00 governs the payment rates for adult long-term residential (ALTR) services purchased by a governmental unit including, but not limited to, the Department of Developmental Services (DDS), the Massachusetts Commission for the Blind (MCB), and the Massachusetts Rehabilitation Commission (MRC).

(2) Applicable Dates of Service. Rates are applicable for dates of service on and after July 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 420.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 420.00. Governmental units that purchase the services described in 101 CMR 420.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 420.00.

History

Amended by Mass Register Issue 1316, eff. 7/1/2016.

101 CMR, § 420.02 Definitions

As used in 101 CMR 420.00, unless the context requires otherwise, terms have the meanings in 101 CMR 420.02.

ALTR Services. Residential site-specific programs that provide adult clients a place of overnight housing for an extended period in a residential facility with necessary daily living, physical, social, and clinical and/or medical support, and that are not subject to licensure under M.G.L. c. 111, § 71.

Basic. The category of ALTR service models for clients who need daily intervention, supervision, and skills training in activities of daily living, managing within a home environment, and community integration. Individuals may require some physical assistance or accommodation due to cognitive and/or intellectual disability, including a mild-to-moderate developmental delay.

Client. An individual receiving ALTR services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Direct Care (DC) Staff Intensity Level. The number of full-time equivalent (FTE) positions for direct care staff included in each program model. The DC staff intensity level reflects the sum of the FTEs for direct care workers, including overnight staffs.

Emergency Stabilization Residence. This service provides temporary, flexible, and individualized services to adults in a facility or home-like environment. The program is designed for adults who are not able to be stabilized in their current family home or residential program due to behavioral, mental health, or other care issues. The program is available 24 hours a day/seven days a week. Provider billing for Emergency Stabilization Residence services utilizing rates under 101 CMR 420.00 is pursuant to contract with the purchasing governmental unit and for dates of service on or after July 1, 2016.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Full-time Equivalent (FTE). Staff position equivalent to a full-time employee.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Intermediate. The category of ALTR service models designed to meet the needs of clients with support need beyond the basic level. These program models include specialized staffing, training or additional skills for staff, and/or additional operational support when compared to basic. The selection of intermediate tier programs is based on client need for behavioral supports, enhanced supervision, or interventions designed to address multiple disabilities.

Medical/Clinical. The category of ALTR service models that delivers additional supports, when compared to the intermediate models, through the utilization of direct nursing services and highly experienced or credentialed direct care staff. At the discretion of the purchasing governmental unit, medical/clinical level 1 may alternatively reflect programs where specialized behavioral/ clinical staff constitute a significant portion of the total staffing pattern. The intermediate models are used as the foundation for all medical models. For each intermediate model, there are three associated medical models, each reflecting the additional direct nursing resources available for the site.

| Model Type | Model Nursing % | Eligible Nursing % | | --- | --- | --- | | Medical/Clinical Level 1 | 25 | 20-29 | | Medical Level 2 | 35 | 30-39 | | Medical Level 3 | 45 | 40+ |

New Program/Replacement Rate. Rate for a new program site or replacement of an existing site.

Program Per Diem. Program service unit based on a 24-hour period of care.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the UFR.

Service Model Rate. A rate that includes the programmatic resources to provide the client focused direct care and support services, including consultants, materials and supplies, and administrative services attributed to the service portion of the program. It does not include the resources for provision of the physical space associated with the program and included in the site rate.

Site Rate. A rate established by the purchasing governmental unit for the provision of the physical site housing the ALTR program, which may include, but is not limited to, lease or rental payments, depreciation, interest associated with long-term debt, insurance on buildings, maintenance, electricity, heat, water, and meals. Lease payments to related parties must not exceed the cost of what the provider would pay if the provider directly owned the property.

Site Unit Cost. The result of dividing the total annualized cost of a program's physical site for the period from July 1, 2011 through June 30, 2012, by the product of the capacity times 365. The purchasing governmental unit will determine the total annualized cost of a program's physical site based on applicable line items in the UFR as determined by the purchasing governmental unit, and may approve adjustments to the site unit cost for unanticipated circumstances as determined by the purchasing governmental unit.

Specialized Behavioral. The category of ALTR service models that delivers additional supports, when compared to the intermediate models, by using specialized behavioral staff. The selection of this program is based on client need for behavioral supports, enhanced supervision, or interventions designed to address multiple, complex behavioral needs by using highly experienced or credentialed interdisciplinary teams.

History

Amended by Mass Register Issue 1316, eff. 7/1/2016.

101 CMR, § 420.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate, except as cited in 101 CMR 420.03.

(4) Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. Providers must demonstrate that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(5) Blended Contract Rate Calculation. Purchasing governmental units may pay a blended contract rate for the purchase of two or more ALTR programs. The blended rate will be calculated according to the following formula: Sum of {[( Per Diem rate for Program Model 1)(Units purchased of Program Model 1)(Number of clients purchased in Program 1) / (Total number of clients in Program 1)], [( Per Diem rate for Program Model 2)(Units purchased of Program Model 2) * (Number of clients purchased in Program 2) / (Total number of clients in Program 2)], [( Per Diem rate for Program Model 3)(Units purchased of Program Model 3) * (Number of clients purchased in Program 3) / (Total number of clients in Program 3)],..., [Total funding for Add-ons]} Divided by the [(Sum of the Units purchased)*(Count of clients)] for all programs in the contract.

(6) Service Model Naming Convention. 101 CMR 420.03(6)(a) and (b) describe the naming convention for the service models as listed in the rate tables.

(a) Basic and Intermediate. The name of each service model rate consists of six characters. The first character represents the category of the service tier, "B" for basic, and "I" for intermediate. The second through fifth characters describe the number of direct care FTEs associated with the model. The sixth character represents the capacity range for the model. Capacity 1 models are represented with "A," capacity 2-3 models are represented with "B," and capacity 4+ models are represented with "C". Example: I06.5B describes an intermediate, 6.5 FTE program with capacity of 2 or 3.

(b) Medical/Clinical. The name of each medical/clinical service model rate consists of seven characters. The first character, "M," represents the medical/clinical service tier. The second through fifth characters describe the number of direct care FTEs associated with the model. The sixth character represents the capacity range for the model. Capacity 1 models are represented with "A," capacity 2-3 models are represented with "B," and capacity 4+ models are represented with "C". The seventh character represents the level of incremental resources contained in the medical/clinical service model. Example: M10.5C2 represents a medical level 2 program with 10.5 FTEs and a capacity of four or more.

(7) Programs Located outside the Commonwealth of Massachusetts.

(a) If an ALTR is located outside of the Commonwealth of Massachusetts in a state that has an established state rate or price setting mechanism the purchasing governmental unit will pay for the service using the rate established, authorized, or approved by the state in which the program is located, provided that the rate is the lowest charged by a provider for the program. If the requested rate is not the lowest charged by the provider for the program, the provider must identify and document the amount of the lowest rate charged, which will then be used by the purchasing governmental unit to pay for services. In order for the purchasing governmental unit to pay this rate, the following must be submitted to the purchasing governmental unit by the provider:

a certification from the provider that the rate requested to be authorized is the lowest charged by the provider for the program; and
a copy of the rate authorization or approval by the state in which the program is located, including the effective dates of the rate.

(b) If an ALTR service is located outside the Commonwealth of Massachusetts in a state where there is no established state rate or price setting mechanism, the purchasing governmental unit will pay for the service using the rates set forth in 101 CMR 420.03(8).

(8) Approved Rates. The rates set forth in 101 CMR 420.03(8) govern the payment rates for services purchased by a governmental unit. The approved rate will be the lower of the provider's charge or amount accepted as payment from another payer or the rate listed.

(a) Per Diem Service Model Program Rates.

| 1 Capacity Site | | | | --- | --- | --- | | FTE | Basic Level | Intermediate Level | | 3 | $767.36 | $775.51 | | 3.5 | - | $879.82 | | 4 | - | $984.13 | | 4.5 | - | $1,088.44 | | 5 | - | $1,192.75 | | 5.5 | - | $1,297.06 | | 6 | - | $1,401.37 | | 6.5 | - | $1,505.68 | | 7 | - | $1,608.20 |

| 2-3 Capacity Site | | | | | | | | --- | --- | --- | --- | --- | --- | --- | | FTE | Basic Level | Intermediate Level | Medical 1 | Medical 2 | Medical 3 | Specialized Behavioral | | 3 | - | - | - | - | - | - | | 3.5 | $1,029.16 | $1,065.13 | $1,146.64 | $1,178.86 | $1,222.55 | $1,571.31 | | 4 | $1,130.92 | $1,169.44 | $1,270.40 | $1,310.32 | $1,364.43 | $1,713.79 | | 4.5 | $1,232.67 | $1,273.75 | $1,394.16 | $1,441.77 | $1,506.31 | $1,856.27 | | 5 | $1,334.43 | $1,378.06 | $1,517.93 | $1,573.23 | $1,648.20 | $2,001.17 | | 5.5 | $1,436.18 | $1,482.38 | $1,641.69 | $1,704.68 | $1,790.08 | $2,143.66 | | 6 | $1,537.94 | $1,586.69 | $1,765.45 | $1,836.14 | $1,931.96 | $2,286.14 | | 6.5 | $1,639.69 | $1,691.00 | $1,889.22 | $1,967.59 | $2,073.84 | $2,428.62 | | 7 | $1,739.69 | $1,793.51 | $2,010.84 | $2,096.78 | $2,213.28 | $2,573.52 | | 7.5 | $1,841.45 | $1,897.82 | $2,134.61 | $2,228.24 | $2,355.16 | $2,716.01 | | 8 | $1,943.20 | $2,002.13 | $2,258.37 | $2,359.69 | $2,497.05 | $2,858.49 | | 8.5 | $2,044.96 | $2,106.44 | $2,382.13 | $2,491.15 | $2,638.93 | $3,000.98 | | 9 | $2,146.71 | $2,210.75 | $2,505.90 | $2,622.60 | $2,780.81 | $3,145.87 | | 9.5 | - | $2,315.06 | $2,629.66 | $2,754.06 | $2,922.69 | $3,288.36 | | 10 | - | $2,419.37 | $2,753.42 | $2,885.51 | $3,064.57 | $3,430.84 | | 10.5 | - | $2,523.68 | $2,877.19 | $3,016.97 | $3,206.46 | $3,573.33 | | 11 | - | $2,627.99 | $3,000.95 | $3,148.42 | $3,348.34 | $3,718.22 |

| 4+ Capacity Site | | | | | | | | --- | --- | --- | --- | --- | --- | --- | | FTE | Basic Level | Intermediate Level | Medical 1 | Medical 2 | Medical 3 | Specialized Behavioral | | 3 | - | - | - | - | - | - | | 3.5 | $1,212.72 | | - | - | - | - | | 04 | $1,314.48 | $1,365.75 | - | - | - | - | | 4.5 | $1,416.23 | $1,470.06 | - | - | - | - | | 5 | $1,517.99 | $1,574.37 | - | - | - | - | | 5.5 | $1,619.74 | $1,678.68 | - | - | - | - | | 6 | $1,721.50 | $1,782.99 | $1,961.75 | $2,032.44 | $2,128.26 | $2,485.65 | | 6.5 | $1,823.25 | $1,887.30 | $2,085.52 | $2,163.89 | $2,270.15 | $2,628.13 | | 7 | $1,923.25 | $1,989.81 | $2,207.15 | $2,293.08 | $2,409.58 | $2,773.03 | | 7.5 | $2,025.01 | $2,094.12 | $2,330.91 | $2,424.54 | $2,551.46 | $2,915.52 | | 8 | $2,126.76 | $2,198.43 | $2,454.67 | $2,555.99 | $2,693.35 | $3,058.00 | | 8.5 | $2,228.52 | $2,302.74 | $2,578.44 | $2,687.45 | $2,835.23 | $3,200.49 | | 9 | $2,330.27 | $2,407.05 | $2,702.20 | $2,818.90 | $2,977.11 | $3,345.38 | | 9.5 | $2,432.03 | $2,511.36 | $2,825.96 | $2,950.36 | $3,118.99 | $3,487.87 | | 10 | $2,533.78 | $2,615.67 | $2,949.73 | $3,081.81 | $3,260.88 | $3,630.35 | | 10.5 | $2,635.54 | $2,719.98 | $3,073.49 | $3,213.27 | $3,402.76 | $3,772.84 | | 11 | $2,737.29 | $2,824.29 | $3,197.25 | $3,344.72 | $3,544.64 | $3,917.74 | | 11.5 | $2,839.05 | $2,928.60 | $3,321.02 | $3,476.18 | $3,686.52 | $4,060.22 | | 12 | $2,939.05 | $3,031.11 | $3,442.64 | $3,605.37 | $3,825.96 | $4,202.70 | | 12.5 | $3,040.81 | $3,135.42 | $3,566.41 | $3,736.82 | $3,967.84 | $4,345.19 | | 13 | - | $3,239.73 | $3,690.17 | $3,868.28 | $4,109.73 | $4,490.09 | | 13.5 | - | $3,344.04 | $3,813.93 | $3,999.73 | $4,251.61 | $4,632.57 | | 14 | - | $3,448.35 | $3,937.70 | $4,131.19 | $4,393.49 | $4,775.05 | | 14.5 | - | $3,552.66 | $4,061.46 | $4,262.64 | $4,535.37 | $4,917.54 | | 15 | - | $3,656.97 | $4,185.22 | $4,394.10 | $4,677.25 | $5,062.44 | | 15.5 | - | $3,761.28 | $4,308.99 | $4,525.55 | $4,819.14 | $5,204.92 |

(b) Add-on Rates.

| Category | Unit | Rate | | --- | --- | --- | | Direct Care | Hour | $27.85 | | Direct Care | Day | $222.80 | | Direct Care (Intermediate/Medical) | Hour | $28.78 | | Direct Care (Intermediate/Medical) | Day | $230.24 | | Certified Nurse Assistant (CNA) | Hour | $27.85 | | Licensed Practical Nurse (LPN) | Hour | $48.76 | | Registered Nurse (RN) | Hour | $75.92 | | Clinician (LICSW) | Hour | $59.84 | | Clinical Psychologist | Hour | $56.45 | | Psychologist/Psychiatrist (PhD Level) | Hour | $145.05 |

| Vehicle Add-on | Per Day | Per Month | | --- | --- | --- | | Sedan | $37.20 | $1,131.49 | | Minivan | $50.20 | $1,526.68 | | Van | $61.97 | $1,884.92 | | Wheelchair Van | $82.05 | $2,495.83 |

| Vehicle Upgrade | Per Day | Per Month | | --- | --- | --- | | Sedan to Minivan | $13.00 | $395.40 | | Sedan to Van | $24.77 | $753.44 | | Sedan to Wheelchair Van | $44.85 | $1,364.35 | | Minivan to Van | $11.77 | $358.04 | | Minivan to Wheelchair Van | $31.85 | $968.95 | | Van to Wheelchair Van | $20.08 | $610.91 |

| Remote Direct Supports | Per Hour | | --- | --- | | Remote Direct Supports | $20.15 |

Site Rates for Programs Operating Prior to July 1, 2014. The table in 101 CMR 420.03(8)(c) lists per diem site unit cost ranges and the corresponding per diem site rate.

| Occupancy Rate Index | Site Unit Cost Range | Per Diem Site Rate | | --- | --- | --- | | 01 | $0.01 - $3.84 | $3.90 | | 02 | $3.85 - $8.30 | $8.42 | | 03 | $8.31 - $12.76 | $12.72 | | 04 | $12.77 - $17.22 | $17.64 | | 05 | $17.23 - $21.68 | $22.14 | | 06 | $21.69 - $26.15 | $27.12 | | 07 | $26.16 - $30.60 | $31.92 | | 08 | $30.61 - $35.07 | $36.54 | | 09 | $35.08 - $39.52 | $41.28 | | 10 | $39.53 - $43.98 | $45.98 | | 11 | $43.99 - $48.44 | $51.07 | | 12 | $48.45 - $52.90 | $56.20 | | 13 | $52.91 - $57.36 | $60.82 | | 14 | $57.37 - $61.82 | $65.69 | | 15 | $61.83 - $66.28 | $69.04 | | 16 | $66.29 - $70.74 | $75.02 | | 17 | $70.75 - $75.20 | $80.27 | | 18 | $75.21 - $79.66 | $84.99 | | 19 | $79.67 - $84.12 | $90.38 | | 20 | $84.13 - $88.58 | $95.61 | | 21 | $88.59 - $94.15 | $100.89 | | 22 | $94.16 - $99.73 | $106.10 | | 23 | $99.74 - $103.07 | $109.75 | | 24 | $103.08 - $107.53 | $114.69 | | 25 | $107.54 - $111.99 | $119.79 | | 26 | $112.00 - $116.45 | $124.74 | | 27 | $116.46 - $120.91 | $129.68 | | 28 | $120.92 - $125.37 | $134.64 | | 29 | $125.38 - $129.83 | $139.59 | | 30 | $129.84 - $134.29 | $144.54 | | 31 | $134.30 - $138.75 | $149.49 | | 32 | $138.76 - $143.21 | $154.45 | | 33 | $143.22 + | $160.10 |

New Program Site or Current Site Replacement Rate.

a. A site rate for a new or replacement residence, based on the particular needs of the individuals proposed for placement at the site, will be established using the Application for New Site Occupancy, or other such process as determined by the purchasing governmental unit. The application must include the provider's best estimates of site-specific costs and must be supported by available documentation. Costs may be subject to reasonable limits as determined by the purchasing governmental unit. A food allowance of $9.15 per resident per day will be included as an occupancy expense for each new or replacement residence. The application will be subject to audit and verification by the purchasing governmental unit to ensure the application data is accurate. The purchasing governmental unit may require the provider to return any excess funding received through this provision. New site occupancy rates established by the Executive Office of Health and Human Services and the purchasing governmental units during the period of July 1, 2014 through June 30, 2022, will continue at the rates established by the New Site Occupancy process effective during that period, but may be subject to adjustments for extenuating circumstances as determined by the purchasing governmental unit.

b. The maximum per person/per month rates for new program sites or replacement sites for each region as defined in 101 CMR 420.03(9) are as follows.

| Region | Maximum Allowable Rate Index | Maximum Allowable Monthly Rate | Unit | | --- | --- | --- | --- | | Central/West | 15 | $2,100 | per person per month | | Southeast | 16 | $2,282 | per person per month | | Northeast | 16 | $2,282 | per person per month | | Metro Boston | 17 | $2,442 | per person per month |

c. The maximum per person/per month rate for new program or replacement sites that serve individuals with acquired brain injury, or sites that are medically intensive, as determined by the purchasing governmental unit, is $2,908.

d. The maximum per person per month rate for new program or replacement sites that serve individuals in sites designated as behaviorally intensive, as determined by the purchasing governmental unit, is $2,908, that is, rate index 20.

e. Exceptions to the maximum allowable rate for new program sites or replacement sites established pursuant to 101 CMR 420.03(8)(c)2.b. may be granted by the purchasing governmental unit to new or replacement sites where the site developer has applied to receive Facility Consolidation Funding administered through the Community Economic Development Assistance Corporation. The purchasing governmental unit may issue guidance by bulletin or other written issuance to clarify its application of exceptions made in accordance with 101 CMR 420.03(8)(c)2.e.

(9) Geographic Regions for New Program or Current Replacement Site Rates.

(a) Metro Boston: Ashland, Belmont, Boston, Brookline, Cambridge, Canton, Chelsea, Dedham, Dover, Foxborough, Framingham, Holliston, Hopkinton, Hudson, Marlborough, Medfield, Millis, Natick, Needham, Newton, Norfolk, Northborough, Norwood, Plainville, Revere, Sharon, Sherborn, Somerville, Southborough, Sudbury, Walpole, Waltham, Watertown, Wayland, Wellesley, Westborough, Weston, Westwood, Winthrop, Wrentham.

(b) Southeast: Abington, Acushnet, Aquinnah, Attleboro, Avon, Barnstable, Berkley, Bourne, Braintree, Brewster, Bridgewater, Brockton, Carver, Chatham, Chilmark, Cohasset, Dartmouth, Dennis, Dighton, Duxbury, East Bridgewater, Eastham, Easton, Edgartown, Fairhaven, Fall River, Falmouth, Freetown, Gosnold, Halifax, Hanover, Hanson, Harwich, Hingham, Holbrook, Hull, Kingston, Lakeville, Mansfield, Marion, Marshfield, Mashpee, Mattapoisett, Middleborough, Milton, Nantucket, New Bedford, North Attleborough, Norton, Norwell, Oak Bluffs, Orleans, Pembroke, Plymouth, Plympton, Provincetown, Quincy, Randolph, Raynham, Rehoboth, Rochester, Rockland, Sandwich, Scituate, Seekonk, Somerset, Stoughton, Swansea, Taunton, Tisbury, Truro, Wareham, Wellfleet, West Bridgewater, West Tisbury, Westport, Weymouth, Whitman, Yarmouth.

(c) Northeast: Acton, Amesbury, Andover, Arlington, Bedford, Beverly, Billerica, Boxborough, Boxford, Burlington, Carlisle, Chelmsford, Concord, Danvers, Dracut, Dunstable, Essex, Everett, Georgetown, Gloucester, Groveland, Hamilton, Haverhill, Ipswich, Lawrence, Lexington, Lincoln, Littleton, Lowell, Lynn, Lynnfield, Malden, Manchester by the Sea, Marblehead, Maynard, Medford, Melrose, Merrimac, Methuen, Middleton, Nahant, Newbury, Newburyport, North Andover, North Reading, Peabody, Reading, Rockport, Rowley, Salem, Salisbury, Saugus, Stoneham, Stow, Swampscott, Tewksbury, Topsfield, Tyngsborough, Wakefield, Wenham, West Newbury, Westford, Wilmington, Winchester, Woburn.

(d) Central/West: Adams, Agawam, Alford, Amherst, Ashburnham, Ashby, Ashfield, Athol, Auburn, Ayer, Barre, Becket, Belchertown, Bellingham, Berlin, Bernardston, Blackstone, Blandford, Boylston, Brimfield, Brookfield, Buckland, Charlemont, Charlton, Cheshire, Chester, Chesterfield, Chicopee, Clarksburg, Clinton, Colrain, Conway, Cummington, Dalton, Bolton, Deerfield, Douglas, Dudley, East Brookfield, East Longmeadow, Easthampton, Egremont, Erving, Fitchburg, Florida, Franklin, Gardner, Gill, Goshen, Grafton, Granby, Granville, Great Barrington, Greenfield, Groton, Hadley, Hampden, Hancock, Hardwick, Harvard, Hatfield, Hawley, Heath, Hinsdale, Holden, Holland, Holyoke, Hopedale, Hubbardston, Huntington, Lancaster, Lanesborough, Lee, Leicester, Lenox, Leominster, Leverett, Leyden, Longmeadow, Ludlow, Lunenburg, Medway, Mendon, Middlefield, Milford, Millbury, Millville, Monroe, Monson, Montague, Monterey, Montgomery, Mount Washington, New Ashford, New Braintree, New Marlborough, New Salem, North Adams, North Brookfield, Northampton, Northbridge, Northfield, Oakham, Orange, Otis, Oxford, Palmer, Paxton, Pelham, Pepperell, Peru, Petersham, Phillipston, Pittsfield, Plainfield, Princeton, Richmond, Rowe, Royalston, Russell, Rutland, Sandisfield, Savoy, Sheffield, Shelburne, Shirley, Shrewsbury, Shutesbury, South Hadley, Southampton, Southbridge, Southwick, Spencer, Springfield, Sterling, Stockbridge, Sturbridge, Sunderland, Sutton, Templeton, Tolland, Townsend, Tyringham, Upton, Uxbridge, Wales, Ware, Warren, Warwick, Washington, Webster, Wendell, West Boylston, West Brookfield, West Springfield, West Stockbridge, Westfield, Westhampton, Westminster, Whately, Wilbraham, Williamsburg, Williamstown, Winchendon, Windsor, Worcester, Worthington.

History

Amended by Mass Register Issue 1316, eff. 7/1/2016.

101 CMR, § 420.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(a) an annual UFR completed in accordance with the filing requirements of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services ;

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Amended by Mass Register Issue 1316, eff. 7/1/2016.

101 CMR, § 420.05 Severability

The provisions of 101 CMR 420.00 are severable. If any provision of 101 CMR 420.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 420.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1316, eff. 7/1/2016.

Rates For Adult Housing And Community Support Services Rates For Adult Housing And Community Support Services

101 CMR, § 421.01 General Provisions

(1) Scope. 101 CMR 421.00 governs the payment rates for adult housing and community support services purchased by a governmental unit. These services are designed to provide various types of assistance to homeless individuals and, following stabilization, promote more structured supports for them.

(2) Applicable Dates of Service. The rates contained in 101 CMR 421.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 421.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 421.00. Governmental units that purchase adult housing and community support services are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 421.00.

History

Adopted by Mass Register Issue 1296, eff. 9/25/2015.

101 CMR, § 421.02 Definitions

As used in 101 CMR 421.00, unless the context requires otherwise, terms have the meanings in 101 CMR 421.02.

Assertive Treatment and Relapse Prevention. A supportive housing program for persons at risk of homelessness, who have a dual diagnosis of mental illness and substance-related addictive disorders. The model is an intensive clinical outreach service designed to provide individualized support in community housing placements. The intensive clinical outreach services promote housing retention, assistance in accessing treatment, and other resources so that the individuals served can achieve recovery.

Client. An individual who receives adult housing and community support services purchased by a governmental unit.

Cost Report. The documentation used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Dual Diagnosis Shelter. This service model is a specialized shelter for homeless individuals who have a dual diagnosis of mental illness and substance-related addictive disorders. The specialized shelter provides emergency beds and clinical support. Staffing is provided 24 hours per day and seven days per week. On-site shelter support includes assessment of needs, service coordination, crisis intervention, assistance with activities of daily living, assistance with medication, and nutritional education.

Enrolled Month. In general, an enrolled month is the unit of service used to bill the governmental unit, applicable in homeless support services where there are specialized residential supports in a system of closed referrals. An enrolled month is a calendar month where an enrolled client is authorized by the governmental unit to receive services, including lease management or lease management with other supportive services as determined by the governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Housing Options Program. Low-intensity services for homeless individuals with disabilities who qualify for specialized housing subsidies with supportive services. Level I services include assistance in maintaining housing subsidies provided by the federal Department of Housing and Urban Development. Level 2 services include supportive help with life tasks, such as ensuring adequate food, paying bills, mediation with landlords, and/or help with social interactions with the goal of housing retention.

Outreach and Engagement Services. These services, provided by an outreach team, focus on making contact in the community with individuals who are experiencing homelessness in an effort to engage them and facilitate referrals for essential treatment, including behavioral health and primary care, employment services, housing, and assistance in applying for benefits for which they may be eligible. Services include engagement, assessments, crisis intervention, and information and referral.

Program Staffing Supports. This service provides direct care staffing assistance to help ensure successful outcomes for individuals experiencing homelessness. The service is typically provided as a part of a larger project of which the governmental unit purchasing the service is a funding partner. Direct care staff may range from nonspecialized to licensed independent clinical social workers (LICSW).

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Safe Haven. This service model is an alternative to shelter for individuals whose symptoms of mental illness make it difficult to utilize shelters and who may have otherwise been sleeping outdoors. Safe Haven programs are residential in design, transitional in nature, and are targeted for individuals with serious and persistent mental illness. Services beyond housing include help with benefits, other housing applications, social support, and crisis intervention, with staffing provided 24 hours per day, seven days per week with the goal of stabilization and assistance in transitioning into long-term housing.

History

Adopted by Mass Register Issue 1296, eff. 9/25/2015.

101 CMR, § 421.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for the services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(5) Approved Rates. The approved rate is the lower of a provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 421.03(5).

| Program/Service Type | Rate | Unit | | --- | --- | --- | | Outreach and Engagement | $35,983 | Month | | Safe Haven: ten to 12 beds | $207.14 | Enrolled day | | Safe Haven: seven to nine beds | $229.46 | Enrolled day | | Dual Diagnosis Shelter - donated space | $189.38 | Enrolled day | | Dual Diagnosis Shelter - with occupancy costs | $210.62 | Enrolled day | | Housing Options Program: Level 1 | $45.43 | Enrolled month | | Housing Options Program: Level 2 | $189.97 | Enrolled month | | Assertive Treatment and Relapse Prevention: Model A - nine to 12 clients | $58.01 | Enrolled day | | Assertive Treatment and Relapse Prevention: Model B - six to eight clients | $55.62 | Enrolled day |

| Program Staffing Supports | Rates | | | | | --- | --- | --- | --- | --- | | FTE Basis | | | | | | 0.25 | 0.5 | 1 | | | | Position Titles | Per Diem | Monthly | | | | Direct Care | $184.00 | $1,061.00 | $2,122.00 | $4,244.00 | | Direct Care III | $234.00 | $1,354.00 | $2,708.00 | $5,415.00 | | LICSW | $340.00 | $1,965.00 | $3,929.00 | $7,858.00 |

History

Adopted by Mass Register Issue 1296, eff. 9/25/2015.

101 CMR, § 421.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1296, eff. 9/25/2015.

101 CMR, § 421.05 Severability

The provisions of 101 CMR 421.00 are severable. If any provision of 101 CMR 421.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 421.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1296, eff. 9/25/2015.

Rates for General Programs - Disability Services Rates for General Programs - Disability Services

101 CMR, § 422.01 General Provisions

(1) Scope. 101 CMR 422.00 governs the payment rates for general programs - disability services purchased by a governmental unit. General programs - disability services are services designed to provide various types of assistance to disabled individuals to aid them in achieving personal independence.

(2) Applicable Dates of Service. The rates contained in 101 CMR 422.00 apply for dates of service provided on or after January 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 422.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 422.00. Governmental units that purchase the services described in 101 CMR 422.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 422.00.

(5) Services and Rates Covered by Other Regulations. Payment rates for the following services are not included within the scope of 101 CMR 422.00 and are governed by other regulations promulgated by EOHHS as follows.

| Service | Regulation | | --- | --- | | Client Financial Assistance/Flex Funding Administration | 101 CMR 414.00: Rates for Family Stabilization Services |

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 422.02 Definitions

As used in 101 CMR 422.00, unless the context requires otherwise, terms have the meanings in 101 CMR 422.02.

Assistive Technology Independent Living. A program that provides services to assist an individual with severe disabilities in the selection, acquisition, and/or use of an assistive device (any item that is used to increase, maintain, or improve functional capabilities of individuals with disabilities). Services include a functional evaluation of the individual client, guidance in the acquisition and maintenance of assistive technology devices, the coordination of therapies using assistive technology devices, and training and technical assistance for the client, his or her family, and the client's employer.

Brain Injury Community Center. A community center-based rehabilitation program that provides supports through a membership-based program with an emphasis on abilities rather than disabilities. All members are involved in the operation of the community center. This responsibility fosters essential skills and self-esteem development, which are supported by social relationships and training.

Brain Injury Site-based and Community Outreach. Site- and community-based services that provide support and opportunities for people with brain injury to enrich their lives, develop personal skills and competencies, and participate in their communities. These services have an array of day supports promoting opportunities to acquire, improve, and maintain skills and abilities needed for community participation, meaningful socialization, and quality of life.

Client. A person receiving general programs - disability services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Deaf/Blind Community Access Network. A program that serves individuals who are deaf and/or blind and have complex needs requiring a continuum of supports to live and work in the community. This program empowers deaf/blind consumers to increase and sustain their independence by offering highly specialized personal assistance services that enhance community integration, such as shopping, tending to personal business matters, attending community educational events, and accessing medical care.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

General Programs - Disability Services. Programs and services purchased by the Massachusetts Commission for the Blind (MCB) and the Massachusetts Rehabilitation Commission (MRC) that provide various types of assistance to disabled individuals to aid them in achieving personal independence. These programs and services include the following:

(a) orientation and mobility;

(b) mobile eye clinic;

(d) assistive technology independent living;

(e) home care assistance; and

(f) vocational rehabilitation assistant.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth, and any political subdivision of the Commonwealth.

Home Care Assistance. A program that provides homemaking services to eligible disabled adults 18 through 59 years of age who have medically documented physical or mental disabilities that prevent them from performing essential homemaking activities and who need assistance with homemaking and coordination of services in order to live independently and avoid hospitalization or institutionalization.

Homemaking Services. Direct assistance with meal preparation, grocery, shopping, medication pick-up, laundry, and light housekeeping.

Orientation and Mobility. A service that provides individualized travel training programs to consumers in their homes, workplaces, and communities in addressing the many new challenges encountered by individuals experiencing vision loss. Certified Orientation and Mobility Specialists assess the individual's travel needs, motivation, and visual and physical abilities. Training is developed with the goal of maximizing independence or providing orientation to a new environment, such as a college campus, work location, or new residence, based upon the assessment.

State Funding. The aggregate state fiscal year amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 422.00. State funding does not include any amounts attributable to federal funding or grant funds.

Vocational Rehabilitation Assistant (VRA). A program that provides orientation and mobility services for individuals with legal blindness and intellectual disabilities who reside in the community and may also provide trainings for individuals and families and staff. Vocational rehabilitation assistants work under the clinical supervision of certified staff.

Workforce Initiatives. Funds directed to a provider for workforce development.

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 422.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of payment by any purchasing governmental unit, accept the approved rate as full payment and discharge of all obligations for the services rendered. Payments by the purchasing governmental unit for services rendered to the client are reduced by the amount of any payment from any other source.

(3) Payment Limitations. Except as provided in 101 CMR 422.03(2) and (4), each purchasing governmental unit pays for services at the rates established in 101 CMR 422.03(4).

(5) Approved Rates. The rates set forth in 101 CMR 422.03(5) govern payments for services provided pursuant to contracts executed under the FY 2013 or subsequent procurements of the governmental unit procuring the service. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 422.03(5).

| Service Classification | Rate | Unit | | --- | --- | --- | | Orientation and Mobility (Level 1) | $101.44 | Per Hour | | Orientation and Mobility (Level 2) | $115.33 | Per Hour | | Orientation and Mobility (Level 3) | $129.20 | Per Hour | | Deaf/Blind Community Access Network | $47.98 | Per Hour | | Assistive Technology Independent Living | $174.50 | Per Hour | | Assistive Technology Independent Living | IC | Device | | Home Care Assistance | | | | West | $32.75 | Per Hour | | Central | $30.81 | Per Hour | | Metropolitan Boston | $30.96 | Per Hour | | North | $31.91 | Per Hour | | South | $31.81 | Per Hour | | Vocational Rehabilitation Assistant | $70.44 | Per Hour | | Brain Injury Community Outreach Service | $24.52 | Per % hour | | Brain Injury Site-based Service | $7.84 | Per % hour | | Brain Injury Direct Care Add-on | $6.97 | Per % hour |

(6) Geographic Areas for Home Care Assistance Rates. The following cities and towns comprise the geographic areas encompassed by the rates for Home Care Assistance.

(b) Metropolitan Boston: Belmont, Boston, Brookline, Cambridge, Chelsea, Newton, Revere, Somerville, Waltham, Watertown, Winthrop.

(c) North: Acton, Amesbury, Andover, Arlington, Bedford, Beverly, Billerica, Boxborough, Boxford, Burlington, Carlisle, Chelmsford, Concord, Danvers, Dracut, Dunstable, Essex, Everett, Georgetown, Gloucester, Groveland, Hamilton, Haverhill, Ipswich, Lawrence, Lexington, Lincoln, Littleton, Lowell, Lynn, Lynnfield, Malden, Manchester-by-the-Sea, Marblehead, Maynard, Medford, Melrose, Merrimac, Methuen, Middleton, Nahant, Newbury, Newburyport, North Andover, North Reading, Peabody, Reading, Rockport, Rowley, Salem, Salisbury, Saugus, Stoneham, Stow, Swampscott, Tewksbury, Topsfield, Tyngsborough, Wakefield, Wenham, Westford, West Newbury, Wilmington, Winchester, Woburn.

(d) South: Abington, Acushnet, Aquinnah, Attleboro, Avon, Barnstable, Berkeley, Bourne, Braintree, Brewster, Bridgewater, Brockton, Canton, Carver, Chatham, Chilmark, Cohasset, Dartmouth, Dedham, Dennis, Dighton, Duxbury, East Bridgewater, Eastham, Easton, Edgartown, Fairhaven, Fall River, Falmouth, Foxborough, Freetown, Gosnold, Halifax, Hanover, Hanson, Harwich, Hingham, Holbrook, Hull, Kingston, Lakeville, Mansfield, Marion, Marshfield, Mashpee, Mattapoisett, Medfield, Middleborough, Millis, Milton, Nantucket, New Bedford, Norfolk, North Attleboro, Norton, Norwell, Norwood, Oak Bluffs, Orleans, Pembroke, Plainville, Plymouth, Plympton, Provincetown, Quincy, Randolph, Raynham, Rehoboth, Rochester, Rockland, Sandwich, Scituate, Seekonk, Sharon, Somerset, Stoughton, Swansea, Taunton, Tisbury, Truro, Walpole, Wareham, Wellfleet, West Bridgewater, Westport, West Tisbury, Westwood, Weymouth, Whitman, Wrentham, Yarmouth.

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 422.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 422.05 Severability

The provisions of 101 CMR 422.00 are severable. If any provision of 101 CMR 422.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 422.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

Rates For Certain In-Home Basic Living Supports Rates For Certain In-Home Basic Living Supports

101 CMR, § 423.01 General Provisions

(1) Scope. 101 CMR 423.00 governs the payment rates for certain in-home basic living support services that are purchased by a governmental unit including, but not limited to, the Department of Developmental Services (DDS), Massachusetts Commission for the Blind (MCB), and the Massachusetts Rehabilitation Commission (MRC).

(2) Applicable Dates of Service. Rates contained in 101 CMR 423.00 apply for dates of service on or after July 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 423.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 423.00. Governmental units that purchase the services described in 101 CMR 423.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 423.00.

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 423.02 Definitions

As used in 101 CMR 423.00, unless the context requires otherwise, terms have the meanings in 101 CMR 423.02.

Client. An individual that receives in-home basic living support services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

In-home Basic Living Supports. A broad range of service levels that assist clients in living as independently as possible within the community, encompassing support services customized to their specific needs in a variety of life activities on a regular or intermittent basis, and determined as necessary to prevent institutionalization. These services provide the assistance and supervision necessary for clients to establish, live in, and maintain, on an ongoing basis, a household of their choosing in a personal home or the family home, to meet their habilitative needs. These services may include teaching and fostering the acquisition, retention, or improvement of skills related to personal finance, health, shopping, use of community resources, community safety, and other social and adaptive skills to live in the community. They may also include training and education in self-determination and self-advocacy, enabling clients to acquire skills to exercise control and responsibility over the services and supports they receive and to become more independent, integrated, and productive in their communities. In-home basic living support services do not include room and board or the cost of facility upkeep and maintenance, and are not provided to clients living in 24-hour licensed group home settings.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 423.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. Except as provided in 101 CMR 423.03(2) and (4), each purchasing governmental unit pays for services at the rates established in 101 CMR 423.03(5).

(4) Administrative Adjustment for Extraordinary Circumstances. A provider may petition the purchasing governmental unit for an administrative adjustment to reflect increases in operating costs due to unusual and unforeseen circumstances or extraordinary client service requirements not considered in the development of the current rates. Unusual and unforeseen circumstances are events of catastrophic nature ( e.g ., fire, flood, or earthquake) that are not covered by insurance that the prudent provider would carry. The provider must demonstrate that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(5) Approved Rates. The rate for a particular service is based on the level (A - K) assigned by the purchasing agency, and is based on the intensity of identified needs and characteristics of the client receiving the service. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 423.03(5).

| Level | Rate | Unit | | --- | --- | --- | | A | $9.09 | 15 minutes | | B | $10.23 | 15 minutes | | C | $11.19 | 15 minutes | | D | $11.72 | 15 minutes | | E | $12.80 | 15 minutes | | F | $14.02 | 15 minutes | | G | $15.68 | 15 minutes | | H | $16.85 | 15 minutes | | I | $20.92 | 15 minutes | | J | $24.76 | 15 minutes | | K | $25.88 | 15 minutes |

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 423.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

101 CMR, § 423.05 Severability

The provisions of 101 CMR 423.00 are severable. If any provision of 101 CMR 423.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 423.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1308, eff. 3/11/2016.

Rates for Certain Developmental and Support Services Rates for Certain Developmental and Support Services

101 CMR, § 424.01 General Provisions

(1) Scope. 101 CMR 424.00 governs the payment rates for certain developmental and support services purchased by a governmental unit including, but not limited to, the Department of Developmental Services (DDS) and MassAbility (formerly the Massachusetts Rehabilitation Commission).

(2) Applicable Dates of Service. Rates contained in 101 CMR 424.00 apply for dates of service provided on or after January 1, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 424.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 424.00. Governmental units that purchase the services described in 101 CMR 424.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 424.00.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 424.02 Definitions

As used in 101 CMR 424.00, unless the context requires otherwise, terms have the meanings in 101 CMR 424.02.

Client. An individual that receives developmental and support services purchased by a governmental unit.

Clinical Team. The clinical team is comprised of medical, psychological, and social service professionals, and provides around-the-clock on-call response to individuals in crisis.

Corporate Representative Payee. Individualized financial supports and advocacy for individuals who benefit from support in managing their own funds. The program supports the individual in his or her personal movement toward integration into the larger community by handling or supporting various aspects of the individual's bank accounts, bill payments, and personal expenditures. Intensity levels are differentiated by complexity of the individual's finances and level of 1:1 support provided.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Intensive Community Wrap Autism Services (ICWAS). Services for individuals with Autism Spectrum Disorder (ASD), Serious Mental Illness (SMI), or other significant mental health diagnosis designed to provide support and stabilization, as necessary. This service consists of a multi-disciplinary team to deliver clinical assessment and stabilization services, coaching, and peer mentoring supports in a variety of community and daily life activities.

Psychology Practitioner. Psychology practitioner may be any of the following:

(a) a psychologist who is licensed to practice by the Massachusetts Board of Registration of Psychologists;

(b) a graduate of a master's or doctoral level psychology program; or

(c) a behavioral analyst, board certified by the Behavior Analyst Certification Board (BACB), a private nonprofit organization based in Littleton, Colorado.

Remote Supports and Monitoring Services (RSM). A service that provides for the use of communication and non-invasive monitoring technologies to assist individuals in attaining or maintaining independence in their homes and communities while minimizing the need for on-site staff presence and intervention. The service includes the use of two-way "real-time" audio/video communication technology and will be delivered by staff at a remote location. The service also includes on-call in-person backup supports.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Transition to Adulthood Program (TAP). A program that assists students with disabilities to prepare for the transition from high school to adulthood by providing advocacy, skills training, and peer counseling, to help students learn to live independently in the community of their choice. TAP services are available to any individual who is 14 through 22 years of age and enrolled in special education.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 424.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 424.03.

| Program | Rate | Unit | | --- | --- | --- | | Corporate Representative Payee | | | | Basic Intensity | $64.80 | Client per Month | | Moderate Intensity | $91.16 | Client per Month | | High Intensity | $221.26 | Client per Month | | Transition to Adulthood Program | $97.92 | Hour |

| Clinical Team Staff Title | Level | Hourly Rate | | --- | --- | --- | | Clinical Team Program Manager | 1 | $48.74 | | Clinical Team Program Manager | 2 | $59.10 | | Clinical Team Program Manager | 3 | $64.78 | | Clinical Team Program Manager | 4 | $76.77 | | Clinical Team Psychiatrist | 1 | $123.69 | | Clinical Team Psychiatrist | 2 | $145.05 | | Clinical Team Psychiatrist | 3 | $175.93 | | Clinical Team Nurse (LPN) | 1 | $56.99 | | Clinical Team Nurse (RN) | 2 | $77.39 | | Clinical Team Nurse (APRN) | 3 | $102.88 | | Clinical Team Specialist | 1 | $54.50 | | Clinical Team Specialist | 2 | $60.18 | | Clinical Team Specialist | 3 | $69.92 | | Clinical Team Specialist | 4 | $76.14 | | Clinical Team Specialist | 5 | $88.28 | | Clinical Team Direct Care/Clerical | 1 | $36.03 | | Clinical Team Direct Care III | 2 | $44.91 | | Clinical Team Direct Care/Social/Caseworker | 3 | $50.54 | | Clinical Team Direct Care/Social/Case Manager | 4 | $54.50 |

| Remote Supports and Monitoring | | | | --- | --- | --- | | Level | Rate | Unit | | A | $43.07 | Daily | | B | $77.35 | Daily | | C | $98.40 | Daily |

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 424.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 424.05 Severability

The provisions of 101 CMR 424.00 are severable. If any provision of 101 CMR 424.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 424.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

Rates for Certain Young Parent Support Programs Rates for Certain Young Parent Support Programs

101 CMR, § 425.01 General Provisions

(1) Scope. 101 CMR 425.00 governs the payment rates for certain young parent support services purchased by a governmental unit including, but not limited to, the Department of Transitional Assistance (DTA).

(2) Applicable Dates of Service. Rates contained in 101 CMR 425.00 apply for dates of service provided on or after July 1, 2024.

(3) Disclaimer of Authorization of Services. 101 CMR 425.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 425.00. Governmental units that purchase the services described in 101 CMR 425.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 425.00.

History

Adopted by Mass Register Issue 1317, eff. 7/15/2016.

101 CMR, § 425.02 Definitions

As used in 101 CMR 425.00, unless the context requires otherwise, terms have the meanings in 101 CMR 425.02.

Client. An individual that receives young parent support services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Enrollment Completion. An enrollment payment occurs when a YPP enrollee has been accepted into the Young Parent Program by the contractor and has participated in program activities for a minimum of 40 hours. The official enrollment date reflects the date of the start of participation, at a minimum 100% attendance.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Outcome Completion. Achievement of a high school diploma or HiSETT. At a minimum, eight weeks at 100% attendance is required prior to completion. An outcome can also be defined as a job placement, acceptance into skills training, acceptance into a community college, transitioning to a college program, a progress payment with two grade levels of improvement, work program placement, full employment program placement, or high school placement. Outcome completions are further defined by the purchasing agency in the scope of services and contracts.

Placement Completion. The start date of the placement must occur while the participant is actively participating in YPP or within 90 days of a reimbursable completion (HiSETT). A placement is counted as a completion only after 30 days of employment. Placement completions are further defined by the purchasing agency in the scope of services and contracts.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Young Parent Program. The Young Parent Program (YPP) is a part of the Department of Transitional Assistance's Employment Services Program (ESP). These services are provided for Transitional Aid to Families with Dependent Children (TAFDC) participants. The YPP is directed toward reducing welfare dependency among young parents, 14 through 24 years of age, who have not achieved a high school diploma or its equivalent.

History

Adopted by Mass Register Issue 1317, eff. 7/15/2016.

101 CMR, § 425.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 425.03(5).

| Service | Rate | | --- | --- | | Enrollment Completion | $4,566 | | Outcome/Placement Completion | $4,696 |

History

Adopted by Mass Register Issue 1317, eff. 7/15/2016.

101 CMR, § 425.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1317, eff. 7/15/2016.

101 CMR, § 425.05 Severability

The provisions of 101 CMR 425.00 are severable. If any provision of 101 CMR 425.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 425.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1317, eff. 7/15/2016.

Rates for Certain Adult Community Mental Health Services Rates for Certain Adult Community Mental Health Services

101 CMR, § 426.01 General Provisions

(1) Scope. 101 CMR 426.00 governs the payment rates for certain adult community mental health services purchased by governmental units.

(2) Applicable Dates of Service. Rates contained in 101 CMR 426.00 apply for dates of service provided on or after January 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 426.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 426.00. Governmental units that purchase the services described in 101 CMR 426.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 426.00.

History

Adopted by Mass Register Issue 1355, eff. 12/29/2017.

101 CMR, § 426.02 Definitions

As used in 101 CMR 426.00, unless the context requires otherwise, terms have the meanings in 101 CMR 426.02.

Client. An individual who receives certain adult community mental health services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Group Living Environment (GLE). This temporary setting provides a clinically oriented environment and structure in which staff is present on a planned staffing schedule. The setting provides increased treatment and engagement interventions to enable the client to develop the skills necessary to live in a more independent setting. Clients residing in GLEs can also receive supervision and support from an Integrated Team. Certain GLE staff members are part of the Integrated Team and perform the duties and responsibilities of the direct care staff members of the Team for clients residing in the GLEs.

Integrated Team. A multi-disciplinary team of clinical, direct care, and peer staff providing clinical interventions, housing services, and peer and family support to facilitate engagement, support functioning and community living skill development, and maximize self-management consistent with the treatment plan.

Intensive Group Living Environment Services. This group living setting provides clients with the service components and specific clinical interventions particular to a defined service model for which they are referred. The Intensive Group Living Environment Service locations will be designated by the purchasing governmental unit. The following are the intensive GLE services.

(a) Medically Intensive Group Living Environment. Provides daily medical management that may be complicated by symptoms and/or behaviors related to the client's mental health. In addition to medical management and other rehabilitative services, clients receive support and supervision services as their needs indicate.

(b) Intensive Behavioral Group Living Environment. Provides increased therapeutic interventions and supervision that focus on identifying triggers and precipitant behaviors, coping skills, improving communication skills, addressing issues around substance use, and identifying and resolving barriers to more independent community living and employment. Other rehabilitative, support, and supervision services are provided to clients as their needs indicate.

(c) Intensive Behavioral Assessment Group Living Environment. Provides an intensive level of supervision, including one-to-one (line of sight) coaching on a consistent basis throughout the day. Coaching interventions focus on identifying and practicing pro-social communication and community engagement. Rehabilitation and other support services are provided to clients, as their needs indicate.

(d) Intensive Fire Safety Group Living Environment. Provides enhanced supervision and monitoring for fire setting behavior, therapeutic interventions to address individually identified risk behaviors assessed in the Fire Setting Behavior Evaluation, and a special physical setting to minimize the risk of fire. Rehabilitative, support, and supervision services are provided to clients as their needs indicate.

(e) Clinically Intensive Group Living Environment. Delivers rapid response to a client's emerging clinical needs including, but not limited to, symptom management, de-escalation strategies, or one to one assistance. Clients enrolled in this program require either an experience of a length of stay in a Department of Mental Health (DMH) Continuing Care Hospital for two years or more or prior histories of multiple failed efforts in standard DMH community services. The program is designed to develop, implement, and monitor person centered clinically intensive care. Other rehabilitative, support, and supervision services are provided to clients as their needs indicate.

(f) Intensive Dialectical Behavioral Therapy Group Living Environment. Delivers therapeutic interventions to increase awareness of emotional triggers, manage personal safety, coaching emotional regulation skills and improving skills for social interactions. Intensive Dialectical Behavioral Therapy supports clients to meet the community integration goals, including employment, education, and independent housing. Other rehabilitative, support, and supervision services are provided to clients as their needs indicate.

(g) Enhanced Medical Group Living Environment. Provides a variety of skilled health care and supportive services, including nursing and hands-on personal care to clients with serious mental illness in addition to compounding medical needs. These services are designed to meet and support the daily needs of clients with chronic medical conditions, terminal illnesses, and/or disabilities that are impacted by their significant mental illness

Lease Management. A lease management function responsible for managing client leasing requirements for those clients enrolled in Adult Community Clinical Services (ACCS) who are benefitting from sponsor-based rental assistance. Covered lease management activities include those leasing arrangements where the ACCS provider is directly involved in the category of sponsor-based leasing.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Supported Independent Environments (SIE). This setting provides clinical outreach and treatment in an environment with individual or shared units and staff present on a planned schedule within the setting, generally within an office or separate unit. Clients residing in SIEs can also receive supervision and support from an Integrated Team. Certain SIE staff members are part of the Integrated Team and perform the duties and responsibilities of the direct care staff members of the team for clients residing in the SIEs.

History

Adopted by Mass Register Issue 1355, eff. 12/29/2017.

101 CMR, § 426.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations.

(a) No purchasing governmental unit may pay less than or more than the approved program rate.

(b) Governmental units do not pay for Integrated Team services for clients residing in Intensive Group Living Environment service locations.

(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 426.03(5).

(a) Service Rates.

| Program Service Model | Per Enrolled Day Rate | | --- | --- | | Integrated Team | $56.32 | | Integrated Team with GLE/SIE | $38.58 | | Supervised Group Living Environments (GLEs): | | | Fewer than 13 Beds (Standard GLEs): | | | Four to Six Beds | $361.85 | | Seven to Nine Beds | $257.01 | | Ten to 12 Beds | $209.36 | | Supported Independent Environments (SIEs): | | | 13 to 16 Beds (Model A) | $89.16 | | 17 to 25 Beds (Model B) | $70.32 | | 26 to 35 Beds (Model C) | $51.49 | | Intensive Group Living Environment Services: | | | Medically Intensive Group Living Environment: Four to Six Beds | $529.22 | | Medically Intensive Group Living Environment: Seven to Nine Beds | $440.27 | | Medically Intensive Group Living Environment: Ten to 12 Beds | $395.87 | | Intensive Behavioral Group Living Environment: Four to Six Beds | $569.68 | | Intensive Behavioral Group Living Environment: Seven to Nine Beds | $431.37 | | Intensive Behavioral Group Living Environment: Ten to 12 Beds | $370.77 | | Intensive Behavioral Assessment Group Living Environment: Four to Six Beds | $462.33 | | Intensive Behavioral Assessment Group Living Environment: Ten to 12 Beds | $319.89 | | Intensive Fire Safety Group Living Environment: Four to Six Beds | $549.85 | | Clinically Intensive Group Living Environment: Four to Six Beds | $614.30 | | Clinically Intensive Group Living Environment: Seven to Nine Beds | $524.67 | | Clinically Intensive Group Living Environment: Ten to 12 Beds | $496.93 | | Intensive Dialectical Behavioral Therapy Group Living Environment: Four to Six Beds | $532.24 | | Intensive Dialectical Behavioral Therapy Group Living Environment: Seven to Nine Beds | $417.39 | | Enhanced Medical Group Living Environment: Four to Six Beds | $600.76 | | Enhanced Medical Group Living Environment: Seven to Nine Beds | $485.10 | | Enhanced Medical Group Living Environment: Ten to 12 Beds | $456.52 | | Program Service Model Add-on | Per Client, per Month | | Lease Management Add-on | $35.09 |

(b) Occupancy Rates.

Occupancy rates are determined by multiplying $13,015 by the applicable regional occupancy modifier listed below at 101 CMR 426.03(5)(b)3. This is then multiplied by the provider's total bed capacity to arrive at the occupancy rate.

The occupancy rate is determined on an annual basis and paid in 12 monthly units.
The applicable regional modifier determination for towns and cities that appear in more than one region is at the discretion of the purchasing governmental unit.

| Region | Occupancy Modifier | | --- | --- | | Boston | 107.4% | | Brockton | 100.9% | | Buzzards Bay | 97.7% | | Fall River | 100.4% | | Fitchburg | 98.9% | | Framingham | 101.3% | | Greenfield | 95.1% | | Hyannis | 98.9% | | Lawrence | 104.1% | | Lowell | 103.0% | | New Bedford | 100.0% | | Pittsfield | 95.2% | | Springfield | 96.2% | | Worcester | 100.9% |

(6) Geographic Areas for the Regional Occupancy Modifier. The following cities and towns comprise the geographic areas encompassed by the Regional Occupancy Modifier.

(a) Boston: Allston, Boston, Brighton, Chelsea, Dorchester, East Boston, Hyde Park, Jamaica Plain, Mattapan, Readville, Revere, Roslindale, Roxbury, South Boston, West Roxbury, Winthrop

(b) Brockton: Abington, Bridgewater, Brockton, Carver, Duxbury, East Bridgewater, Halifax, Hanover, Hanson, Hingham, Hull, Kingston, Lakeville, Marion, Marshfield, Mattapoisett, Middleboro, Norwell, Pembroke, Plymouth, Plympton, Rochester, Rockland, Scituate, Wareham, West Bridgewater, Whitman

(c) Buzzards Bay: Aquinnah, Barnstable, Bourne, Brewster, Chatham, Chilmark, Dennis, Eastham, Edgartown, Falmouth, Gosnold, Harwich, Mashpee, Nantucket, Oak Bluffs, Orleans, Provincetown, Sandwich, Tisbury, Truro, Wellfleet, West Tisbury, West Yarmouth, Yarmouth

(d) Fall River: Fall River, Freetown, Somerset, Swansea, Westport

(e) Fitchburg: Ashburnham, Athol, Auburn, Barre, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dudley, East Brookfield, Fitchburg, Gardner, Grafton, Hardwick, Harvard, Holden, Hopedale, Hubbardston, Lancaster, Leicester, Lunenburg, Mendon, Milford, Millbury, Millville, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Petersham, Phillipston, Princeton, Royalston, Rutland, Shrewsbury, Southborough, Southbridge, Spencer, Sterling, Sturbridge, Sutton, Templeton, Upton, Uxbridge, Warren, Webster, West Boylston, West Brookfield, Westboro, Westminster, Winchendon, Worcester

(f) Framingham: Acton, Arlington, Ashby, Ashland, Avon, Ayer, Bedford, Bellingham, Belmont, Billerica, Boxboro, Braintree, Brookline, Burlington, Cambridge, Canton, Carlisle, Chelmsford, Cohasset, Concord, Dedham, Dover, Dracut, Dunstable, Somerville, Stoneham, Stoughton, Stow, Sudbury, Tewksbury, Townsend, Tyngsboro, Wakefield, Walpole, Waltham, Watertown, Wayland, Wellesley, Westford, Weston, Westwood, Weymouth, Wilmington, Winchester, Woburn, Wrentham

(g) Greenfield: Ashfield, Bernardston, Buckland, Charlemont, Colrain, Conway, Deerfield, Erving, Gill, Greenfield, Hawley, Heath, Leverett, Leyden, Monroe, Montague, New Salem, Northfield, Orange, Rowe, Shelburne Falls, Shutesbury, Sunderland, Warwick, Wendell, Whately

(h) Hyannis: Aquinnah, Barnstable, Bourne, Brewster, Chatham, Chilmark, Dennis, Eastham, Edgartown, Falmouth, Gosnold, Harwich, Mashpee, Nantucket, Oak Bluffs, Orleans, Provincetown, Sandwich, Tisbury, Truro, Wellfleet, West Tisbury, West Yarmouth, Yarmouth

(i) Lawrence: Amesbury, Andover, Beverly, Boxford, Danvers, Essex, Georgetown, Gloucester, Groveland, Hamilton, Haverhill, Ipswich, Lawrence, Lynn, Lynnfield, Manchester By The Sea, Marblehead, Merrimac, Methuen, Middleton, Nahant, Newbury, Newburyport, North Andover

(j) Lowell: Acton, Arlington, Ashby, Ashland, Avon, Ayer, Bedford, Bellingham, Belmont, Billerica, Boxboro, Braintree, Brookline, Burlington, Cambridge, Canton, Carlisle, Chelmsford, Cohasset, Concord, Dedham, Dover, Dracut, Dunstable, Somerville, Stoneham, Stoughton, Stow, Sudbury, Tewksbury, Townsend, Tyngsboro, Wakefield, Walpole, Waltham, Watertown, Wayland, Wellesley, Westford, Weston, Westwood, Weymouth, Wilmington, Winchester, Woburn, Wrentham

(k) New Bedford: Acushnet, Dartmouth, Fairhaven, Gosnold, Marion, Mattapoisett, New Bedford, Onset, Rochester, Wareham

(l) Pittsfield: Adams, Alford, Becket, Cheshire, Clarksburg, Dalton, Egremont, Florida, Great Barrington, Hancock, Hinsdale, Lanesboro, Lee, Lenox, Monterey, Mount Hermon, New Ashford, New Marlborough, North Adams, North Egremont, Otis, Peru, Pittsfield, Richmond, Savoy, Sheffield, Stockbridge, Tyringham, Washington, West Stockbridge, Williamstown, Windsor

(m) Springfield: Agawam, Amherst, Belchertown, Blandford, Brimfield, Chester, Chesterfield, Chicopee, Cummington, East Longmeadow, Easthampton, Goshen, Granby, Granville, Hadley, Hampden, Hatfield, Holland, Holyoke, Huntington, Longmeadow, Ludlow, Middlefield, Monson, Montgomery, Northampton, Palmer, Pelham, Plainfield, Russell, South Hadley, Southampton, Southwick, Springfield, Tolland, Wales, Ware, West Springfield, Westfield, Westhampton, Wilbraham, Williamsburg, Worthington

(n) Worcester: Ashburnham, Athol, Auburn, Barre, Berlin, Blackstone, Bolton, Boylston, Brookfield, Charlton, Clinton, Douglas, Dudley, East Brookfield, Fitchburg, Gardner, Grafton, Hardwick, Harvard, Holden, Hopedale, Hubbardston, Lancaster, Leicester, Lunenburg, Mendon, Milford, Millbury, Millville, New Braintree, North Brookfield, Northborough, Northbridge, Oakham, Oxford, Paxton, Petersham, Phillipston, Princeton, Royalston, Rutland, Shrewsbury, Southborough, Southbridge, Spencer, Sterling, Sturbridge, Sutton, Templeton, Upton, Uxbridge, Warren, Webster, West Boylston, West Brookfield, Westboro, Westminster, Winchendon, Worcester

History

Adopted by Mass Register Issue 1355, eff. 12/29/2017.

101 CMR, § 426.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1355, eff. 12/29/2017.

101 CMR, § 426.05 Severability

The provisions of 101 CMR 426.00 are severable. If any provision of 101 CMR 426.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 426.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1355, eff. 12/29/2017.

Rates for Certain Youth and Young Adult Support Services Rates for Certain Youth and Young Adult Support Services

101 CMR, § 427.01 General Provisions

(1) Scope. 101 CMR 427.00 governs the payment rates for certain youth and young adult support services purchased by a governmental unit, including the Department of Children and Families, the Department of Mental Health, and the Department of Public Health.

(2) Applicable Dates of Service. Rates contained in 101 CMR 427.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 427.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 427.00. Governmental units that purchase the services described in 101 CMR 427.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 427.00.

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 427.02 Definitions

As used in 101 CMR 427.00, unless the context requires otherwise, terms have the meanings in 101 CMR 427.02.

Alternative to Lock-up Program. This program provides non-secure alternatives to lock-up for juveniles in police custody to comply with federal and state regulations regarding the placement of juveniles in their custody for either status or non-violent delinquent offenses.

Client. An individual that receives certain youth and young adult support services purchased by a governmental unit.

Conflict of Interest Services. The provision of case management services to families in need of protective services when a potential conflict of interest may exist with the Department of Children and Families.

Contact Hour. An hour spent engaging with young people in Teen Pregnancy Prevention Youth Development activities.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Curriculum Hour. An hour spent delivering Teen Pregnancy Prevention evidence-based or evidence-informed sexuality programming to young people in a school setting or outside a school setting.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Extraordinary Circumstances/Flex Funding. A method whereby, subject to availability, a purchasing governmental unit may provide resource allocations to a client and/or provider across the state. Flexible funding may be provided through a number of means including, but not limited to, reimbursement to client for specific support services or funds directed to a qualified provider for extraordinary circumstances.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration (I.C). Payment rates for certain services are designated as individual consideration (I.C.). Where I.C. rates are designated, the purchasing governmental unit will determine the appropriate payment as the actual cost of the item or service as evidenced by invoice, published tuition amount, or other price reasonably obtained by a competitive market for the product or service.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Teen Pregnancy Prevention Program. The teen pregnancy prevention programs deliver evidence-based or evidence-informed sexuality education programming to youth and young adults, with fidelity to the original program model. All teen pregnancy prevention programs use a positive youth development model that focuses on youth assets; some programs may choose to add additional positive youth development activities. Teen pregnancy prevention programs may be delivered in a virtual setting, school setting or outside of the school setting.

Teen Pregnancy Prevention Partnership Development. Partnership development services focus on developing and maintaining relationships with community-based organizations and schools to support the delivery of Adolescent Sexuality Educational services including, but not limited to, coalition meetings and local advisory meetings focused on adolescents.

Teen Pregnancy Prevention Youth Development. The Teen Pregnancy Prevention Youth Development model focuses on young people as resources and emphasizes caring relationships between youth and trustworthy adults. Youth development activities can enhance the success of adolescent sexuality education curriculum delivery by supporting the growth and development of the whole young person. Youth development may include, but is not limited to, the following strategies, delivered in addition to teen pregnancy prevention curricula: peer leadership models, youth summits/retreats, education/employment supports, and youth advisory councils.

Therapeutic Day Services. Therapeutic Day Services are voluntary, structured, therapeutic group programs for children and/or adolescents who have serious emotional disturbance or mental illness. Therapeutic Day Services are available to children and adolescents who require interventions beyond what the school, family, and traditional outpatient or recreational services can provide.

Young Parents Support Program. The Young Parents Support program (YPS) provides intensive counseling, case management, and other services to parents at the highest risk of abuse or neglect. Young Parents Support program supports clients 14 through 23 years of age who are typically referred to the program because they are not eligible for other teen parent programs. YPS enables their clients to meet their responsibilities as parents, students, and employees.

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 427.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 427.03.

| Service | Model | Unit of Service | Rate | | --- | --- | --- | --- | | Alternative Lock-up Program | A | Month | $12,725 | | B | Month | $21,928 | | | C | Month | $27,967 | | | Conflict of Interest Services | 1 Family | Month | $1,248 | | 5 Families | Month | $6,202 | | | Extraordinary Circumstances/Flex Funding | N/A | N/A | I.C. | | Teen Pregnancy Prevention Program | In school | Curriculum Hour | $380.85 | | Outside school | Curriculum Hour | $476.06 | | | Remote Add-on | Hour | $95.21 | | | Peer Leadership & Youth Development | N/A | Contact Hour | $285.64 | | Partnership Development | N/A | Hour | $53.81 | | Therapeutic Day Services | Model 1 | Month | $32,797 | | Model 2 | Month | $27,789 | | | Model 3A | Month | $29,917 | | | Model 3B | Month | $40,722 | | | Model 4A | Month | $23,425 | | | Model 4B | Month | $43,943 | | | Young Parent Support Program (YPS) | A | Month | $9,295 | | B | Month | $18,590 | | | YPS Specialty Direct Care III Add-on (.5 FTE) | A | Month | $2,708 | | YPS Specialty Direct Care III Add-on (1 FTE) | B | Month | $5,415 |

| Add-on Staff for Teen Pregnancy Prevention Program | | | | --- | --- | --- | | Title | Unit of Service | Rate | | Direct Care | Hourly | $24.49 | | Direct Care III | Hourly | $31.24 |

| Add-on Staff for Therapeutic Day Services | | | | | | | --- | --- | --- | --- | --- | --- | | Title | Unit of Service | .25 FTE | .5 FTE | .75 FTE | 1 FTE | | Clinical (LICSW) | Monthly | $1,965 | $3,929 | $5,894 | $7,858 | | Peer/Direct Care | Monthly | $1,061 | $2,122 | $3,183 | $4,245 | | Direct Care III | Monthly | $1,354 | $2,708 | $4,061 | $5,415 |

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 427.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

101 CMR, § 427.05 Severability

The provisions of 101 CMR 427.00 are severable. If any provision of 101 CMR 427.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 427.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1336, eff. 4/7/2017.

Rates for Certain Independent Living Communities and Services Rates for Certain Independent Living Communities and Services

101 CMR, § 428.01 General Provisions

(1) Scope. 101 CMR 428.00 governs the payment rates for certain independent living communities and services purchased by a governmental unit including, but not limited to, the Department of Mental Health (DMH), the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH), and the Massachusetts Rehabilitation Commission (MRC).

(2) Applicable Dates of Service. Rates contained in 101 CMR 428.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 428.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 428.00. Governmental units that purchase the services described in 101 CMR 428.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 428.00 and to update the initial payment percentages provided in 101 CMR 428.03(3)(c).

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 428.02 Definitions

As used in 101 CMR 428.00, unless the context requires otherwise, terms have the meanings in 101 CMR 428.02.

Client. An individual that receives certain independent living community services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Deaf and Hard of Hearing Independent Living Services (DHILS). This service provides person-specific supports to deaf and hard of hearing individuals across the Commonwealth. The goal of this program is to ensure that deaf and hard of hearing individuals have access to information, services, education, economic self-sufficiency, and opportunities equal to those of individuals who are not deaf or hard of hearing.

EOHHS. The Executive Office of Health and Human Services, established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Recovery Learning Community (RLC). A peer support service provided to individuals identifying as having mental illness. Peer services are designed to offer person-specific supports, connection to a variety of community resources, support services, training, and education as needed. Recovery Learning Communities also support peers through training, and consultation and provide a forum for community education aimed at reducing the stigmas around mental illness and assist communities to engage and coordinate efforts to improve service delivery for people experiencing mental illness.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Vocational Rehabilitation Independent Living Services. A service comprised of various components, as described in 101 CMR 428.03(4), which provide person-specific vocational/independent living training and supports to individuals seeking employment. The goal of the program is to ensure individuals seeking employment have adequate environmental conditions to support their search for and maintenance of employment.

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 428.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Service Component Payment Methods.

(a) General. Purchasing governmental units will pay providers a total payment per completed service component as defined in 101 CMR 428.03(4).

(b) Standard Progress Documentation. Providers must use a standard form to document initiation and completion of a service component for each client. Providers must submit all progress documentation, billing, and performance reporting through the Enterprise Invoice Management Service.

(c) Initial Payment. The purchasing governmental unit pays the provider an initial payment based on a specified percentage of the total payment at the initiation of a service component for a client. For assessment, the purchasing governmental unit makes an initial payment equal to 20% of the service component payment in 101 CMR 428.03(4). For all other service components, except ongoing and interim supports, the purchasing agency makes an initial payment equal to 40% of the service component payment in 101 CMR 428.03(4). EOHHS may revise these percentages by administrative bulletin.

(d) Final Payment. The purchasing governmental unit pays the difference between the initial payment and the total service component payment upon completion of the service component and submission of required documentation pursuant to 101 CMR 428.03(3)(b).

(4) Service Components. Payment is based on the following five separate service components.

(a) Assessment. This service component requires the client to articulate initial goals, commit to a service plan, and engage in services. Provider activities included in this service component include, but are not limited to, solicitation of client referrals; review of applications; initial client screening; interview of applicants; assessment of client abilities, interests, skills, and needs; performance of a situational assessment; identification of recommended support services; and completion of a comprehensive service plan.

(b) Independent Living Skills Training. This service component is designed to ensure that the client has sufficient independent living, pre-employment, and skills training. Specific provider activities include, but are not limited to, depending on client skills and learning style: vocational English language training; "fast-track," HiSET testing; short-term "soft" or "technical" job skills training; and work adjustment, job search, and interviewing skills.

(c) Community Resource Access. This service component is designed to assist the client to be able to access community services in order to assist them with their ability to live and work independently in their community.

(d) Plan of Achieving Self-support (PASS Plan). This service component is designed to assist the consumer with completing Social Security Administration (SSA) paperwork. Additional supports assist the consumer to set aside resources in order to obtain a product or a service; and to assist them to work or live independently in the community.

(e) Single Service Purchase. This service component is designed to assist the client to work and live in the community successfully.

(5) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(6) Administrative Adjustment for Extraordinary Circumstances. A method whereby, subject to availability of funds, a purchasing governmental unit may provide additional resource allocations to a qualified provider in response to unusual and unforeseen circumstances that substantially increase the cost of service delivery in ways not contemplated in the development of current rates. It must be demonstrated that such cost increases gravely threaten the stability of service provision such that client or consumer access to necessary services is at risk. The purchasing governmental unit will evaluate the need for the administrative adjustment, determine whether funding is available, and convey that information to EOHHS for review to determine the amount of any adjustment.

(7) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 428.03.

| Program | Rate | Unit | | --- | --- | --- | | Deaf and Hard of Hearing Independent Living Services | | | | Region 1 | $49,256 | Monthly | | Region 2 | $44,538 | Monthly | | Region 3 | $40,028 | Monthly | | Region 4 | $36,842 | Monthly | | Region 5 | $23,490 | Monthly | | Region 6 | $20,782 | Monthly | | Region 7 | $12,757 | Monthly | | Region 8 | $8,181 | Monthly | | ASL Interpreter Add-on | | | | .25 FTE | $1,398 | Monthly | | .5 FTE | $2,796 | Monthly | | .75 FTE | $4,194 | Monthly | | 1.0 FTE | $5,591 | Monthly | | Recovery Learning Communities | $84,032 | Monthly | | Vocational Rehabilitation Independent Living Services | | | | Assessment | $558 | Per Component | | Independent Living Skills Training | $2,094 | Per Component | | Community Resource Access | $2,094 | Per Component | | PASS Plan | $2,094 | Per Component | | Single Service Purchase | $977 | Per Component | | Service Add-on | $140 | Per Hour | | Group Training Add-on | $50.20 | Per Client per Class |

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 428.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 428.05 Severability

The provisions of 101 CMR 428.00 are severable. If any provision of 101 CMR 428.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 428.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

Rates for Certain Sexual and Domestic Violence Services Rates for Certain Sexual and Domestic Violence Services

101 CMR, § 429.01 General Provisions

(1) Scope. 101 CMR 429.00 governs the payment rates for certain sexual and domestic violence services purchased by a governmental unit.

(2) Applicable Dates of Service. Rates contained in 101 CMR 429.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 429.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 429.00. Governmental units that purchase the services described in 101 CMR 429.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 429.00.

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

101 CMR, § 429.02 Definitions

As used in 101 CMR 429.00, unless the context requires otherwise, terms have the meanings in 101 CMR 429.02.

Client. An individual that receives certain sexual and domestic violence services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

Domestic Violence Community-based Services. The Domestic Violence (DV) programs, which include supervised visitation and Child Witness to Violence, offer an array of services to survivors of domestic violence and their families. Domestic violence providers help victims of verbal abuse, financial abuse, emotional, sexual, and physical abuse by delivering specialized direct services and access to community resources.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Extraordinary Circumstances/Flex Funding. A method whereby, subject to availability, a purchasing governmental unit may provide resource allocations to a client and/or provider across the state. Flexible funding may be provided through a number of means including, but not limited to, reimbursement to client for specific support services or funds directed to a qualified provider for extraordinary circumstances.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Housing Stabilization Flexible Funding. An additional support to survivors of domestic violence who are not eligible for other assistance and/or have exhausted other assistance available to them for the stabilization of current housing and/or securing more permanent housing.

Intimate Partner Abuse Education Program. The Massachusetts Department of Public Health certified Intimate Partner Abuse Education Programs (IPAEPs) work to increase the safety of domestic violence victims and survivors by holding their intimate partners accountable for abusing them. These 80-hour educational programs help abusers to develop respectful and non-abusive attitudes and behaviors toward their partners and children. IPAEPs contact victims and survivors to help them to plan for their safety, to refer them to support services like domestic violence service agencies and child witness to violence programs, and to ask about their abuser's behavior at home.

New Sexual Assault Nurse Examiner (SANE) Site Development. One-time rate for start-up costs associated with a new MA SANE-designated hospital site or MA SANE-designated telemedicine hospital site within a rape crisis center's DPH-established service area.

Rape Crisis Center Services. The Rape Crisis Centers (RCC), part of the Sexual Assault Prevention and Survivor Services (SAPSS), serve as a vital community resource for survivors of sexual violence. Services are focused on the needs of the survivor and help with the short- and long-term community and health needs. Specific services include, but are not limited to, 24/7 hotline services; accompaniment to hospitals, police stations, and court appointments; and individual and group counseling.

Rape Crisis Center Statewide Specialized Hotline. A statewide hotline created to support primary and secondary survivors of sexual violence who are from a specific population at high-risk of experiencing sexual violence or who experience specific barriers to accessing resources including, but not limited to, language barriers. Any such hotline will provide these services under the supervision of a DPH-funded rape crisis center. Hours of service and other service provision conditions will be negotiated with DPH.

Rape Crisis Satellite Center. An additional physical point of access to clients with established and maintained office hours in locations external to the main RCC site.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Sexual and Domestic Violence Equity Services. Sexual and domestic violence (SDV) affects some groups of people at disproportionate levels as seen in higher prevalence, poorer access to services, and/or worse outcomes from SDV. Research on disparities has identified some of these groups as Black women, LGBTQ, immigrants, people with disabilities, people who are deaf or hard of hearing, and people in rural areas. The service offers, but is not limited to, supports services, outreach, education, and community engagement with groups and individuals who are disproportionately adversely affected.

Sexual and Domestic Violence Equity Legal Services. Services for the relief/amelioration of immigration or humanitarian crises encountered by refugees and immigrants, such as legal representation and humanitarian relief following natural disasters, immigration raids, etc .

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

101 CMR, § 429.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Certain Unit Contract Payment Rates for Certain Sexual and Domestic Violence Services. The payment rate for certain sexual and domestic violence services established in 101 CMR 429.03(6)(a), provided pursuant to contracts purchasing only one unit in total, is at the rate established in 101 CMR 429.03(6)(a) times a factor of 1.18. The payment rate for certain sexual and domestic violence services established in 101 CMR 429.03(6)(a), provided pursuant to contracts purchasing only two units in total, is at the rate established in 101 CMR 429.03(6)(a) times a factor of 1.06

(6) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 429.03.

(a) Rates of Payment for Certain Sexual and Domestic Violence Services.

| Program | Unit | Rate | Frequency | | --- | --- | --- | --- | | Domestic Violence Community-based Services | .25 Direct Care FTE | $2,201 | Monthly | | Child Exposed to Domestic Violence Services | .25 Direct Care FTE | $2,310 | Monthly | | Supervised Visitation Services | .25 Direct Care FTE | $2,201 | Monthly | | Sexual and Domestic Violence Equity Services | .25 Direct Care FTE | $2,201 | Monthly | | Sexual and Domestic Violence Equity Legal Services | .25 Direct Care FTE | $3,282 | Monthly | | Intimate Partner Abuse Education Services | Per cohort | $2,973 | Monthly |

(b) Rates of Payment for Rape Crisis Centers and for Certain Sexual and Domestic Violence Service Add-ons.

| Program | Unit | Rate | Frequency | | --- | --- | --- | --- | | Rape Crisis Centers - Dual Agency | Tier 1 | $74,503 | Monthly | | Tier 2 | $65,419 | Monthly | | | Tier 3 | $56,335 | Monthly | | | Tier 4 | $47,252 | Monthly | | | Tier 5 | $38,168 | Monthly | | | Tier 6 | $29,084 | Monthly | | | Tier 7 | $20,001 | Monthly | | | Tier 8 | $10,917 | Monthly | | | Rape Crisis Centers - Stand-alone Agency | Tier 1 | $77,240 | Monthly | | Tier 2 | $67,821 | Monthly | | | Tier 3 | $58,403 | Monthly | | | Tier 4 | $48,984 | Monthly | | | Tier 5 | $39,566 | Monthly | | | Tier 6 | $30,147 | Monthly | | | Tier 7 | $20,729 | Monthly | | | Tier 8 | $11,310 | Monthly | |

| Add-on Rates | Rate | Frequency | | --- | --- | --- | | Rape Crisis Satellite Center | $45.18 | Hourly | | Rape Crisis Statewide Specialized Hotline | $1,949 | Monthly | | Rape Crisis Direct Care.25 FTE | $2,201 | Monthly | | Housing Stabilization | I.C. | N/A | | Extraordinary Circumstances/Flex Funding | I.C. | N/A | | New SANE or SANE Telemedicine Site Development | I.C. | N/A | | Supervised Visitation Security Add-on per Site | $952.26 | Monthly | | Intimate Partner Abuse Education Services - Outreach and Development | $488 | Monthly |

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

101 CMR, § 429.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

101 CMR, § 429.05 Severability

The provisions of 101 CMR 429.00 are severable. If any provision of 101 CMR 429.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 429.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue S1331, eff. 1/27/2017.

Rates for Program of Assertive Community Treatment Services Rates for Program of Assertive Community Treatment Services

101 CMR, § 430.01 General Provisions

(1) Scope. 101 CMR 430.00 governs the payment rates for certain Program of Assertive Community Treatment services purchased by governmental units, including the Department of Mental Health.

(2) Applicable Dates of Service. Rates contained within 101 CMR 430.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 430.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 430.00. Governmental units that purchase the services described in 101 CMR 430.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 430.00.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 430.02 Definitions

As used in 101 CMR 430.00, unless the context requires otherwise, terms have the meanings in 101 CMR 430.02.

Client. An individual who receives certain Program of Assertive Community Treatment services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Extraordinary Circumstances/Flex Funding. A method whereby, subject to availability, a purchasing governmental unit may provide resource allocations to a client and/or provider across the state. Flexible funding may be provided through a number of means including, but not limited to, reimbursement to client for specific support services or funds directed to a qualified provider for extraordinary circumstances.

Forensic Group Living Environment (GLE). A five-bed group living environment (GLE) with 24/7 staffing coverage. Persons served are admitted into the GLE only with DMH approval. It is expected that individuals who are referred to the GLE will be determined to need more intensive rehabilitation, and additional structure and supports. The GLE must be licensed by DMH in accordance with 104 CMR 28.15: General Provisions .

Forensic Program of Assertive Community Treatment (PACT). The Forensic PACT is a comprehensive service model designed to have special capabilities to serve individuals with serious and persistent mental illness who have current criminal justice involvement or a history of repetitive criminal justice involvement; may benefit from intensive coordinated services; and have not responded well to program or office-based interventions. Forensic PACT has a multidisciplinary team approach to providing active, ongoing, comprehensive, integrated community-based services. These services are designed to be responsive to changing needs and are typically long term. Services include outreach, engagement, rehabilitation, clinical, health-related as well as recovery-based interventions and support. Services are individually directed and the team is the single point of accountability for all services required by DMH. Forensic PACT is a recovery-oriented service with the goal of facilitating each individual's recovery journey.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Program of Assertive Community Treatment (PACT). A comprehensive service model for individuals with serious mental illness who may benefit from intensive coordinated services and have not responded well to program or office-based interventions. It has a multidisciplinary team approach to providing active, ongoing, comprehensive, integrated community-based services. These services are designed to be responsive to changing needs and are typically long term. Services include outreach, engagement, rehabilitation, clinical, health-related as well as recovery-based interventions and support. The PACT model is an evidence-based practice referred to by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Alliance on Mental Illness (NAMI) as an Assertive Community Treatment (ACT) program.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 430.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 430.03.

| Service | Model | Rate | Unit of Service | | --- | --- | --- | --- | | Program of Assertive Community Treatment | PACT 50 | $67.10 | Enrollment Day | | PACT 80 | $58.38 | Enrollment Day | | | Forensic PACT | $90.36 | Enrollment Day | | | Forensic GLE | $385.21 | Bed Day | | | PACT Youth | $207.00 | Enrollment Day | | | Extraordinary Circumstances/Flex Funding | Add-on | I.C. | N/A |

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 430.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 430.05 Severability

The provisions of 101 CMR 430.00 are severable. If any provision of 101 CMR 430.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 430.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

Rates for Certain Respite Services Rates for Certain Respite Services

101 CMR, § 431.01 General Provisions

(1) Scope. 101 CMR 431.00 governs the payment rates for certain respite services purchased by governmental units including the Department of Mental Health.

(2) Applicable Dates of Service. Rates contained within 101 CMR 431.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 431.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 431.00. Governmental units that purchase the services described in 101 CMR 431.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 431.00.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 431.02 Definitions

As used in 101 CMR 431.00, unless the context requires otherwise, terms have the meanings in 101 CMR 431.02.

Client. An individual who receives certain respite services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Respite Services. These services provide temporary short-term, community-based clinical and rehabilitative services that enable an individual to live in the community as fully and independently as possible. Respite Services are strength-based and person-centered in supporting clients to maintain, enter, or return to permanent living situations and are available in both site-based and mobile settings.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 431.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 431.03.

| Service | Model | Unit of Service | Rate | | --- | --- | --- | --- | | Respite | A | Month | $75,312 | | B | Month | $98,802 | | | C | Month | $211,448 | | | Peer Model | Month | $50,457 | | | Site Only | Per Diem | $302.00 | | | Mobile Only | Per Diem | $151.04 | |

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 431.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 431.05 Severability

The provisions of 101 CMR 431.00 are severable. If any provision of 101 CMR 431.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 431.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

Rates for Certain Lead Agency Services Rates for Certain Lead Agency Services

101 CMR, § 432.01 General Provisions

(1) Scope. 101 CMR 432.00 governs the payment rates for certain lead agency services purchased by governmental units, including the Department of Children and Families.

(2) Applicable Dates of Service. Rates contained within 101 CMR 432.00 apply for dates of service provided on or after July 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 432.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 432.00. Governmental units that purchase the services described in 101 CMR 432.00 are responsible for the definition, authorization, and approval of services extended to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 432.00.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 432.02 Definitions

As used in 101 CMR 432.00, unless the context requires otherwise, terms have the meanings in 101 CMR 432.02.

Client. An individual that receives certain lead agency services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Flex Funding. A method whereby, subject to availability, a purchasing governmental unit may provide resource allocations to a client(s) and/or provider(s) across the state. Flexible funding may be provided through a number of means including, but not limited to, reimbursement to client for specific support services or funds directed to a qualified provider for extraordinary circumstances.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Lead Agency. An agency that works in partnership with Massachusetts Department of Children and Families Area Offices and its communities to support and enhance the performance of the Area Offices in achieving positive permanent outcomes for children and their families. The lead agency does this by serving as the hub for coordinating purchased services and non-paid community supports.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 432.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Services Provided on the Islands of Martha's Vineyard and Nantucket. In accordance with the provisions of St. 2016, c. 133, payment for services provided in programs located on the islands of Martha's Vineyard and Nantucket will be made at the rate for the service contained in 101 CMR 432.03(6) times a factor of 1.07.

(6) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 432.03.

| Service | Tier | Unit of Service | Rate | | --- | --- | --- | --- | | Lead Agency | 1 | Month | $29,303 | | 2 | Month | $35,571 | | | 3 | Month | $41,494 | | | 4 | Month | $45,631 | | | 5 | Month | $62,841 | | | 6 | Month | $83,214 | | | Flex Funding | n/a | I.C. | | | Case Manager/ Education Coordinator (0.5 FTE) | Add-on | Month | $3,340 | | Case Manager/ Education Coordinator (1.0 FTE) | Add-on | Month | $6,680 |

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 432.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 432.05 Severability

The provisions of 101 CMR 432.00 are severable. If any provision of 101 CMR 432.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 432.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

[Repealed] [Repealed]

101 CMR, § 433.01 General Provisions

(1) Scope. 101 CMR 433.00 governs the payment rates for Certain Health and Human Services Programs Previously Established on July 1, 2021 purchased by a governmental unit, including, but not limited to, Department of Developmental Services (DDS), the Massachusetts Commission for the Blind (MCB), the Massachusetts Rehabilitation Commission (MRC), the Department of Mental Health (DMH), the Department of Youth Services (DYS), the Department of Children and Families (DCF), the Department of Public Health (DPH), the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH), or MassHealth.

(2) Applicable Dates of Service. Rates contained in 101 CMR 433.00 apply for dates of service provided on or after January 1, 2022.

(3) Disclaimer of Authorization of Services. 101 CMR 433.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 433.00. Governmental units that purchase the services described in 101 CMR 433.00 are responsible for the definition, authorization, and approval of services provided to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 433.00.

(5) Parent Regulations. 101 CMR 433.00 describes operational add-on rates for certain services whose basic rates are governed by other regulations. For services not included in 101 CMR 433.00, please refer to the parent regulation listed in 101 CMR 433.01(5).

| Service | Parent Regulation | | --- | --- | | Residential Rehabilitation programs, Clinically Managed Detoxification Services, Supportive Case Management Services, Triage, Engagement and Assessment Services, Youth Residential and Clinical SUD Treatment Services and Office Based Opioid Treatment Services | 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs | | Certain Adult Housing and Community Support Services | 101 CMR 421.00: Rates for Adult Housing and Community Support Services | | Certain Youth and Young Adult Services | 101 CMR 427.00: Rates for Certain Youth and Young Adult Support Services | | Certain Independent Living Communities | 101 CMR 428.00: Rates for Certain Independent Living Communities and Services | | Sexual and Domestic Violence Services | 101 CMR 429.00: Rates for Certain Sexual and Domestic Violence Services | | Program of Assertive Community Treatment Services | 101 CMR 430.00: Rates for Program of Assertive Community Treatment Services | | Certain Respite Services | 101 CMR 431.00: Rates for Certain Respite Services | | Certain Lead Agency Services | 101 CMR 432.00: Rates for Certain Lead Agency Services |

History

Adopted by Mass Register Issue 1450, eff. 7/27/2021.

101 CMR, § 433.02 Definitions

As used in 101 CMR 433.00, terms have the meanings in 101 CMR 433.02, except as otherwise provided.

Client. An individual receiving services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

COVID -19 Payment Rate. A rate that is intended to take into account the change in program model necessary due to COVID-19 requirements, which will be instituted at the discretion of the purchasing governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

History

Adopted by Mass Register Issue 1450, eff. 7/27/2021.

101 CMR, § 433.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Approved Rates with Applicable Dates of Service Provided on or after July 1, 2021. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 433.03(4).

(a) Certain Substance Use Disorder Programs. Terms used in 101 CMR 433.03(4)(a) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 346.02: Definitions .

| Service/Program | Code | Unit of Service | Rate | | --- | --- | --- | --- | | Youth Residential Substance Use Disorder Treatment | H0019-HF | Per Diem | $323.55 | | Clinically Intensive Youth Residential Substance Use Disorder Treatment | H0019-HA | Per Diem | $425.39 | | Residential Services | H0019 | Per Diem | $149.20 | | Residential Rehab Pregnant Enhancement | H0019-TH | Per Diem | $41.58 | | Residential Rehab Postpartum Enhancement | H0019-HD | Per Diem | $93.35 | | Residential Rehab Child Enhancement | H0019-HV | Per Diem | $46.67 | | Medically Monitored Inpatient Detoxification | H0011 | Per Diem | $420.77 | | Clinically Managed Inpatient Detoxification | H0010 | Per Diem | $350.93 | | Transitional Support Services | H0018 | Per Diem | $185.21 | | Second Offender Drive Alcohol Education Residential | H0018-H9 | Per Diem | $148.82 | | Jail Diversion - Phase 1 | H0019-H9 | Per Diem | $222.81 | | Jail Diversion - Phase 2 | H0006-H9 | Per Hour | $61.53 | | Family Supportive Housing | H0019-HR | Per Diem | $197.63 | | Family Residential Treatment | H01019-HR | Per Diem | $327.92 | | Supportive Case Management - Permanent Adult | N/A | Enrolled Client Day | $12.43 | | Supportive Case Management - Permanent Families | N/A | Enrolled Client Day | $25.06 | | Supportive Case Management - Permanent Young Adult | N/A | Enrolled Client Day | $34.46 | | Supportive Case Management - Transitional Adult | N/A | Enrolled Client Day | $14.80 | | Supportive Case Management - Transitional Families | N/A | Enrolled Client Day | $29.79 | | Supportive Case Management - Transitional Young Adult | N/A | Enrolled Client Day | $40.17 | | Supportive Case Management - House Manager Add-on | N/A | Month | $2,917.00 | | Supportive Case Management - Outreach and Staffing Supports | N/A | Month | $3,997.00 | | Supportive Case Management - Low Threshold | N/A | Enrolled Client Day | $51.43 | | Supportive Case Management - School Based Targeted Prevention | N/A | Month | $16,882.00 | | Triage, Engagement & Assessment Services - Model A -Base Rate | N/A | Monthly Per Slot | $952.00 | | Triage, Engagement & Assessment Services - Model A -Engagement Staff Rate | N/A | Monthly Per Slot | $534.00 | | Triage, Engagement & Assessment Services - Model A -Engagement Staff Rate Day Program Only | N/A | Monthly Per Slot | $273.00 | | Triage, Engagement & Assessment Services - Model B -Base Rate | N/A | Monthly Per Slot | $1,141.00 | | Triage, Engagement & Assessment Services - Model B -Engagement Staff Rate | N/A | Monthly Per Slot | $720.00 | | Triage, Engagement & Assessment Services - Model B -Engagement Staff Rate Day Program Only | N/A | Monthly Per Slot | $447.00 | | Triage, Engagement & Assessment Services - Peer Service Coordinator Add-on | N/A | Per Diem | $22.04 | | Triage, Engagement & Assessment Services - Social Worker LICSW Add-on | N/A | Per Diem | $38.08 | | Triage, Engagement & Assessment Services - Care Coordinator Add-on | N/A | Per Diem | $22.04 | | Triage, Engagement & Assessment Services - Direct Care Staff Add-on | N/A | Per Diem | $22.04 | | Triage, Engagement & Assessment Services - Support Staff Add-on | N/A | Per Diem | $22.04 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 1 | N/A | Monthly | $2,562.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 2 | N/A | Monthly | $3,611.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 3 | N/A | Monthly | $4,659.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 4 | N/A | Monthly | $5,708.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 5 | N/A | Monthly | $6,757.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 6 | N/A | Monthly | $8,108.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 7 | N/A | Monthly | $9,459.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 8 | N/A | Monthly | $10,810.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 9 | N/A | Monthly | $12,162.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - Tier 10 | N/A | Monthly | $13,513.00 | | Office Based Opioid Treatment (FQHCs) Wraparound Services - 25 Client Add-on | N/A | Monthly | $1,351.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 1 | N/A | Monthly | $4,714.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 2 | N/A | Monthly | $5,763.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 3 | N/A | Monthly | $6,811.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 4 | N/A | Monthly | $7,860.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 5 | N/A | Monthly | $8,908.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 6 | N/A | Monthly | $10,690.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 7 | N/A | Monthly | $12,472.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 8 | N/A | Monthly | $14,253.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 9 | N/A | Monthly | $16,035.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - Tier 10 | N/A | Monthly | $17,817.00 | | Office Based Opioid Treatment - Outpatient Clinic Wraparound Services - 25 Client Add-on | N/A | Monthly | $3,503.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 1 | N/A | Monthly | $4,968.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 2 | N/A | Monthly | $8,495.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 3 | N/A | Monthly | $11,985.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 4 | N/A | Monthly | $15,501.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 5 | N/A | Monthly | $19,018.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 6 | N/A | Monthly | $22,821.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 7 | N/A | Monthly | $26,625.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 8 | N/A | Monthly | $30,428.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 9 | N/A | Monthly | $34,232.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - Tier 10 | N/A | Monthly | $38,035.00 | | Office Based Opioid Treatment - Hospital Wraparound Services - 25 Client Add-on | N/A | Monthly | $2,562.00 | | Office Based Opioid Treatment (FQHCs) Start-up - Level 1 | N/A | Monthly | $8,659.00 | | Office Based Opioid Treatment (FQHCs) Start-up -Level 2 | N/A | Monthly | $12,669.00 |

(b) Adult Housing and Community Support Services. Terms used in 101 CMR 433.03(4)(f) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 421.02: Definitions .

Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | Outreach and Engagement | Month | $31,757 | | Safe Haven: ten to 12 beds | Enrolled day | $180.45 | | Safe Haven: seven to nine beds | Enrolled day | $200.40 | | Dual Diagnosis Shelter - donated space | Enrolled day | $163.66 | | Dual Diagnosis Shelter - with occupancy costs | Enrolled day | $184.38 | | Housing Options Program: Level 1 | Enrolled month | $40.58 | | Housing Options Program: Level 2 | Enrolled month | $165.45 | | Assertive Treatment and Relapse Prevention: Model A - nine to 12 clients | Enrolled day | $50.98 | | Assertive Treatment and Relapse Prevention: Model B - six to eight clients | Enrolled day | $48.57 |

Adult Housing and Community Support Service Add-on Rates.

| Position Title | Per Diem | .25 FTE Monthly | .50 FTE Monthly | 1.0 FTE Monthly | | --- | --- | --- | --- | --- | | Direct Care | $166 | $897 | $1,793 | $3,587 | | Direct Care III | $214 | $1,161 | $2,321 | $4,643 | | LICSW | $302 | $1,633 | $3,267 | $6,534 |

Congregate Care Hourly Add-on Rates.

| Position | Hourly Rate | | --- | --- | | Direct Care | $22.04 | | Certified Nursing Assistant | $22.67 | | Direct Care III | $28.53 | | Occupational Therapist | $55.04 | | Occupational Therapist Assistant | $43.56 | | Case Manager, Social Worker, Clinician (MA level - not Independent Licensed) | $38.10 | | LPN | $41.91 | | Registered Nurse | $63.20 | | Clinician with Independent License | $44.53 | | Social/Caseworker (BA Level) | $31.75 | | Nurse Practitioner/APRN | $86.75 |

(c) Youth And Young Adult Support Services. Terms used in 101 CMR 433.03(4)(g) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 427.02: Definitions .

Alternative Lock-up Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | A | Monthly | $11,547 | | B | Monthly | $20,111 | | C | Monthly | $25,703 |

Conflict of Interest Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | One Family | Monthly | $1,090 | | Five Families | Monthly | $5,448 |

Teen Pregnancy Prevention Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | In school | Curriculum Hour | $324.70 | | Outside school | Curriculum Hour | $405.88 | | Remote Add-on | Hour | $81.18 | | Peer Leadership & Youth Development | Contact Hour | $243.53 | | Partnership Development | Hour | $46.70 |

Therapeutic Day Services Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | Model 1 | Month | $28,418 | | Model 2 | Month | $24,586 | | Model 3A | Month | $25,547 | | Model 3B | Month | $34,615 | | Model 4A | Month | $20,030 | | Model 4B | Month | $37,806 |

Therapeutic Day Services Add-on Rates.

| Title | Unit of Service | .25 FTE | .5 FTE | .75 FTE | 1 FTE | | --- | --- | --- | --- | --- | --- | | Clinical (LICSW) | Monthly | $1,633 | $3,268 | $4,900 | $6,534 | | Peer/Direct Care | Monthly | $897 | $1,794 | $2,690 | $3,587 | | Direct Care III | Monthly | $1,160 | $2,321 | $3,481 | $4,641 |

Young Parent Support Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | Model A | Month | $8,435 | | Model B | Month | $16,869 | | YPS Specialty Direct Care III Add-on (.5 FTE) | Month | $2,321 | | YPS Specialty Direct Care III Add-on (1 FTE) | Month | $4,641 |

(d) Independent Living Community Programs. Terms used in 101 CMR 433.03(4)(h) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 428.02: Definitions .

Deaf and Hard of Hearing Independent Living Service Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | DHILs - Region 1 | Monthly | $46,315 | | DHILs - Region 2 | Monthly | $40,707 | | DHILs - Region 3 | Monthly | $36,502 | | DHILs - Region 4 | Monthly | $33,600 | | DHILs - Region 5 | Monthly | $21,841 | | DHILs - Region 6 | Monthly | $18,927 | | DHILs - Region 7 | Monthly | $11,631 | | DHILs - Region 8 | Monthly | $7,495 |

Recovery Learning Communities Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | Recovery Learning Communities | Monthly | $76,935 |

Vocational Rehabilitation Independent Living Service Program Rates.

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | VRIL Service Add-on | Per Hour | $129 | | VRIL Assessment | Per Component | $515 | | Independent Living Skills Training | Per Component | $1,931 | | Community Resource Access | Per Component | $1,931 | | PASS Plan | Per Component | $1,931 | | Single Service Purchase | Per Component | $901 | | VRIL Group Training Add-on | Per Client per Class | $43.49 |

Independent Living Communities Add-on Rates.

| Position | Unit of Service | Rate | | --- | --- | --- | | Direct Care 0.25 FTE Add-on | Monthly | $1,161 | | Direct Care 0.5 FTE Add-on | Monthly | $2,321 | | Direct Care 0.75 FTE Add-on | Monthly | $3,482 | | Direct Care 1.0 FTE Add-on | Monthly | $4,643 |

(e) Sexual and Domestic Violence Services. Terms used in 101 CMR 433.03(4)(i) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 429.02: Definitions .

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | Domestic Violence Community-based Services | .25 Direct Care FTE | $1,952 | | Child Exposed to Domestic Violence Services | .25 Direct Care FTE | $2,097 | | Supervised Visitation Services | .25 Direct Care FTE | $1,990 | | Sexual and Domestic Violence Equity Services | .25 Direct Care FTE | $1,952 | | Sexual and Domestic Violence Equity Legal Services | .25 Direct Care FTE | $3,028 | | Intimate Partner Abuse Education Services | Per Cohort | $2,658 | | Intimate Partner Abuse Education Services - Outreach and Development | Monthly | $443 | | Rape Crisis Centers - Dual Agency Tier 1 | Monthly | $67,141 | | Rape Crisis Centers - Dual Agency Tier 2 | Monthly | $58,974 | | Rape Crisis Centers - Dual Agency Tier 3 | Monthly | $50,807 | | Rape Crisis Centers - Dual Agency Tier 4 | Monthly | $42,640 | | Rape Crisis Centers - Dual Agency Tier 5 | Monthly | $34,473 | | Rape Crisis Centers - Dual Agency Tier 6 | Monthly | $26,306 | | Rape Crisis Centers - Dual Agency Tier 7 | Monthly | $18,139 | | Rape Crisis Centers - Dual Agency Tier 8 | Monthly | $9,972 | | Rape Crisis Centers - Stand-alone Agency Tier 1 | Monthly | $70,328 | | Rape Crisis Centers - Stand-alone Agency Tier 2 | Monthly | $61,771 | | Rape Crisis Centers - Stand-alone Agency Tier 3 | Monthly | $53,214 | | Rape Crisis Centers - Stand-alone Agency Tier 4 | Monthly | $44,658 | | Rape Crisis Centers - Stand-alone Agency Tier 5 | Monthly | $36,101 | | Rape Crisis Centers - Stand-alone Agency Tier 6 | Monthly | $27,544 | | Rape Crisis Centers - Stand-alone Agency Tier 7 | Monthly | $18,987 | | Rape Crisis Centers - Stand-alone Agency Tier 8 | Monthly | $10,430 | | Rape Crisis Satellite Center Add-on | Hourly | $40.40 | | Rape Crisis Direct Care 0.25 FTE Add-on | Monthly | $1,952 |

(f) Program of Assertive Community Treatment. Terms used in 101 CMR 433.03(4)(j) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 430.02: Definitions .

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | Program of Assertive Community Treatment - PACT50 | Enrollment Day | $54.02 | | Program of Assertive Community Treatment - PACT80 | Enrollment Day | $49.83 | | Program of Assertive Community Treatment - Forensic PACT | Enrollment Day | $78.54 | | Program of Assertive Community Treatment - Forensic GLE | Bed Day | $323.39 |

(g) Certain Respite Services. Terms used in 101 CMR 433.03(4)(k) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 431.02: Definitions .

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | Respite - A | Month | $60,629 | | Respite - B | Month | $83,628 | | Respite - C | Month | $172,054 | | Respite - Peer Model | Month | $43,271 | | Respite - Site Only | Per Diem | $262.40 | | Respite - Mobile Only | Per Diem | $130.52 |

(h) Lead Agency Services. Terms used in 101 CMR 433.03(4)(l) that have not been defined elsewhere in 101 CMR 433.00 have the meanings in 101 CMR 432.02: Definitions .

| Service/Program | Unit of Service | Rate | | --- | --- | --- | | Lead Agency Tier 1 | Month | $26,181 | | Lead Agency Tier 2 | Month | $31,772 | | Lead Agency Tier 3 | Month | $37,060 | | Lead Agency Tier 4 | Month | $40,706 | | Lead Agency Tier 5 | Month | $55,781 | | Lead Agency Tier 6 | Month | $73,749 | | Case Manager/Education Coordinator 0.50 FTE Add-on | Month | $2,916 | | Case Manager/Education Coordinator 1.0 FTE Add-on | Month | $5,832 |

History

Adopted by Mass Register Issue 1450, eff. 7/27/2021.

101 CMR, § 433.04 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the Executive Director or Chief Financial Officer of the provider.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1450, eff. 7/27/2021.

101 CMR, § 433.05 Severability

The provisions of 101 CMR 433.00 are severable. If any provision of 101 CMR 433.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 433.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1450, eff. 7/27/2021.

Rates for Certain Substance Use Disorder Services Rates for Certain Substance Use Disorder Services

101 CMR, § 444.01 General Provisions

(1) Scope and Purpose. 101 CMR 444.00 governs rates of payment for opioid treatment and other substance use disorder services to be used by all governmental units making payment to eligible providers of certain substance use disorder services to publicly assisted clients. The rates for health care services set forth in 101 CMR 444.00 also apply to individuals covered by M.G.L. c.152 (the Workers' Compensation Act).

(2) Applicable Dates of Service. Rates contained in 101 CMR 444.00 apply for dates of service provided on or after March 28, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 444.00 is neither authorization for nor approval of the substantive services for which rates are determined pursuant to 101 CMR 444.00. Governmental units that purchase services from eligible providers are responsible for the definition, authorization, and approval of services extended to publicly assisted clients.

(4) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list:

(a) codes for which only the code numbers change, with the corresponding cross references between existing and new codes;

(b) deleted codes for which there are no corresponding new codes; and

(c) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (IC) reimbursement for these codes until appropriate rates can be developed.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 444.02 Definitions

As used in 101 CMR 444.00, terms shall have the following meanings, unless the context requires otherwise.

Meaning of Terms. As used in 101 CMR 444.00, unless the context requires otherwise, terms have the following meanings.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Eligible Provider. Any individual, group, partnership, trust, corporation, or other legal entity that offers services for purchase by a governmental unit and that meets the conditions of purchase or licensure that have been or may be adopted by a purchasing governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Established Charge. The lowest fee that is charged or accepted as payment by the eligible provider to the general public or any third-party payer, other than a governmental unit, for the provision of services. Fees based upon the client's ability to pay, as in the case of a sliding fee scale, and fees subject to EOHHS review and approval are not deemed to be established charges.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Individualized Treatment and Stabilization Services. Acute Treatment Services (ASAM Level 3.7) and Clinical Stabilization Services (ASAM Level 3.5) provided in an appropriately licensed facility and in accordance with all applicable specifications.

Medical Evaluation. A history, physical examination, and assessment of mental status that incorporates the principles of The American Society of Addiction Medicine completed prior to admission to Individualized Treatment and Stabilization Services and Opioid Treatment Programs and as needed based on clinical presentation.

Opioid Treatment Program (OTP). A program that provides opioid treatment services. An opioid treatment program must be federally certified by the Substance Abuse Mental Health Services Administration and must be licensed as an opioid treatment program by the Department of Public Health under 105 CMR 164.000: Licensure of Substance Use Disorder Treatment Programs . Opioid treatment programs must conform to the federal opioid treatment standards set forth in 42 CFR 8.12: Federal Opioid Treatment Standards

Opioid Treatment Services. Supervised assessment and treatment of an individual, using FDA approved medications (including methadone, buprenorphine, buprenorphine/naloxone, and naltrexone), along with a comprehensive range of medical and rehabilitative services, when clinically necessary, to alleviate the adverse medical, psychological, or physical effects incident to opiate use disorders. This term encompasses withdrawal management and maintenance treatment.

Publicly Assisted Client. A person who receives program services for which a governmental unit is liable, in whole or in part, under a statutory program of financial assistance.

Purchasing Governmental Unit. A governmental unit that has purchased or is purchasing service units from an eligible provider.

Recovery Support Navigator. A paraprofessional or peer specialist who receives specialized training in the essentials of substance use disorder and evidence-based techniques such as motivational interviewing, and who supports members in accessing and navigating the substance use disorder treatment system through activities that can include care coordination, case management, and motivational support.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 444.03 Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

(3) An eligible provider that was paid by a governmental unit for opioid treatment services provided in a prior fiscal year, and whose program operated for the entire prior fiscal year must submit the following information to the Operational Services Division and/or to the Center for Health Information and Analysis as required:

a. An annual Uniform Financial Statements and Independent Auditor's Report (UFR) completed in accordance with:

the filing requirements and schedule of 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services ; and
any special instructions appearing in the UFR Audit & Preparation Manual, that may require that certain providers distinguish certain programs by filing separate UFR Schedule Bs for each program; and

b. Any cost report supplemental schedule or any additional information requested by the Center within the timeframe specified by the Center on the request.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 444.04 Rate Provisions

(2) Rates as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other sources is used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Rates of Payment. Payment rates under 101 CMR 444.00 must be the lower of:

(a) the eligible provider's usual charge to the general public; or

(b) the schedule of allowable rates for services provided by substance use disorder treatment programs as set forth in 101 CMR 444.04(4)(a) and (b).

(4) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate except as provided in 101 CMR 444.04(2).

(a) Allowable fees for dates of service on or after March 14, 2025 through June 30, 2025:

| Code | Rate | Unit | Description | | --- | --- | --- | --- | | G2067 | $190.82 | Per Week | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | | G2068 | $227.96 | Per Week | Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | | G2073 | $1,209.57 | Per Week | Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | | G2074 | $149.34 | Per Week | Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician or qualified personnel that includes preparation of a treatment plan that includes the patient's short-term goals and the tasks the patient must perform to complete the short-term goals; the patient's requirements for education, vocational rehabilitation, and employment; and the medical, psycho-social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure | | G2076 | $165.73 | Per Initial Visit | | | G2078 | $31.77 | Per Week | Take-home supply of methadone; up to seven additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure. | | G2079 | $68.92 | Per Week | Take-home supply of buprenorphine (oral); up to seven additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure. | | H2015-HF | $17.54 | Per 15 Minutes | Comprehensive community support services, per 15 minutes (Recovery Support Navigator) | | H2036 - HK | $919.21 | Per Diem | Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 1) | | H2036 - HF | $667.22 | Per Diem | Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 2) | | H0015 | $121.90 | Per Diem | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3.5 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Structured Outpatient Addiction Program, 3.5 hours, not to exceed two units a day). | | H0015-TF | $176.15 | Per Diem | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3.5 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Enhanced Structured Outpatient Addiction Program, 3.5 hours, not to exceed 2 units a day.) |

(b) Allowable fees for dates of service on or after July 1, 2025:

| Code | Rate | Description | | --- | --- | --- | | G2067 | See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | | G2068 | See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs | Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | | G2073 | See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs | Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | | G2074 | See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs | Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled Opioid Treatment Program) | | G2076 | See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs | Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician or qualified personnel that includes preparation of a treatment plan that includes the patient's short-term goals and the tasks the patient must perform to complete the short-term goals; the patient's requirements for education, vocational rehabilitation, and employment; and the medical, psycho-social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure | | G2078 | See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs | Take-home supply of methadone; up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure. | | G2079 | See 101 CMR 346.00: Rates for Certain Substance-Related and Addictive Disorders Programs | Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure. | | H2015-HF | $17.54 | Comprehensive community support services, per 15 minutes (Recovery Support Navigator) | | H2036-HK | $919.21 | Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 1) | | H2036-HF | $667.22 | Alcohol and/or other drug treatment program, per diem (Individualized Treatment and Stabilization, Tier 2) | | H0015 | $121.90 | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3.5 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Structured Outpatient Addiction Program) | | H0015-TF | $176.15 | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3.5 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education (Enhanced Structured Outpatient Addiction Program) |

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

101 CMR, § 444.05 Severability

The provisions of 101 CMR 444.00 are severable. If any provision of 101 CMR 444.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 444.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Amended by Mass Register Issue 1485, eff. 1/1/2023.

[Repealed] [Repealed]

101 CMR, § 445.01 General Provisions

(1) Scope. 101 CMR 445.00 governs the payment rates for Adult Day Health Services, Day Habilitation Services, Day Services, Prevocational Services, and Supported Employment Services as defined in 101 CMR 445.02, purchased by a governmental unit.

(2) Applicable Dates of Service. Rates contained in 101 CMR 445.00 apply for dates of service as stated in 101 CMR 445.03(2).

(3) Disclaimer of Authorization of Services. 101 CMR 445.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 445.00. Governmental units that purchase the services described in 101 CMR 445.00 are responsible for the definition, authorization, and approval of services provided to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 445.00.

History

Adopted by Mass Register Issue 1431, eff. 8/14/2020.

101 CMR, § 445.02 Definitions

As used in 101 CMR 445.00, unless the context requires otherwise, terms have the meanings in 101 CMR 445.02.

Client. An individual receiving services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

COVID-19 Payment Rate. A rate that is intended to take into account the change in program model necessary due to COVID-19 requirements, which will be instituted at the discretion of the purchasing governmental unit.

Day Services (HCBS). A structured, site-based, group program for participants that fosters community integration and offers assistance with the acquisition, retention, or improvement in self-help, socialization, and adaptive skills, and that takes place in a nonresidential setting separate from the participant's private residence or other residential living arrangement. Services often include assistance to learn activities of daily living and functional skills; language and communication training; compensatory, cognitive and other strategies; interpersonal skills; prevocational skills; and recreational and socialization skills.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Prevocational Services. A service that consists of a range of learning and experimental type activities that prepares a participant for paid or unpaid employment in an integrated, community setting. Services are not job-task oriented but instead, are aimed at a generalized result ( e.g ., attention span, motor skills). The service may include teaching such concepts as attendance, task completion, problem solving, and safety as well as social skills training, improving attention span, and developing or improving motor skills. Basic skill-building activities are expected to specifically involve strategies to enhance a participant's employability in integrated, community settings.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

State Funding. The aggregate state fiscal year amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 445.00. State funding does not include any amounts attributable to federal funding or grant funds.

History

Adopted by Mass Register Issue 1431, eff. 8/14/2020.

101 CMR, § 445.03 Rate Provisions

(2) Reimbursement as Full Payment. Each provider must, as a condition of acceptance of payment by a purchasing agency for services provided to a client, accept the payment rates established by 101 CMR 445.00 as full payment and discharge of all obligations for the services provided. The provider may not seek additional or supplemental payment from clients or other third parties for services for which rates are established by 101 CMR 445.00. If a provider receives any client funds or third-party payments for services provided to a client, the purchasing agency's obligation for services to the client will be offset by the amount received.

(a) Rates with Applicable Dates of Service Provided on or after December 1, 2020.

| Service Description | Code | Unit | Rate | | --- | --- | --- | --- | | Adult Day Health - Basic Level of Care | S5102 | Per Diem | $87.74 | | Adult Day Health - Complex Level of Care | S5102 TG | Per Diem | $111.10 | | Adult Day Health - Basic Level of Care | S5100 | Per 15 Min. | $3.65 | | Adult Day Health - Basic Level of Care | S5101 | Per 3 Hours | $43.85 | | Adult Day Health - Complex Level of Care | S5100 TG | Per 15 Min. | $4.62 | | Adult Day Health - Complex Level of Care | S5101 TG | Per 3 Hours | $55.44 | | Day Habilitation - Skills training and development, per 15 minutes (community program, low need) | H2014 | Per 15 Min. | $4.09 | | Day Habilitation - Skills training and development, per 3 hours (community program, low need) | S5101 | Per 3 Hours | $49.06 | | Day Habilitation - Skills training and development, per 6 hours (community program, low need) | S5102 | Per 6 Hours | $98.11 | | Day Habilitation - Skills training and development per 15 minutes, intermediate level of care (community program, moderate need) | H2014-TF | Per 15 Min. | $4.62 | | Day Habilitation - Skills training and development per 3 hours, intermediate level of care (community program, moderate need) | S5101-TF | Per 3 Hours | $55.44 | | Day Habilitation - Skills training and development per 6 hours, intermediate level of care (community program, moderate need) | S5012-TF | Per 6 Hours | $111.10 | | Day Habilitation - Skills training and development, per 15 minutes, complex/high tech level of care (community program, high need) | H2014-TG | Per 15 Min. | $5.99 | | Day Habilitation - Skills training and development, per 3 hours complex/high tech level of care (community program, high need) | S5101-TG | Per 3 Hours | $71.90 | | Day Habilitation - Skills training and development, per 6 hours complex/high tech level of care (community program, high need) | S5102-TG | Per 6 Hours | $143.81 | | Day Habilitation - Skills training and development per 15 minutes (nursing facility, one-to-two or one to three staffing level) | H2014-U1 | Per 15 Min. | $5.77 | | Day Habilitation - Skills training and development per 3 hours (nursing facility, one-to-two or one to three staffing level) | S5101-U1 | Per 3 Hours | $69.22 | | Day Habilitation - Skills training and development per 6 hours (nursing facility, one-to-two or one to three staffing level) | S5102-U1 | Per 6 Hours | $138.43 | | Day Habilitation - Skills training and development, per 15 minutes (nursing facility, one-to-one staffing level) | H2014-U2 | Per 15 Min. | $10.40 | | Day Habilitation - Skills training and development, per 3 hours (nursing facility, one-to-one staffing level) | S5101-U2 | Per 3 Hours | $124.82 | | Day Habilitation - Skills training and development, per 6 hours (nursing facility, one-to-one staffing level) | S5102-U2 | Per 6 Hours | $249.65 | | Day Habilitation - Skills training and development, per 15 minutes, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | H2014-22 | Per 15 Min. | $4.77 | | Day Habilitation - Skills training and development, per 3 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | S5101-22 | Per 3 Hours | $57.29 | | Day Habilitation - Skills training and development, per 6 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | S5102-22 | Per 6 Hours | $114.58 | | Day Habilitation - Nonemergency transportation; encounter/trip (used only when serving four or more individuals in a nursing facility) | T2003 | Per Trip/ Encounter | $5.11 | | Day Services - HCBS (ABI/MFP) | Multiple | Per Diem | $147.14 | | Day Services - HCBS (ABI/MFP) - partial day | Multiple | Per 3 Hours | $73.57 | | Individual Supported Employment | Multiple | Per 15 Min. | $18.16 | | Prevocational Services | T2019 | Per 15 Min. | $13.09 |

(b) Rates with Applicable Dates of Service Provided on or after March 1, 2021.

| Service Description | Code | Unit | Rate | | --- | --- | --- | --- | | Adult Day Health - Basic Level of Care | S5102 | Per Diem | $78.34 | | Adult Day Health - Complex Level of Care | S5102 TG | Per Diem | $99.20 | | Adult Day Health - Basic Level of Care | S5100 | Per 15 Min. | $3.26 | | Adult Day Health - Basic Level of Care | S5101 | Per 3 Hours | $39.15 | | Adult Day Health - Complex Level of Care | S5100 TG | Per 15 Min. | $4.13 | | Adult Day Health - Complex Level of Care | S5101 TG | Per 3 Hours | $49.50 | | Day Habilitation - Skills training and development, per 15 minutes (community program, low need) | H2014 | Per 15 Min. | $3.65 | | Day Habilitation - Skills training and development, per 3 hours (community program, low need) | S5101 | Per 3 Hours | $43.80 | | Day Habilitation - Skills training and development, per 6 hours (community program, low need) | S5102 | Per 6 Hours | $87.60 | | Day Habilitation - Skills training and development per 15 minutes, intermediate level of care (community program, moderate need) | H2014-TF | Per 15 Min. | $4.13 | | Day Habilitation - Skills training and development per 3 hours, intermediate level of care (community program, moderate need) | S5101-TF | Per 3 Hours | $49.50 | | Day Habilitation - Skills training and development per 6 hours, intermediate level of care (community program, moderate need) | S5102-TF | Per 6 Hours | $99.00 | | Day Habilitation - Skills training and development, per 15 minutes, complex/high tech level of care (community program, high need) | H2014-TG | Per 15 Min. | $5.35 | | Day Habilitation - Skills training and development, per 3 hours complex/high tech level of care (community program, high need) | S5101-TG | Per 3 Hours | $64.20 | | Day Habilitation - Skills training and development, per 6 hours complex/high tech level of care (community program, high need) | S5102-TG | Per 6 Hours | $128.40 | | Day Habilitation - Skills training and development per 15 minutes (nursing facility, one-to-two or one to three staffing level) | H2014-U1 | Per 15 Min. | $5.15 | | Day Habilitation - Skills training and development per 3 hours (nursing facility, one-to-two or one to three staffing level) | S5101-U1 | Per 3 Hours | $61.80 | | Day Habilitation - Skills training and development per 6 hours (nursing facility, one-to-two or one to three staffing level) | S5102-U1 | Per 6 Hours | $123.60 | | Day Habilitation - Skills training and development, per 15 minutes (nursing facility, one-to-one staffing level) | H2014-U2 | Per 15 Min. | $9.29 | | Day Habilitation - Skills training and development, per 3 hours (nursing facility, one-to-one staffing level) | S5101-U2 | Per 3 Hours | $111.45 | | Day Habilitation - Skills training and development, per 6 hours (nursing facility, one-to-one staffing level) | S5102-U2 | Per 6 Hours | $222.90 | | Day Habilitation - Skills training and development, per 15 minutes, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | H2014-22 | Per 15 Min. | $4.26 | | Day Habilitation - Skills training and development, per 3 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | S5101-22 | Per 3 Hours | $51.15 | | Day Habilitation - Skills training and development, per 6 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | S5102-22 | Per 6 Hours | $102.30 | | Day Habilitation - Nonemergency transportation; encounter/trip (used only when serving four or more individuals in a nursing facility) | T2003 | Per Trip/ Encounter | $4.56 | | Day Services - HCBS (ABI/MFP) | Multiple | Per Diem | $131.38 | | Day Services - HCBS (ABI/MFP) - partial day | Multiple | Per 3 Hours | $65.69 | | Individual Supported Employment | Multiple | Per 15 Min. | $16.21 | | Prevocational Services | T2019 | Per 15 Min. | $11.69 |

| Service Description | Code | Unit | Rate (Refer to the rate listed in the cited regulation.) | | --- | --- | --- | --- | | Adult Day Health - Basic Level of Care | S5102 | Per Diem | 101 CMR 310.00: Adult Day Health Services | | Adult Day Health - Complex Level of Care | S5102 TG | Per Diem | | | Adult Day Health - Basic Level of Care | S5100 | Per 15 Min. | 101 CMR 310.00: Adult Day Health Services | | Adult Day Health - Basic Level of Care | S5101 | Per 3 Hours | | | Adult Day Health - Complex Level of Care | S5100 TG | Per 15 Min. | | | Adult Day Health - Complex Level of Care | S5101 TG | Per 3 Hours | | | Day Habilitation - Skills training and development, per 15 minutes (community program, low need) | H2014 | Per 15 Min. | 101 CMR 348.00: Day Habilitation Program Services | | Day Habilitation - Skills training and development, per 3 hours (community program, low need) | S5101 | Per 3 Hours | | | Day Habilitation - Skills training and development, per 6 hours (community program, low need) | S5102 | Per 6 Hours | | | Day Habilitation - Skills training and development per 15 minutes, intermediate level of care (community program, moderate need) | H2014-TF | Per 15 Min. | | | Day Habilitation - Skills training and development per 3 hours, intermediate level of care (community program, moderate need) | S5101-TF | Per 3 Hours | | | Day Habilitation - Skills training and development per 6 hours, intermediate level of care (community program, moderate need) | S5102-TF | Per 6 Hours | | | Day Habilitation - Skills training and development, per 15 minutes, complex/high tech level of care (community program, high need) | H2014-TG | Per 15 Min. | | | Day Habilitation - Skills training and development, per 3 hours complex/high tech level of care (community program, high need) | S5101-TG | Per 3 Hours | | | Day Habilitation - Skills training and development, per 6 hours complex/high tech level of care (community program, high need) | S5102-TG | Per 6 Hours | | | Day Habilitation - Skills training and development per 15 minutes (nursing facility, one-to-two or one to three staffing level) | H2014-U1 | Per 15 Min. | | | Day Habilitation - Skills training and development per 3 hours (nursing facility, one-to-two or one to three staffing level) | S5101-U1 | Per 3 Hours | | | Day Habilitation - Skills training and development per 6 hours (nursing facility, one-to-two or one to three staffing level) | S5102-U1 | Per 6 Hours | | | Day Habilitation - Skills training and development, per 15 minutes (nursing facility, one-to-one staffing level) | H2014-U2 | Per 15 Min. | | | Day Habilitation - Skills training and development, per 3 hours (nursing facility, one-to-one staffing level) | S5101-U2 | Per 3 Hours | 101 CMR 348.00: Day Habilitation Program Services | | Day Habilitation - Skills training and development, per 6 hours (nursing facility, one-to-one staffing level) | S5102-U2 | Per 6 Hours | | | Day Habilitation - Skills training and development, per 15 minutes, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | H2014-22 | Per 15 Min. | | | Day Habilitation - Skills training and development, per 3 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | S5101-22 | Per 3 Hours | | | Day Habilitation - Skills training and development, per 6 hours, unusual procedural service, when the service(s) provided is greater than that usually listed for the listed procedure (supplemental staffing for nursing facility residents in community day habilitation) | S5102-22 | Per 6 Hours | | | Day Habilitation - Non-emergency transportation; encounter/trip (used only when serving four or more individuals in a nursing facility) | T2003 | Per Trip/ Encounter | | | Day Services - HCBS (ABI/MFP) | Multiple | Per Diem | 101 CMR 359.00: Rates for Home and Communitybased Services Waivers | | Day Services - HCBS (ABI/MFP) - partial day | Multiple | Per 3 Hours | | | Individual Supported Employment | Multiple | Per 15 Min. | 101 CMR 419.00: Rates for Supported Employment Services | | Prevocational Services | T2019 | Per 15 Min. | 101 CMR 359.00: Rates for Home and Communitybased Services Waivers |

History

Adopted by Mass Register Issue 1431, eff. 8/14/2020.

101 CMR, § 445.04 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the Executive Director or Chief Financial Officer of the provider.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

(3) Penalty for Noncompliance. The purchasing governmental unit may reduce the payment rates by 15% for any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 445.04(3).

History

Adopted by Mass Register Issue 1431, eff. 8/14/2020.

101 CMR, § 445.05 Severability

The provisions of 101 CMR 445.00 are severable. If any provision of 101 CMR 445.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 445.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1431, eff. 8/14/2020.

COVID-19 and Public Health Emergency Payment Rates For Certain Community Health Care Providers COVID-19 and Public Health Emergency Payment Rates For Certain Community Health Care Providers

101 CMR, § 446.01 General Provisions

(1) Scope and Purpose. 101 CMR 446.00 governs the rates of payment to certain community health care providers to be used by all governmental units for services provided to publicly aided individuals. The rates set forth in 101 CMR 446.03(5) also apply to such services paid for by governmental units for individuals covered by M.G.L. c. 152 (the Workers' Compensation Act). These rates are for services related to Coronavirus Disease 2019 (COVID-19).

(2) Applicable Dates of Service. Rates in 101 CMR 446.00 apply for dates of service on or after October 1, 2024, except as otherwise noted.

(3) Disclaimer of Authorization of Services. 101 CMR 446.00 is not authorization for or approval of the services for which rates are determined pursuant to 101 CMR 446.00. Governmental units that purchase services are responsible for the definition, authorization, and approval of care and services provided to publicly aided individuals.

(4) Coverage. The rates of payment in 101 CMR 446.00 constitute payment in full for all services provided by an eligible provider, including administration and professional supervision services. The payment rates will apply to services set forth in 101 CMR 446.00 provided by eligible providers to publicly aided individuals under the conditions described by the purchasing governmental unit.

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list

(b) codes for which the code number remains the same but the description has changed;

(d) codes for entirely new services that require pricing, or codes that had been previously added at individual consideration (I.C.). EOHHS may list and price these codes according to the rate methodology used in setting rates when Medicare fees are available. When Medicare fees are not available, EOHHS may apply I.C. payment for these codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 446.00, or to issue coding updates and corrections under 101 CMR 446.01(5).

History

Adopted by Mass Register Issue 1429, eff. 10/30/2020.

101 CMR, § 446.02 Definitions

As used in 101 CMR 446.00, terms have the meanings in 101 CMR 446.02, except as otherwise provided.

Clinical Care Team. The staff necessary to provide I&R Services to guests at an I&R site. The clinical care team may include physicians, nurse practitioners, physician assistants, registered nurses, licensed practical nurses, certified nursing assistants, home health aides, masters of social work, licensed independent clinical social workers, and administrative support staff. EOHHS may approve other staff types to be part of the clinical care team, including staff with different clinical qualifications than those listed herein, as appropriate. The make-up of the clinical care team for each I&R community health center will be established in the special conditions amendment to each I&R community health center's provider contract.

Commonwealth COVID-19 Vaccination Plan. The plan describing the administration of COVID-19 vaccinations within the Commonwealth, available at www.mass.gov/info-details/covid-19-vaccine-information.

COVID-19 Services. Services relating to the March 10, 2020 Declaration of State of Emergency within the Commonwealth due to the 2019 novel coronavirus (COVID-19), for which payment rates are set under 101 CMR 446.00.

Eligible Additional Individuals. As determined by the governmental unit or its designee, any

(a) family member of an eligible resident currently residing in the eligible resident's household; or

(b) home health worker who provides regular care to an eligible resident in the eligible resident's household.

Eligible Provider. A person, partnership, corporation, governmental unit, or other entity that provides authorized COVID-19 services and that also meets such conditions of participation as have been or may be adopted from time to time by a governmental unit purchasing COVID-19 services.

Eligible Resident. A Massachusetts resident determined to be eligible for in-home vaccination services by the governmental unit or its designee.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth of Massachusetts or any of its departments, agencies, boards, commissions, or political subdivisions.

Household. A home or residence within the Commonwealth in which at least one eligible resident resides, including congregate care facilities and other congregate housing, but excluding any facility or unit licensed by DPH as a long-term-care facility or unit pursuant to 105 CMR 150.000: Standards for Long-term Care Facilities .

In-home Vaccination Provider. An eligible provider who provides in-home vaccination services pursuant to a contract between the governmental unit and the eligible provider.

In-home Vaccination Services. COVID-19 vaccine administration services performed in a household by an in-home vaccination provider pursuant to a contract between the governmental unit and the in-home vaccination provider.

I&R Community Health Center. A community health center that has agreed to provide services at an I&R site through an executed special conditions amendment to its provider contract.

I&R Services. The services that the clinical care team at an I&R community health center must provide, as provided by the special conditions amendment to the provider contract.

I&R Site. A location, such as a hotel or motel, that separately contracts with EOHHS to provide safe, isolated lodging for individuals with a COVID-19 diagnosis.

Other Vaccinable Individuals. Residents of the Commonwealth who are neither eligible residents nor eligible additional individuals, but who are otherwise eligible to receive a COVID-19 vaccination in accordance with the Commonwealth's COVID-19 vaccination plan.

Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program.

Waste Prevention Vaccinations. COVID-19 vaccinations administered by an in-home vaccination provider to other vaccinable individuals in any setting solely to avoid wasting COVID-19 vaccine doses that would otherwise spoil.

History

Adopted by Mass Register Issue 1429, eff. 10/30/2020.

101 CMR, § 446.03 General Rate Provisions and Payment

(1) Community Health Centers.

(a) General Rate Determination. Rates of payment for services for which 101 CMR 446.03(1) applies are the lowest of

the eligible provider's usual fee to patients other than publicly aided individuals;
the eligible provider's actual charge submitted; or
the schedule of allowable fees set forth in 101 CMR 446.03(1)(c), taking into account appropriate modifiers and any other applicable rate provisions in accordance with 101 CMR 446.03(1).

(b) Defined Terms. Terms used in 101 CMR 446.03(1), that have not been defined elsewhere in 101 CMR 446.00, have the meanings ascribed to those terms in 101 CMR 304.02: Definitions .

Governmental units may pay I&R community health centers for I&R services they provide through a weekly, facility-specific, all-inclusive rate established through the alternative payment methodology described in 101 CMR 446.03(1)(c) a. through 2. This rate must be set forth and agreed to by each I&R community health center and the governmental unit through a contract or special conditions amendment to the provider contract, sufficient to cover the following allowable costs associated with the provision of I&R services, as agreed to by the governmental unit and the I&R community health center.

a. The direct labor costs for the clinical care team, staffed appropriately to meet the clinical and administrative needs of the I&R site.

b. The costs to acquire and maintain sufficient amounts of medical supplies necessary to provide I&R services at the I&R site.

c. Appropriate set-up and other one-time costs associated with the provision of I&R services at the I&R site, which may include information technology equipment and services and office supplies.

d. For the costs described in 101 CMR 446.03(1)(c)1. through 2. to be considered allowable, the cost must, at a minimum, be reasonable, directly related to the provision of I&R services, and identified in the contract or special conditions amendment to the I&R community health center's provider contract.

Billing and Disbursement of Payment. I&R community health centers must bill the governmental unit for the I&R services provided pursuant to 101 CMR 446.03(1)(c) and a contract or special conditions amendment to the provider contract through weekly invoice. The government unit will pay the I&R community health center for such services weekly, upon receipt of such invoice, consistent with the terms of the contract or special conditions amendment to the provider contract.

(d) Supplemental Payments to Community Health Centers.

Subject to federal approval, community health centers that are federally qualified health centers in Massachusetts will receive one-time, health center-specific supplemental payments to account for services rendered during calendar year 2021. The one-time, health center-specific supplemental payment will be paid to each community health center by the end of the second calendar quarter of 2021. A community health center's health center-specific supplemental payment was calculated based on the following components:

a. an amount equal to a portion of the community health center's average monthly claims, based on annualized data from January and February 2020, paid by MassHealth and MassHealth managed care entities, as determined by EOHHS;

b. as applicable, the amount that would have been paid to the community health center, if not for the scheduled decrease to the community health center's 340B supplemental payment under 101 CMR 304.04(3): 340B Transition Supplemental Payments , which took effect on January 1, 2021; and

c. as applicable, an amount determined by EOHHS for the heightened costs faced by community health centers with greater than 100,000 annual individual medical visits, based on annualized data from January and February 2020.

The supplemental payments, as described in 101 CMR 446.03(1)(d)1., will equal the following amounts for each community health center:

| Community Health Center | Supplemental Payment | | --- | --- | | Boston Health Care for the Homeless | $4,839,557 | | Brockton Neighborhood Health Center, Inc. | $2,810,993 | | Caring Health Center, Inc. | $1,318,873 | | Charles River Community Health | $666,458 | | Community Health Center of Cape Cod | $774,741 | | Community Health Center of Franklin County | $353,940 | | Community Health Connections Family Health Center | $1,418,345 | | Community Health Programs CHC | $491,729 | | Dimock Community Health Center | $876,407 | | Duffy Health Center | $361,499 | | Edward M. Kennedy Community Health Center | $1,713,369 | | Family Health Center of Worcester | $2,545,653 | | Fenway Community Health Center | $1,700,062 | | Greater Lawrence Family Health Center, Inc. | $5,340,713 | | Greater New Bedford Community Health Center | $1,329,984 | | Harbor Health Services, Inc. | $1,780,265 | | Harvard Street Neighborhood Health Center | $379,641 | | Healthfirst Family Care Center, Inc. | $841,430 | | Hilltown Community Health Centers, Inc. | $295,175 | | Holyoke Health Center | $2,910,268 | | Island Health Care | $30,351 | | Lowell Community Health Center | $2,738,370 | | Lynn Community Health Center | $3,909,622 | | Manet Community Health Center | $832,276 | | Mattapan Community Health Center | $402,987 | | North End Waterfront Health | $336,460 | | North Shore Community Health, Inc. | $815,613 | | Outer Cape Health Services, Inc. | $586,726 | | South Cove Community Health Center | $1,978,226 | | Springfield Health Services for the Homeless | $138,746 | | Stanley Street Treatment and Resources (SSTAR) | $2,832,520 | | Uphams' Corner Health Center | $715,148 | | Whittier Street Health Center | $908,376 | | TOTAL | $48,974,525 |

(2) Medicine.

(a) General Rate Determination. Rates of payment for services for which 101 CMR 446.03(2) applies are the lowest of

the eligible provider's usual fee to patients other than publicly aided individuals;
the eligible provider's actual charge submitted; or
the schedule of allowable fees set forth in 101 CMR 446.03(2)(e), taking into account appropriate modifiers and any other applicable rate provisions in accordance with 101 CMR 446.03(2).

(b) Individual Consideration. Medical services services designated "I.C." are individually considered items. The governmental unit or purchaser analyzes the eligible provider's report of services rendered and charges submitted under the appropriate unlisted services or procedures category. The governmental unit or purchaser determines appropriate payment for procedures designated I.C. in accordance with the following standards and criteria:

the amount of time required to perform the service;
the degree of skill required to perform the service;

the severity or complexity of the patient's disease, disorder, or disability;

any applicable relative-value studies;
any complications or other circumstances that may be deemed relevant;
the policies, procedures, and practices of other third-party insurers;
the payment rate for prescribed drugs as set forth in 101 CMR 331.00: Prescribed Drugs ; and
a copy of the current invoice from the supplier.

(c) Defined Terms. Terms used in 101 CMR 446.03(2) that have not been defined elsewhere in 101 CMR 446.00 have the meanings in 101 CMR 317.02: General Definitions .

(d) Codes and Modifiers.

Except as otherwise provided, the codes and modifiers for the services described in 101 CMR 446.03(2) are as defined in 101 CMR 317.04(3): Modifiers and 101 CMR 317.04(4): Fee Schedule .
The modifier "SL": State supplied vaccine or antibodies. This modifier is to be applied to codes to identify vaccine or antibodies provided at no cost, whether by the Massachusetts Department of Public Health or other federal or state agency. No payment shall be made for codes with this modifier.

(e) Allowable Fee for Remote Patient Monitoring (RPM) Bundled Services. The following code, modifier, and fee apply for the provision of RPM bundled services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 99423 - U9 | $870.72 | Online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven days; 21 or more minutes. (Used for COVID-19 remote patient monitoring bundled services provided through any appropriate technology or modality, including up to seven days of daily check-ins for evaluation and monitoring; multidisciplinary clinical team reviews of a member's status and needs; appropriate physician oversight; necessary care coordination; and provision of a thermometer and pulse oximeter for remote monitoring.) |

(f) Allowable Fee for COVID-19 Vaccine and Vaccine Administration. The allowable fees for COVID-19 vaccines and their administration are 100% of the corresponding Medicare Part B payment rates, without geographic adjustment. Payment for administration of the COVID-19 vaccine provided by eligible providers who are certified nurse practitioners, certified nurse midwives, psychiatric clinical nurse specialists, clinical nurse specialists, physician assistants, registered nurses, pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C, and home health agencies as specified in 101 CMR 317.02 is 85% of the allowable fee. In the event this fee structure conflicts with the rates for the same codes in 101 CMR 317.00: Rates for Medicine Services , then the fee structure in 101 CMR 317.00 will control.

This fee structure applies for the following codes:

| Code | Description of Code | | --- | --- | | 90480 | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose | | 91304 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5mL dosage, for intramuscular use | | 91318 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use | | 91319 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use | | 91320 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use | | 91321 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use | | 91322 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use |

(g) Allowable Fee for COVID-19 Treatment. The allowable fees for monoclonal antibodies and their administration for the treatment of COVID-19 are 100% of the corresponding Medicare Part B payment rates, without geographic adjustment. Payment for the administration of monoclonal antibodies provided by eligible providers who are certified nurse practitioners, certified nurse midwives, psychiatric clinical nurse specialists, clinical nurse specialists, physician assistants, registered nurses, pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C, and home health agencies as specified in 101 CMR 317.02 is 85% of the allowable fee. In the event this fee structure conflicts with the rates for the same codes in 101 CMR 317.00: Rates for Medicine Services , then the fee structure in 101 CMR 317.00 will control.

This fee structure applies for the following codes:

| Code | Description of Code | | --- | --- | | Q0220 SL | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg | | Q0221SL | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg | | Q0222 | Injection, bebtelovimab, 175 mg | | Q0240 SL | Injection, casirivimab and imdevimab, 600 mg | | Q0243 SL | Injection, casirivimab and imdevimab, 2400 mg | | Q0244 SL | Injection, casirivimab and imdevimab, 1200 mg | | Q0245 SL | Injection, bamlanivimab and etesevimab, 2100 mg | | Q0247 | Injection, sotrovimab, 500 mg | | Q0249 | Injection, tocilizumab, for hospitalized adults and pediatric patients (two years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg | | M0220 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring | | M0221 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider based to the hospital during the federal COVID-19 public health emergency | | M0222 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | | M0223 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the federal COVID-19 public health emergency | | M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses | | M0241 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the federal COVID-19 public health emergency, subsequent repeat doses | | M0243 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring | | M0244 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the federal COVID-19 public health emergency | | M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring | | M0246 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the federal COVID-19 public health emergency | | M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring | | M0248 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the federal COVID-19 public health emergency | | M0249 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (two years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose | | M0250 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (two years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose |

(h) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after September 22, 2021. The following code and fee applies for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 0004A | $45.87 | Pfizer-BioNTech COVID-19 Vaccine (Purple Cap) Administration - Booster (ADM SARSCOV2 30MCG/0.3ML BST) |

(i) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after October 20, 2021. The following codes and fees apply for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 0034A | $45.87 | Janssen COVID-19 Vaccine Administration - Booster[ ( (ADM SARSCOV2 VAC AD26.5ML B) | | 91306 SL | $0.00 | Moderna COVID-19 Vaccine (Low Dose) (SARSCOV2 VAC 50MCG/0.25ML IM) | | 0064A | $45.87 | Moderna COVID-19 Vaccine (Low Dose) Administration - Booster (ADM SARSCOV2 50MCG/0.25MLBST) |

(j) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after October 29, 2021. The following codes and fees apply for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 91307 SL | $0.00 | Pfizer-BioNTech COVID-19 Pediatric Vaccine (Orange Cap) | | 0071A | $45.87 | Pfizer-BioNTech COVID-19 Pediatric Vaccine (Orange Cap) - Administration - First dose (ADM SARSCV2 10MCG TRS-SUCR 1) | | 0072A | $45.87 | Pfizer-BioNTech COVID-19 Pediatric Vaccine (Orange Cap) - Administration - Second dose (ADM SARSCV2 10MCG TRS-SUCR 2) |

(k) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after January 3, 2022. The following codes and fees apply for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 91305 SL | $0.00 | Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) (SARSCOV2 VAC 30 MCG TRS-SUCR) | | 0051A | $45.87 | Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose (ADM SARSCV2 30MCG TRS-SUCR 1) | | 0052A | $45.87 | Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose (ADM SARSCV2 30MCG TRS-SUCR 2) | | 0053A | $45.87 | Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose (ADM SARSCV2 30MCG TRS-SUCR 3) | | 0054A | $45.87 | Pfizer-BioNTech COVID-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster (ADM SARSCV2 30MCG TRS-SUCR B) | | 0073A | $45.87 | Pfizer-BioNTech COVID-19 Pediatric Vaccine (Orange Cap) - Administration - Third dose (ADM SARSCV2 10MCG TRS-SUCR 3) |

(l) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after March 22, 2022. The following codes and fees apply for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | D1708 | $45.87 | D1708 Pfizer-BioNTech COVID-19 vaccine administration - third dose (SARSCOV2 COVID-19 VAC mRNA 30mcg/0.3mL IM DOSE 3) | | D1709 | $45.87 | D1709 Pfizer-BioNTech Covid-19 vaccine administration - booster dose (SARSCOV2 COVID-19 VAC mRNA 30mcg/0.3mL IM DOSE BOOSTER) | | D1710 | $45.87 | D1710 Moderna COVID-19 vaccine administration -third dose (SARSCOV2 COVID-19 VAC mRNA 100mcg/0.5mL IM DOSE 3) | | D1711 | $45.87 | D1711 Moderna COVID-19 vaccine administration -booster dose (SARSCOV2 COVID-19 VAC mRNA 50mcg/0.25mL IM DOSE BOOSTER) | | D1712 | $45.87 | D1712 Janssen COVID-19 vaccine administration -booster dose (SARSCOV2 COVID-19 VAC Ad26 5x1010 VP/0.5mL IM DOSE BOOSTER) | | D1713 | $45.87 | D1713 Pfizer-BioNTech COVID-19 vaccine administration tris-sucrose pediatric - first dose (SARSCOV2 COVID-19 VAC mRNA 10mcg/0.2mL tris-sucrose IM DOSE 1) | | D1714 | $45.87 | D1714 Pfizer-BioNTech COVID-19 vaccine administration tris-sucrose pediatric - second dose (SARSCOV2 COVID-19 VAC mRNA 10mcg/0.2mL tris-sucrose IM DOSE 2) |

(m) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after March 29, 2022. The following codes and fees apply for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 91309 SL | $0.00 | Moderna Covid-19 Vaccine (Aged 6 years through 11 years or aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML (SARSCOV2 VAC 50MCG/0.5ML IM) | | 0094A | $45.87 | Moderna Covid-19 Vaccine (Aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML Administration - Booster (ADM SARSCOV2 50MCG/0.5 MLBST) |

(n) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after May 17, 2022. The following code and fee applies for the listed COVID-19 vaccine and its administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 0074A | $45.87 | Pfizer-BioNTech COVID-19 Pediatric Vaccine (Orange Cap) - Administration - Booster (ADM SARSCV2 10MCG TRS-SUCR B) |

(o) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after June 17, 2022. The following codes and fees apply for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 91308 SL | $0.00 | Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) (SARSCOV2 VAC 3MCG TRS-SUCR) | | 0081A | $45.87 | Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration -First dose (ADM SARSCOV2 3MCG TRS-SUCR 1) | | 0082A | $45.87 | Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration -Second dose (ADM SARSCOV2 3MCG TRS-SUCR 2) | | 0083A | $45.87 | Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration -Third dose (ADM SARSCOV2 3MCG TRS-SUCR 3) | | 0091A | $45.87 | Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - First dose (ADM SARSCOV2 50 MCG/.5 ML1ST) | | 0092A | $45.87 | Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Second dose (ADM SARSCOV2 50 MCG/.5 ML2ND) | | 0093A | $45.87 | Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Third dose (ADM SARSCOV2 50 MCG/.5 ML3RD) | | 91311 SL | $0.00 | Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) 250MCG/0.25ML (SARSCOV2 VAC 25MCG/0.25ML IM) | | 0111A | $45.87 | Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - First dose (ADM SARSCOV2 25MCG/0.25ML1ST) | | 0112A | $45.87 | Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Second dose (ADM SARSCOV2 25MCG/0.25ML2ND) | | 0113A | $45.87 | Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Third dose (ADM SARSCOV2 25MCG/0.25ML3RD) |

(p) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after July 13, 2022. The following codes and fees apply for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 91304 SL | $0.00 | Novavax Covid-19 Vaccine, Adjuvanted (Aged 12 years and older) (SARSCOV2 VAC 5MCG/0.5ML IM) | | 0041A | $45.87 | Novavax Covid-19 Vaccine, Adjuvanted Administration -First Dose (ADM SARSCOV2 5MCG/0.5ML 1ST) | | 0042A | $45.87 | Novavax Covid-19 Vaccine, Adjuvanted Administration -Second Dose ADM SARSCOV2 5MCG/0.5ML 2ND |

(q) Allowable Fee for COVID-19 Vaccine and Vaccine Administration Applicable for Dates of Service on or after August 31, 2022. The following codes and fees apply for the listed COVID-19 vaccines and their administration.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | 91313 SL | $0.00 | Moderna COVID-19 Vaccine, Bivalent Product (Aged 18 years and older) (Dark Blue Cap with gray border) (SARSCOV2 VAC BVL 50MCG/0.5ML) | | 0134A | $45.87 | Moderna COVID-19 Vaccine, Bivalent (Aged 18 years and older) (Dark Blue Cap with gray border) Administration - Booster Dose (ADM SARSCV2 BVL 50MCG/.5ML B) | | 91312 SL | $0.00 | Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Gray Cap) (SARSCOV2 VAC BVL 30MCG/0.3M) | | 0124A | $45.87 | Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Gray Cap) Administration - Booster Dose (ADM SARSCV2 BVL 30MCG/.3ML B) |

(r) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after May 6, 2021. The following codes and fees apply for the listed COVID-19 treatment services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0243 SL | $0.00 | Injection, casirivimab and imdevimab, 2400 mg | | M0243 | $450.00 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring | | M0244 | $750.00 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the federal COVID-19 public health emergency | | Q0245 SL | $0.00 | Injection, bamlanivimab and etesevimab, 2100 mg | | M0245 | $450.00 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring | | M0246 | $750.00 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the federal COVID-19 public health emergency |

(s) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after May 26, 2021. The following codes and fees apply for the listed COVID-19 treatment services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0247 | $2,394.00 | Injection, sotrovimab, 500 mg | | M0247 | $450.00 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring | | M0248 | $750.00 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the federal COVID-19 public health emergency |

(t) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after June 3, 2021. The following codes and fees apply for the listed COVID-19 treatment service.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0244 SL | $0.00 | Injection, casirivimab and imdevimab, 1200 mg |

(u) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after June 24, 2021. The following codes and fees apply for the listed COVID-19 treatment services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0249 | $6.57 | Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg | | M0249 | $450.00 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose | | M0250 | $450.00 | Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose |

(v) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after July 31, 2021. The following codes and fees apply for the listed COVID-19 treatment services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0240 SL | $0.00 | Injection, casirivimab and imdevimab, 600 mg | | M0240 | $450.00 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses | | M0241 | $750.00 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the COVID-19 public health emergency, subsequent repeat doses |

(w) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after December 8, 2021. The following codes and fees apply for the listed COVID-19 treatment services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0220 SL | $0.00 | Injection, tixagevimab and cilgavimab, for the preexposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg | | M0220 | $150.50 | Injection, tixagevimab and cilgavimab, for the preexposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring | | M0221 | $250.50 | Injection, tixagevimab and cilgavimab, for the preexposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the COVID-19 public health emergency |

(x) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after February 11, 2022. The following codes and fees apply for the listed COVID-19 treatment services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0222 SL | $0.00 | Injection, bebtelovimab, 175 mg | | M0222 | $350.50 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | | M0223 | $550.50 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency |

(y) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after April 24, 2022. The following code and fee applies for the listed COVID-19 treatment service.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0221 SL | $0.00 | Injection, tixagevimab and cilgavimab, for the preexposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg |

(z) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after April 1, 2022. The following code and fee applies for the listed COVID-19 treatment services.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | J0248 | $5.51 | Injection, remdesivir, 1 mg |

(aa) Allowable Fee for COVID-19 Treatment Applicable for Dates of Service on or after August 15, 2022. The following code and fee applies for the listed COVID-19 treatment service.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | Q0222 | $2394.00 | Injection, bebtelovimab, 175 mg |

(3) Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment, and Supplies.

(a) General Rate Determination. Rates of payment for services for which 101 CMR 446.03(3) applies are the lowest of

the eligible provider's usual fee to patients other than publicly aided individuals;
the eligible provider's actual charge submitted; or
the schedule of allowable fees set forth in 101 CMR 446.03(3)(f) and (g), taking into account appropriate modifiers and any other applicable rate provisions in accordance with 101 CMR 446.03(3).

(b) Defined Terms. Terms used in 101 CMR 446.03(3) have the meaning defined in 101 CMR 322.02: General Definitions .

(c) Codes and Modifiers. Except as otherwise provided, the codes and modifiers for the DME services described in 101 CMR 446.03(3) are as defined in 101 CMR 322.03(13): Modifiers and 101 CMR 322.06: Allowable Fees and Rate Schedule .

(d) Allowable Fee for Distribution of Personal Protective Equipment (PPE).

Authorization for the provision of, and billing and payment for, distribution of PPE to certain MassHealth members is governed by an executed special conditions amendment to a MassHealth DME provider's provider contract.
The fee and modifier in 101 CMR 446.03(3)(d)2. apply for distribution of PPE.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | E1399U9 | $40.00 | Durable medical equipment, miscellaneous. (Used for PPE distribution services, specifically the packaging, preparing, and delivering or shipping of a two-week supply PPE kit to an authorized individual during the COVID-19 public health emergency) |

(e) Allowable Fee for Nonsterile Gloves. The following fee in 101 CMR 446.03(3)(e) is in effect for nonsterile gloves.

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | A4927 | $11.00 | Gloves, non-sterile, per 100 |

(f) Allowable Fee for Over-the-counter Diagnostic Tests for SARS-CoV-2. For over-the-counter diagnostic tests for SARS-CoV-2 supplied through pharmacies to MassHealth members, EOHHS may set allowable fees no higher than $12.00 per test. EOHHS may set the allowable fee for particular tests below $12.00 per test, so long as the allowable fee is equal to or greater than the lowest retail rate available to MassHealth members in Massachusetts. For over-the-counter tests supplied through pharmacies for MassHealth members, EOHHS will designate allowable fees via Pharmacy Facts, provider bulletin, or other written issuance, consistent with 101 CMR 446.03(3)(f). The $12.00 maximum allowable fee per test rate may be adjusted via administrative bulletin if guidance from the federal Departments of Labor, Health and Human Services, or the Treasury changes regarding rates payable by commercial plans.

(g) Allowable Fee for Formula and Thickening Agents. For formula and thickening agents dispensed through pharmacies to MassHealth members, the allowable fee is the wholesale acquisition cost. For purposes of 101 CMR 446.03(3)(g), the wholesale acquisition cost means the manufacturer's price published in a national price compendium or other publicly available source or an adjusted list price.

(h) Reporting Requirements. Reporting requirements for 101 CMR 446.03(3) are those in 101 CMR 322.04: Reporting Requirements .

(4) Ambulance and Wheelchair Van Services.

(a) General Rate Determination. Rates of payment for services for which 101 CMR 446.03(4) applies are the lowest of

the eligible provider's usual fee to patients other than publicly aided individuals;
the eligible provider's actual charge submitted; or
the schedule of allowable fees set forth in 101 CMR 446.03(4)(c), taking into account appropriate modifiers and any other applicable rate provisions in accordance with 101 CMR 446.03(4).

(b) Defined Terms. Terms used in 101 CMR 446.03(4) that have not been defined elsewhere in 101 CMR 446.00 have the meanings in 101 CMR 327.02: General Definitions .

(c) Allowable Fees for Ambulance and Wheelchair Van Services. The following code and allowable fee applies, notwithstanding the definition of "trip" in 101 CMR 327.02: General Definitions .

| Code | Allowable Fee | Description of Code | | --- | --- | --- | | A0998 | $157.88 | Ambulance response and treatment, no transport (Used for medically necessary visits to patients to obtain and transport specimens for COVID-19 diagnostic testing) | | A0120 | $100.00 | Nonemergency transportation: mini-bus, mountain area transports, or other transportation systems. (Each way. Used only for non-emergency wheelchair van transport for a person under investigation or known to have COVID-19.) |

(d) Billing Certification. Each eligible provider who submits an invoice to a governmental unit for authorized ambulance services must certify the accuracy of the level of services provided, as listed on its invoice.

(e) Reporting Requirements. Reporting requirements under 101 CMR 446.03(4) are those in 101 CMR 327.05: Reporting Requirements .

(5) Prescribed Drugs.

(a) Defined Terms. Terms used in 101 CMR 446.03(5) that have not been defined elsewhere in 101 CMR 446.00 have the meanings in 101 CMR 331.02: General Definitions .

(b) Delivery Fee. Eligible providers will receive a payment adjustment to the professional dispensing fee when medications are delivered to a personal residence (including homeless shelters). The payment adjustment will be the lower of the provider's usual and customary charge for prescription delivery or $8.00, and will be made only when the MassHealth agency is the primary payer. Payment of this fee by MassHealth will occur only in such circumstances as is designated by Pharmacy Facts, provider bulletin, or other written issuance from the MassHealth agency.

(c) Reporting Requirements. Reporting requirements for 101 CMR 446.03(5) are those in 101 CMR 331.03: Reporting Requirements .

(6) Testing Services.

(a) General Rate Determination. Rates of payment for services under which 101 CMR 446.03(6) applies are the lowest of

the eligible provider's usual and customary charge to patients, other than publicly aided individuals;
the eligible provider's actual charge submitted; or
the schedule of allowable fees set forth in 101 CMR 446.03(6)(d) through (f), taking into account appropriate modifiers and any other applicable rate provisions in accordance with 101 CMR 446.03(6).

(b) Defined Terms. Terms used in 101 CMR 446.03(6), that have not been defined elsewhere in 101 CMR 446.00, have the meanings in 101 CMR 320.02: Definitions .

(c) Individual Consideration (I.C.). Unlisted procedures and laboratory tests designated I.C. are individually considered items. The eligible provider's bill for such a test must be accompanied by a brief report of the procedure or test performed and the eligible provider's usual and customary charge for that procedure or test. Determination of appropriate payments for procedures and tests designated I.C. are in accordance with the following standards and criteria:

time required to perform the procedure;
degree of skill required in the procedure performed;
severity or complexity of the patient's disease, disorder, or disability;
policies, procedures, and practices of other third-party purchasers of care;
prevailing medical-laboratory ethics and accepted custom of the medical laboratory community; and
such other standards and criteria as may be adopted by EOHHS. In no event may an eligible provider bill or be paid in excess of the usual and customary charge for the service.

(d) Allowable Fees for Certain Individual COVID-19 Testing Services - Not Including Laboratory Analysis. The allowable fees in 101 CMR 446.03(6)(d) apply for the listed COVID-19 testing services performed by an eligible provider at a mobile testing site where the eligible provider is not required to perform, pay for, or contract for the laboratory analysis.

| Allowable Fee | Description of Service | | --- | --- | | $20.81 | Ordering, resulting, and follow-up counseling services, per COVID-19 test completed by an eligible mobile testing vendor where the provider is not required to perform, pay for, or contract for the laboratory analysis | | $60.00 | COVID-19 specimen collection completed by an mobile testing vendor, including test administration or observation, and specimen transport services, per hour, per staff member |

(e) Allowable Fees for Certain Individual COVID-19 Testing Services - Including Laboratory Analysis. The allowable fees in 101 CMR 446.03(6)(e) apply for the listed COVID-19 testing services where the eligible provider is required to perform, pay for, or contract for the laboratory analysis.

| Allowable Fee | Description of Service | | --- | --- | | $144.27 | Site-based or mobile COVID-19 testing service administered or observed by an eligible provider, including specimen collection, laboratory processing, ordering, resulting, and follow-up counseling services, per test | | Individual Consideration | Self-administered COVID-19 testing service completed by an eligible provider, including transport of testing materials, laboratory processing, ordering, resulting, and follow-up counseling services, per test |

(f) Allowable Fees for Certain Pooled COVID-19 Testing Services - Including Laboratory Analysis.

Effective for dates of service on or after February 4, 2021, governmental units may pay eligible providers for pooled COVID-19 testing services, including laboratory analysis, through a per-pool rate and a rate for individual testing, if any, provided by the pooled testing provider as part of a pooled testing program. The rates must be set forth and agreed to by each eligible provider and the governmental unit through a contract or special conditions amendment to the provider contract. Specimen collection costs, specimen transport costs, and administrative fees may be billed separately from testing services.

Eligible providers must bill the governmental unit for the pooled COVID-19 testing services provided pursuant to 101 CMR 446.03(6)(f) and a contract or special conditions amendment to the provider contract, consistent with the terms of the contract or special conditions amendment to the provider contract. The governmental unit will pay the eligible provider for such services, upon receipt of such invoice, consistent with the terms of the contract or special conditions amendment to the provider contract.

(g) Billing Certification. Each eligible provider who submits an invoice to a governmental unit for authorized services under 101 CMR 446.03(6) must certify to the accuracy of the level of services provided, as listed on its invoice.

(7) Allowable Fee for In-home Vaccination Services and Waste Prevention Vaccinations Provided Pursuant to a Contract Between an In-home Vaccination Provider and a Governmental Unit.

(a) General Rate Determination. Rates of payment for services for which 101 CMR 446.03(7) applies are the lowest of

the in-home vaccination provider's usual fee to patients other than publicly aided individuals;
the in-home vaccination provider's actual charge submitted; or
the schedule of allowable fees set forth in 101 CMR 446.03(7)(c), taking into account appropriate modifiers and any other applicable rate provisions in accordance with 101 CMR 446.03(7).

(b) Defined Terms. Terms used in 101 CMR 446.03(7) that have not been defined elsewhere in 101 CMR 446.00 have the meanings ascribed to those terms in the contract between the in-home vaccination provider and the governmental unit.

(c) Allowable Fee for In-home Vaccination Services and Waste Prevention Vaccinations Provided by In-home Vaccination Providers. The following fees apply for the listed in-home vaccination services and waste prevention vaccinations rendered by in-home vaccination providers.

| Service | Allowable Fee | | --- | --- | | In-home vaccination services rendered to eligible residents, inhome vaccination services rendered to eligible additional individuals, or waste prevention vaccinations administered to other vaccinable individuals | $150.00 per COVID-19 vaccine dose administered |

History

Adopted by Mass Register Issue 1429, eff. 10/30/2020.

101 CMR, § 446.04 Special Contracts

Notwithstanding 101 CMR 446.03, a governmental unit may enter into a special contract with an eligible provider under which the governmental unit will pay for services authorized but not listed in 101 CMR 446.00, or authorized services performed in exceptional circumstances.

History

Adopted by Mass Register Issue 1429, eff. 10/30/2020.

101 CMR, § 446.05 Reporting Requirements

(1) Required Reports. Except as otherwise provided, reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements .

(2) Penalty for Noncompliance. Except as otherwise provided, the purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under 101 CMR 446.05(2).

History

Adopted by Mass Register Issue 1429, eff. 10/30/2020.

101 CMR, § 446.06 Severability

The provisions of 101 CMR 446.00 are severable and if any provisions of 101 CMR 446.00 or the application of such provisions to any person or circumstances is held to be invalid or unconstitutional, such invalidity will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 446.00 or application of such provisions to eligible providers or circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1429, eff. 10/30/2020.

101 CMR, 101 CMR 447.00 Reserved

History

Adopted by Mass Register Issue 1449, eff. 7/19/2021.
REGULATORY AUTHORITY 101 CMR 447.00: M.G.L. c. 118E.

[Repealed] [Repealed]

101 CMR, § 448.01 General Provisions

(1) Scope and Purpose.101 CMR 448.00 governs the payment rates for workforce investment rates for certain Health and Human Services programs purchased by a governmental unit including, but not limited to, the Department of Developmental Services (DDS), the Massachusetts Commission for the Blind (MCB), the Massachusetts Rehabilitation Commission (MRC), the Department of Mental Health (DMH), the Department of Public Health (DPH), the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH), the Department of Children and Families (DCF), the Department of Youth Services (DYS), the Executive Office of Elder Affairs (EOEA), and MassHealth.

(2) Applicable Dates of Service. Rates contained in 101 CMR 448.00 apply for dates of service as stated in 101 CMR 448.03(5).

(3) Disclaimer of Authorization of Services. 101 CMR 448.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 448.00. Governmental units that purchase the services described in 101 CMR 448.00 are responsible for the definition, authorization, and approval of services provided to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 448.00.

(5) Parent Regulations. 101 CMR 448.00 describes operational add-on rates for certain services whose basic rates are governed by other regulations. For services not included in 101 CMR 448.00, please refer to the parent regulation listed in 101 CMR 448.01(5).

| Service | Parent Regulation | | --- | --- | | Inpatient Services, Residential Services, Opioid Treatment Services, Ambulatory Services, Clinical Case Management Services, Day Treatment Services, Outpatient Services, Supportive Case Management Services, Triage, Engagement and Assessment Services, Office-based Opioid Treatment Programs | 101 CMR 346.00: Rates for Certain Substance-related and Addictive Disorders Programs | | Alternative Lock-up Program, Conflict of Interest Services, Teen Pregnancy Prevention Services, Therapeutic Day Services and Staff Add-on Services, and Young Parent Support Program and Staff Add-on Services | 101 CMR 427.00: Rates for Certain Youth and Young Adult Support Services | | Deaf and Hard of Hearing Independent Living Services, Recovery Learning Communities, Vocational Rehabilitation Independent Living Services | 101 CMR 428.00: Rates for Certain Independent Living Communities and Services | | Domestic Violence Community-based Services, Child Exposed to Domestic Violence Services, Supervised Visitation Services, Sexual and Domestic Equity and Legal Services, Intimate Partner Abuse and Educational Services, Rape Crisis Centers and Satellite Centers, Rape Crisis Direct Care Add-on Staff Services, and Statewide Specialized Hotline Services | 101 CMR 429.00: Rates for Certain Sexual and Domestic Violence Services | | Early Intervention Services | 101 CMR 349.00: Rates for Early Intervention Program Services | | Program of Assertive Community Treatment Services | 101 CMR 430.00: Rates for Program of Assertive Community Treatment Services | | Respite Services | 101 CMR 431.00: Rates for Certain Respite Services | | Lead Agency Services | 101 CMR 432.00: Rates for Certain Lead Agency Services | | Psychological Services | 101 CMR 329.00: Psychological Testing, Treatment, and Related Services | | Competitive Integrated Employment Services | 101 CMR 410.00: Rates for Competitive Integrated Employment Services | | Community Mental Health Center Services | 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health and Mental Health Centers | | Intensive Foster Care and Specialty Service and Adoption Management Support Services | 101 CMR 411.00: Rates for Certain Placement, Support, and Shared Living Services | | Family Transitional Support Services | 101 CMR 412.00: Rates for Family Transitional Support Services | | Youth Residential Substance Use Disorder Treatment, Clinically Intensive Youth Residential Substance Use Disorder Treatment, Adjudicated Youth Residential Treatment, Clinically Intensive Residential Treatment, Community Treatment Residential, Emergency Residence, Intensive Residential Treatment, Intensive Treatment Residence, Medically Complex and Behavioral Residence, Medically Complex Residence, Specialty Treatment Residence, Young Parent Assessment and Living Program, Staff Add-on Services, Adjudicated Youth Staff Add-on Services, Community Service Network Program and Staff Add-on Services, and the services formerly known as "Caring Together" Services | 101 CMR 413.00: Payments for Youth Intermediate-term Stabilization Services | | Adolescent Support Network, Afterschool Respite, Autism/Family Support Centers, Agency with Choice Administration, Community-based Afterschool Social and Recreational Programs, Clinical and Nonclinical Combined Hourly Services, Comprehensive Services, Educational Coordination, Family Navigation, Family and Micro Family Resource Centers and Staff Add-on Services, Specialty Family and Family Skills Development Programs and Staff Add-on Services, Family Training, Intensive Flexible Family Support Services, Medically Complex Programs, Peer Support, Planned Site-based Respite, Respite in Caregiver or Recipient's Home, Site-based Respite and Site-based Respite with Nursing, Unbundled Intensive Foster Care Special Support Services, and Flexible Support Services | 101 CMR 414.00: Rates for Family Stabilization Services | | Clubhouse Services | 101 CMR 416.00: Rates for Clubhouse Services | | Congregate Care Housing Services, Central Intake and Assessment Program, Basic Home Care Case Management, ECOP Case Management, Protective Services, Protective Services Intake, Supportive Senior Housing, Money Management Services, and Guardianship Services | 101 CMR 417.00: Rates for Certain Elder Care Services | | Staffing Support Services and Transitional Age Youth Detoxification and Stabilization Programs | 101 CMR 418.00: Payments for Youth Short-term Stabilization and Emergency Placement Services | | Adult Housing and Community Support Services | 101 CMR 421.00: Rates for Adult Housing and Community Support Services | | Orientation and Mobility Services, Mobile Eye Clinic, Deaf/Blind Community Access Network, Assistive Technology Independent Living Service, Homecare Assistance, Vocational Rehabilitation Assistant Services, Brain Injury Community- and Site-based Services | 101 CMR 422.00: Rates for General Programs - Disability Services | | Corporate Representative Payee Services, Transition to Adulthood Services, Clinical Team Services | 101 CMR 424.00: Rates for Certain Developmental and Support Services | | Young Parent Support Services | 101 CMR 425.00: Rates for Certain Young Parent Support Programs | | Alternative Lock-up Program, Conflict of Interest Services, Teen Pregnancy Prevention Services, Therapeutic Day Services and Staff Add-on Services, and Young Parent Support Program and Staff Add-on Services | 101 CMR 427.00: Rates for Certain Youth and Young Adult Support Services | | Deaf and Hard of Hearing Independent Living Services, Recovery Learning Communities, Vocational Rehabilitation Independent Living Services | 101 CMR 428.00: Rates for Certain Independent Living Communities and Services | | Domestic Violence Community-based Services, Child Exposed to Domestic Violence Services, Supervised Visitation Services, Sexual and Domestic Equity and Legal Services, Intimate Partner Abuse and Educational Services, Rape Crisis Centers and Satellite Centers, Rape Crisis Direct Care Add-on Staff Services, and Statewide Specialized Hotline Services | 101 CMR 429.00: Rates for Certain Sexual and Domestic Violence Services | | Program of Assertive Community Treatment Services | 101 CMR 430.00: Rates for Program of Assertive Community Treatment Services | | Respite Services | 101 CMR 431.00: Rates for Certain Respite Services | | Lead Agency Services | 101 CMR 432.00: Rates for Certain Lead Agency Services | | Psychological Services | 101 CMR 329.00: Psychological Testing, Treatment, and Related Services | | Community Mental Health Center Services | 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health and Mental Health Centers | | Psychiatric Day Treatment | 101 CMR 307.00: Rates for Psychiatric Day Treatment Center Services | | Applied Behavior Analysis | 101 CMR 358.00: Rates of Payment for Applied Behavior Analysis | | Opioid Treatment Services (excluding codes J0571-J0575 and J3490), Recovery Support Navigator, Individualized Treatment and Stabilization Services | 101 CMR 444.00: Rates for Certain Substance Use Disorder Services |

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 448.02 Definitions

As used in 101 CMR 448.00, terms have the meanings as defined in 101 CMR 448.02, except as otherwise provided.

Client. An individual receiving services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) pursuant to 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services is used when required.

COVID-19 Payment Rate. A rate that is intended to take into account the change in program model necessary due to COVID-19 requirements, which will be instituted at the discretion of the purchasing governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR) pursuant to 808 CMR 1.00: Compliance, Reporting and Auditing for Human and Social Services .

State Funding. The aggregate amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 448.01(5). State funding does not include any amounts attributable to federal funding or grant funds.

Workforce Investment. Funds directed to a provider for workforce investment. As a condition of receipt of these additional funds, eligible provider agencies must complete an attestation assuring EOHHS that they will use at least 90% of the funds for health and human service workforce development, which could include hiring and retention bonuses and other categories of front-line worker compensation.

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 448.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Lump Sum Payment. Purchasing governmental units may pay a lump sum payment limited to the equivalent of six monthly units. The lump sum payment will be calculated according to the following formula: Sum of {[(total May 2021 (one month) State spend on the services listed in 101 CMR 448.01(5) (Add-on rate of 10%)(6 units)]}.

(5) Approved Rates with Applicable Dates of Service Provided from July 1, 2021 through June 30, 2022. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 448.03(5). Effective July 1, 2022, the rates revert to the rates in the parent regulations listed in 101 CMR 448.01(5).

| Add-on | Unit | Rate | | --- | --- | --- | | Workforce Investment for the Services Listed in 101 CMR 448.01(5) | Monthly | 10% of the Provider's May 2021 (FY21) State Funding |

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 448.04 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the Executive Director or Chief Financial Officer of the provider.

(c) Field Audits. EOHHS may conduct a field audit. EOHHS will make reasonable attempts to schedule an audit at the mutual convenience of both parties.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 448.05 Severability

The provisions of 101 CMR 448.00 are severable. If any provision of 101 CMR 448.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 448.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1451, eff. 8/13/2021.

101 CMR, § 449.01 General Provisions

(1) Scope. 101 CMR 449.00 governs the payment rates for MassHealth-covered state plan home health aide services purchased by a governmental unit. 101 CMR 449.00 also governs the payment rates for MassHealth-covered homemaker and personal care homemaker waiver services when purchased by a governmental unit in one of four MassHealth Home and Community-based Services (HCBS) Waivers. The four HCBS Waivers are: Acquired Brain Injury Non-residential Habilitation (ABI-N) Waiver, Acquired Brain Injury Residential Habilitation (ABI-RH) Waiver, Moving Forward Plan Community Living (MFP-CL) Waiver, and Moving Forward Plan Residential Supports (MFP-RS) Waiver.

(2) Applicable Dates of Service. Rates contained in 101 CMR 449.00 apply for dates of service as stated in 101 CMR 449.03.

(3) Disclaimer of Authorization of Services. 101 CMR 449.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 449.00. Governmental units that purchase the services described in 101 CMR 350.00: Rates for Home Health Services , 101 CMR 359.00: Rates for Home and Community-based Services Waivers , and 101 CMR 453.00: Enhanced Rates for Certain Home- and Community-based Services Related to Section 9817 of the American Rescue Plan Act are responsible for the definition, authorization, and approval of services provided to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 449.00.

(5) Parent Regulations. 101 CMR 449.00 describes operational add-on rates for certain services whose basic rates are governed by other regulations. For services not included in 101 CMR 449.00, please refer to the parent regulation at 101 CMR 350.00: Rates for Home Health Services , 101 CMR 359.00: Rates for Home and Community-based Services Waivers , or 101 CMR 453.00: Enhanced Rates for Certain Home- and Community-based Services Related to Section 9817 of the American Rescue Plan Act .

History

Adopted by Mass Register Issue 1454, eff. 10/1/2021.

101 CMR, § 449.02 Definitions

As used in 101 CMR 449.00, terms have the meanings in 101 CMR 449.02, except as otherwise provided.

Client. An individual receiving services purchased by a governmental unit.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) is used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

History

Adopted by Mass Register Issue 1454, eff. 10/1/2021.

101 CMR, § 449.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Approved Rates with Applicable Dates of Service Provided on or after July 1, 2022. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 449.03(4).

(a) Home Health Aide Services. Terms used in 101 CMR 449.03(4)(a) that have not been defined elsewhere in 101 CMR 449.00 have the meanings in 101 CMR 350.02: General Definitions .

| Code | Unit | Rate | Per Unit Rate Add-on | Total | | --- | --- | --- | --- | --- | | G0156 | Per 15 minutes | $7.40 | $0.89 | $8.29 | | G0156 UD | Per 15 minutes | $7.40 | $0.89 | $8.29 | | 99509 | Per 15 minutes | $7.40 | $0.89 | $8.29 |

(b) Home- and Community-based Services Waivers. Terms used in 101 CMR 449.03(4)(b) that have not been defined elsewhere in 101 CMR 449.00 have the meanings in 101 CMR 359.02: Definitions .

Approved Rates.

| Code | Service | Unit | Rate | Per Unit Rate Add-on | Total | | --- | --- | --- | --- | --- | --- | | S5130 U4, S5130 U8 U1 | Homemaker (Agency Rate) | Per 15 minutes | $6.93 | $0.99 | $7.92 | | S5130 U8 U2, S5130 U8 UB | Homemaker (Non-agency Rate for Individual Providers and Self-directed Services) | Per 15 minutes | $6.22 | $0.99 | $7.21 | | G0156 U8 | Home Health Aide (Agency Rate) | Per 15 minutes | See 101 CMR 449.03(4)(a). | | | | T1019 U4, T1019 U8 U1 | Personal Care (Agency Rate) | Per 15 minutes | $6.99 | $0.99 | $7.98 |

Non-agency Rates for Self-directed Services. The non-agency rates for self-directed services consist of two components: the self-directed worker rate and the employer expense component (EEC).

| Service | Unit | Self-directed Worker Rate | Employer Expense Component | Self-directed Service Rate | | --- | --- | --- | --- | --- | | Homemaker | Per 15 minutes | $6.40 | $0.81 | $7.21 |

(5) Approved Rates with Applicable Dates of Service Provided on or after July 1, 2023.

(a) Home Health Services. For dates of service on or after July 1, 2023, see 101 CMR 350.00: Rates for Home Health Services .

| Code | Unit | Rate | Per Unit Rate Add-on | Total | | --- | --- | --- | --- | --- | | G0156 | Per 15 minutes | $6.73 | $0.89 | $7.62 | | G0156 UD | Per 15 minutes | $6.73 | $0.89 | $7.62 |

(b) Home- and Community-based Services Waivers. For dates of service on or after July 1, 2023, see 101 CMR 359.00: Rates for Home and Community-based Services Waivers .

Approved Rates.

| Code | Service | Unit | Rate | Per Unit Rate Add-on | Total | | --- | --- | --- | --- | --- | --- | | S5130 U4, S5130 U8 U1 | Homemaker (Agency Rate) | Per 15 minutes | $6.30 | $0.99 | $7.29 | | S5130 U8 U2, S5130 U8 UB | Homemaker (Non-agency Rate for Individual Providers and Self-directed Services) | Per 15 minutes | $5.65 | $0.99 | $6.64 | | G0156U8 | Home Health Aide (Agency Rate) | Per 15 minutes | See 101 CMR 449.03(5)(a). | | | | T1019 U4, T1019 U8 U1 | Personal Care (Agency Rate) | Per 15 minutes | $6.35 | $0.99 | $7.34 |

Non-agency Rate for Self-directed Services. The non-agency rates for self-directed services consist of two components: the self-directed worker rate and the employer expense component (EEC).

(6) Approved Rates with Applicable Dates of Service Provided on or after July 1, 2022

(a) Home Health Services. For dates of service on or after July 1, 2022, see 101 CMR 350.00: Rates for Home Health Services.

(b) Home and Community-based Services Waiver. For dates of service on or after July 1, 2022, see 101 CMR 359.00: Rates for Home and Community-based Services Waivers.

History

Adopted by Mass Register Issue 1454, eff. 10/1/2021.

101 CMR, § 449.04 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the Executive Director or Chief Financial Officer of the provider.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1454, eff. 10/1/2021.

101 CMR, § 449.05 Severability

The provisions of 101 CMR 449.00 are severable. If any provision of 101 CMR 449.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 449.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1454, eff. 10/1/2021.

Rates for Certain Youth and Children Services Rates for Certain Youth and Children Services

101 CMR, § 451.01 General Provisions

(1) Scope. 101 CMR 451.00 governs the payment rates for certain youth and children services purchased by a governmental unit including, but not limited to, the Department of Children and Families (DCF).

(2) Applicable Dates of Service. Rates contained in 101 CMR 451.00 are effective for dates of service provided on or after January 1, 2025.

(3) Disclaimer of Authorization of Services. 101 CMR 451.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 451.00. Governmental units that purchase the services described in 101 CMR 451.00 are responsible for the definition, authorization, and approval of services provided to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 451.00.

History

Adopted by Mass Register Issue 1534, eff. 1/1/2025.

101 CMR, § 451.02 Definitions

As used in 101 CMR 451.00, unless the context requires otherwise, terms have the meanings in 101 CMR 451.02.

Assessment Services for Child Welfare. Services that evaluate caregivers' and/or children's strengths and needs to assist with decisions for case direction and/or the development of action plans designed to strengthen caregiving capacity and/or children's safety, stability, permanency, and/or well-being.

Client. A child, adolescent, or young adult receiving certain youth and children's services purchased by a governmental unit.

Comprehensive Services for Child Welfare. Services delivered by a team on a planned schedule to build caregiving capacity and meet children's needs on a 24/7 schedule to respond to families' emergency needs.

Cost Report. The document used to report costs and other financial and statistical data. The Uniform Financial Statements and Independent Auditor's Report (UFR) are used when required.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Evidence-based Practices for Child Welfare. Services that support children and caregivers through evidence-based practices.

Family Crisis/Trauma Intervention. Services that support children and caregivers during times of crisis or trauma when medical or behavioral health intervention/treatment is not indicated, but there is a need for supporting and strengthening caregiving capacity.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

Groups for Child Welfare. Services delivered to groups of children or caregivers to provide emotional support, training in skills development, or another service best provided in a group setting.

Mediation for Child Welfare. Services designed to apply the problem-solving approach of negotiation to reaching agreements and resolving conflicts that occur in child welfare cases.

Preparation Support for Child Welfare. Services that prepare families ( e.g. , families of origin, kinship caregivers, and/or foster caregivers) prior to children being returned to or placed in their care.

Respite for Child Welfare. Services that support caregivers and children by providing caregivers with temporary relief from caregiving responsibilities and children with developmentally appropriate care and supervision.

Reporting Year. The provider's fiscal year for which costs incurred are reported to the Operational Services Division on the Uniform Financial Statements and Independent Auditor's Report (UFR).

Safe and Stable Family Services. Services that support caregivers to ensure child safety and stability in a family setting.

Substance Use Interventions for Child Welfare. Interventions for children or caregivers that promote safety and prevent child maltreatment/neglect related to substance use.

Therapeutic Family/Child Support for Child Welfare. Services that provide clinical mental and/or behavioral health treatments for children and/or caregivers and include a focus on improving family functioning, attachments, and caregiving skills.

Youth Support and Stabilization. Services that support any child, wherever they are, in their safety, permanency, and well-being.

History

Adopted by Mass Register Issue 1534, eff. 1/1/2025.

101 CMR, § 451.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 451.03(4).

| Service | Unit | Rate | | --- | --- | --- | | Safe and Stable Family Services | | | | Safe and Stable | Hourly | $81.93 | | Safe and Stable - Peer Support Specialist | Hourly | $82.39 | | Safe and Stable - Social Connections and Permanency Support | Daily | $73.61 | | Preparation Support for Child Welfare | | | | Preparation Support | Hourly | $89.30 | | Preparation Support - Supervised Family Time | Hourly | $110.85 | | Preparation Support - Peer Support Specialist | Hourly | $85.43 | | Therapeutic Family/Child Support for Child Welfare | | | | Therapeutic - Family | Hourly | $125.20 | | Therapeutic - Youth | Hourly | $125.20 | | Substance Use Interventions for Child Welfare | | | | Substance Use Interventions for Child Welfare - Parent/Caregiver Substance Use | Daily | $95.10 | | Substance Use Interventions for Child Welfare- Youth Substance Use | Daily | $95.10 | | Substance Use Interventions for Child Welfare - Peer Support Specialist, Substance Use | Daily | $71.20 | | Youth Support and Stabilization | | | | Youth Support - Enrichment | Hourly | $57.32 | | Youth Support - Educational and Vocational | Daily | $79.17 | | Youth Support - Non-school Hours for Children with Disabilities | Hourly | $87.17 | | Youth Support - Transition-aged Youth | Daily | $96.70 | | Evidence-based Practices for Child Welfare | | | | Evidence-based - Multi-systemic Therapy | Daily | $151.08 | | Evidence-based - Multi-systemic Therapy Ongoing Supervision/Fidelity Monitoring/Report | N/A | IC | | Evidence-based - Brief Strategic Family Therapy | Hourly | $173.38 | | Evidence-based - Intercept | Daily | $172.04 | | Evidence-based - Intercept Ongoing Supervision/Fidelity Monitoring/Report | N/A | IC | | Family Crisis/Trauma Intervention | | | | Family Crisis/Trauma Intervention | Daily | $165.77 | | Respite for Child Welfare | | | | Caregiver Respite - Hourly | Hourly | $83.09 | | Caregiver Respite - Daily | Daily | $400.66 | | Assessment Services for Child Welfare | | | | Assessment | Hourly | $114.17 | | Mediation for Child Welfare | | | | Mediation | Hourly | $103.35 | | Comprehensive Services for Child Welfare | | | | Comprehensive Services - Family | Daily | $91.35 | | Comprehensive Services - Intensive Family | Daily | $135.35 | | Comprehensive Services - Therapeutic | Daily | $184.28 | | Comprehensive Services - Family Member with a Disability | Daily | $166.68 | | Groups for Child Welfare | | | | Child Welfare - Groups | Group Rate | $2,547 | | Child Welfare - Specialty Groups | Group Rate | $3,335 |

History

Adopted by Mass Register Issue 1534, eff. 1/1/2025.

101 CMR, § 451.04 Filing and Reporting Requirements

(1) General Provisions.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1534, eff. 1/1/2025.

101 CMR, § 451.05 Severability

The provisions of 101 CMR 451.00 are severable. If any provision of 101 CMR 451.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 451.00 or application of those provisions to applicable individuals, entities, or circumstances.

History

Adopted by Mass Register Issue 1534, eff. 1/1/2025.

[Repealed] [Repealed]

101 CMR, § 452.01 General Provisions

(1) Scope and Purpose. 101 CMR 452.00 governs the payment rates for workforce investment for certain Health and Human Services programs purchased by a governmental unit including, but not limited to, the Department of Developmental Services (DDS), the Massachusetts Commission for the Blind (MCB), the Massachusetts Rehabilitation Commission (MRC), the Department of Mental Health (DMH), the Department of Public Health (DPH), the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH), the Department of Children and Families (DCF), the Department of Youth Services (DYS), the Executive Office of Elder Affairs (EOEA), and MassHealth.

(2) Applicable Dates of Service. Rates contained in 101 CMR 452.00 apply for dates of service as stated in 101 CMR 452.03(5).

(3) Disclaimer of Authorization of Services. 101 CMR 452.00 is neither authorization for nor approval of the services for which rates are determined pursuant to 101 CMR 452.00. Governmental units that purchase the services described in 101 CMR 452.00 are responsible for the definition, authorization, and approval of services provided to clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on substantive provisions of 101 CMR 452.00.

(5) Parent Regulations. 101 CMR 452.00 describes operational add-on rates for certain services whose basic rates are governed by other regulations. For services not included in 101 CMR 452.01(5), please refer to the parent regulation listed below.

| Parent Regulation | | --- | | 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health Centers and Mental Health Centers | | 101 CMR 346.00: Rates for Certain Substance-related and Addictive Disorders Programs | | 101 CMR 413.00: Payments for Youth Intermediate-term Stabilization Services | | 101 CMR 414.00: Rates for Family Stabilization Services | | 101 CMR 417.00: Rates for Certain Elder Care Services | | 101 CMR 418.00: Payments for Youth Short-term Stabilization and Emergency Services | | 101 CMR 421.00: Rates for Adult Housing and Community Support Services | | 101 CMR 424.00: Rates for Certain Developmental and Support Services | | 101 CMR 427.00: Rates for Certain Youth and Young Adult Support Services | | 101 CMR 428.00: Rates for Certain Independent Living Communities and Services | | 101 CMR 429.00: Rates for Certain Sexual and Domestic Violence Services | | 101 CMR 430.00: Rates for Program of Assertive Community Treatment Services | | 101 CMR 431.00: Rates for Certain Respite Services | | 101 CMR 432.00: Rates for Certain Lead Agency Services | | 101 CMR 329.00: Psychological Testing, Treatment, and Related Services | | 101 CMR 307.00: Rates for Psychiatric Day Treatment Center Services | | 101 CMR 358.00: Rates of Payment for Applied Behavior Analysis | | 101 CMR 444.00: Rates for Certain Substance Use Disorder Services |

History

Adopted by Mass Register Issue 1474, eff. 7/1/2022 (EMERGENCY).

101 CMR, § 452.02 Definitions

As used in 101 CMR 452.00, terms have the meanings as defined in 101 CMR 452.02, except as otherwise provided.

Client. An individual receiving services purchased by a governmental unit.

COVID-19 Payment Rate. A rate that is intended to take into account the change in program model necessary due to COVID-19 requirements, which will be instituted at the discretion of the purchasing governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any board, commission, department, division, or agency of the Commonwealth and any political subdivision of the Commonwealth.

State Funding. The aggregate amount of payments to a provider by a governmental unit for services purchased at rates established in 101 CMR 452.01(5). State funding does not include any amounts attributable to federal funding or grant funds.

History

Adopted by Mass Register Issue 1474, eff. 7/1/2022 (EMERGENCY).

101 CMR, § 452.03 Rate Provisions

(2) Reimbursement as Full Payment. Each eligible provider must, as a condition of acceptance of payment made by any purchasing governmental units for services rendered, accept the approved program rate as full payment and discharge of all obligations for the services rendered. Payment from any other source will be used to offset the amount of the purchasing governmental unit's obligation for services rendered to the publicly assisted client.

(3) Payment Limitations. No purchasing governmental unit may pay less than or more than the approved program rate.

(4) State Funding Monthly Calculation. The state funding monthly average calculation is calculated according to the following formula: Sum of {[(total fiscal year 2022 State spend on the services listed in 101 CMR 452.01(5) /12 (months)]}.

(5) Approved Rates. The approved rate is the lower of the provider's charge or amount accepted as payment from another payer or the rate listed in 101 CMR 452.03(5).

(a) Program Service Rates Effective July 1, 2022 through September 30, 2022. Effective October 1, 2022, the rates revert to the rates in the parent regulations listed in 101 CMR 452.01(5), unless otherwise provided at 101 CMR 452.03(5).

| Add-on | Unit | Rate | | --- | --- | --- | | Workforce Investment for the Services Listed in 101 CMR 452.03(5)(a) | Monthly | 10% of the Provider's Fiscal Year 2022 Average monthly State Funding |

| Applicable Program Service(s) | Parent Regulation | | --- | --- | | Community Mental Health Center Services | 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health Centers and Mental Health Centers | | Inpatient Services, Residential Services (Excluding Residential Rehab Co-occurring Enhanced), Opioid Treatment Services, Ambulatory Services, Clinical Case Management Services, Day Treatment Services, Outpatient Services, Supportive Case Management Services, Triage, Engagement and Assessment Services, and Office-based Opioid Treatment Programs | 101 CMR 346.00: Rates for Certain Substance-related and Addictive Disorders Programs | | Youth Residential Substance Use Disorder Treatment, Clinically Intensive Youth Residential Substance Use Disorder Treatment, Clinically Intensive Residential Treatment, Congregate Care Program Services and Rates and Add-on services, and the services formerly known as "Caring Together" Services | 101 CMR 413.00: Payments for Youth Intermediate-term Stabilization Services | | Family and Micro Family Resource Centers and Staff Add-on Services and DMH's Flexible Support Services | 101 CMR 414.00: Rates for Family Stabilization Services | | Central Intake and Assessment Program | 101 CMR 417.00: Rates for Certain Elder Care Services | | Staffing Support Services and Transitional Age Youth Detoxification and Stabilization Programs | 101 CMR 418.00: Payments for Youth Short-term Stabilization and Emergency Placement Services | | Adult Housing and Community Support Services | 101 CMR 421.00: Rates for Adult Housing and Community Support Services | | Clinical Team Services | 101 CMR 424.00: Rates for Certain Developmental and Support Services | | Alternative Lock-up Program, Conflict of Interest Services, Teen Pregnancy Prevention Services, Therapeutic Day Services and Staff Add-on Services, and Young Parent Support Program and Staff Add-on Services | 101 CMR 427.00: Rates for Certain Youth and Young Adult Support Services | | Deaf and Hard of Hearing Independent Living Services, Recovery Learning Communities, and Vocational Rehabilitation Independent Living Services | 101 CMR 428.00: Rates for Certain Independent Living Communities and Services | | Domestic Violence Community-based Services, Child Exposed to Domestic Violence Services, Supervised Visitation Services, Sexual and Domestic Equity and Legal Services, Intimate Partner Abuse and Educational Services, Rape Crisis Centers and Satellite Centers, Rape Crisis Direct Care Add-on Staff Services, and Statewide Specialized Hotline Services | 101 CMR 429.00: Rates for Certain Sexual and Domestic Violence Services | | Program of Assertive Community Treatment Services | 101 CMR 430.00: Rates for Program of Assertive Community Treatment Services | | Respite Services | 101 CMR 431.00: Rates for Certain Respite Services | | Lead Agency Services | 101 CMR 432.00: Rates for Certain Lead Agency Services | | Psychological Services | 101 CMR 329.00: Psychological Testing, Treatment, and Related Services | | Psychiatric Day Treatment | 101 CMR 307.00: Rates for Psychiatric Day Treatment Center Services | | Applied Behavior Analysis | 101 CMR 358.00: Rates of Payment for Applied Behavior Analysis | | Opioid Treatment Services (excluding codes J0571-J0575 and J3490), Recovery Support Navigator, Individualized Treatment and Stabilization Services | 101 CMR 444.00: Rates for Certain Substance Use Disorder Services |

(b) Program Service Rates Effective October 1, 2022 through December 31, 2022. Effective January 1, 2023, the rates revert to the rates in the parent regulations listed in 101 CMR 452.01(5), unless otherwise provided at 101 CMR 452.03(5).

| Add-on | Unit | Rate | | --- | --- | --- | | Workforce Investment for the Services Listed in 101 CMR 452.03(5)(b) | Monthly | 10% of the Provider's Fiscal Year 2022 Average monthly State Funding |

| Applicable Program Service(s) | Parent Regulation | | --- | --- | | Community Mental Health Center Services | 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health Centers and Mental Health Centers | | Inpatient Services, Residential Services (Excluding Residential Rehab Co-occurring Enhanced), Opioid Treatment Services, Ambulatory Services, Clinical Case Management Services, Day Treatment Services, Outpatient Services, Supportive Case Management Services, Triage, Engagement and Assessment Services, and Office-based Opioid Treatment Programs | 101 CMR 346.00: Rates for Certain Substance-related and Addictive Disorders Programs | | Youth Residential Substance Use Disorder Treatment, Clinically Intensive Youth Residential Substance Use Disorder Treatment, Clinically Intensive Residential Treatment, Community Treatment Residential, Emergency Residence, Intensive Residential Treatment, Intensive Treatment Residence, Medically Complex and Behavioral Residence, Medically Complex Residence, Specialty Treatment Residence, Young Adult and Youth Therapeutic Group Care, Young Parent Assessment and Living Program, Staff Add-on Services, and the services formerly known as "Caring Together" Services | 101 CMR 413.00: Payments for Youth Intermediate-term Stabilization Services | | Family and Micro Family Resource Centers and Staff Add-on Services and DMH's Flexible Support Services | 101 CMR 414.00: Rates for Family Stabilization Services | | Central Intake and Assessment Program | 101 CMR 417.00: Rates for Certain Elder Care Services | | Adult Housing and Community Support Services | 101 CMR 421.00: Rates for Adult Housing and Community Support Services | | Clinical Team Services | 101 CMR 424.00: Rates for Certain Developmental and Support Services | | Alternative Lock-up Program, Conflict of Interest Services, Teen Pregnancy Prevention Services, Therapeutic Day Services and Staff Add-on Services, and Young Parent Support Program and Staff Add-on Services | 101 CMR 427.00: Rates for Certain Youth and Young Adult Support Services | | Deaf and Hard of Hearing Independent Living Services, Recovery Learning Communities, and Vocational Rehabilitation Independent Living Services | 101 CMR 428.00: Rates for Certain Independent Living Communities and Services | | Domestic Violence Community-based Services, Child Exposed to Domestic Violence Services, Supervised Visitation Services, Sexual and Domestic Equity and Legal Services, Intimate Partner Abuse and Educational Services, Rape Crisis Centers and Satellite Centers, Rape Crisis Direct Care Add-on Staff Services, and Statewide Specialized Hotline Services | 101 CMR 429.00: Rates for Certain Sexual and Domestic Violence Services | | Program of Assertive Community Treatment Services | 101 CMR 430.00: Rates for Program of Assertive Community Treatment Services | | Respite Services | 101 CMR 431.00: Rates for Certain Respite Services | | Lead Agency Services | 101 CMR 432.00: Rates for Certain Lead Agency Services | | Psychological Services | 101 CMR 329.00: Psychological Testing, Treatment, and Related Services | | Psychiatric Day Treatment | 101 CMR 307.00: Rates for Psychiatric Day Treatment Center Services | | Opioid Treatment Services (excluding codes J0571-J0575 and J3490), Recovery Support Navigator, Individualized Treatment and Stabilization Services | 101 CMR 444.00: Rates for Certain Substance Use Disorder Services |

(c) Program Service Rates Effective January 1, 2023 through June 30, 2023. Effective July 1, 2023, the rates revert to the rates in the parent regulations listed in 101 CMR 452.01(5).

| Add-on | Unit | Rate | | --- | --- | --- | | Workforce Investment for the Services Listed in 101 CMR 452.03(5)(c) | Monthly | 10% of the Provider's Fiscal Year 2022 Average monthly State Funding |

| Applicable Program Service(s) | Parent Regulation | | --- | --- | | Inpatient Services, Residential Services (Excluding Residential Rehab Co-occurring Enhanced), Supportive Case Management Services, Triage, Engagement and Assessment Services, and Office-based Opioid Treatment Programs | 101 CMR 346.00: Rates for Certain Substance-related and Addictive Disorders Programs | | Youth Residential Substance Use Disorder Treatment, Clinically Intensive Youth Residential Substance Use Disorder Treatment, Clinically Intensive Residential Treatment, Community Treatment Residential, Emergency Residence, Intensive Residential Treatment, Intensive Treatment Residence, Medically Complex and Behavioral Residence, Medically Complex Residence, Specialty Treatment Residence, Young Adult and Youth Therapeutic Group Care, Young Parent Assessment and Living Program, Staff Add-on Services, and the services formerly known as "Caring Together" Services | 101 CMR 413.00: Payments for Youth Intermediate-term Stabilization Services | | Family and Micro Family Resource Centers and Staff Add-on Services | 101 CMR 414.00: Rates for Family Stabilization Services | | Staffing Support Services and Transitional Age Youth Detoxification and Stabilization Programs | 101 CMR 418.00: Payments for Youth Short-term Stabilization and Emergency Placement Services | | Adult Housing and Community Support Services | 101 CMR 421.00: Rates for Adult Housing and Community Support Services | | Alternative Lock-up Program, Conflict of Interest Services, Teen Pregnancy Prevention Services, Therapeutic Day Services and Staff Add-on Services, and Young Parent Support Program and Staff Add-on Services | 101 CMR 427.00: Rates for Certain Youth and Young Adult Support Services | | Deaf and Hard of Hearing Independent Living Services, Recovery Learning Communities, and Vocational Rehabilitation Independent Living Services | 101 CMR 428.00: Rates for Certain Independent Living Communities and Services | | Domestic Violence Community-based Services, Child Exposed to Domestic Violence Services, Supervised Visitation Services, Sexual and Domestic Equity and Legal Services, Intimate Partner Abuse and Educational Services, Rape Crisis Centers and Satellite Centers, Rape Crisis Direct Care Add-on Staff Services, and Statewide Specialized Hotline Services | 101 CMR 429.00: Rates for Certain Sexual and Domestic Violence Services | | Program of Assertive Community Treatment Services | 101 CMR 430.00: Rates for Program of Assertive Community Treatment Services | | Respite Services | 101 CMR 431.00: Rates for Certain Respite Services | | Lead Agency Services | 101 CMR 432.00: Rates for Certain Lead Agency Services | | Psychiatric Day Treatment | 101 CMR 307.00: Rates for Psychiatric Day Treatment Center Services | | Individualized Treatment and Stabilization Services | 101 CMR 444.00: Rates for Certain Substance Use Disorder Services |

History

Adopted by Mass Register Issue 1474, eff. 7/1/2022 (EMERGENCY).

101 CMR, § 452.04 Filing and Reporting Requirements

(1) General Provisions.

(c) Field Audits. EOHHS may conduct a field audit. EOHHS will make reasonable attempts to schedule an audit at the mutual convenience of both parties.

(2) Required Reports. Each provider must file

(b) any cost report supplemental schedule as issued by EOHHS; and

History

Adopted by Mass Register Issue 1474, eff. 7/1/2022 (EMERGENCY).

101 CMR, § 452.05 Severability

The provisions of 101 CMR 452.00 are severable. If any provision of 101 CMR 452.00 or application of such provision to any eligible provider or fiscal intermediary is held invalid or unconstitutional, such determination will not affect the validity or constitutionality of any remaining provisions of 101 CMR 452.00 or application of such provisions to eligible providers or fiscal intermediaries in circumstances other than those held invalid.

History

Adopted by Mass Register Issue 1474, eff. 7/1/2022 (EMERGENCY).

101 CMR, 101 CMR 453.00 [Repealed]

History

Adopted by Mass Register Issue 1474, eff. 7/1/2022 (EMERGENCY).
REGULATORY AUTHORITY 101 CMR 453.00: M.G.L. c. 118E.

Nursing Facility User Fees Nursing Facility User Fees

101 CMR, § 512.01 General Provisions

101 CMR 512.00 governs the collection of nursing facility user fees.

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 512.02 Definitions

As used in 101 CMR 512.00, unless the context otherwise requires, terms have the following meanings.

Assessment. The total payment due each quarter for each non-Medicare patient day, as set forth in 101 CMR 512.00.

Centers for Medicare and Medicaid Services (CMS). The federal agency under the U.S. Department of Health and Human Services that is responsible for administering the Medicare and Medicaid programs.

Changes in Ownership (CHOW). Changes in ownership of a nursing facility will, in the case of a corporation, mean transfer of a majority of the stock thereof, and in all other cases, a transfer of a majority interest therein, pursuant to M.G.L. c. 111, § 71.

Continuing Care Retirement Community (CCRC). A community that furnishes board and lodging together with nursing services, medical services, or other health-related services, regardless of whether or not the lodging and services are provided at the same location, to individuals, other than those related by consanguinity or affinity to the person furnishing such care, pursuant to a contract effective for the life of the individual or for a period in excess of one year, and that has filed disclosure information with the Massachusetts Executive Office of Elder Affairs pursuant to M.G.L. c. 93, § 76(e). Licensed nursing facility beds not under the direct control of the board of the CCRC are not considered part of the CCRC.

Department of Public Health (DPH). An agency of the Commonwealth of Massachusetts, established under M.G.L. c. 17, § 1.

Executive Office of Health and Human Services (EOHHS). The executive department of the Commonwealth of Massachusetts established under M.G.L. c. 6A, § 2 that, through the Department of Elder Affairs and other agencies within EOHHS, as appropriate, operates and administers the programs of medical assistance and medical benefits under M.G.L. c. 118E and that serves as the single state agency under § 1902(a)(5) of the Social Security Act.

Facility. A nursing facility licensed by DPH under M.G.L. c. 111, § 71, including nursing or convalescent homes, an infirmary maintained in a town, a charitable home for the aged, and transitional care units.

Fiscal Year (FY). The state fiscal year from July 1^st through June 30^th.

MassHealth Program (MassHealth). The medical assistance benefits plans operated and administered by EOHHS pursuant to M.G.L. c. 118E, § 1 et seq. and 42 U.S.C. § 1396 et seq. Title XXI of the Social Security Act (42 U.S.C. 1397), and other applicable laws and waivers to provide and pay for medical services to eligible members (Medicaid).

Medicaid Bed Day. A patient day for which the primary payer is either MassHealth or a non-Massachusetts Medicaid program, including patient days paid for by a Senior Care Organization (SCO), One Care, the Program for All-inclusive Care for the Elderly (PACE), or a MassHealth-affiliated Accountable Care Organization (ACO). Medicaid bed days include patient days of individuals who elect hospice care for which Medicaid pays for room and board.

Medicare. The federal health insurance program for people who are 65 years of age or older, certain younger people with disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) established by Title XVIII of the Social Security Act.

Medicare Patient Day. A patient day covered by Medicare Part A under either an indemnity fee-for-service arrangement (also known as "original Medicare") or a Medicare managed care plan (also known as Medicare Advantage plan).

MassHealth-affiliated Accountable Care Organization (ACO). An entity that enters into a population-based payment model contract with EOHHS as an accountable care organization, wherein the entity is held financially accountable for the cost and quality of care for an attributed or enrolled member population. ACOs include Accountable Care Partnership Plans, Primary Care ACOs, and MCO-administered ACOs.

Non-Medicare Patient Day. A patient day that is not covered by Medicare Part A under either an indemnity fee-for-service arrangement (also known as "original Medicare") or a Medicare managed care plan (also known as Medicare Advantage plan). Non-Medicare patient days do not include residential care patient days

One Care (also known as an Integrated Care Organization (ICO)). An organization with a comprehensive network of medical, behavioral health care, and long-term services and supports providers that integrates all components of care, either directly or through subcontracts, and has contracted with EOHHS and CMS and has been designated as an ICO to provide services to dual eligible individuals under M.G.L. c. 118E. ICOs are responsible for providing enrollees with the full continuum of Medicare- and MassHealth-covered services.

Patient Day. A day of care provided to an individual by a facility regardless of whether or not the facility has been paid for the day. The date an individual is admitted to the facility is a patient day. The date an individual is discharged is not a patient day, unless the individual is admitted and discharged on the same day. Patient days include days for which a facility reserves and customarily charges for a vacant bed for an individual temporarily placed in a different care situation ("bed hold days"). Patient days also include Medicaid "medical leave of absence days" and "non-medical leave of absence days" in accordance with 130 CMR 456.425: Medical Leave of Absence: Introduction through 130 CMR 456.433: Nonmedical Leave of Absence: Payment.

Program of All-inclusive Care for the Elderly (PACE). A comprehensive service delivery and financing model that integrates medical and long-term services and supports (LTSS) under dual capitation agreements with Medicare and Medicaid as described under federal regulations for PACE at 42 CFR 460. The PACE program is open to eligible MassHealth members 55 years of age and older who meet MassHealth's skilled-nursing-facility level of care criteria and reside in a PACE service area.

Residential Care. The minimum basic care and services and protective supervision required by DPH in accordance with 105 CMR 150.000: Licensing of Long-term Care Facilities for residents who do not routinely require nursing or other medically related services.

Senior Care Organization (SCO). An organization that participates in MassHealth under a contract with the MassHealth agency and the Centers for Medicare & Medicaid Services (CMS) to provide a comprehensive network of medical, health-care, and social-service providers and that integrates components of care, either directly or through subcontracts. Senior Care Organizations are responsible for providing enrollees with the full continuum of Medicare- and MassHealth-covered services.

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 512.03 Facility Groups

(1) Nursing facility user fee payment liability will vary by facility group. The two groups of facilities for purposes of 101 CMR 512.00 are defined in 101 CMR 512.03(1)(a) and (b):

(a) Group I: All facilities that do not meet the criteria for group II, and;

(b) Group II: Any nursing facility meeting one or more of the following criteria:

a non-profit continuing care retirement community or non-profit residential care facility;
a non-profit facility that provides at least 39,000 annual Medicaid bed days, as determined by EOHHS; or
a facility with a Medicaid utilization rate of 87% or higher, as determined by EOHHS.

(2) New facilities that come into operation subsequent to the effective date of EOHHS's approved waiver under 42 CFR 433.68(e)(2), or facilities otherwise not included in the approved waiver application, will be considered Group I facilities until EOHHS determines the facility's group eligibility. Facilities that undergo a change in status that alters their group eligibility subsequent to January 1, 2023, will remain in their original group until EOHHS determines eligibility. If the determination of eligibility for a new facility or a facility's change in status would result in noncompliance with EOHHS's approved federal waiver, the facility will remain in its current group until such time as EOHHS is able to amend its approved waiver.

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 512.04 Calculation of User Fee

(1) EOHHS or its designee calculates the per diem user fee annually. The user fee is calculated as follows.

(a) Determine the amount of revenue to be collected in a fiscal year in accordance with M.G.L. c. 118E, § 63.

(b) Determine the expected number of non-Medicare patient days in Group I facilities.

(d) Determine the standard rate such that the product of estimated non-Medicare patient days in Group I facilities and the Group I facility user fee rate and the product of estimated non-Medicare patient days in Group II facilities and the Group II facility user fee rate equal the amount of revenue to be collected in a fiscal year in accordance with M.G.L. c. 118E, § 63.

(2) Group I will pay the standard rate per non-Medicare patient day.

(3) Group II will pay 30% of the standard rate.

(4) The total collections are prohibited from exceeding 6% of the revenues received by the taxpayer class.

(5) Effective January 1, 2023, the user fee will be applied as follows.

| Facility Group | Per Diem User Fee | Relative Rate % | | --- | --- | --- | | Group I | $24.16 | 100% | | Group II | $7.25 | 30% |

(6) If, during the course of the fiscal year, EOHHS determines that the total amount of user fee revenue will be significantly different than previously estimated, it may recalculate the user fee and may change the user fee prospectively by administrative bulletin to reflect such changes based on the methodology described in 101 CMR 512.04(1).

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 512.05 Payment of User Fee

(1) Quarterly Assessment. Each facility must pay a quarterly assessment to EOHHS. Each facility must determine the amount of the assessment owed for each quarter by multiplying (1) its total non-Medicare patient days by (2) the per diem user fee established by EOHHS.

(2) User Fee Form. Each facility must submit its quarterly assessment on a form prepared by EOHHS. Each facility must report its total patient days by payer and its non-Medicare patient days on the user fee form. A facility is still obligated to pay the user fee even if they have not received or accessed the form.

(3) Due Date.

(a) Assessment payments and the user fee form are due according to the following schedule:

| Assessment Period | Payment and Form Due Date | | --- | --- | | July 1^st - September 30^th | November 1^st | | October 1^st - December 31^st | February 1^st | | January 1^st - March 31^st | May 1^st | | April 1^st - June 30^th | August 1^st |

(b) If a facility closes, it must pay any outstanding user fee obligations within 30 days of the date of closure.

(c) Mergers, Acquisitions, and CHOW. The assessment obligation of any nursing facility is applied to an obligation of any successor in interest or assignee of such nursing facility, as determined by EOHHS. A successor in interest may include, but is not limited to, any purchaser of the assets or stock, any new operator or licensee of an existing nursing facility, any surviving entity resulting from merger or liquidation, or any receiver or any trustee of the original nursing facility.

(4) Administration. EOHHS will inform facilities by administrative bulletin of the procedures for the payment and collection of the user fee. EOHHS may update these procedures by administrative bulletin.

(5) Interest and Late Fees. EOHHS may assess interest and late fees on unpaid liabilities. If a facility fails to remit an assessment by the due date, EOHHS will assess interest at up to 1.5% per month on the outstanding balance and calculate the interest from the due date. EOHHS may also impose a late fee of up to 5% per month of the outstanding balance.

(6) Assessment Revenue. The total amount of assessments collected, any federal financial participation generated from the payments to facilities based on the collected assessments, penalties, and any interest earned will be credited to the general fund of the Commonwealth of Massachusetts.

(7) Enforcement Provisions. In addition to interest and late fees imposed pursuant to 101 CMR 512.05(5), EOHHS may take enforcement actions including, but not limited to, the following:

(a) recoupment of a nursing facility's claims not to exceed an amount established by administrative bulletin or other appropriate written issuance;

(b) creation, after demand for payment, of a lien in favor of the Commonwealth; and

(c) notifying DPH if a facility fails to pay a required assessment. Under M.G.L. 118E, § 63(f), DPH will impose a limitation on new admissions or revoke licensure of a facility that fails to pay a delinquent assessment.

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 512.06 Reporting Requirements

(1) General. Each facility must file or make available information that is required or that EOHHS deems reasonably necessary for calculating and collecting the user fee.

(2) Required Reports. Each facility must file required reports and forms with EOHHS or its designee and must submit any additional documentation requested by EOHHS or its designee to verify the accuracy of the data submitted.

(3) Audit. EOHHS or its designee may inspect and copy the records of a facility for purposes of auditing its calculation of the assessment.

(a) If EOHHS or its designee determines that a facility has either overpaid or underpaid the assessment, it will notify the facility of the amount due or refund the overpayment.

(b) EOHHS or its designee may offset overpayments against amounts due EOHHS for the assessment.

(c) If a facility is aggrieved by a decision of EOHHS or its designee as to the amount due, it may file an appeal to the Division of Administrative Law Appeals within 60 days of the date of the notice of underpayment or the date the notice is received, whichever is later. The filing of an appeal will not toll the collection of interest and penalties.

(4) Penalties. EOHHS may impose a per diem penalty of $100 per day if a facility fails to submit required reports or furni sh other documentation requested under 101 CMR 512.00 by the dates specified in 101 CMR 512.05(3) or as specified by EOHHS in administrative bulletins or other written issuances.

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

101 CMR, § 512.07 Other Provisions

(1) Severability. The provisions of 101 CMR 512.00 are severable. If any provision or the application of any provision is held to be invalid or unconstitutional, such invalidity will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 512.00 or the application of such provisions.

(2) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify policies, update administrative requirements, and specify information and documentation necessary to comply with 101 CMR 512.00.

History

Adopted by Mass Register Issue 1329, eff. 12/30/2016.

Hospital Assessment Hospital Assessment

101 CMR, § 514.01 General Provisions

(1) Scope and Purpose. 101 CMR 514.00 governs the collection of the hospital assessment established under M.G.L. c. 118E, § 67.

History

Adopted by Mass Register Issue 1483, eff. 11/3/2022 (EMERGENCY).

101 CMR, § 514.02 Definitions

As used in 101 CMR 514.00, unless the context requires otherwise, terms have the following meanings.

Acute Hospital. A hospital licensed under M.G.L. c. 111, § 51 that contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the Department of Public Health.

Assessed Charges. Gross patient service revenue attributable to all patients less gross patient service revenue attributable to programs administered pursuant to Titles XVIII, XIX, and XXI of the Social Security Act in each hospital's fiscal year 2019.

Assessment. The total payment due by each hospital each month or quarter, as set forth in 101 CMR 514.00.

Center for Health Information and Analysis (CHIA). The Center for Health Information and Analysis established under M.G.L. c. 12C.

Centers for Medicare & Medicaid Services (CMS). The federal agency under the U.S. Department of Health and Human Services that is responsible for administering the Medicare and Medicaid programs.

Department of Public Health (DPH). An agency of the Commonwealth of Massachusetts, established under M.G.L. c. 17, § 1.

Fiscal Year (FY). The 12-month period that hospitals use for financial reporting and budgeting.

Gross Patient Service Revenue. The total dollar amount of a hospital's charges for services rendered in a hospital's fiscal year, as reported to the Center for Health Information and Analysis (CHIA) through Hospital Cost Reports in 2019.

Health Safety Net. The payment program established and administered in accordance with M.G.L. c. 118E, § 8A, and §§ 64 through 69 and regulations promulgated thereunder, and other applicable legislation.

Health Safety Net Office. The office within the Office of Medicaid established under M.G.L. c. 118E, § 65.

Health Safety Net Trust Fund. The fund established under M.G.L. c. 118E, § 66.

Hospital Cost Report. The Massachusetts Hospital Statement of Costs, Revenues, and Statistics required to be reported to CHIA pursuant to 957 CMR 9.00: Hospital Financial Data Reporting Requirements.

Licensee. Any natural person, corporation, partnership, trust, estate, or other legal entity holding a license to operate a nonpublic acute or non-acute hospital in Massachusetts; and, in the case of a licensee that is not a natural person, includes

(1) any shareholder owning not less than 5%, any officer, and any director of any corporate licensee;

(2) any limited partner owning not less than 5% and any general partner of a partnership licensee;

(3) any trustee of any trust licensee;

(4) any sole proprietor of any licensee that is a sole proprietorship; or

(5) any mortgagee in possession and any executor or administrator of any licensee that is an estate.

MassHealth Program (MassHealth). The medical assistance benefits plans operated and administered by EOHHS pursuant to M.G.L. c. 118E, § 1 et seq . and 42 U.S.C. § 1396 et seq ., Title XXI of the Social Security Act (42 U.S.C. 1397), and other applicable laws and waivers to provide and pay for medical services to eligible members (Medicaid).

Non-public Gross Patient Service Revenue. Total gross patient service revenues (as defined in Gross Patient Service Revenue) minus gross patient service revenues attributable to Medicare, Medicaid, and Out-of-state Medicaid, as determined by EOHHS.

Non-acute Hospital. A nonpublic hospital that is

(1) licensed by the Department of Public Health under M.G.L. c. 111, § 51 but not defined as an acute-care hospital under M.G.L. c. 111, § 25B; or

(2) licensed as an inpatient facility by the Department of Mental Health (DMH) under M.G.L. c. 19, § 19 and regulations promulgated thereunder, but not categorized as Class VII licensees under the regulations.

Rate Year (RY). The 12 months from October 1^st through September 30^th.

Total Assessment Amount. A fixed amount equal to $1,484,050,000 plus 50% of the estimated cost, as determined by the Secretary of Administration and Finance, of administering the Health Safety Net and related assessments in accordance with M.G.L. c. 118E, §§ 65 to 69.

History

Adopted by Mass Register Issue 1483, eff. 11/3/2022 (EMERGENCY).

101 CMR, § 514.03 Hospital Groups

(1) Hospital Assessment Liability. Hospital assessment liability will vary by hospital group and by inpatient versus outpatient revenues. The nine groups of hospitals for purposes of 101 CMR 514.00 are defined as follows.

(a) Group I: Any acute hospital that had not less than 355 staffed beds in fiscal year 2022 as reported by CHIA and that is identified as a group 1 safety net hospital in the MassHealth demonstration waiver approved under Title XI of the federal Social Security Act § 1115, subsection (a) in effect as of October 1, 2022.

(b) Group II: Any acute hospital that had less than 355 staffed beds in fiscal year 2022 as reported by CHIA and that is identified as a group 1 safety net hospital in the MassHealth demonstration waiver approved under Title XI of the federal Social Security Act § 1115, subsection (a) in effect as of October 1, 2022.

(c) Group III: Any acute hospital that had not less than 355 staffed beds in fiscal year 2022 as reported by CHIA and that is identified as a group 2 safety net hospital in the MassHealth demonstration waiver approved under Title XI of the federal Social Security Act § 1115, section(a) in effect as of October 1, 2022.

(d) Group IV: Any acute hospital that had less than 355 staffed beds in fiscal year 2022 as reported by CHIA and that is identified as a group 2 safety net hospital in the MassHealth demonstration waiver approved under Title XI of the federal Social Security Act § 1115, subsection (a) in effect as of October 1, 2022.

(e) Group V: Any acute hospital that is a freestanding pediatric hospital.

(f) Group VI: Any acute hospital that is an academic medical center, teaching hospital, or specialty hospital, as determined by CHIA as of September 30, 2019, but excluding any high public payer hospital as defined by CHIA or any hospital included in Group V.

(g) Group VII: Any private acute hospital operating as of September 30, 2019, but excluding any hospital included in Groups I through VI.

(h) Group VIII: The Commonwealth's only non-state-owned public hospital, operating as of September 30, 2019.

(i) Group IX: Any nonpublic non-acute hospital operating as of September 30, 2019.

(2) Consistent Application of Assessment. Hospitals will remain in the group they are in as of October 1, 2024, and will be subject to the same assessment rate established for their group, except as follows.

(a) New Acute Hospitals. New acute hospitals that come into operation subsequent to October 1, 2022, or for whom there is no FY 2019 hospital-specific gross patient service revenue data (as reported by CHIA based on the annual collection of cost report data), or acute hospitals otherwise not included in the approved waiver application, will be considered Group VI hospitals, under 101 CMR 514.03(1), until EOHHS determines the hospital's group eligibility.

(b) New Non-acute Hospitals. New non-acute hospitals that come into operation subsequent to October 1, 2022, or for whom there is no FY 2019 hospital-specific gross patient service revenue data (as reported by CHIA based on the annual collection of cost report data), or non-acute hospitals otherwise not included in the approved waiver application, will be considered Group IX hospitals, under 101 CMR 514.03(1), until EOHHS determines the hospital's group eligibility.

(c) Hospital Closures. If a hospital subject to the assessment closes, with no successor in interest or assignee as determined by EOHHS consistent with the criteria described in 101 CMR 514.03(2)(d), the former hospital will no longer be subject to the assessment, provided that the hospital is subject to the assessment up to and included its date of closure. No changes will be made to the assessment rates for remaining assessed hospitals as a result of a hospital's closure when there is no successor in interest or assignee.

(d) Mergers and Acquisitions. The original assessment obligation of any hospital is applied to and becomes an obligation of any successor in interest or assignee of such hospital, as determined by EOHHS. A successor in interest may include, but is not limited to, any purchaser of the assets or stock, any new licensee of an existing acute or non-acute hospital, any surviving entity resulting from merger or liquidation, or any receiver or any trustee of the original hospital. The assessment obligation of the successor in interest or assignee with respect to the acquired or merged hospital(s) will be equal to the assessment obligation of the affected hospitals prior to the merger or acquisition. The assessment will be applied to hospitals that merge, or hospitals that acquire another or are acquired, as if no such merger or acquisition occurred.

(e) Multi-factorial Changes. The assessment obligation will follow the rules established in 101 CMR 514.03(2)(a) through (d), provided that:

In the event an existing hospital has merged with or acquired only a portion of another existing hospital and the two hospitals both continue to exist as hospitals after the merger or acquisition, the original assessment obligations of the two hospitals will be applied proportionally to each hospital based on the gross patient service revenue attributable to each portion of each hospital after the merger or acquisition.
In the event that a new hospital opens and also acquires a portion or all of an existing hospital, and the portion of the hospital that is new accounts for greater than 50% of the gross patient service revenue of the total hospital entity, the hospital's assessment obligation will be determined in accordance with 101 CMR 514.03(2)(a) or (b), as applicable depending on the hospital's status as an acute or non-acute hospital.
In the event that a new hospital opens and also acquires a portion or all of an existing hospital, and the portion of the hospital that is new accounts for 50% or less of the gross patient service revenue of the total hospital entity, the hospital's assessment obligation will be equal to the portion of the assessment attributable to the acquired portion of the hospital.

History

Adopted by Mass Register Issue 1483, eff. 11/3/2022 (EMERGENCY).

101 CMR, § 514.04 Calculation of Hospital Assessment

(1) To determine each hospital's annual assessment liability, the assessment rates established in 101 CMR 514.04(3) are applied to a static fiscal year 2019 dataset of non-public gross patient service revenues, except as described in 101 CMR 514.04(2).

(2) For new acute hospitals described in 101 CMR 514.03(2)(a) and new non-acute hospitals described in 101 CMR 514.03(2)(b), the assessment rates established in 101 CMR 514.04(3) are applied to an annual projection of non-public gross patient service revenues, provided by the hospital in accordance with 101 CMR 514.06(2), until such time as CHIA includes the new hospital in their release of fiscal year cost report data.

(a) For new acute hospitals, beginning with the first complete calendar month following the date of the new acute hospital's inclusion in CHIA's fiscal year cost report data, the assessment rates established in 101 CMR 514.04(3) are applied to the static data included in such fiscal year cost report data.

(b) For new non-acute hospitals, beginning with the first complete calendar quarter following the date of the new non-acute hospital's inclusion in CHIA's fiscal year cost report data, the assessment rates established in 101 CMR 514.04(3) are applied to the static data included in such fiscal year cost report data.

(3) Beginning hospital fiscal year 2025, the assessment will be applied as follows.

| Assessment Group | Hospital Group Description | Inpatient Assessment Rate | Outpatient Assessment Rate | | --- | --- | --- | --- | | Group I | Large Group 1 Safety Net | 24.0000% | 5.9500% | | Group II | Small Group 1 Safety Net | 14.5000% | 5.5000% | | Group III | Large Group 2 Safety Net | 18.0000% | 18.2000% | | Group IV | Small Group 2 Safety Net | 18.0000% | 10.2000% | | Group V | Freestanding Pediatric | 4.8000% | 4.2500% | | Group VI | Academic Medical Center, Teaching, Specialty | 4.7010% | 1.0650% | | Group VII | Other Private Acute | 8.5000% | 1.0450% | | Group VIII | Non-state Owned Public | 1.6150% | 1.5000% | | Group IX | Non-acute | 3.3000% | 3.3000% |

(4) EOHHS will provide each hospital its total annual assessment liability, and its required monthly or quarterly assessment amounts, as applicable, prior to the due date of the first payment.

History

Adopted by Mass Register Issue 1483, eff. 11/3/2022 (EMERGENCY).

101 CMR, § 514.05 Payment of Hospital Assessment

(1) Acute Hospital Monthly Assessment. Beginning October 1,2022, each acute hospital must pay a monthly assessment to EOHHS in a form and manner specified by the Health Safety Net Office, equal to one twelfth of its total annual assessment.

(2) Non-acute Hospital Quarterly Assessment. Beginning October 1, 2022, each non-acute hospital must pay a quarterly assessment to EOHHS in a form and manner specified by the Health Safety Net Office, equal to one fourth of its total annual assessment.

(3) Due Date.

(a) Acute hospital assessment payments are due on a monthly basis, with each assessment payment due on the last day of each month.

(b) Non-acute hospital assessment payments are due on a quarterly basis, with each quarterly assessment payment due on the last day of each calendar quarter.

(c) If a hospital closes, it must pay any outstanding hospital assessment obligations within 30 days of the date of closure. If a hospital is acquired by or merges with another hospital, any outstanding hospital assessments owed by the hospital being acquired or merging must be paid within 30 days of the date of the acquisition or merger.

(4) Administration. EOHHS may provide updates and further details, by administrative bulletin or other written issuance, regarding procedures for the payment and collection of the hospital assessment.

(5) Interest and Late Fees.

(a) EOHHS may assess interest and late fees on unpaid liabilities. If a hospital fails to remit an assessment by the due date, EOHHS may assess interest at up to 3% per month on the outstanding balance and calculate the interest from the due date. EOHHS will calculate the interest on the outstanding balance as of the due date.

(b) EOHHS may assess up to an additional 3% penalty against the outstanding balance and prior penalties for each month that a hospital remains delinquent. EOHHS will credit partial payments from delinquent hospitals to the current outstanding liability. If any amount remains from the partial payment, EOHHS will then credit such amount to the penalty amount.

(c) In determining the penalty amount, EOHHS may consider factors including, but not limited to, the hospital's payment history, financial situation, and relative share of the payments.

(6) Assessment Revenue. An amount equal to the total amount of assessments collected, plus any penalties and interest, will be credited to the Health Safety Net Trust Fund.

History

Adopted by Mass Register Issue 1483, eff. 11/3/2022 (EMERGENCY).

101 CMR, § 514.06 Reporting Requirements

(1) General. Each hospital must file or make available information that EOHHS deems reasonably necessary for calculating and collecting the hospital assessment.

(2) Required Reporting for Hospitals with Change of Status. Any new hospital, merging hospital, acquiring or acquired hospital, or closing hospital, as described in 101 CMR 514.03(2)(a) through (c), must inform EOHHS of its change in status at least 14 days prior to such change in status. Any new acute or non-acute hospital, as described in 101 CMR 514.03(2)(a) and (b), must provide projected annual revenue information, and any additional supporting documentation as requested by EOHHS, in the form and format requested by EOHHS within 30 days of beginning operations.

(3) Additional Documentation. Each hospital must submit any additional documentation requested by EOHHS or its designee to verify the accuracy of the data submitted.

(4) Audit. EOHHS or its designee may inspect and copy the records of a hospital for purposes of auditing its calculation of the assessment. If EOHHS or its designee determines that a hospital has either overpaid or underpaid the assessment, it will notify the hospital of the amount due or refund the overpayment.

(5) Penalties. EOHHS may impose a per diem penalty of $100 per day if a hospital fails to furnish documentation required or requested under 101 CMR 514.06 within the timeframes specified in 101 CMR 514.05(3) or as specified by EOHHS upon request, or in administrative bulletins or other written issuances.

(6) Enforcement Provisions. In addition to interest and late fees imposed pursuant to 101 CMR 514.05(5), EOHHS may take enforcement actions including, but not limited to, the following:

(a) for hospitals licensed by the department of health, notifying the department of the unpaid assessments and such information shall be considered by the department in determining suitability in accordance with M.G.L. c. 111, § 51 for the hospital or its affiliate provider entities;

(b) offsetting delinquent assessment amounts owed, including any interest, penalties and reasonable attorneys' fees, against:

the hospital's MassHealth claims payments, MassHealth supplemental or incentive payments, Health Safety Net payments, or other payments that may otherwise be due to the hospital from MassHealth or the Health Safety Net,
other hospitals or MassHealth-contracted entities under common ownership as the delinquent hospital, or
any successor in interest to the hospital or such provider entities under common ownership; or

(c) creating, after demand for payment, a lien in favor of the commonwealth in an amount not to exceed the delinquent fees owed, including any interest, penalties and reasonable attorneys' fees, encumbering the building in which the delinquent hospital is located, encumbering the real property upon which the delinquent hospital is located, including fixtures, equipment or goods used in the operation of the delinquent hospital, or encumbering any real property in which the delinquent hospital holds an interest

(d) take any other action, through EOHHS or in partnership with other state agencies, to collect on the delinquent debt permissible under law.

History

Adopted by Mass Register Issue 1483, eff. 11/3/2022 (EMERGENCY).

101 CMR, § 514.07 Severability

The provisions of 101 CMR 514.00 are severable. If any provision or the application of any provision is held to be invalid or unconstitutional, such invalidity will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 514.00 or the application of such provisions.

History

Adopted by Mass Register Issue 1483, eff. 11/3/2022 (EMERGENCY).

Managed Care Organization Services Payor Assessment Managed Care Organization Services Payor Assessment

101 CMR, § 515.01 General Provisions

101 CMR 515.00 governs the collection of the managed care organization services payor assessment established under M.G.L. c. 118E, § 68.

History

Adopted by Mass Register Issue 1543, eff. 2/26/2025 (EMERGENCY).

101 CMR, § 515.02 Definitions

As used in 101 CMR 515.00, unless the context requires otherwise, terms have the meanings in 101 CMR 515.02.

Assessed Services. Services rendered by a managed care organization for which a premium or membership payment is made by or on behalf of the member; provided, however, that managed care organization services subject to assessment do not include services which are

(a) rendered to members enrolled per month in Medicare managed care organizations;

(b) rendered to members dually enrolled per month in both Medicaid and Medicare;

(d) rendered to members through a limited benefit plan;

(e) rendered to members through an indemnity plan; or

(f) preempted from taxation by 5 U.S.C. § 8909(f); and provided further, that assessed services are identified and assessed through claims paid by managed care organizations for healthcare services rendered in Massachusetts.

Assessment. The total payment due by each managed care organization each month, as set forth in 101 CMR 515.00.

Assessment Year. The calendar year, from January 1^st through December 31^st of each year.

Center for Health Information and Analysis (CHIA). An agency of the Commonwealth of Massachusetts, established under M.G.L. c. 12C.

Center for Health Information and Analysis Revenue Amount. An amount equal to the sum of the amount collected by CHIA from acute hospitals and ambulatory surgical centers under M.G.L. c. 12C, § 7.

Centers for Medicare & Medicaid Services (CMS). The federal agency under the US Department of Health and Human Services that is responsible for administering the Medicare and Medicaid programs.

Division of Insurance. An agency of the Commonwealth of Massachusetts, established under M.G.L. c. 26.

Entity. A natural person, corporation, partnership, trust, estate, or other legal entity operating as a managed care organization rendering managed care organization services in Massachusetts; and, in the case of an entity that is not a natural person, includes

(a) any shareholder owning no less than 5%, any officer, and any director of any corporate entity;

(b) any limited partner owning no less than 5% and any general partner of a partnership entity;

(d) any sole proprietor of any entity that is a sole proprietorship; or

(e) any mortgagee in possession and any executor or administrator of any entity that is an estate.

Executive Office of Health and Human Services (EOHHS). The executive department of the Commonwealth of Massachusetts established under M.G.L. c. 6A, § 2. Through the Executive Office of Aging & Independence and other agencies within EOHHS, the department operates and administers the programs of medical assistance and medical benefits, as appropriate under M.G.L. c. 118E, and serves as the single state agency under § 1902(a)(5) of the Social Security Act.

Health Policy Commission. An agency of the Commonwealth of Massachusetts, established under M.G.L. c. 6D.

Health Policy Commission Revenue Amount. An amount equal to the sum of the amount collected by the health policy commission from hospitals and ambulatory surgical centers under M.G.L. c. 6D.

Health Safety Net. The payment program established and administered in accordance with M.G.L. c. 118E, §§ 8A, and 64 through 69.

Health Safety Net Managed Care Organization Revenue Amount. An amount equal to $160,000,000 plus 50% of the estimated cost, as determined by the secretary for administration and finance, of administering the Health Safety Net and related assessments in accordance with M.G.L. c. 118E, §§ 65 through 69.

Health Safety Net Office. The office within the Office of Medicaid established under M.G.L. c. 118E, § 65.

Health Safety Net Trust Fund. The fund established under M.G.L. c. 118E, § 66.

Immunization Revenue Amount. The estimated costs to purchase, store, and distribute vaccines for routine immunizations and to administer trust funds established for such purpose under M.G.L. c. 111, and to operate the computerized immunization registry, established in M.G.L. c. 111, § 24M, taking into consideration the limitations on expenditures described in M.G.L. c. 111, as well as any anticipated surplus or deficit in said trust funds, but excluding any costs anticipated to be covered by federal contribution.

Indemnity Plan. A plan that does not offer benefits through a restricted or preferred network of healthcare providers, whether directly or through a third party.

Limited Benefit Plan. A plan for stand-alone coverage of dental, vision, or long-term-care services.

Managed Care Organization. An entity that is

(a) accredited under M.G.L. c. 176O and that is

licensed or otherwise authorized to transact accident or health insurance under M.G.L. c. 175;
a nonprofit hospital service corporation organized under M.G.L. c. 176A;
a nonprofit medical service corporation organized under M.G.L. c. 176B;

a health maintenance organization organized under M.G.L. c. 176G; or

an organization entering into a preferred provider arrangement under M.G.L. c. 176I;

(b) a Medicaid managed care organization;

(d) a self-insured group for which a carrier provides administrative services under M.G.L. c. 176O, § 21; or

(e) a health insurance plan that contracts with the commonwealth health insurance connector authority.

Managed Care Organization Reinvestment Revenue Amount. A fixed amount equal to $246,000,000.

Massachusetts Child Psychiatry Access Project Revenue Amount. The amount equal to the amounts expended annually for the Massachusetts Child Psychiatry Access Project that are related to services provided on behalf of commercially insured clients.

MassHealth Program (MassHealth). The medical assistance benefits plans (Medicaid) operated and administered by EOHHS under M.G.L. c. 118E, § 1 and 42 U.S.C. § 1396, Title XXI of the Social Security Act (42 U.S.C. 1397), and other applicable laws and waivers to provide and pay for medical services to eligible members.

Medicare. The federal health insurance program for people who are 65 years of age or older, certain younger people with disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant) established by Title XVIII of the Social Security Act.

Total Assessment Amount. An amount to be determined annually by MassHealth, and noticed to managed care organizations annually via administrative bulletin or other written issuance prior to the start of the assessment year, which equals the total of

(a) the Managed Care Organization Reinvestment Revenue Amount;

(b) the Health Safety Net Managed Care Organization Revenue Amount;

(d) the Immunization Revenue Amount;

(e) the Health Policy Commission Revenue Amount;

(f) the Center for Health Information and Analysis Revenue Amount;

(g) the amount transferred, under M.G.L. c. 118E, § 66, to the Behavioral Health Access and Crisis Intervention Trust Fund established in M.G.L. c. 29, § 2WWWWW; and

(h) the amounts necessary to prospectively incorporate all adjustments or reconciliations to account for under-assessments in the prior assessment year.

History

Adopted by Mass Register Issue 1543, eff. 2/26/2025 (EMERGENCY).

101 CMR, § 515.03 Managed Care Organization Services Groups

(1) Managed Care Organization Assessment Liability. Managed care organization assessment liability will vary by managed care organization services group, whether Medicaid or non-Medicaid services, and for Medicaid services, by the size of the Medicaid services as determined by Medicaid total revenues. The three groups of managed care organization services for purposes of 101 CMR 515.00 are defined as follows.

(a) Group I. Non-Medicaid assessed services;

(b) Group II. Medicaid assessed services provided by a managed care organization with annual total paid claims less than or equal to $2,000,000,000; and

(c) Group III. Medicaid assessed services provided by a managed care organization with annual total paid claims greater than $2,000,000,000.

(2) Annual Application of Assessment. The assessment rate will be established annually and will apply to a managed care organization's assessed services, based on the managed care organization's assessed services in each assessment group described in 101 CMR 515.03(1), as such assessed services are reported each month by managed care organizations.

History

Adopted by Mass Register Issue 1543, eff. 2/26/2025 (EMERGENCY).

101 CMR, § 515.04 Calculation of Managed Care Organization Services Assessment

(1) Assessment Basis. To determine each managed care organization's assessment liability, the assessment rates established in accordance with 101 CMR 515.04 are applied to the managed care organization's monthly assessed services, calculated based on total claims paid by the managed care organization in the month assessed.

(2) Assessment Rate.

(a) For the assessment year beginning January 1, 2025, the assessment will be applied as follows.

| Assessment Group | Assessment Group Description | Assessment Rate | | --- | --- | --- | | Group I | Commercial Services: Non-Medicaid assessed services | 1.18% | | Group II | Tier 1 Medicaid Services: Medicaid assessed services rendered by managed care organizations with annual revenues of less than or equal to $2,000,000,000 | 8.00% | | Group III | Tier 2 Medicaid Services: Medicaid assessed services rendered by managed care organizations with annual revenues of greater than $2,000,000,000 | 0.50% |

(b) For assessment years beginning on or after January 1, 2026, the assessment rates for each group will be issued via administrative bulletin and determined by the total assessment amount to be collected each assessment year, taking into account any reconciliation for over-or under-assessment amounts from the previous assessment year; provided that each assessment year, assessment rates are set in a manner to meet the requirements of 42 CFR 433.68(e)(2) and 42 CFR 433.68(f).

(3) Assessment Rate Annual Determination and Reconciliation.

(a) Prior to each assessment year, EOHHS will determine the assessment rate for the assessment year, incorporating any necessary adjustments to account for rates set in prior assessment years that were insufficient or in excess to assess the total assessment amount.

(b) EOHHS may prospectively redetermine the assessment rate during an assessment year, if EOHHS projects that the initial assessment rate established for the assessment year will produce significantly less or more than the total assessment amount.

(c) In each determination or redetermination of the assessment rate, EOHHS will use the best data available, as determined by EOHHS. EOHHS will incorporate all adjustments, including, but not limited to, updates or corrections or final settlement amounts, by prospective adjustment rather than by retrospective payments or assessments.

History

Adopted by Mass Register Issue 1543, eff. 2/26/2025 (EMERGENCY).

101 CMR, § 515.05 Payment of Managed Care Organization Services Assessment

(1) Managed Care Organization Services Monthly Assessment Payment. Beginning January 1, 2025, each managed care organization must pay a monthly assessment to EOHHS in a form and manner specified by EOHHS.

(2) Due Date.

(a) Managed care organization services assessment payments are due the first business day after the month following the month assessed. For example, the January 1, 2025, monthly assessment is due on March 3, 2025.

(c) If a managed care organization ceases to exist or ceases to render assessed services, it must pay any outstanding managed care organization services assessment obligations within 30 days of the date of such cessation. If a managed care organization is acquired by or merges with another managed care organization, any outstanding managed care organization services assessments owed by the managed care organization being acquired or merging must be paid within 30 days of the date of the acquisition or merger.

(3) Administration. EOHHS may provide updates and further details for implementation of the managed care organization services assessment, by administrative bulletin or other written issuance. Such written issuances may provide additional requirements for matters including, but not limited to, procedures for the payment and collection of the managed care organization services assessment, reporting requirements, annual assessment rate setting, mid-assessment year rate adjustments, enforcement processes and procedures, etc .

(4) Interest and Late Fees.

(a) EOHHS may assess interest and late fees on unpaid liabilities. If a managed care organization fails to remit an assessment by the due date, EOHHS may assess interest at up to 3% per month on the outstanding balance and calculate the interest from the due date. EOHHS will calculate the interest on the outstanding balance as of the due date.

(b) EOHHS may assess up to an additional 3% penalty against the outstanding balance and prior penalties for each month that a managed care organization remains delinquent. EOHHS will credit partial payments from delinquent managed care organizations to the current outstanding liability. If any amount remains from the partial payment, EOHHS will then credit such amount to the penalty amount.

(c) In determining the penalty amount, EOHHS may consider factors including, but not limited to, the managed care organization's payment history, financial situation, and relative share of the payments.

(5) Assessment Revenue. An amount equal to the total amount of assessments collected, plus any penalties and interest, will be credited to the Health Safety Net Trust Fund.

History

Adopted by Mass Register Issue 1543, eff. 2/26/2025 (EMERGENCY).

101 CMR, § 515.06 Reporting Requirements

(1) General. Each managed care organization must file or make available information that EOHHS deems reasonably necessary for calculating and collecting the assessment.

(2) Required Reporting for Managed Care Organizations with Change of Status. Any new managed care organization, merging managed care organization, acquiring or acquired managed care organization, or managed care organization ceasing to operate or provide managed care organization services, must inform EOHHS of its change in status at least 14 days prior to such change in status. Any such managed care organization entities must provide projected annual revenue information and any additional supporting documentation, as requested by EOHHS, in the form and format requested by EOHHS within 30 days of beginning operations.

(3) Additional Documentation. Each managed care organization must submit any additional documentation requested by EOHHS or its designee to verify the accuracy of the data submitted.

(4) Audit. EOHHS or its designee may inspect and copy the records of a managed care organization for purposes of auditing its calculation of the assessment. If EOHHS or its designee determines that a managed care organization has either overpaid or underpaid the assessment, it will notify the managed care organization of the amount due or refund the overpayment.

(5) Penalties. EOHHS may impose a per diem penalty of $100 per day if a managed care organization fails to furnish documentation required or requested under 101 CMR 515.06 within the timeframes specified in 101 CMR 515.06(2) or as specified by EOHHS upon request, or in administrative bulletins or other written issuances.

(6) Enforcement Provisions. In addition to interest and late fees imposed under 101 CMR 515.06(5), EOHHS may take enforcement actions including, but not limited to, the following:

(a) for managed care organizations licensed by the department of insurance, notifying the department of the unpaid assessments and such information may be considered by the department when reviewing managed care organizations' financial reports or conducting other regulatory oversight;

(b) creating, after demand for payment, a lien in favor of the commonwealth in an amount not to exceed the delinquent fees owed, including any interest, penalties, and reasonable attorneys' fees; encumbering the building in which the delinquent managed care organization is located; encumbering the real property upon which the delinquent managed care organization is located, including fixtures, equipment, or goods used in the operation of the delinquent managed care organization; or encumbering any real property in which the delinquent managed care organization holds an interest; or

(c) take any other action, through EOHHS or in partnership with other state agencies, to collect on the delinquent debt permissible under law.

History

Adopted by Mass Register Issue 1543, eff. 2/26/2025 (EMERGENCY).

101 CMR, § 515.07 Other Provisions

(1) Severability. The provisions of101 CMR 515.00 are severable. If any provision or the application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 515.00 or application of those provisions to applicable individuals, entities, or circumstances.

(2) Application of 101 CMR 515.00. The provisions of 101 CMR 515.00 implement statutory requirements enacted through St. 2024, c. 140, which repealed, as of January 1, 2025, payor surcharges on payments for services rendered by acute hospitals and ambulatory surgical centers. Therefore, the statutory requirement is applicable for assessment years beginning on or after January 1,2025, and supersedes the collection of such payor surcharges provided, however, that such payor surcharges shall continue to be applicable for all surcharge amounts due for months prior to January 1, 2025.

History

Adopted by Mass Register Issue 1543, eff. 2/26/2025 (EMERGENCY).

Behavioral Health Access and Crisis Intervention Trust Fund Surcharge Behavioral Health Access and Crisis Intervention Trust Fund Surcharge

101 CMR, § 516.01 Scope and Purpose

101 CMR 516.00 governs the procedures for collecting a surcharge to fund the Behavioral Health Access and Crisis Intervention Trust Fund. The Behavioral Health Access and Crisis Intervention Trust Fund surcharge is a surcharge on certain payments made to Massachusetts acute hospitals and ambulatory surgical centers.

History

Adopted by Mass Register Issue 1484, eff. 11/25/2022 (EMERGENCY).

101 CMR, § 516.02 Definitions

Ambulatory Surgical Center. Any distinct entity located in Massachusetts that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and meets the U.S. Centers for Medicare and Medicaid (CMS) requirements for participation in the Medicare program.

Ambulatory Surgical Center Services. Services described for purposes of the Medicare program pursuant to 42 U.S.C. § 1395k(a)(2)(F)(i). These services include only facility services and do not include physician fees.

Department of Public Health. The Massachusetts Department of Public Health.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Fund. The Behavioral Health Access and Crisis Intervention Trust Fund established by M.G.L. c. 29 § 2WWWWW.

General Appropriations Act. The act of the General Court, or any subsequent amendment or supplemental act enacting the Commonwealth's fiscal year budget.

Hospital. An acute hospital licensed under M.G.L. c. 111, § 51, that contains a majority of medical surgical, pediatric, obstetric and maternity beds, as defined by the Massachusetts Department of Public Health.

Hospital Services. Services listed on an acute hospital's license issued by the Massachusetts Department of Public Health.

Indirect Payment. A payment made by a payer to a group of providers, including one or more Massachusetts acute care hospitals or ambulatory surgical centers, that then forward the payment to member hospitals or ambulatory surgical centers; or a payment made to an individual to reimburse him or her for a payment made to a hospital or ambulatory surgical center.

Managed Care Organization. A managed care organization as defined in M.G.L. c. 118E, § 64.

Medicaid. The medical assistance program administered by the Executive Office of Health and Human Services Office of Medicaid pursuant to M.G.L. c. 118E and in accordance with Titles XIX and XXI of the Federal Social Security Act, and a Section 1115 Demonstration Waiver.

Medicare Program. The medical insurance program established by Title XVIII of the Social Security Act.

Payer. A surcharge payer that meets the criteria set forth in 101 CMR 516.03(2).

Payment. A check, draft, or other paper instrument, an electronic fund transfer, or any order, instruction, or authorization to a financial institution to debit one account and credit another.

Payments Subject to Surcharge. All amounts paid, directly or indirectly, by surcharge payers to acute hospitals for health services and ambulatory surgical centers for ambulatory surgical center services; provided however, that it does not include:

(a) payments, settlements, and judgments arising out of third-party liability claims for bodily injury that are paid under the terms of property or casualty insurance policies; and

(b) payments made on behalf of Medicaid recipients, Medicare beneficiaries or persons enrolled in policies issued under M.G.L. c. 176K or similar policies issued on a group basis; provided further, that it includes payments made by a managed care organization on behalf of:

Medicaid recipients younger than 65 years old; and
enrollees in the Commonwealth care health insurance program; and provided further, that it may exclude amounts established under regulations promulgated by EOHHS for which the costs and efficiency of billing a surcharge payer or enforcing collection of the surcharge from a surcharge payer would not be cost effective.

Surcharge. The surcharge on payments made to hospitals and ambulatory surgical centers established by M.G.L. c. 118E, § 69A.

Surcharge Payer. An individual or entity that pays for or arranges for the purchase of health care services provided by acute hospitals and ambulatory surgical center services provided by ambulatory surgical centers; provided however, that it includes a managed care organization; and provided further, that it does not include Title XVIII and Title XIX programs and their beneficiaries or recipients, other governmental programs of public assistance and their beneficiaries or recipients and the workers' compensation program established under M.G.L. c. 152.

Third-party Administrator. An entity that administers payments for health care services on behalf of a client plan in exchange for an administrative fee. A third-party administrator may provide client services for a self insured plan or an insurance carrier's plan. A third-party administrator will be deemed to use a client plan's funds to pay for health care services whether the third-party administrator pays providers with funds from a client plan, with funds advanced by the third-party administrator subject to reimbursement by the client plan, or with funds deposited with the third-party administrator by a client plan.

Total Behavioral Health Surcharge Amount. An amount equal to $33,700,000.

History

Adopted by Mass Register Issue 1484, eff. 11/25/2022 (EMERGENCY).

101 CMR, § 516.03 Determination of Surcharge Liability and Payment.

(1) EOHHS will collect a surcharge on certain payments to hospitals and ambulatory surgical centers. The surcharge amount equals the product of:

(a) payments subject to the surcharge as defined in 101 CMR 516.03(3); and

(b) the assessment percentage as defined in 101 CMR 516.03(4).

(2) Payers subject to surcharge:

(a) Payers are subject to the surcharge if:

the payer is a surcharge payer; and
the payer's payments subject to surcharge were $1,000,000 or more during the previous state fiscal year or the most recent state fiscal year for which data is available.

(b) The same entity that pays the hospital or ambulatory surgical center for services must pay the surcharge.

(c) A payer that pays for hospital or ambulatory surgical center services on behalf of a client plan must pay the surcharge on those services. A payer that administers payments for health care services on behalf of a client plan in exchange for an administrative fee will be deemed to use the client plan's funds to pay for health care services whether the payer pays providers with funds from the client plan, with funds advanced by the payer subject to reimbursement by the client plan, or with funds deposited with the payer by the client plan.

(d) In the case of a transfer of ownership, a surcharge payer's liability to the Fund must be assumed by the successor in interest to the surcharge payer.

(3) Payments subject to the surcharge include direct and indirect payments made by surcharge payers in a time period as determined by EOHHS and released annually, to hospitals for the purchase of hospital services; and to ambulatory surgical centers for the purchase of ambulatory surgical center services.

(4) EOHHS will determine the surcharge percentage as follows:

(a) EOHHS will, on an annual basis, collect the Total Behavioral Health Surcharge Amount by collecting a portion of the total amount from all payers.

(b) EOHHS will require each payer to pay a portion of the total behavioral health surcharge amount proportional to their payments subject to surcharge during the most recent period for which data is available.

(c) The surcharge percentage is determined by dividing the total amount to be collected determined under 101 CMR 516.03(4)(a) by total payments subject to surcharge determined under 101 CMR 516.03(4)(b).

(d) EOHHS may establish the surcharge percentage by administrative bulletin. EOHHS may adjust the surcharge percentage by Administrative Bulletin if an adjustment is necessary to collect the revenue required to be collected.

(5) Each payer must determine its surcharge liability in accordance with guidance issued by EOHHS in administrative bulletins. The surcharge liability is the product of the payer's payments subject to the surcharge, as defined in 101 CMR 516.03(3) and the surcharge percentage as defined in 101 CMR 516.03(4)(c). The total amount to be collected may vary depending on the outcome of any administrative review of payments pursuant to 101 CMR 516.04.

(6) Payers that pay a global fee or capitation for services that include hospital or ambulatory surgical center services, as well as other services not subject to the surcharge, must develop a reasonable method for allocating the portion of the payment intended to be used for services provided by hospitals or ambulatory surgical centers. Such payers must file this allocation with EOHHS by February 1^st of each year. If there is a significant change in the global fee or capitation payment arrangement that necessitates a change in the allocation method, the payer must notify EOHHS and file a new allocation method at least 45 days before the new payment arrangement takes effect. Payers may not change the allocation method later in the year unless there is a significant change in the payment arrangement.

(a) EOHHS will review allocation plans within 90 days of receipt. During this review period, EOHHS may require a payer to submit supporting documentation or to make changes in this allocation method if it finds that the method does not reasonably allocate the portion of the global payment or capitation intended to be used for services provided by hospitals or ambulatory surgical centers.

(b) A payer must include the portion of the global payment or capitation intended to be used for services provided by hospitals or ambulatory surgical centers, as determined by this allocation method, in its determination of payments subject to the surcharge.

(7) A payer must include all payments made as a result of settlements, judgments or audits in its determination of payments subject to the surcharge. A payer may include payments made by Massachusetts hospitals or ambulatory surgical centers to the payer as a result of settlements, judgments or audits as a credit in its determination of payments subject to the surcharge.

(8) Each payer must pay its surcharge liability in the first quarter of each calendar year in accordance with a schedule developed and released by the EOHHS through administrative bulletin.

(9) Penalties for Non-payment.

(a) If a payer does not pay the amount calculated pursuant to 101 CMR 516.03(4)(c), or a specified portion thereof, by the due date established by EOHHS, EOHHS may assess up to a 3% penalty on the outstanding balance. EOHHS will calculate the penalty on the outstanding balance as of the due date. EOHHS may assess up to an additional 3% penalty against the outstanding balance and prior penalties for each month that a payer remains delinquent. EOHHS will credit partial payments from delinquent payers to the current outstanding liability. If any amount remains from the partial payment, EOHHS will then credit such amount to the penalty amount.

(b) In determining the penalty amount, EOHHS may consider factors including, but not be limited to, the payer's payment history, financial situation, and relative share of the payments.

History

Adopted by Mass Register Issue 1484, eff. 11/25/2022 (EMERGENCY).

101 CMR, § 516.04 Administrative Review

(1) Surcharge Liability. EOHHS may conduct an administrative review of surcharge liability payments at any time.

(2) Reviews and Audits. In conducting such review, EOHHS will review data submitted by hospitals, ambulatory surgical centers, and any other relevant data, including surcharge data. All information provided by, or required from, any payer, pursuant to 101 CMR 516.00 will be subject to audit by EOHHS. For surcharge liability payments based upon a global fee or capitation payment allocated according to an allocation method accepted by EOHHS pursuant to 101 CMR 516.03(4)(b), EOHHS' review will be limited to determining whether this method was followed accurately and whether the amounts reported were accurate.

(a) EOHHS may require the payer to submit additional documentation reconciling the data it submitted with data received from hospitals and ambulatory surgical centers.

(b) If EOHHS determines through its review that a payer's surcharge liability payment was materially incorrect, EOHHS will require a payment adjustment.

(3) Notification. EOHHS will notify the payer in writing if it determines there should be a payment adjustment. The notification will include a detailed explanation of the proposed adjustment.

(4) Objection Process. A payer may object to proposed adjustment in writing, within 15 business days of the mailing of the notification letter. The payer may request an extension of this period for cause. The written objection must, at a minimum, contain:

(a) the specific reason(s) for each of the payer's objections; and

(b) all documentation that supports the payer's position.

(5) Written Determination. Following review of the payer's objection, EOHHS will notify the payer of its determination in writing, with an explanation of its reasoning.

(6) Payment of Adjustment Amounts. Payment of adjustment amounts are due within 30 days following the mailing of the determination letter.

History

Adopted by Mass Register Issue 1484, eff. 11/25/2022 (EMERGENCY).

101 CMR, § 516.05 Other Provisions

(1) Reporting Requirements. Each payer must file or make available information that is required or that EOHHS deems reasonably necessary for calculating and collecting the surcharge.

History

Adopted by Mass Register Issue 1484, eff. 11/25/2022 (EMERGENCY).

101 CMR, § 516.06 Severability

The provisions of 101 CMR 516.00 are severable. If any provision or the application of any provision is held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 516.00 or the application of such provisions.

History

Adopted by Mass Register Issue 1484, eff. 11/25/2022 (EMERGENCY).

Health Safety Net Eligible Services Health Safety Net Eligible Services

101 CMR, § 613.01 General Provisions

Scope and Purpose. 101 CMR 613.00 governs the criteria applicable April 1, 2024, for determining the services for which Acute Hospitals and Community Health Centers may be paid by the Health Safety Net, including the types of services that are paid by the Health Safety Net, and the criteria to determine Low Income Patient status, to determine Medical Hardship, and to submit claims for Bad Debt. Payment rates for Eligible Services, as defined in 101 CMR 613.03, are set forth in 101 CMR 614.00: Health Safety Net Payments and Funding .

History

Amended by Mass Register Issue 1271, eff. 10/10/2014.

101 CMR, § 613.02 Definitions

As used in 101 CMR 613.00, unless the context otherwise requires, terms have the following meanings. All defined terms in 101 CMR 613.00 are capitalized.

340B Provider. An Acute Hospital or Community Health Center eligible to purchase discounted drugs through a program established by § 340B of United States Public Law 102-585, the Veterans Health Act of 1992, permitting certain grantees of federal agencies access to reduced cost drugs for their Patients, and registered and listed as a 340B Pharmacy within the United States Department of Health and Human Services, Office of Pharmacy Affairs database. Pharmacy services may be provided by a 340B Provider at on-site or off-site locations.

Acute Hospital. A hospital licensed under M.G.L. c. 111, § 51 that contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the Department of Public Health.

Administrative Day. A day of inpatient hospitalization on which a Patient's care needs can be provided in a setting other than an inpatient Acute Hospital in accordance with the standards in 130 CMR 415.000: Acute Inpatient Hospital Services and on which the Patient is clinically ready for discharge.

Adult Dental Services. Dental services provided to individuals 21 years of age and older and billed using the codes listed in the Health Safety Net claims specifications for Acute Hospitals and Community Health Centers.

Ancillary Services. Nonroutine services for which charges are customarily made in addition to routine charges that include, but are not limited to, laboratory, diagnostic and therapeutic radiology, surgical services, and physical, occupational, or speech-language therapy. Generally, ancillary services are billed as separate items when the Patient receives these services.

Application. A request for health benefits that is received by the MassHealth Agency and includes all required information and a signature by the applicant or his or her authorized representative. The application may be submitted online at www.MAHealthConnector.org, or the applicant may complete a paper application, complete a telephone application, or apply in person at a MassHealth Enrollment Center (MEC). The date of application for an online, telephonic, or in-person application is the date the application is submitted to the MassHealth Agency. The date of application for a paper application that is either mailed or faxed is the date the application is received by the MassHealth Agency.

Assets. As defined in 130 CMR 515.001: Definition of Terms .

Bad Debt. An account receivable based on services furnished to a Patient that is

(a) regarded as uncollectible, following reasonable collection efforts consistent with the requirements in 101 CMR 613.06;

(b) charged as a credit loss;

(d) not a Reimbursable Health Service.

Caretaker Relative. An adult who is the primary care giver for a child, is related to the child by blood, adoption, or marriage, or is a spouse or former spouse of one of those relatives, and lives in the same home as that child, provided that neither parent is living in the home.

Charge. The uniform price for a specific service charged by a Provider.

Children's Medical Security Plan (CMSP). A program of primary and preventive pediatric health care services for eligible children, from birth through 18 years old, administered by the MassHealth Agency pursuant to M.G.L. c. 118E, § 10F.

Collection Action. Any activity by which a Provider or designated agent requests payment for services from a Patient, a Patient's guarantor, or a third-party responsible for payment. Collection Actions include activities such as preadmission or pretreatment deposits, billing statements, collection follow-up letters, telephone contacts, personal contacts, and activities of collection agencies and attorneys.

Community Health Center. A health center operating in conformance with the requirements of § 330 of United States Public Law 95-626, including a Community Health Center that files a cost report as requested by the Center for Health Information and Analysis. Such a health center must

(a) be licensed as a freestanding clinic by the Massachusetts Department of Public Health pursuant to M.G.L. c. 111, § 51;

(b) meet the qualifications for certification (or provisional certification) by the MassHealth Agency and enter into a Provider agreement pursuant to 130 CMR 405.000: Community Health Center Services ; and

Confidential Services. Services for the treatment of sexually transmitted diseases provided under M.G.L. c. 112, § 12F and family planning services provided under M.G.L. c. 111, § 24E.

Countable Income. Income as defined in 101 CMR 613.05(1)(b).

Dental-only Low Income Patient. An uninsured Low Income Patient for whom payment from the Health Safety Net Trust Fund is only allowable for dental services, as specified in 101 CMR 613.04(6)(a)2.a.

Eligible Services. Services eligible for Health Safety Net payment pursuant to 101 CMR 613.03. Eligible Services include

(a) Reimbursable Health Services to Low Income Patients;

(b) Medical Hardship; and

Emergency Aid to the Elderly, Disabled and Children (EAEDC). A program of governmental benefits under M.G.L. c. 117A.

Emergency Medical Condition. A medical condition, whether physical or mental, manifesting itself by symptoms of sufficient severity, including severe pain, that the absence of prompt medical attention could reasonably be expected by a prudent layperson who possesses an average knowledge of health and medicine to result in placing the health of the person or another person in serious jeopardy, serious impairment to body function, or serious dysfunction of any body organ or part, or, with respect to a pregnant individual, as further defined in 42 U.S.C. § 1395dd(e)(1)(B).

Emergency Services. Medically Necessary Services provided to an individual with an Emergency Medical Condition.

EMTALA. The federal Emergency Medical Treatment and Active Labor Act under 42 U.S.C. § 1395dd.

EVS. The MassHealth Eligibility Verification System.

Federal Poverty Level (FPL). Income standards issued annually in the Federal Register to account for the last calendar year's increase in prices as measured by the Consumer Price Index.

Fiscal Year. The time period of 12 months beginning on October 1^st of any calendar year and ending on September 30^th of the following calendar year.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Gross Income. The total money earned or unearned, such as wages, salaries, rents, pensions, or interest, received from any source without regard to deductions.

Guarantor. A person or group of persons that assumes the responsibility of payment for all or part of a Provider's charge for services.

Health Connector. Commonwealth Health Insurance Connector Authority or Health Connector established pursuant to M.G.L. c. 176Q, § 2.

Health Insurance Plan. Medicare, MassHealth, the Premium Assistance Payment Program Operated by the Health Connector, a Qualified Health Plan, or an individual or group contract or other plan providing coverage of health care services issued by a health insurance company, as defined in M.G.L. c. 175, 176A, 176B, 176G, or 176I.

Health Safety Net. The payment program established and administered in accordance with M.G.L. c. 118E, §§ 8A, and 64 through 69 and regulations promulgated thereunder, and other applicable legislation.

Health Safety Net Office (Office). The office within the Office of Medicaid established under M.G.L. c. 118E, § 65.

Health Safety Net - Partial. A Low Income Patient eligible for either Health Safety Net - Primary or Health Safety Net - Secondary who documents MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), greater than 150% and less than or equal to 300% of the FPL, is considered Health Safety Net - Partial as described in 101 CMR 613.04(6)(b)3.

Health Safety Net - Partial Deductible (Deductible). Annual deductible applied as described in 101 CMR 613.04(8)(c).

Health Safety Net - Primary. A Health Safety Net eligibility category for uninsured Low Income Patients as described in 101 CMR 613.04(6)(a)1.

Health Safety Net - Secondary. A Health Safety Net eligibility category for Low Income Patients with primary health insurance as described in 101 CMR 613.04(6)(a)2.

Health Safety Net Trust Fund. The fund established under M.G.L. c. 118E, § 66.

Health Services. Medically necessary inpatient and outpatient services as authorized under Title XIX of the Social Security Act. Health services do not include

(a) nonmedical services, such as social, educational, and vocational services;

(b) cosmetic surgery;

(d) telephone conversations and consultations;

(e) court testimony;

(f) research or the provision of experimental or unproven procedures; and

(g) the provision of whole blood, but the administrative and processing costs associated with the provision of blood and its derivatives are payable.

Hospital Licensed Health Center. A Satellite Clinic that

(a) meets MassHealth requirements for reimbursement as a Hospital Licensed Health Center as provided at 130 CMR 410.413: Medical Services Required on Site at a Hospital-licensed Health Center ; and

(b) is approved by and enrolled with MassHealth's Provider Enrollment Unit as a Hospital Licensed Health Center.

Hospital Services. Services listed on an Acute Hospital's license by the Department of Public Health. This does not include services provided in transitional care units; services provided in skilled nursing facilities; and home health services, or separately licensed services, including residential treatment programs and ambulance services.

Hospital Visit. A face-to-face meeting between a Patient and a physician, physician assistant, nurse practitioner, or registered nurse or when the Patient has been admitted to a hospital by a physician on a Community Health Center's staff.

Low Income Patient. An individual who meets the criteria under 101 CMR 613.04(2).

MassHealth. The medical assistance and benefit programs administered by the MassHealth Agency pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq .), Title XXI of the Social Security Act (42 U.S.C. §§ 1397aa et seq .), M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services to eligible members.

MassHealth Agency. The Executive Office of Health and Human Services in accordance with the provisions of M.G.L. c. 118E.

MassHealth Care Plus. A program of health care services for eligible adults, 21 through 64 years old, administered by the MassHealth Agency pursuant to 130 CMR 505.000: MassHealth: Coverage Types .

MassHealth Common Health. A MassHealth program for disabled adults and disabled children administered by the MassHealth Agency pursuant to M.G.L. c. 118E.

MassHealth Family Assistance. A program of health care services for eligible children, young adults and adults administered by the MassHealth Agency pursuant to 130 CMR 505.000: MassHealth: Coverage Types .

MassHealth Family Assistance - Children. A program of health care services for eligible minors administered by the MassHealth Agency pursuant to 130 CMR 505.000: MassHealth: Coverage Types .

MassHealth Limited. A program of emergency health care services for individuals administered by the MassHealth Agency pursuant to 130 CMR 505.000: MassHealth: Coverage Types .

MassHealth MAGI Household. A household as defined in 130 CMR 506.002(B): MassHealth MAGI Household Composition .

MassHealth Standard. A program of health care services for eligible individuals administered by the MassHealth Agency pursuant to 130 CMR 505.000: MassHealth: Coverage Types .

Medical Coverage Date.

(a) The medical coverage date begins on the tenth day before the date the Application is received as described in 130 CMR 502.003: Verification of Eligibility Factors , if all required verifications, including a completed disability supplement, have been received within 90 days of the receipt of the Request for Information, as described at 130 CMR 502.003(C): Request for Information Notice except for applicants otherwise subject to rules detailed in 130 CMR 516.001: Application for Benefits , the medical coverage date is outlined in 130 CMR 516.006: Coverage Date if all required verifications have been received within the guidelines listed in 130 CMR 516.003: Verification of Eligibility Factors .

(b) If these required verifications listed on the Request for Information are received after the periods referenced in 101 CMR 613.02, the begin date of medical coverage is ten days before the date on which the verifications were received, if such verifications are received within one year of receipt of the Application, or as outlined in 130 CMR 516.003: Verification of Eligibility Factors , if applicable.

(c) For children younger than 21 years old and pregnant individuals receiving Provisional Eligibility as described in 130 CMR 502.003: Verification of Eligibility Factors , the medical coverage date begins ten days prior to the date of Application. For all other applicants receiving Provisional Eligibility as described in 130 CMR 502.003: Verification of Eligibility Factors , the medical coverage date begins on the date of the provisional eligibility determination. If all required verifications are received before the end of the provisional eligibility period, the medical coverage date of the verified coverage type will be ten days prior to the date of the Application.

Medical Hardship. Health Safety Net eligibility type available to Massachusetts Residents at any Countable Income level whose allowable medical expenses have so depleted his or her Countable Income that he or she is unable to pay for Eligible Services as described in 101 CMR 613.05.

Medical Hardship Family. Persons who live together, and consist of

(a) a child or children younger than 19 years old, any of their children, and their parents;

(b) siblings younger than 19 years old and any of their children who live together even if no adult parent or Caretaker Relative is living in the home; or

(c) a child or children younger than 19 years old, any of their children, and their Caretaker Relative when no parent is living in the home. A Caretaker Relative may choose whether or not to be part of the Medical Hardship Family. A parent may choose whether or not to be included as part of the Medical Hardship Family of a child younger than 19 years old only if that child is

pregnant; or
a parent.

A child who is absent from the home to attend school is considered as living in the home. A parent may be a natural, step, or adoptive parent. Two parents are members of the same family as long as they are both mutually responsible for one or more children that live with them.

Medically Necessary Service. A service that is reasonably expected to prevent, diagnose, prevent the worsening of, alleviate, correct, or cure conditions that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or to aggravate a disability, or result in illness or infirmity. Medically Necessary Services include inpatient and outpatient services as authorized under Title XIX of the Social Security Act.

Medicare Advantage. A type of Medicare health plan established by Title II of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Medicare Program (Medicare). The medical insurance program established by Title XVIII of the Social Security Act.

Mental Health Services. A comprehensive group of diagnostic and psychotherapeutic treatment services to mentally or emotionally disturbed persons and their families by an interdisciplinary team under the medical direction of a psychiatrist.

Minor. A person younger than 19 years old.

Modified Adjusted Gross Income (MAGI). Income as defined in 130 CMR 501.001: Definition of Terms .

Patient. An individual who receives or has received Medically Necessary Services at an Acute Hospital or Community Health Center.

Pharmacy Online Processing System (POPS). The MassHealth online, real-time computer network that adjudicates pharmacy claims, incorporating prospective drug utilization review, prior authorization, and Patient eligibility verification.

Premium Assistance Payment Program Operated by the Health Connector. An insurance subsidy program that provides state subsidies for low-income individuals and families administered by the Health Connector.

Premium Billing Family Group (PBFG). A group of persons who live together as defined in 130 CMR 501.001: Definition of Terms .

Primary or Elective Care. Medical care that is not an Urgent Care Service and is required by individuals or families for the maintenance of health and the prevention of illness. Primary Care consists of health care services customarily provided by general practitioners, family practitioners, general internists, general pediatricians, and primary care nurse practitioners or physician assistants. Primary Care does not require the specialized resources of an Acute Hospital emergency department and excludes Ancillary Services and maternity care services.

Provider. An Acute Hospital or Community Health Center that provides Eligible Services.

Provider Affiliate. An individual practitioner, practice group, or any other entity that provides emergency or medically necessary care in an Acute Hospital, including in affiliated Satellite Clinics or Hospital Licensed Health Centers.

Provisional Eligibility. Initial approval for Low Income Patient status when an applicant's certain self-attested circumstances show eligibility for the Health Safety Net, pending further eligibility verification for continued eligibility in accordance with 130 CMR 502.003: Verification of Eligibility Factors .

Qualified Health Plan (QHP). A health plan licensed under M.G.L. c. 175, 176A, 176B, or 176G that has received the Commonwealth Health Insurance Connector's Seal of Approval as meeting the criteria under 45 CFR § 155.1000 and is offered through the Health Connector in accordance with the provisions of 45 CFR § 155.1010.

Reimbursable Health Services. Eligible Services provided by Acute Hospitals or Community Health Centers to Uninsured and Underinsured Patients who are determined to be financially unable to pay for their care, in whole or in part and who meet the criteria for Low Income Patient; provided that such services are not eligible for reimbursement by any other public or third-party payer.

Resident. A person living in the Commonwealth of Massachusetts with the intention to remain as defined by 130 CMR 503.002(A) through (D). Persons who are not considered residents are

(a) individuals who came to Massachusetts for the purpose of receiving medical care in a setting other than a nursing facility, and who maintain a residence outside of Massachusetts;

(b) persons whose whereabouts are unknown; or

they are inpatients of a medical facility; or
they are living outside of the penal institution, are on parole, probation, or home release, and are not returning to the institution for overnight stays.

Satellite Clinic. A facility that operates under an Acute Hospital's license, is subject to the fiscal, administrative, and clinical management of the Acute Hospital, provides services solely on an outpatient basis, is not located at the same site as the Acute Hospital's inpatient facility, and has CMS Provider-based status in accordance with 42 CFR § 413.65.

Student Health Plan. Student health insurance plan operated in compliance with M.G.L. c. 15A, § 18.

Third-party. Any individual, entity, or program that is or may be responsible to pay all or part of the cost for medical services.

Underinsured Patient. A Patient whose Health Insurance Plan or self-insurance plan does not pay, in whole or in part, for Health Services that are eligible for payment from the Health Safety Net Trust Fund, provided that the Patient meets income eligibility standards set forth in 101 CMR 613.04.

Uninsured Patient. A Patient who is a resident of the Commonwealth, who is not covered by a Health Insurance Plan or a self-insurance plan, and who is not eligible for a medical assistance program. A Patient who has a policy of health insurance or is a member of a health insurance or benefit program that requires such Patient to make payment of deductibles or copayments, or fails to cover certain medical services or procedures is not uninsured.

Urgent Care Services. Medically Necessary Services provided in an Acute Hospital or Community Health Center after the sudden onset of a medical condition, whether physical or mental, manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson would believe that the absence of medical attention within 24 hours could reasonably expect to result in placing a Patient's health in jeopardy, impairment to bodily function, or dysfunction of any bodily organ or part. Urgent Care Services are provided for conditions that are not life threatening and do not pose a high risk of serious damage to an individual's health. Urgent Care Services do not include Primary or Elective Care.

History

Amended by Mass Register Issue 1271, eff. 10/10/2014.

101 CMR, § 613.03 Eligible Services Requirements

(1) General. To qualify as a service eligible for payment, the service must meet the following criteria.

(a) Eligible Services Categories. There are three categories of services eligible for payment from the Health Safety Net, as follows:

Reimbursable Health Services to Low Income Patients as defined in 101 CMR 613.04;
Medical Hardship, pursuant to the requirements in 101 CMR 613.05; and
Bad Debt, pursuant to the requirements in 101 CMR 613.06.

(b) Eligible Services Limitations

General. The Health Safety Net does not pay for, and Providers may not submit claims to the Office for, services that are not medically necessary or for which another public or private payer is responsible. The Health Safety Net is the payer of last resort.

The Health Safety Net Office may request, and the Provider must provide, any and all medical records (or clear photocopies of such records) corresponding to or documenting the services claimed upon request of the Health Safety Net Office or its agent.
The medical record must contain sufficient data to document fully the nature, extent, quality, and necessity of the care provided to a Patient for each service claimed for payment.
For services for which MassHealth requires prior authorization, the Provider must ensure that current clinical standards are used to determine whether the service is medically necessary. The Health Safety Net Office or its agent may audit claims to verify medical necessity.
All Providers must make diligent efforts to obtain payment first from other resources, including personal injury protection (PIP) payments, to ensure that the Health Safety Net is the payer of last resort.
If the Health Safety Net Office, or its agent, identifies a third-party resource after the Provider has billed and received payment from the Health Safety Net, it will notify the Provider of this available third-party resource. Upon receipt of notification, the Provider must remit the Health Safety Net payment or provide documentation of diligent efforts as described in 101 CMR 613.03(1)(c)3. to obtain payment from the third-party resource. The Office, or its agent, will review the submitted documentation to determine whether the Provider made diligent efforts. If the Office, or its agent, determines the Provider did not make diligent efforts to receive payment from the third party, the Health Safety Net may recover the payment by deducting it from future payments.
If the Office, or its agent, identifies a third-party resource, the Office may recover from the financially responsible third party the costs attributable to services provided to an individual that were paid by the Health Safety Net. A payment from the Health Safety Net for such services is recoverable from the third party and the payment, after notice to the third party, operates as a lien under M.G.L. c. 118E.

For insured Low Income Patients, the Health Safety Net does not pay for, and Providers may not submit claims for, services for which the primary insurer has denied payment because of a technical billing error, because the Patient obtained out of network services, because the Patient failed to obtain required prior authorization for services, or because of other administrative reasons. The Health Safety Net does not pay claims for the balance of an insurer's contractual allowance or for late charges for a service that has been paid by another payer.
For insured Low Income Patients with other available resources including, but not limited to, private health and casualty insurance, the Health Safety Net

a. does not pay a Provider if it determines that, among other things, the Provider has not made diligent efforts to obtain payment from those resources; and

b. recovers any payments made if it determines that the Provider has not made diligent efforts to obtain payment from those resources.

"Diligent efforts" is defined as making every effort to identify and obtain payment from all other liable parties, including insurers. Diligent efforts include, but are not limited to

a. determining the existence of insurance that could pay for medical expenses by asking the Patient if he or she has other insurance and by using insurance databases available to the Provider. In the event of a motor vehicle accident, this includes investigating whether the Patient, driver, and/or owner of any motor vehicle involved had a motor vehicle liability policy;

b. verifying the Patient's other health insurance coverage, currently known to the Health Safety Net, through EVS, or any other health insurance resource available to the Provider, on each date of service and at the time of billing;

c. submitting claims to all insurers with the insurer's designated service code for the service provided;

d. complying with the insurer's billing and authorization requirements;

e. appealing a denied claim when the service is payable in whole or in part by an insurer; and

f. immediately returning any payment received from the Office when any available third-party resource has been identified.

For insured Low Income Patients with private insurance, including Student Health Plans and Qualified Health Plans other than the Premium Assistance Payment Program Operated by the Health Connector, the Health Safety Net pays only for deductibles, coinsurance, and Reimbursable Health Services not covered by the insurer. The Health Safety Net does not pay for copayments required by a private insurer.
For MassHealth members enrolled in MassHealth Limited, EAEDC, CMSP, CMSP plus Limited, and for MassHealth Family Assistance - Children, the Health Safety Net pays only for Reimbursable Health Services not covered by the member's MassHealth benefit. A Provider may submit a claim for Reimbursable Health Services not covered by EAEDC only if the member's EAEDC eligibility is non-temporary. A Provider may submit a claim for Reimbursable Health Services not covered by CMSP only if the individual's MAGI income is less than or equal to 300% of the FPL.
For MassHealth members enrolled in MassHealth Standard, MassHealth CarePlus, CommonHealth, and Family Assistance, excluding MassHealth Family Assistance -Children, the Health Safety Net pays only for Adult Dental Services provided by a Community Health Center, Hospital Licensed Health Center, or other Satellite Clinic that are not covered by MassHealth.
For MassHealth members, the Health Safety Net does not pay for, and Providers may not submit, claims to the Office for MassHealth copayments.
For Low Income Patients enrolled in Medicare (including Medicare Advantage), including MassHealth members eligible for Medicare Buy-In and Senior Buy-In, the Health Safety Net pays for Reimbursable Health Services not covered by the patient's insurance, and for copayments, coinsurance, and deductibles required by the patient's insurance.
The Health Safety Net does not pay copayments for the Premium Assistance Payment Program Operated by the Health Connector.
The Health Safety Net pays for Reimbursable Health Services provided to Low Income Patients for services provided during the Eligibility Period specified in 101 CMR 613.04(7).

(d) Eligible Services Limitations - Serious Reportable Events. The Health Safety Net does not pay for services directly related to a Serious Reportable Event (SRE) as defined in 105 CMR 130.332(A): Definitions Applicable to 105 CMR 130.332 .

A Provider must not charge, bill, or otherwise seek payment from the Health Safety Net, a Patient, or any other payer as required by 105 CMR 130.332: Serious Reportable Events (SREs) and Serious Adverse Drug Events (SADE) , for services provided as a result of an SRE occurring on premises covered by a Provider's license, if the Provider determines that the SRE was

a. preventable;

b. within the Provider's control; and

c. unambiguously the result of a system failure as required by 105 CMR 130.332(B): Reporting of SREs and (C): Preventability Determination .

A Provider must not charge, bill, or otherwise seek payment from the Health Safety Net, a Patient, or any other payer as required by 105 CMR 130.332: Serious Reportable Events (SREs) and Serious Adverse Drug Events (SADE) for services directly related to

a. the occurrence of the SRE;

b. the correction or remediation of the event; or

c. subsequent complications arising from the event as determined by the Health Safety Net Office on a case-by-case basis.

A Provider may submit a claim for services it provides that result from an SRE that did not occur on its premises only if the treating facility and the facility responsible for the SRE do not have common ownership or a common corporate parent.
Readmissions to the same hospital or follow-up care provided by the same Provider or a Provider owned by the same parent organization are not billable if the services are associated with the SRE as described in 101 CMR 613.03(1)(d)2.

(2) Reimbursable Health Services.

(a) General. The Health Safety Net pays only for the Reimbursable Health Services listed below. Providers may submit claims only for Reimbursable Health Services provided by Acute Hospitals and Community Health Centers in accordance with the MassHealth Standard program using the payment codes as listed in Subchapter 6 of the MassHealth Inpatient and Outpatient Provider Manuals and other MassHealth Provider manuals, unless otherwise specified in 101 CMR 614.00: Health Safety Net Payments and Funding . The Health Safety Net Office may add additional codes and Reimbursable Health Services by administrative bulletin, as described in 101 CMR 613.08(4).

(b) Pharmacy.

The Health Safety Net pays only for prescribed drugs according to the coverage rules, including 130 CMR 406.411: Prescription Requirements ; 130 CMR 406.412(A): Drugs and (B)(1); 130 CMR 406.413: Limitations on the Coverage of Drugs ; and 130 CMR 406.422: Prior Authorization , established by MassHealth and processed through POPS. Providers may not submit claims for drugs excluded from the MassHealth Drug List.
Notwithstanding 101 CMR 613.03(2)(b)1., the Health Safety Net may pay for prescribed drugs designated by the MassHealth agency as excluded from coverage for MassHealth members through the 340B Drug Pricing Program pursuant to 130 CMR 406.404(D)(1): Notification of Participation .

A 340B Provider may submit a Health Safety Net claim only for outpatient pharmacy services provided through the Provider's 340B pharmacy unless the claim is submitted by a Provider that directly operates both a 340B pharmacy and a retail pharmacy and the claim is for a drug provided to an individual who cannot be seen by a Provider-based prescriber to obtain a prescription within a clinically appropriate time period. The Provider must inform the Patient that it may not fill future prescriptions unless the individual becomes a Patient of the Provider or is placed on a waiting list in the instance that the Provider is not accepting new patients. A Provider may submit a Health Safety Net claim only for the dispensing fee for covered prescribed drugs provided to Low Income Patients if that individual is using a pharmaceutical company sponsored free drug program and the drug is dispensed by the pharmacy. A Provider may not submit a Health Safety Net claim for free or donated prescribed drugs where the drugs are stored and dispensed from a site other than the pharmacy ( e.g ., secured closet near exam room).
A 340B Provider must provide the Health Safety Net Office 90 days' advance written notice of its intent to discontinue providing prescribed drugs to Low Income Patients or submitting claims to the Health Safety Net for outpatient pharmacy services pursuant to 101 CMR 613.03(2)(c)1.

(d) Utilization Review. The Health Safety Net Office conducts a utilization review program designed to monitor the appropriateness of services for which payments are made and to promote the delivery of care in the most appropriate setting.

(e) Noncovered Services. The Health Safety Net does not pay for any of the following services: nonmedical services, such as social, educational, and vocational services; cosmetic surgery; canceled or missed appointments; telephone conversations or consultations; court testimony; research or the provision of experimental, cosmetic, unproven, or otherwise medically unnecessary procedures or treatments; the provision of whole blood except for the administrative and processing costs associated with the provision of blood and its derivatives; the treatment of male or female infertility (including, but not limited to, laboratory tests, drugs, and procedures associated with such treatment; however, the Health Safety Net pays for the diagnosis of male and female infertility); vocational rehabilitation services; sheltered workshops; recreational services; life-enrichment services; alcohol or drug drop-in centers; drugs used for the treatment of obesity; cough and cold preparations; drugs related to the treatment of male or female infertility; absorptive lenses of greater than 25% absorption; photochromatic lenses, sunglasses, or fashion tints; treatment of congenital dyslexia; extended-wear contact lenses; invisible bifocals; and the Welsh 4-Drop Lens.

(3) Reimbursable Health Services - Acute Hospitals.

(a) The Health Safety Net pays Acute Hospitals only for the Reimbursable Health Services listed in 101 CMR 613.03(3)(a)1. through 34.

Abortion Services. The Health Safety Net pays for abortion services performed in accordance with the applicable provisions of 130 CMR 410.434: Abortion Services: Reimbursable Services .

Administrative Days. The Health Safety Net pays for Administrative Days meeting the requirements set forth in 130 CMR 415.415: Reimbursable Administrative Days and 130 CMR 415.416: Nonreimbursable Administrative Days .

Ambulatory Surgery Services.

Audiologist Services.

Chiropractic Services.

Dental Services. The Health Safety Net pays only for dental services identified in Subchapter 6 of the MassHealth Dental Manual and for Adult Dental Services not covered by MassHealth. Certain dental services may be subject to prior authorization, as specified by the Health Safety Net Office in billing instructions, administrative bulletins, or other written issuances.

Durable Medical Equipment. The Health Safety Net pays only for crutches and canes provided during a Hospital Visit.

Family Planning Services.

Hearing Instrument Services.

Inpatient Hospice Services.

Inpatient Services.

Inpatient Psychiatric. The Health Safety Net pays only for services provided in a Medicare certified psychiatric unit.

Laboratory Services. The Health Safety Net does not pay separately for routine specimen collection and preparation for the purpose of clinical laboratory analysis. Specimen collection and preparation is considered part of the laboratory service.

Medical Supplies. The Health Safety Net pays for medical supplies used in the delivery of inpatient and outpatient care. It also pays for spacers used with metered dose inhalers, nebulizers, diabetic supplies, home glucose monitors, and portable peak flow monitors.

Mental Health Services. The Health Safety Net pays for mental health services except for noncovered services in 101 CMR 613.03(2)(e). The Health Safety Net pays only for mental health services that meet the requirements in the MassHealth Acute Outpatient Hospital Manual at 130 CMR 410.471: Mental Health Services: Introduction through 130 CMR 410.475: Mental Health Services: Staffing Requirements , and 130 CMR 410.479(A): Provision of Services .

Nurse Midwife Services.

Nurse Practitioner Services.

Observation Services. Outpatient hospital services provided anywhere in an Acute Hospital, to evaluate a Patient's medical condition and determine the need for an inpatient admission. Observation services are provided under order of a physician, consist of the use of a bed and intermittent monitoring by professional licensed clinical staff, and may be provided for more than 24 hours.

Orthotic Services.

Outpatient Services. Outpatient services are services provided by Acute Hospital outpatient departments and by Hospital Licensed Health Centers or other Satellite Clinics. Such services include, but are not limited to, Emergency Services, Primary or Elective Care, observation services, Ancillary Services, and day-surgery services.

Outpatient Psychiatric Services.

Pharmacy Services.

Physician Services. The Health Safety Net pays only for services provided at Acute Hospital sites by Acute Hospital-based physicians who are employed or contracted by the Acute Hospital and who receive payment from the Acute Hospital for their services.

Podiatrist Services.

Prosthetic Services.

Radiology Services.

Rehabilitation Services. For inpatient rehabilitation, the Health Safety Net pays only for services provided in a Medicare certified rehabilitation unit.

Renal Dialysis Services.

Speech and Hearing Services.

Sterilization Services.

Substance Use Disorder Services, including methadone treatment as described in 130 CMR 418.000: Substance Use Disorder Treatment Services , except for noncovered services in 101 CMR 613.03(2)(e).

Therapy Services. The Health Safety Net pays only for therapy services as defined in the MassHealth Acute Outpatient Hospital Manual , at 130 CMR 410.451(A) and (B). Before therapy is initiated, there must be a comprehensive evaluation of the Patient's medical condition, disability, and level of functioning to determine the need for treatment and, when treatment is indicated, to develop a treatment plan.

Tobacco Cessation. The Health Safety Net pays only for services as defined by Subchapter 6 of the MassHealth Acute Hospital Outpatient Manual .

Vision Care Services. The Health Safety Net pays only for services as defined in 130 CMR 410.481: Vision Care Services .

(4) Reimbursable Health Services

Community Health Centers.

(a) General. Community Health Centers may submit claims only for Reimbursable Health Services set forth in 101 CMR 613.03(4)(b). The Reimbursable Health Services must meet the requirements set forth in 101 CMR 613.03(4)(c).

Community Health Centers may submit claims only for services provided under the Community Health Center's clinic license.
A Community Health Center may submit claims only for Reimbursable Health Services provided on site, except for off-site 340B Pharmacy Services and certain Evaluation and Management visits provided to the Community Health Center's Patients at an Acute Hospital. A Community Health Center may submit claims for dentures provided on site but manufactured or repaired at an off-site contractor.
The Health Safety Net does not pay Community Health Centers for performing, administering, or dispensing experimental, cosmetic, unproven, or otherwise medically unnecessary procedures or treatments or treatment of male or female infertility (including, but not limited to, laboratory tests, drugs, and procedures associated with such treatment); however, the Health Safety Net pays for the diagnosis of male and female infertility.

(b) Reimbursable Health Services.

Audiology Services. The Health Safety Net pays for audiology services if the services were provided at the written request of a physician, nurse practitioner, or physician assistant who has found some indication of a hearing problem. Documentation of the request and of the hearing problem must be kept in the Patient's medical record. 2. Behavioral Health Services.

Cardiovascular and Pulmonary Diagnostic Services.

Dental Services. The Health Safety Net pays for dental services identified in Subchapter 6 of the MassHealth Dental Manual and for Adult Dental Services not covered by MassHealth. Certain dental services may be subject to prior authorization, as specified by the Health Safety Net Office in billing instructions, administrative bulletins, or other written issuances.

Diabetes Self-management Training. The Health Safety Net pays for diabetes self-management training services as defined by Subchapter 6 of the MassHealth Community Health Center Manual .

Electrocardiogram (EKG) Services. The Health Safety Net pays for EKG services only when the service is provided at the written request of a Community Health Center staff physician who will interpret or review the interpretation of the EKG. Documentation of the physician's request must be kept in the Patient's medical record. A Community Health Center may claim payment for EKG services only when the Community Health Center owns or rents its own EKG equipment and the EKG is taken at the Community Health Center.

Family Planning Services. The Health Safety Net pays for family planning counseling, prescribed drugs, family planning supplies, and laboratory tests.

Individual Medical Visits. The Health Safety Net pays for face-to-face meetings at a Community Health Center between a Patient and a physician, physician assistant, nurse practitioner, nurse midwife, registered nurse, or paraprofessional for medical examination, diagnosis, or treatment.

Laboratory Services. The Health Safety Net pays only for laboratory services for which a written request for that service from an authorized subscriber is present in the Patient's medical record. The Office does not pay for the following laboratory services: routine specimen collection and preparation for the purpose of clinical laboratory analysis (for example, venipunctures, urine, fecal, and sputum samples; Pap smears; cultures; and swabbing and scraping for removal of tissue); laboratory tests associated with treatment of male or female infertility (however, the Health Safety Net pays for the diagnosis of male and female infertility); or such calculations as red cell indices, A/G ratio, creatinine clearance, and those ratios calculated as part of a profile. The Office does not pay a Community Health Center for a laboratory service when the Community Health Center bills separately for the professional component of that service.

Medical Nutrition Therapy. The Health Safety Net pays for medical nutrition therapy services as defined by Subchapter 6 of the MassHealth Community Health Center Manual . Medical nutrition therapy does not include enteral therapy.

Obstetrical Services.

Pharmacy Services.

Podiatry Services.

Radiology Services. The Health Safety Net pays for radiology services only when the services are provided at the written request of a licensed physician or dentist. The professional component of a radiology service is the component for interpreting a diagnostic test or image. The technical component of a radiology service is the component for the cost of rent, equipment, utilities, supplies, administrative and technical supplies and benefits, and other overhead expenses.

Surgery Services.

Tobacco Cessation Services. The Health Safety Net pays for tobacco cessation services as defined by Subchapter 6 of the MassHealth Community Health Center Manual .

Vision Care Services.

Immunization Visits and Vaccines.

(c) Reimbursable Health Services Requirements. The Health Safety Net pays only for services provided by the licensed professionals listed in the HSN CHC Billable Procedure Codes list and pays in accordance with 101 CMR 614.00: Health Safety Net Payments and Funding .

History

Amended by Mass Register Issue 1271, eff. 10/10/2014.

101 CMR, § 613.04 Eligible Services to Low Income Patients

(1) General. Providers may submit claims for Reimbursable Health Services to Low Income Patients determined in accordance with the criteria in 101 CMR 613.04. Low Income Patients may be determined eligible for Health Safety Net - Primary or Health Safety Net - Secondary, in accordance with 101 CMR 613.04(6). The following individuals are not eligible for Low Income Patient status:

(a) individuals who have been determined eligible for any MassHealth program, including any premium assistance program, but who have failed to enroll; and

(b) individuals whose enrollment in MassHealth or the Premium Assistance Payment Program Operated by the Health Connector has been terminated due to failure to pay premiums.

(2) Low Income Patient Determination. Except as provided in 613.04(3) and 613.04(4) an individual must complete and submit an Application for benefits using the eligibility procedures and requirements under 130 CMR 502.000: MassHealth: The Eligibility Process or 130 CMR 516.000: MassHealth: The Eligibility Process . In order to be determined a Low Income Patient, an individual must be a Resident of the Commonwealth and document that the Modified Adjusted Gross Income of his or her MassHealth MAGI Household is equal to or less than 300% of the FPL, or that the Countable Income of his or her Medical Hardship Family is less than or equal to 300% of the FPL that if the individual used a Senior Application as defined in 130 CMR 515.001: Definition of Terms .

(a) Determination Notice. The MassHealth Agency or the Commonwealth Health Insurance Connector notifies the individual of his or her eligibility determination for health care coverage or if the individual is a Low Income Patient.

(b) Verification of Income. Verification of income is mandatory. Income may be verified either through electronic data matches or paper verification.

Electronic Data Matches. MassHealth electronically matches with federal and state data sources described at 130 CMR 502.004: Matching Information to verify attested income. The income data received through an electronic data match is compared to the attested income amount to determine if the attested amount and the data source amount are reasonably compatible. If these amounts are reasonably compatible, the attested income is considered verified for purposes of an eligibility determination. To be considered reasonably compatible

a. both the attested income and the income from the data sources must be above the applicable income standard for the individual; or

b. both the attested income and the income from the data sources must be below the applicable income standard for the individual; or

c. the attested income and the income from the data sources must be within a ten percent range of each other.

Asset Verification. If the MassHealth agency requests an asset verification pursuant to 130 CMR 520.000: MassHealth: Financial Eligibility for an applicant, the applicant must comply with the guidelines listed in 130 CMR 516.003: Verification of Eligibility Factors in order to obtain and/or maintain their Health Safety Net determination.

Paper Verification. If the attested income and the income from the electronic data source are not reasonably compatible, or if the electronic data match is unavailable, paper verification of income is required.

a. Paper verification of monthly earned income includes, but is not limited to

i. recent paystubs;

ii. a signed statement from the employer; or

iii. the most recent federal tax return.

b. Verification of monthly unearned income is mandatory and includes, but is not limited to

i. a copy of a recent check or paystub showing gross income from the source;

ii. a statement from the income source, where matching is not available; or

iii. the most recent federal tax return.

c. Verification of gross monthly income may also include any other reliable evidence of the Patient's earned or unearned income.

The following are acceptable proof of identity, provided such documentation has a photograph or other identifying information including, but not limited to, name, age, sex, race, height, weight, eye color, or address:

a. identity documents listed at 8 CFR § 274a.2(b)(1)(v)(B)(1), except a driver's license issued by a Canadian government authority;

b. driver's license issued by a state or territory;

c. school identification card;

d. U.S. military card or draft record;

e. identification card issued by the federal, state, or local government;

f. military dependent's identification card; or

g. U.S. Coast Guard Merchant Mariner card;

for children younger than 19 years old, a clinic, doctor, hospital, or school record, including preschool or day care records;
two documents containing consistent information that corroborates an applicant's identity. Such documents include, but are not limited to

a. employer identification cards;

b. high school and college diplomas (including high school equivalency diplomas);

c. marriage certificates;

d. divorce decrees;

e. property deeds or titles;

f. a pay stub from a current employer with the applicant's name and address preprinted, dated within 60 days of the application;

g. census verification containing the applicant's name and address, dated not more than 12 months before the date of the application;

h. a pension or retirement statement from a prior employer or pension fund stating the applicant's name and address, dated within 12 months of the application;

i. tuition or student loan bill containing the applicant's name and address, dated not more than 12 months before the date of the application;

j. utility bill, cell phone bill, credit card bill, doctor's bill, or hospital bill containing applicant's name and address, dated not more than 60 days before the date of the application;

k. valid homeowner's, renter's, or automobile insurance policy with preprinted address, dated not more than 12 months before the date of the application, or a bill for such insurance with preprinted address, dated not more than 60 days before the date of the application;

l. lease dated not more than 12 months before the date of the application, or home mortgage identifying applicant and address; or

m. employment verification by means of W-2 forms or other documents bearing the applicant's name and address submitted by the employer to a government agency as a consequence of employment;

(d) Matching Information. The MassHealth Agency initiates information matches with other agencies and information sources when an application is received, at annual renewal and periodically, in order to update or verify eligibility. These agencies and information sources may include, but are not limited to, the following: the Federal Data Services Hub, the Division of Unemployment Assistance, Department of Public Health's Bureau of Vital Statistics, Department of Industrial Accidents, Department of Veterans' Services, Department of Revenue, Bureau of Special Investigations, Internal Revenue Service, Social Security Administration, Systematic Alien Verification for Entitlements, Department of Transitional Assistance, and health insurance carriers.

(3) Confidential Services. The Health Safety Net Office's Application for Health Safety Net Confidential Services may be used for the following special application types. For these application types, five percentage points of the current FPL are subtracted from the applicable total Countable Income to determine the applicant's eligibility for Low Income Patient status. An individual seeking these services is not required to report his or her primary address.

(a) Minors receiving Confidential Services may apply to be determined a Low Income Patient using their own Countable Income information and using the Office's application for Health Safety Net Confidential Services. If a minor is determined to be a Low Income Patient, the Provider may submit claims for Confidential Services when no other source of funding is available to pay for the services confidentially. For all other services, Minors are subject to the standard Low Income Patient determination process. Providers may submit claims for Eligible Services rendered to these individuals for Confidential Services only.

(b) An individual who has been a victim of domestic violence, or who has a reasonable fear of domestic violence or continued domestic violence, may apply for Low Income Patient status using his or her own Countable Income information if he or she seeks medically necessary Eligible Services.

(4) Presumptive Determination. An individual may be determined to be a Low Income Patient for a limited period of time, if on the basis of attested information submitted to a Provider on the form specified by the Health Safety Net Office, the Provider determines the individual is presumptively a Low Income Patient. An individual may not be determined to be a Low Income Patient pursuant to 101 CMR 613.04(4)(b)4. if the individual has already been determined to be a Low Income Patient pursuant to 101 CMR 613.04(4)(b)4. within the previous 12 months. Notwithstanding 101 CMR 613.04(7)(a), Providers may submit claims for Reimbursable Health Services provided to individuals with time-limited presumptive Low Income Patient determinations only for dates of service beginning on the date on which the Provider makes the presumptive determination and continuing until the earlier of

(a) the end of the month following the month in which the Provider made the presumptive determination if the individual has not submitted a complete Application, or

(b) the date of the determination notice described in 101 CMR 613.04(6)(a) related to the individual's Application.

(5) Grievance Process. An individual may request that the Office conduct a review of a determination of Low Income Patient status, Provider compliance with the provisions of 101 CMR 613.00, or Medical Hardship eligibility if exceptional circumstances outside of the individual's control had a material impact on the Medical Hardship eligibility determination. The Health Safety Net Office will conduct a review using the following process.

(a) In order to request a review, the individual must send a written request to the Office with supporting documentation.

(b) To request a review of a determination of Low Income Patient status, the individual must send the review request within 30 days from the date of the official notification of the determination.

(c) To request a review of a Medical Hardship eligibility determination, the individual must send the review request, including a description of the circumstances outside of the individual's control that had a material impact on the eligibility determination, within six months from the date of the official notification of the determination. For all grievances, the Office may request additional information as necessary from the grievant, other state agencies, and/or the Provider(s). Additional information requested from the grievant by the Office must be submitted within 30 days.

(d) The Office will provide an initial response to the grievant within 30 days of receipt of the grievance and will issue a written decision and explanation of the reasons for its decision to the grievant and other relevant parties within a reasonable time after receipt of all necessary information.

(6) Low Income Patient Eligibility Categories.

(a) The categories of Low Income Patient eligibility for Health Safety Net services are:

Health Safety Net - Primary. A Low Income Patient is eligible for Health Safety Net - Primary if he or she is uninsured and documents MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), between 0% and 300% of the FPL, subject to the following exceptions.

a. Low Income Patients eligible for enrollment in the Premium Assistance Payment Program Operated by the Health Connector are not eligible for Health Safety Net -Primary except as provided in 101 CMR 613.04(7)(a) and (b).

b. Low Income Patients subject to the Student Health Program requirements of M.G.L. c. 15A, § 18 are not eligible for Health Safety Net - Primary.

Health Safety Net - Secondary. A Low Income Patient is eligible for Health Safety Net - Secondary if he or she has other primary health insurance and documents MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), between 0 and 300% of the FPL, subject to the following exceptions.

a. Effective 101 days after the Medical Coverage Date, Low Income Patients eligible for the Premium Assistance Payment Program Operated by the Health Connector are eligible only for dental services not otherwise covered by the Premium Assistance Payment Program Operated by the Health Connector.

b. Low Income Patients enrolled in MassHealth Standard, MassHealth Care Plus, MassHealth Common Health, and MassHealth Family Assistance excluding MassHealth Family Assistance - Children are eligible only for Adult Dental Services provided at a Community Health Center, Hospital Licensed Health Center, or Satellite Clinic.

c. Low Income Patients enrolled in a qualifying Student Health Plan are eligible for Health Safety Net

Secondary.

(b) Other Requirements.

Affordable Insurance. An individual with MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), less than or equal to 300% of the FPL, and for whom insurance is deemed affordable as defined in 956 CMR 6.00: Determining Affordability for the Individual Mandate, is not eligible for Health Safety Net - Primary. If such an individual's employer offers employer-sponsored insurance, he or she is not eligible for Health Safety Net - Primary except during the employer's waiting period before the employer-sponsored insurance becomes effective.

Pending Disability Determination. Providers may submit claims for individuals whose MassHealth eligibility status is pending due to a MassHealth disability determination. If the individual is determined eligible for MassHealth, the Provider must void Health Safety Net claims for the individual and submit claims for services to MassHealth.

Health Safety Net - Partial. A Low Income Patient eligible for either Health Safety Net - Primary or Health Safety Net - Secondary who documents MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), greater than 150% and less than or equal to 300% of the FPL is considered Health Safety Net - Partial and must meet the Health Safety Net - Partial deductible described in 101 CMR 613.04(8)(c).

(7) Eligibility Period.

(a) Except as specified in 101 CMR 613.04(5)(b), providers may submit claims for Reimbursable Health Services effective on the Medical Coverage Date until the Patient's eligibility is terminated.

(b) For Low Income Patients eligible for the Premium Assistance Payment Program Operated by the Health Connector:

Providers may submit claims for Reimbursable Health Services for the period beginning on the Patient's Medical Coverage Date and ending 100 days after the Patient's Medical Coverage Date.
Effective 101 days after the Patient's Medical Coverage Date, providers may submit claims only for dental services not otherwise covered by the Premium Assistance Payment Program Operated by the Health Connector until the Patient's eligibility is terminated.

(c) Low Income Patient status is effective for a maximum of one year from the date of determination, subject to periodic redetermination and verification that the Patient's MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), or insurance status has not changed to such an extent that the Patient no longer meets eligibility requirements.

(8) Low Income Patient Responsibilities.

(a) Cost Sharing Requirements. Low Income Patients are responsible for paying deductibles in accordance with 101 CMR 613.04(8)(c).

(b) Low Income Patient Copayment Requirements. Low Income Patients are responsible for copayments for pharmacy services.

The copayments for pharmacy services are

a. $1 for each prescription and refill for each generic drug in the following drug classes: antihyperglycemics, antihypertensives, and antihyperlipidemics;

b. $3.65 for each prescription and refill for other generic drugs; and

c. $3.65 for each prescription and refill for brand-name drugs.

There are no copayments for services provided to Low Income Patients who are

a. younger than 21 years old; or

b. pregnant or in the postpartum period that extends through the last day of the 12^th calendar month following the month in which their pregnancy ends (for example, if the individual gave birth on May 15^th, the individual is exempt from the copayment requirement until June 1^st of the next year).

There is an annual maximum of $250 per Patient on pharmacy copayments.
Notwithstanding 101 CMR 613.04(8)(b)1. through 3., Low Income Patients are not responsible for the making copayments for pharmacy services during the period May 1, 2023, through March 31,

Annual Deductible. For Health Safety Net - Partial Low Income Patients with MassHealth MAGI Household income or Medical Hardship Family Countable Income greater than 150% and less than or equal to 300% of the FPL, there is an annual deductible if all members of the PBFG have an FPL above 150%. If any member of the PBFG has an FPL equal to or below 150% there is no deductible for any member of the PBFG. The annual deductible is equal to the greater of

a. the lowest cost Premium Assistance Payment Program Operated by the Health Connector premium, adjusted for the size of the PBFG proportionally to the MassHealth FPL income standards, as of the beginning of the calendar year; or

b. 40% of the difference between the lowest MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), in the applicant's Premium Billing Family Group (PBFG) and 200% of the FPL.

Applying the Deductible. The Patient is responsible for payment for all services provided up to this deductible amount. Once the Patient has incurred the deductible, a Provider may submit claims for Reimbursable Health Services in excess of the deductible. There is only one deductible per PBFG per approval period. The deductible is not applied to pharmacy services. Copayments are not considered expenses to be included in the deductible amount.

Deductible Tracking. The annual deductible is applied to all Reimbursable Health Services provided to a Low Income Patient or PBFG member during the Eligibility Period. Each PBFG member must be determined a Low Income Patient in order for his or her expenses for Reimbursable Health Services to be applied to the deductible. The Provider must track the Patient's Reimbursable Health Services expenses until the Patient meets the deductible. If more than one PBFG member is determined to be a Low Income Patient, or if the Patient or PBFG members receive services from more than one Provider, it is the Patient's responsibility to track the deductible and provide documentation to the Provider that the deductible has been reached.

Acute Hospitals. The Patient must incur expenses for Reimbursable Health Services in excess of the annual deductible before the Provider may submit a claim for Reimbursable Health Services. Once the Patient has incurred the deductible, the Provider may submit a claim for the remaining balance of Reimbursable Health Service expenses. The Acute Hospital may require a deposit and/or a payment plan in accordance with 101 CMR 613.08(1)(g).

Community Health Centers and Hospital Licensed Health Centers.

a. Health Safety Net - Partial Low Income Patients receiving Reimbursable Health Services from Community Health Centers are responsible for 20% of the Health Safety Net payment for each visit, to be applied to the amount of the Patient's annual deductible until the Patient meets his or her deductible. Health Safety Net - Partial Low Income Patients receiving Reimbursable Health Services from Hospital Licensed Health Centers, Satellite Clinics, and school-based health centers are responsible for either 20% of the Health Safety Net payment for each visit or the full amount of the service, as specified by the Provider. If the Provider specifies that a Health Safety Net - Partial Low Income Patient is responsible for 20% of the payment amount, the Provider may submit a claim for the remaining balance of each eligible service.

b. If a Hospital Licensed Health Center, Satellite Clinic, or school-based health center that provides Reimbursable Health Services specifies that any Health Safety Net - Partial Low Income Patient is responsible for only 20% of the payment amount, it must offer this option to all Health Safety Net - Partial Low Income Patients receiving Reimbursable Health Services at the location.

c. The Health Safety Net Office may require a Community Health Center to report when a Patient's deductible has been met or any other information regarding the Patient's deductible in a manner specified by the Health Safety Net Office.

(d) Assignment of Third-party Payments. A Low Income Patient must assign to the MassHealth Agency his or her rights to third-party payments for medical benefits provided under the Health Safety Net and must fully cooperate with and provide the MassHealth Agency with information to help pursue any source of third-party payment. A Low Income Patient must inform the Health Safety Net Office or MassHealth when he or she is involved in an accident or suffers from an illness or injury, or other loss that has resulted or may result in a lawsuit or insurance claim, other than a medical insurance claim. The Low Income Patient must

file an insurance claim for compensation, if available;

assign to the MassHealth Agency or its agent, the right to recover an amount equal to the Health Safety Net benefits provided from the proceeds of any claim or other proceeding against a third party;

provide information about the claim or any other proceeding and cooperate fully with the MassHealth Agency, unless the MassHealth Agency determines that cooperation would not be in the best interests of, or would result in serious harm or emotional impairment to, the Low Income Patient;
notify the Health Safety Net Office or MassHealth in writing within ten days of filing any claim, civil action or other proceeding; and
repay the Health Safety Net Office from the money received from a third party for all Health Safety Net services provided on or after the date of the accident or other incident. If the Low Income Patient is involved in an accident or other incident after becoming Health Safety Net eligible, repayment will be limited to Health Safety Net Eligible Services provided as a result of the accident or incident.

(e) Patients are obligated to return money to the Health Safety Net Office, and the Health Safety Net Office may recover such sums directly from a Patient, only to the extent that the Patient has received payment from a third party for the medical care paid by the Health Safety Net or to the extent specified in 101 CMR 613.06(5).

History

Amended by Mass Register Issue 1271, eff. 10/10/2014.

101 CMR, § 613.05 Medical Hardship

(1) Eligibility.

(a) General. A Massachusetts Resident at any Countable Income level may qualify for Medical Hardship if allowable medical expenses exceed a certain percentage of his or her Countable Income as specified in 101 CMR 613.05(1)(c). A determination of Medical Hardship is a one-time determination and not an ongoing eligibility category. An applicant may submit no more than two Medical Hardship applications within a 12-month period.

(b) Countable Income.

Gross Earned Income.

a. Gross earned income is the total amount of compensation received for work or services performed without regard to any deductions.

b. Gross earned income for the self-employed is the total amount of business income listed on the most recently filed federal tax return or allowable on a federal tax return.

c. Seasonal income is income derived from an income source that is associated with a particular time of the year. Annual gross income is divided by 12 to obtain a monthly gross income with the following exception: if the Patient has a disabling illness or accident during or after the seasonal employment period that prevents the person's continued or future employment, only current income will be considered in the eligibility determination.

Gross Unearned Income.

a. Gross unearned income is the total amount of income that does not directly result from the individual's own labor before any income deductions are made.

b. Unearned income includes, but is not limited to, social security benefits, railroad retirement benefits, pensions, annuities, federal veterans' benefits, interest and dividend income, unemployment benefits, child support, and alimony.

Rental Income. Rental income is the total amount of gross income less any deductions listed or allowable on the Patient's most recently filed federal tax return or allowable on a federal tax return.

(c) Percentage of Countable Income. To qualify for Medical Hardship, the applicant's allowable medical expenses exceed a specified percentage of the applicant's Countable Income as follows.

| Income Level | Percentage of Countable Income | | --- | --- | | 0 - 205% FPL | 10% | | 205.1 - 305% FPL | 15% | | 305.1 - 405% | 20% | | 405.1 - 605% FPL | 30% | | >605.1% FPL | 40% |

(2) Eligibility Determination. An applicant for Medical Hardship must complete a Medical Hardship application and provide required documentation of Countable Income, documentation of Massachusetts residency, proof of identity, and detailed, itemized documentation of medical expenses. The Health Safety Net Office processes applications for Medical Hardship and verifies information contained in the application. Providers must assist the applicant to complete the Medical Hardship application and assemble the required documentation. Once the applicant has completed the application and assembled all of the required documentation, the Provider assisting the applicant must submit the completed application to the Health Safety Net office within five business days. If the Provider assisting the applicant fails to submit the completed application to the Health Safety Net Office within that time frame, the Provider may not undertake a Collection Action against the applicant with respect to any bills that would have been eligible for Medical Hardship payment had the application been submitted and approved. The Health Safety Net Office approves an application for Medical Hardship if the applicant's allowable medical expenses exceed the percentage of Countable Income listed above. If the applicant reports Countable Income less than or equal to 405% of the FPL, the applicant must submit an Application, with all required documentation. The Health Safety Net Office does not approve Medical Hardship applications for individuals reporting Countable Income less than or equal to 405% of the FPL unless the applicant has submitted an Application. The Health Safety Net Office does not make a determination on Medical Hardship applications for individuals reporting Countable Income less than or equal to 405% of the FPL until the Patient has received a determination related to the Application.

(3) Allowable Medical Expenses. The Health Safety Net Office determines the applicant's allowable medical expenses based on review of the submitted documentation. Allowable medical expenses may include only Medical Hardship Family medical bills from any health care Provider that, if paid, would qualify as deductible medical expenses for federal income tax purposes. Allowable medical expenses include paid and unpaid bills for services provided up to 12 months prior to the date of the Medical Hardship application for which the Patient is responsible. If a Patient does not receive an initial medical bill for more than nine months from when the services were provided, the bill may still be considered an allowable medical expense if a Medical Hardship application is submitted within 90 days of the date of the initial medical bill for the service. Allowable medical expenses do not include bills for services incurred while the applicant was a Low Income Patient unless the applicant was a Dental-only Low Income Patient on the date of service. Allowable medical expenses do not include bills for services incurred while the applicant was enrolled in MassHealth or the Premium Assistance Payment Program Operated by the Health Connector. Bills included in an approved Medical Hardship determination cannot be included in a subsequent Medical Hardship application.

(4) Payable Medical Expenses. The Health Safety Net pays only for the services described in 101 CMR 613.03(2) through (4). Other allowable medical expenses are not eligible for Health Safety Net payment.

(5) Medical Hardship Contribution.

(a) The applicant's required contribution is calculated as the specified percentage of Countable Income in 101 CMR 613.05(1)(b) based on the Medical Hardship Family's FPL multiplied by the actual Countable Income less bills not eligible for Health Safety Net payment, for which the applicant will remain responsible.

(b) There is one Medical Hardship contribution for each Medical Hardship determination. If the applicant is determined a Low Income Patient or eligible for MassHealth, the applicant's required contribution will be deferred until the applicant's Low Income Patient status or MassHealth eligibility is ended. If the Health Safety Net Office approves two Medical Hardship applications during a 12-month period, it will prorate the required contribution amounts.

(6) Notification of Determination. The Health Safety Net Office notifies applicants of the determination.

(a) An approval notice explains that the person is eligible for Medical Hardship; includes the dates for which allowable medical expenses may be included; includes the amount of the applicant's Medical Hardship contribution; lists the services that do not qualify as Eligible Services; and includes a contact number for more information. The Office also notifies Providers with bills included in the applicant's allowable medical expenses of the determination and allocates the applicant's contribution to each Provider based on the dates of services and gross charges of services provided to the applicant's Medical Hardship Family.

(b) A denial notice explains that the person is not eligible for Medical Hardship and the reasons for the eligibility denial. Both the Patient and Provider are notified of the denial.

(7) Claims. When the Health Safety Net Office approves a Medical Hardship application, it notifies those Providers whose services were included in the documentation of medical expenses required under 101 CMR 613.05(2). To be eligible for payment for any such service, the Provider must submit a claim to the Health Safety Net Office within 18 months of the date of service. Payment of such claims is subject to all other requirements set forth in 101 CMR 613.00 and other applicable laws and regulations.

History

Amended by Mass Register Issue 1271, eff. 10/10/2014.

101 CMR, § 613.06 Allowable Bad Debt

(1) General Requirements. Acute Hospitals may submit claims for Emergency Bad Debt as defined in 101 CMR 613.06(2). Acute Hospitals and Community Health Centers may submit claims for Bad Debt for Urgent Care Services as defined in 101 CMR 613.06(3) and (4). Providers may not submit a claim for a deductible or coinsurance portion of a claim for which an insured Patient or Low Income Patient is responsible. Providers may only submit claims for the services described in 101 CMR 613.03(2) through (4).

(a) Required Collection Action. Providers may submit claims for Bad Debt only after required collection action, including the following.

Collecting Patient Information.

a. Inpatient Services. An Acute Hospital must identify the department responsible for obtaining the information from the Patient, and make reasonable efforts to obtain the financial information necessary to determine responsibility for payment of the Acute Hospital bill from the Patient or Guarantor. If the Patient or Guarantor is unable to provide the information needed, and the Patient consents, an Acute Hospital must make reasonable efforts to contact the relatives, friends, and Guarantor and the Patient for additional information while the Patient is in the Acute Hospital. If an Acute Hospital has not obtained sufficient Patient financial information to assess the ability of the Patient or the Guarantor to pay for services prior to the date of discharge, the Acute Hospital must make reasonable efforts to obtain the necessary information at the time of the Patient's discharge.

b. Emergency Room, Outpatient Services, and Community Health Center Services. A Provider must make reasonable efforts, as soon as reasonably possible, to obtain the financial information necessary to determine responsibility for payment of the bill from the Patient or Guarantor.

Verification of Patient-supplied Information.

a. Inpatient. An Acute Hospital must make reasonable efforts to verify the Patient-supplied information prior to the Patient discharge. The verification may occur at any time during the provision of services, at the time of the Patient discharge, or during the collection process.

b. Acute Hospital Outpatient and Community Health Centers. A Provider must make reasonable efforts to verify Patient-supplied information at the time the Patient receives the services. The verification of Patient-supplied information may occur at the time the Patient receives the services or during the collection process.

Reasonable Collection Efforts.

a. A Provider must make the same effort to collect accounts for uninsured individuals as it does to collect accounts from any other Patient classifications.

b. The minimum requirements before writing off an account to the Health Safety Net include

i. an initial bill to the party responsible for the Patient's personal financial obligations;

ii. subsequent billings, telephone calls, collection letters, personal contact notices, computer notifications, and any other notification method that constitutes a genuine effort to contact the party responsible for the obligation;

iii. documentation of alternative efforts to locate the party responsible for the obligation or the correct address on billings returned by the postal office service as "incorrect address" or "undeliverable";

iv. sending a final notice by certified mail for balances over $1,000 where notices have not been returned as "incorrect address" or "undeliverable"; and

v. documentation of continuous Collection Action undertaken on a regular, frequent basis. When evaluating whether a Provider has engaged in continuous Collection Action, the Health Safety Net Office may use a gap in Collection Action of greater than 120 days as a guideline for noncompliance, but may use its discretion when determining whether a Provider has made a reasonable effort to meet the standard.

c. If, after reasonable attempts to collect a bill, the debt for Emergency Services for an uninsured individual remains unpaid after a period of 120 days of continuous Collection Action, the bill may be deemed uncollectible and billed to the Health Safety Net Office.

d. The Patient's file must include all documentation of the Provider's collection effort including copies of the bill(s), follow-up letters, reports of telephone and personal contact, and any other effort made.

(b) Reporting Requirements.

Claims Submission. Providers must submit claims in accordance with the requirements of 101 CMR 613.07. Acute Hospitals must submit a claim for each inpatient Bad Debt. Community Health Centers must submit a claim for each Bad Debt.

Additional Information. Providers must submit the following additional information for Community Health Center and Acute Hospital inpatient Bad Debt services in a form specified by the Health Safety Net Office. For outpatient services, Acute Hospitals and Hospital-licensed Health Centers must submit this information within 30 days of a request by the Health Safety Net Office.

Patient Identifiers:

Name

Address

Phone#

DOB

SSN#

TCN

Med Record*

MassHealth# (RID and/or RHN)

Date of Service

Total Charge for Services

Net Charge submitted to Health Safety Net

Evidence of Reasonable Collection Efforts:

Date of Initial Bill

Date of Second Bill

Date of Third Bill

Date of Fourth Bill

Date of Returned Mail

Date of Certified Letter for accounts over $1,000

Date of Initial Phone Contact

Date of Follow up Phone Contact

Dates of Other Efforts (other phone calls, letters to Patient, attorney or referral to collection agency)

Date Account was submitted to Health Safety Net Office

The Health Safety Net Office may deny payment for any claim for which required documentation is not submitted. If the Health Safety Net Office notifies a Provider that a claim will be denied due to insufficient documentation, the Provider must submit the required documentation within 30 days of the date of the notice that the claim will be denied.

(2) Acute Hospital Emergency Bad Debt Claims. An Acute Hospital may submit a claim for Emergency Bad Debt if

(a) the services were provided to

an uninsured individual who is not a Low Income Patient, unless the individual is a Dental-only Low Income Patient, and the Provider has verified through EVS that the individual has not submitted an Application; or
an uninsured individual whom the Acute Hospital assists in completing an Application and is determined to be a Low Income Patient or determined into a category exempt from collection action in accordance with 101 CMR 613.08(3). Bad Debt claims for these individuals are exempt from the requirements of 101 CMR 613.06(2)(c);

(b) the services provided were Emergency or Urgent Care Services;

(c) the Acute Hospital can document that it has undertaken the required Collection Action as defined in 101 CMR 613.06(l)(a) for the account; and

(d) the bill remains unpaid after a period of 120 days of continuous Collection Action.

(3) Hospital Licensed Health Center Bad Debt. An Acute Hospital or a Hospital Licensed Health Center may submit a claim for Bad Debt for Urgent Care Services if

(a) the services were provided at a Hospital Licensed Health Center;

(b) the services were provided to

an uninsured individual who is not a Low Income Patient, unless the individual is a Dental-only Low Income Patient. The Provider may not submit a claim for a deductible or the coinsurance portion of a claim for which an insured Patient is responsible. The Provider may not submit a claim unless it has checked EVS to determine if the Patient has filed an Application; or
an uninsured individual whom the Provider assists in completing an Application is determined into a category exempt from Collection Action in accordance with 101 CMR 613.08(3). Bad Debt claims for these individuals are exempt from the requirements of 101 CMR 613.06(3)(e);

(c) the Provider provided Urgent Care Services as defined in 101 CMR 613.02 to the Patient. A Provider may submit a claim for all Eligible Services provided during the Urgent Care Services visit, including Ancillary Services provided on site;

(d) the responsible physician determined that the Patient required Urgent Care Services. A Provider may submit a claim for Urgent Care Services, but not for other services provided to Patients determined not to require Urgent Care Services;

(e) the Provider undertook the required Collection Action as defined in 101 CMR 613.06(1)(a) and submitted the information required in 101 CMR 613.06(1)(b) for the account; and

(f) the bill remains unpaid after a period of 120 days of continuous Collection Action.

(4) Community Health Center Bad Debt. A Community Health Center may submit a claim for Bad Debt for Urgent Care Services if

(a) the services were provided to

an uninsured individual who is not a Low Income Patient, unless the individual is a Dental-only Low Income Patient. The Provider may not submit a claim for a deductible or the coinsurance portion of a claim for which an insured Patient is responsible. The Provider may not submit a claim unless it has checked EVS to determine if the Patient has filed an application for MassHealth; or
an uninsured individual whom the Provider assists in completing an Application is determined into a category exempt from Collection Action in accordance with 101 CMR 613.08(3). Bad Debt claims for these individuals are exempt from the requirements of 101 CMR 613.06(4)(d);

(b) the Provider provided Urgent Care Services as defined in 101 CMR 613.02 to the Patient. A Provider may submit a claim for all Eligible Services provided during the Urgent Care Services visit, including Ancillary Services provided on site;

(c) the responsible physician determined that the Patient required Urgent Care Services. A Provider may submit a claim for Urgent Care Services, but not for other services provided to Patients determined not to require Urgent Care Services;

(d) the Provider undertook the required Collection Action as defined in 101 CMR 613.06(1)(a) and submitted the information required in 101 CMR 613.06(1)(b) for the account; and

(e) the bill remains unpaid after a period of 120 days of continuous Collection Action.

(5) Department of Revenue Intercept. The Health Safety Net Office initiates a match with the Massachusetts Department of Revenue for individuals for whom a Provider has submitted a claim for Bad Debt. The Health Safety Net Office may request that the Department of Revenue intercept payments to the individual up to an amount equal to the amount paid to the Provider for the Services.

History

Amended by Mass Register Issue 1271, eff. 10/10/2014.

101 CMR, § 613.07 Reporting Requirements

(1) General. Each Provider must file or make available information that the Health Safety Net Office deems necessary to verify that a service for which a Provider submits a claim is an Eligible Service.

(a) The Health Safety Net Office may revise the data specifications, the data collection scheduled, or other administrative requirements by administrative bulletin.

(b) Providers must maintain records sufficient to document compliance with all screening and documentation requirements of 101 CMR 613.00. Providers must maintain records documenting claims for Reimbursable Health Services to Low Income Patients, Bad Debt for Emergency or Urgent Care services, and Medical Hardship.

(c) The Health Safety Net Office may deny payment for claims by any Provider that fails to comply with the reporting requirements of 101 CMR 613.00 or 614.00: Health Safety Net Payments and Funding until such Provider complies with the requirements. The Health Safety Net Office will notify such Provider of its intention to withhold payment.

(2) Medical, Dental and Professional Claims Submission Deadlines. The Health Safety Net pays only for claims that are submitted within the time frames listed in 101 CMR 613.07(2)(a) through (f).

(a) Unless otherwise specified in 101 CMR 613.07(2)(b) through (f), claims must be submitted within 90 days of the date of service. If a service is provided continuously on consecutive dates, the date from which the 90-day deadline is measured is the latest date of service.

(b) If the Health Safety Net is the primary payer, and Low Income Patient status is determined after services are provided, claims must be submitted within 90 days of Low Income Patient determination. A waiver may be requested if the Patient was determined to be a Low Income Patient after services are provided, and the claim cannot be submitted within 90 days of service.

(c) For claims that are not submitted within the 90-day period but that meet one of the exceptions specified in 101 CMR 613.07(2)(c)1. through 3., a Provider must request a waiver of the billing deadline pursuant to the billing instructions provided by the MassHealth Agency. The exceptions are as follows.

A medical service was provided to a person who was not a Low Income Patient on the date of service, but was later determined to be a Low Income Patient for a period that includes the date of service.
A medical service was provided to a Patient who failed to inform the Provider in a timely fashion of the member's eligibility for MassHealth or status as a Low Income Patient.
A medical service was provided to a Patient with health insurance and the Provider delayed submission of the claim in order to bill the Patient's insurer. Claims must be submitted by the later of 90 days of the date of service or 90 days after the date of the primary insurer's explanation of benefits, but no later than 18 months after the date of service.

(e) Claims for Emergency or Urgent Care Bad Debt may be written off by the Provider no earlier than 120 days after services are provided. Such claims must be submitted within 90 days after the date on which the claim is written off as uncollectible.

(f) Claims related to Medical Hardship must be submitted to the Health Safety Net Office by the deadline specified in 101 CMR 613.05(6).

(3) Final Deadline for Submission of Claims.

(a) If the Health Safety Net Office has denied a claim that was initially submitted within the 90-day deadline, the Provider may resubmit the claim with appropriate corrections or supporting information.

(b) The Health Safety Net does not pay any claim submitted or resubmitted for services provided more than 12 months before the date of submission or resubmission, except as provided in 101 CMR 613.07(2).

(4) Pharmacy Billing Deadlines. Pharmacy claims must be submitted to POPS by the later of 90 days after services are provided or 90 days after the date of the primary insurer's explanation of benefits.

(5) Other Acute Hospital Claim Requirements.

(a) Each Acute Hospital claim must contain a site-specific identification number as assigned by the Health Safety Net Office. The Health Safety Net Office assigns individual identification numbers to each Acute Hospital, Hospital Licensed Health Center, Satellite Clinic, and school-based health center that provides Eligible Services.

(b) The Health Safety Net Office may require Acute Hospitals to submit interim data on revenues and costs to monitor compliance with federal upper payment limits and Safety Net Care pool payment limits, including cost limits. Such data may include, but not be limited to, gross and net patient service revenue for Medicaid non-managed care, Medicaid managed care, and all payers combined; and total Patient service expenses for all payers combined.

(6) Other Community Health Centers Claim Requirements.

(a) Each Community Health Center must submit claims to the Health Safety Net Office according to the requirements of 101 CMR 613.00 and 614.00: Health Safety Net Payments and Funding and the data specification requirements of the Office.

(b) Each Community Health Center must, upon request, provide the Health Safety Net Office with Patient account records and related reports as set forth in 101 CMR 613.03(1)(b).

(7) Audits. The Health Safety Net Office or its agent may audit claims and may adjust claims that are not in compliance with the provisions of 101 CMR 613.00.

(a) The Health Safety Net Office may adjust claims for services covered by MassHealth, another program of public assistance, or other Health Insurance Plan in which the Patient is enrolled, or may adjust claims for services that do not meet the criteria for Eligible Services including claims for Reimbursable Health Services to Low Income Patients, Bad Debt, or Medical Hardship.

(b) The Health Safety Net Office may adjust claims for which the Provider cannot provide documentation required by 101 CMR 613.00 or 614.00: Health Safety Net Payments and Funding .

(c) The Health Safety Net Office may adjust payments using a methodology to appropriately extrapolate the audit results of a representative sample of accounts.

(d)

Notification. The Health Safety Net Office will notify the Provider of its proposed audit adjustments. The notification will be in writing and will contain a complete listing of all proposed adjustments.

Objection Process.

a. A Provider may file a written objection to a proposed audit adjustment within 15 business days of the mailing of the notification letter.

b. The written objection must, at a minimum, contain

i. each adjustment to which the Provider is objecting;

ii. the Fiscal Year for each disputed adjustment;

iii. the specific reason for each objection; and

iv. all documentation that supports the Provider's position.

c. Upon review of the Provider's objections, the Health Safety Net Office will notify the Provider of its determination in writing. If the Health Safety Net Office disagrees with the Provider's objections, in whole or in part, the Health Safety Net Office will provide the Provider with an explanation of its reasoning.

d. The Provider may request a conference on objections after receiving the Health Safety Net Office's explanation of reasons. The Health Safety Net Office will schedule such conference on objections if it determines that further articulation of the Provider's position would promote resolution of the disputed adjustments.

(8) Grievances. A Provider must provide any information or documentation requested by the Health Safety Net Office related to a grievance request filed in accordance with 101 CMR 613.04(5) within 30 days of the request from the Office.

History

Amended by Mass Register Issue 1271, eff. 10/10/2014.

101 CMR, § 613.08 Other Requirements

(1) Provider Responsibilities.

(a) Nondiscrimination. A Provider must not discriminate on the basis of race, color, national origin, citizenship, alienage, religion, creed, sex, sexual orientation, gender identity, age, or disability in its policies or in its application of policies, concerning the acquisition and verification of financial information, preadmission or pretreatment deposits, payment plans, deferred or rejected admissions, or Low Income Patient status.

(b) Legal Execution. A Provider or agent thereof must not seek legal execution against the personal residence or motor vehicle of a Low Income Patient determined pursuant to 101 CMR 613.04 without the express approval of the Provider's Board of Trustees. All approvals by the Board must be made on an individual case basis.

Filing Requirements. Each Provider must electronically file a Credit and Collection Policy that is reflective of its practices with the Health Safety Net Office in each of the following circumstances:

a. a new Provider must file a copy of its Credit and Collection Policy prior to Health Safety Net Office approval to submit claims for payments;

b. within 90 days of adoption of amendments to 101 CMR 613.00 that would require a change in the Credit and Collection Policy;

c. when a Provider changes its Credit and Collection Policy; or

d. when two Providers merge and request to be paid as a single merged entity.

Content Requirements. A Provider's Credit and Collection Policy must contain

a. standard collection policies and procedures;

b. policies and procedures for collecting financial information from Patients;

c. for Acute Hospitals, a detailed emergency care classification policy specifying

i. its practices for classifying persons presenting themselves for unscheduled treatment, the urgency of treatment associated with each identified classification;

ii. the location(s) at which Patients might present themselves; and

iii. any other relevant and necessary instructions to Acute Hospital personnel that would see these Patients.

iv. The policy must include the classifications that qualify as Emergency Services and other services including "elective" or "scheduled" services;

d. the policy on deposits and payment plans for qualified Patients as described in 101 CMR 613.08(1)(g);

e. copies of billing invoices, award or denial letters, and any other documents used to inform Patients of the availability of assistance;

f. description of any program by which the Acute Hospital offers discounts from charges for the uninsured;

g. for an Acute Hospital with Hospital Licensed Health Center, Satellite Clinic, or school-based health center locations that provide Eligible Services, an indication whether each location offers Patients a deductible payment plan for outpatient services per 101 CMR 613.04(8)(c)5.; and

h. direct URL(s) where the Provider's Credit and Collection Policy, Provider Affiliate list (if applicable), and other financial assistance policies are posted.

(d) Provider Affiliate List. Acute Hospitals must establish a list of all Provider Affiliates. The list must clearly indicate or delineate which Provider Affiliates provide services that are eligible for reimbursement by the Health Safety Net.

For the purposes of this requirement, Acute Hospitals may use any method adequate to identify Provider Affiliates. This may include, but is not limited to:

a. listing the names of each individual practitioner;

b. listing the names of individual practitioners, practice groups, or any other entities that are providing emergency or medically necessary care in the Acute Hospital by the name used by such entities either to contract with the Acute Hospital or to bill patients for care provided; or

c. list by reference to a department or a type of service if the reference makes clear which Provider Affiliate services are and are not eligible to be reimbursed by the Health Safety Net.

If a Provider Affiliate is eligible to be reimbursed by the Health Safety Net in some circumstances but not in others, the Acute Hospital must describe the circumstances in which the emergency or other medically necessary care delivered by the Provider Affiliate will and will not be eligible for reimbursement by the Health Safety Net.
Acute Hospitals must take reasonable steps to ensure that their Provider Affiliate lists are accurate by updating their Provider Affiliate lists at least quarterly to add new or missing information, correct erroneous information, and delete obsolete information.
The requirements set forth in 101 CMR 613.08(d)1. through 3. are effective as of the first day of the Acute Hospital's fiscal year beginning after December 31,

(e) Notices.

In the following circumstances, a Provider must notify the individual of the availability of financial assistance programs to a Patient expected to incur charges, exclusive of personal convenience items or services, whose services may not be paid in full by third party coverage:

a. during the Patient's initial registration with the Provider;

b. on all billing invoices; and

c. when a Provider becomes aware of a change in the Patient's eligibility or health insurance coverage.

In the following circumstances, a Provider or its designee must notify the individual about Eligible Services and programs of public assistance, including MassHealth, the Premium Assistance Payment Program Operated by the Health Connector, the Children's Medical Security Plan, and Medical Hardship:

a. during the Patient's initial registration with the Provider;

b. on all billing invoices; and

c. when a Provider becomes aware of a change in the Patient's eligibility or health insurance coverage.

A Provider must include a brief notice about the availability of financial assistance in all written Collection Actions. The following language is suggested, but not required, to meet the notice requirements of 101 CMR 613.08(1)(e): "If you are unable to pay this bill, please call [phone number]. Financial assistance is available."
A Provider must notify the Patient that the Provider offers a payment plan as described in 101 CMR 613.08(1)(f), if the Patient is determined to be a Low Income Patient or qualifies for Medical Hardship.

(f) Distribution of Financial Assistance Program Information.

Providers must post signs in the inpatient, clinic, and emergency admissions/ registration areas and in business office areas that are customarily used by Patients that conspicuously inform Patients of the availability of financial assistance programs and the Provider location at which to apply for such programs. Signs must be large enough to be clearly visible and legible by Patients visiting these areas. All signs and notices must be translated into languages other than English if such languages are the primary language of 10% or more of the residents in the Provider's service area. Signs must notify Patients of the availability of financial assistance and of other programs of public assistance. The following language is suggested, but not required:

a. "Are you unable to pay your hospital bills? Please contact a counselor to assist you with various alternatives."; or

b. "Financial assistance is available through this institution. Please contact____________."

Providers must make their Credit and Collection Policies filed in accordance with 101 CMR 613.08(1)(c)1. and Provider Affiliate lists (if applicable), as described in 101 CMR 613.08(1)(d), available on the Provider's website.

(g) Deposits and Payment Plans.

A Provider may not require preadmission and/or pretreatment deposits from individuals that require Emergency Services or that are determined to be Low Income Patients.
A Provider may request a deposit from individuals determined to be Low Income Patients. Such deposits must be limited to 20% of the deductible amount, up to $500. All remaining balances are subject to the payment plan conditions established in 101 CMR 613.08(1)(g).
A Provider may request a deposit from Patients eligible for Medical Hardship. Deposits are limited to 20% of the Medical Hardship contribution up to $1,000. All remaining balances are subject to the payment plan conditions established in 101 CMR 613.08(1)(f).
A Patient with a balance of $1,000 or less, after initial deposit, must be offered at least a one-year, interest-free payment plan with a minimum monthly payment of no more than $25. A Patient with a balance of more than $1,000, after initial deposit, must be offered at least a two-year, interest-free payment plan.

(h) Patient Responsibilities. Providers must advise Patients of the rights and responsibilities described in 101 CMR 613.08(2) in all cases where the Patient interacts with registration personnel.

(2) Patient Rights and Responsibilities.

(a) Patients have the right to

apply for MassHealth, the Premium Assistance Payment Program Operated by the Health Connector, a Qualified Health Plan, Low Income Patient determination, and Medical Hardship; and
a payment plan, as described in 101 CMR 613.08(1)(g), if the Patient is determined to be a Low Income Patient or qualifies for Medical Hardship.

(b) A Patient who receives Reimbursable Health Services must

provide all required documentation;
inform MassHealth of any changes in MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), or insurance status, including but not limited to, income, inheritances, gifts, distributions from trusts, the availability of health insurance, and third-party liability. The Patient may, in the alternative, provide such notice to the Provider that determined the Patient's eligibility status;
track the Patient deductible and provide documentation to the Provider that the deductible has been reached when more than one Premium Billing Family Group member is determined to be a Low Income Patient or if the Patient or Premium Billing Family Group members receive Reimbursable Health Services from more than one Provider; and
inform the Health Safety Net Office or the MassHealth Agency when the Patient is involved in an accident, or suffers from an illness or injury, or other loss that has or may result in a lawsuit or insurance claim. In such a case, the Patient must

a. file a claim for compensation, if available; and

b. agree to comply with all requirements of M.G.L. c. 118E, including but not limited to

i. assigning to the Health Safety Net Office the right to recover an amount equal to the Health Safety Net payment provided from the proceeds of any claim or other proceeding against a third party;

ii. providing information about the claim or any other proceeding, and fully cooperating with the Health Safety Net Office or its designee, unless the Health Safety Net Office determines that cooperation would not be in the best interests of, or would result in serious harm or emotional impairment to, the Patient;

iii. notifying the Health Safety Net Office or the MassHealth Agency in writing within ten days of filing any claim, civil action, or other proceeding; and

iv. repaying the Health Safety Net from the money received from a third party for all Eligible Services provided on or after the date of the accident or other incident after becoming a Low Income Patient for purposes of Health Safety Net payment, provided that only Health Safety Net payments provided as a result of the accident or other incident will be repaid.

(3) Populations Exempt from Collection Action.

(a) A Provider must not bill Patients enrolled in MassHealth and Patients receiving governmental benefits under the Emergency Aid to the Elderly, Disabled and Children program except that the Provider may bill Patients for any required copayments and deductibles. The Provider may initiate billing for a Patient who alleges that he or she is a participant in any of these programs but fails to provide proof of such participation. Upon receipt of satisfactory proof that a Patient is a participant in any of the above listed programs, and receipt of the signed application, the Provider must cease its collection activities.

(b) Participants in the Children's Medical Security Plan whose MAGI income is less than or equal to 300% of the FPL are also exempt from Collection Action. The Provider may initiate billing for a Patient who alleges that he or she is a participant in the Children's Medical Security Plan, but fails to provide proof of such participation. Upon receipt of satisfactory proof that a Patient is a participant in the Children's Medical Security Plan, the Provider must cease all collection activities.

(c) Low Income Patients, other than Dental-only Low Income Patients, are exempt from Collection Action for any Reimbursable Health Services rendered by a Provider receiving payments from the Health Safety Net for services received during the period for which they have been determined Low Income Patients, except for copayments and deductibles. Providers may continue to bill Low Income Patients for Eligible Services rendered prior to their determination as Low Income Patients after their Low Income Patient status has expired or otherwise been terminated.

(d) Low Income Patients, other than Dental-only Low Income Patients, with MassHealth MAGI Household income or Medical Hardship Family Countable Income, as described in 101 CMR 613.04(2), greater than 150% and less than or equal to 300% of the FPL are exempt from Collection Action for the portion of his or her Provider bill that exceeds the deductible and may be billed for deductibles as set forth in 101 CMR 613.04(8)(b). Providers may continue to bill Low Income Patients for services rendered prior to their determination as Low Income Patients after their Low Income Patient status has expired or otherwise been terminated.

(e) Providers may bill Low Income Patients for services other than Reimbursable Health Services provided at the request of the Patient and for which the Patient has agreed to be responsible, with the exception of those services described in 101 CMR 613.08(3)(e) l. and 2. Providers must obtain the Patient's written consent to be billed for the service.

Providers may not bill Low Income Patients for claims related to medical errors including those described in 101 CMR 613.03(l)(d).
Providers may not bill Low Income Patients for claims denied by the Patient's primary insurer due to an administrative or billing error.

(f) At the request of the Patient, a Provider may bill a Low Income Patient in order to allow the Patient to meet the required Common Health one-time deductible as described in 130 CMR 506.009: The One-time Deductible or the required MassHealth asset reduction defined in 130 CMR 520.004: Asset Reduction.

(g) A Provider may not undertake a Collection Action against an individual who has qualified for Medical Hardship with respect to the amount of the bill that exceeds the Medical Hardship contribution. If a claim already submitted as Emergency Bad Debt becomes eligible for Medical Hardship payment from the Health Safety Net, the Provider must cease collection activity on the Patient for the services.

(4) Administrative Bulletins. The Health Safety Net Office may issue administrative bulletins to clarify policies and understanding of substantive provisions of 101 CMR 613.00 and specify information and documentation necessary to implement 101 CMR 613.00.

(5) Severability. The provisions of 101 CMR 613.00 are severable. If any provision or the application of any provision is held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 613.00 or the application of such provisions other than those held invalid.

History

Amended by Mass Register Issue 1271, eff. 10/10/2014.

Health Safety Net Payments and Funding Health Safety Net Payments and Funding

101 CMR, § 614.01 General Provisions

Scope, Purpose, and Effective Date. 101 CMR 614.00 governs Health Safety Net payments and funding effective for dates of service beginning October 1, 2022, including payments to Acute Hospitals and Community Health Centers and payments from Acute Hospitals and Surcharge Payers. The criteria for determining services for which Acute Hospitals and Community Health Centers may be paid by the Health Safety Net are set forth in 101 CMR 613.00: Health Safety Net Eligible Services

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

101 CMR, § 614.02 Definitions

As used in 101 CMR 614.00, unless the context otherwise requires, terms have the following meanings. All defined terms in 101 CMR 614.00 are capitalized.

340B Provider. An Acute Hospital or Community Health Center eligible to purchase discounted drugs through a program established by § 340B of United States Public Law 102-585, the Veterans Health Act of 1992, permitting certain grantees of federal agencies access to reduced cost drugs for their Patients, and registered and listed as a 340B Provider within the United States Department of Health and Human Services, Office of Pharmacy Affairs (OPA) database. Services of a 340B pharmacy may be provided at on-site or off-site locations.

Acute Hospital. A hospital licensed under M.G.L. c. 111, § 51 that contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the Department of Public Health.

Ambulatory Surgical Center. Any distinct entity that operates exclusively for the purpose of providing surgical services to Patients not requiring hospitalization and meets the Centers for Medicare and Medicaid Services (CMS) requirements for participation in the Medicare program.

Bad Debt. An account receivable based on services furnished to a Patient that is

(a) regarded as uncollectible, following reasonable collection efforts consistent with the requirements in 101 CMR 613.06: Allowable Bad Debt;

(b) charged as a credit loss;

(d) not a Reimbursable Health Service.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

Centers for Medicare & Medicaid Services (CMS). The federal agency that administers Medicare, Medicaid, and the State Children's Health Insurance Program.

Charge. The uniform price for a specific service charged by a Provider.

Community Health Center. A health center operating in conformance with the requirements of § 330 of the Public Health Service Act (42 U.S.C. § 254b), including all Community Health Centers that file cost reports with the Center. Such a health center must

(a) be licensed as a freestanding clinic by the Massachusetts Department of Public Health pursuant to M.G.L. c. 111, § 51;

Disproportionate Share Hospital (DSH). An Acute Hospital where a minimum of 63% of the Gross Patient Service Revenue is attributable to Title XVIII and Title XIX of the Social Security Act or other government payers, including the Premium Assistance Payment Program Operated by the Health Connector and the Health Safety Net.

Eligible Services. Services eligible for Health Safety Net payment pursuant to 101 CMR 613.03: Eligible Services Requirements. Eligible Services include

(a) Reimbursable Health Services to Low Income Patients;

(b) Medical Hardship; and

Emergency Bad Debt. The amount of uncollectible debt for Emergency Services that meets the criteria set forth in 101 CMR 613.06: Allowable Bad Debt.

Emergency Services. Medically Necessary Services provided to an individual with an Emergency Medical Condition as defined in 101 CMR 613.02: Definitions.

Federal Poverty Level (FPL). The federal poverty income guidelines issued annually in the Federal Register.

Financial Requirements. An Acute Hospital's requirement for revenue that includes, but is not limited to, reasonable operating, capital, and working capital costs, and the reasonable costs associated with changes in medical practice and technology.

Fiscal Year (FY). The time period of 12 months beginning on October 1^st of any calendar year and ending on September 30^th of the following calendar year.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Gross Patient Service Revenue. The total dollar amount of a hospital's charges for services rendered in a Fiscal Year.

Guarantor. A person or group of persons who assumes the responsibility of payment for all or part of an Acute Hospital's or Community Health Center's charge for services.

Health Connector. Commonwealth Health Insurance Connector Authority or Health Connector established pursuant to M.G.L. c. 176Q, § 2.

Health Safety Net Office. The office within the Office of Medicaid established under M.G.L. c. 118E, § 65.

Health Safety Net Trust Fund. The fund established under M.G.L. c. 118E, § 66.

Health Services. Medically necessary inpatient and outpatient services as authorized under Title XIX of the Social Security Act. Health services do not include

(a) nonmedical services, such as social, educational, and vocational services;

(b) cosmetic surgery;

(d) telephone conversations and consultations;

(e) court testimony;

(f) research or the provision of experimental or unproven procedures; and

(g) the provision of whole blood, but the administrative and processing costs associated with the provision of blood and its derivatives are payable.

Hospital Cost Report. The Massachusetts Hospital Statement of Costs, Revenues, and Statistics reported to the Center pursuant to 957 CMR 9.00: Hospital Financial Data Reporting Requirements .

Hospital Licensed Health Center. A Satellite Clinic that

(a) meets MassHealth requirements for reimbursement as a Hospital Licensed Health Center as provided at 130 CMR 410.413: Medical Services Required on Site at a Hospital-licensed Health Center ; and

(b) is approved by and enrolled with MassHealth's Provider Enrollment Unit as a Hospital Licensed Health Center.

Indirect Payment. A payment made by an entity licensed or approved under M.G.L. chs. 175, 176A, 176B, 176G, or 176I to a group of Providers, including one or more Massachusetts Acute Hospitals or Ambulatory Surgical Centers, that then forward the payment to member Acute Hospitals or Ambulatory Surgical Centers; or a payment made to an individual to reimburse him or her for a payment made to an Acute Hospital or Ambulatory Surgical Center.

Individual Medical Visit. A face-to-face meeting at a Community Health Center between a Patient and a physician, physician assistant, nurse practitioner, nurse midwife, registered nurse, or paraprofessional for medical examination, diagnosis, or treatment.

Individual Payer. A Patient or Guarantor who pays his or her own Acute Hospital or Ambulatory Surgical Center bill and is not eligible for reimbursement from an insurer or any other source.

Institutional Payer. A Surcharge Payer that is an entity other than an Individual Payer.

Low Income Patient. A Patient who meets the criteria in 101 CMR 613.04(1): General .

Managed Care Organization. A managed care organization, as defined in 42 CFR 438.2, and any eligible health insurance plan, as defined in M.G.L. c. 118H, § 1, that contracts with MassHealth or the Commonwealth Health Insurance Connector Authority; provided, however, that a managed care organization does not include a senior care organization, as defined in M.G.L. c. 118E, § 9D, or an integrated care organization as defined in M.G.L. c. 118E, § 9F.

MassHealth. The medical assistance and benefit programs administered by the MassHealth Agency pursuant to Title XIX of the Social Security Act (42 U.S.C. 1396) , Title XXI of the Social Security Act (42 U.S.C. 1397) , M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services to eligible members.

MassHealth Agency. The Executive Office of Health and Human Services in accordance with the provisions of M.G.L. c. 118E.

Medicare Advantage. A type of Medicare health plan established by Title II of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Medicare Program (Medicare). The medical insurance program established by Title XVIII of the Social Security Act.

Non-acute Hospital. A nonpublic hospital that is

(a) licensed by the Department of Public Health under M.G.L. c. 111, § 51 but not defined as an acute-care hospital under M.G.L. c. 111, § 25B; or

(b) licensed as an inpatient facility by the Department of Mental Health under M.G.L. c. 19, § 19 and regulations promulgated thereunder but not categorized as Class VII licensees under the regulations.

Office of Pharmacy Affairs (OPA). The Office of Pharmacy Affairs, and any successor agencies, is a division within the United States Department of Health and Human Services that monitors the registration of 340B pharmacies.

Patient. An individual who receives or has received Medically Necessary Services at an Acute Hospital or Community Health Center.

Pediatric Hospital. An Acute Hospital that limits services primarily to children and that qualifies as exempt from the Medicare Prospective Payment System (PPS).

Prospective Payment System (PPS) Rate . The Medicare Prospective Payment System rate for Community Health Centers set annually by CMS as described in 42 CFR 405.2467.

Provider. An Acute Hospital or Community Health Center that provides Eligible Services.

Publicly Aided Patient. A person who receives Acute Hospital or Community Health Center care and services for which a Governmental Unit is liable in whole or in part under a statutory obligation.

Registered Payer List. A list of Institutional Payers as defined in 101 CMR 614.05(3)(b).

Shortfall Amount. In a Fiscal Year, the positive difference between the sum of allowable Health Safety Net costs for all Acute Hospitals and the revenue available for distribution to Acute Hospitals.

Sole Community Hospital. Any Acute Hospital classified as a Sole Community Hospital by the U.S. Centers for Medicare & Medicaid Services', Medicare regulations, or any Acute Hospital that demonstrates to the Health Safety Net Office's satisfaction that it is located more than 25 miles from other Acute Hospitals in the Commonwealth and that it provides services for at least 60% of its primary service area.

Source Year. The Fiscal Year two Fiscal Years prior to the regulation effective date, from which data is collected to calculate current payment rates, unless otherwise specified by the Health Safety Net Office through administrative bulletin.

Surcharge Payer. An individual or entity that

(a) makes payments for the purchase of health care Hospital Services and Ambulatory Surgical Center Services; and

(b) meets the criteria set forth in 101 CMR 614.05(1)(a).

Surcharge Percentage. The percentage assessed on certain payments to Acute Hospitals and Ambulatory Surgical Centers determined pursuant to 101 CMR 614.05(2).

Third Party Administrator. An entity that administers payments for health care services on behalf of a client plan in exchange for an administrative fee. A Third Party Administrator may provide client services for a self-insured plan or an insurance carrier's plan. A Third Party Administrator is deemed to use a client plan's funds to pay for health care services whether the Third Party Administrator pays Providers with funds from a client plan, with funds advanced by the Third Party Administrator subject to reimbursement by the client plan, or with funds deposited with the Third Party Administrator by a client plan.

Total Surcharge Amount. An amount equal to $160,000,000 plus 50% of the estimated cost, as determined by the Secretary of Administration and Finance, of administering the Health Safety Net and related assessments in accordance with M.G.L. c. 118E, §§ 65 through 69.

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

101 CMR, § 614.03 Sources and Uses of Funds

(1) Available Revenue.

(a) Except as provided in 101 CMR 614.03(1)(b), revenue available to fund Provider payments from the Health Safety Net Trust Fund consists of

revenue produced by Acute Hospital and Non-acute Hospital assessments and the surcharge on Hospital Services and Ambulatory Surgical Center Services payments, less

a. 50% of the estimated cost, as determined by the Secretary of Administration and Finance, of administering the Health Safety Net and related assessments in accordance with M.G.L. c. 118E, §§ 65 through 69;

b. any amount designated to be transferred to the MassHealth Delivery System Reform Trust Fund pursuant to M.G.L. c. 118E, § 66 or otherwise required by law; and

c. any amount designated to be transferred to the Non-acute Care Hospital Reimbursement Trust Fund established in M.G.L. c. 29, § 2WWWW pursuant to M.G.L. c. 118E, § 66 or otherwise required by law;

funds authorized to be transferred from the Commonwealth Care Trust Fund;
amounts previously transferred from the Uncompensated Care Trust Fund;

any interest on monies in the Health Safety Net Trust Fund; and

any additional funding made available through appropriation or otherwise.

(b) Any amounts collected from Surcharge Payers in any Fiscal Year in excess of the Total Surcharge Amount, adjusted to reflect applicable surcharge credits based on prior year collections, are transferred to the General Fund to support a portion of the costs of the MassHealth program.

(2) Payments from the Health Safety Net Trust Fund.

(a) Payment Adjustments. Acute Hospital payments established under 101 CMR 614.06 may be adjusted to reflect additional funding made available during the Fiscal Year or to reflect the shortfall allocation in accordance with 101 CMR 614.03(2). The Health Safety Net may reserve up to 10% of available funding to ensure that funding is available for the entire Fiscal Year. The Health Safety Net may reserve an additional amount of available funding to ensure that funds are available to pay for claims that were denied or held during the Fiscal Year, but are later remediated in a subsequent Fiscal Year.

(b) Shortfall Allocation. The Health Safety Net Office, using the best data available, estimates the projected total Reimbursable Health Services provided by Acute Hospitals and Community Health Centers; total Medical Hardship services; total Bad Debt for Emergency and Urgent Care Services; and total Health Safety Net administrative expenses. If the Health Safety Net Office determines that, after adjusting for projected Community Health Center payments and administrative expenses, Health Safety Net payments to Acute Hospitals will exceed available funding, the Health Safety Net Office allocates the funding in a manner that reflects each Acute Hospital's proportional Financial Requirements for Health Safety Net payments through a graduated payment system. The Health Safety Net Office allocates the shortfall to Disproportionate Share Hospitals and other Acute Hospitals as follows.

Disproportionate Share Hospital. The Health Safety Net Office determines Disproportionate Share Hospital status using data reported on the Hospital Cost Report for the Source Year.

2.. Allocation Method. The Health Safety Net Office allocates the shortfall as follows.

a. Determine the ratio of each Acute Hospital's total Patient care costs to the sum of all Acute Hospitals' total Patient care costs.

b. Multiply this ratio by the total Shortfall Amount.

c. If calculated amount is greater than an Acute Hospital's allowable Health Safety Net payments, then the shortfall allocation is limited to the Acute Hospital's allowable Health Safety Net payments. If an Acute Hospital's allowable Health Safety Net payment is a negative amount, then the shortfall allocation is limited to zero.

d. The Health Safety Net's gross liability to each Acute Hospital is limited by the Acute Hospital's allowable Health Safety Net payments less the Shortfall Amount calculated in 101 CMR 614.03(2)(b)2.a. through c.

e. Each Disproportionate Share Hospital is paid the greater of

i. 85% of its allowable Health Safety Net payments; or

ii. the revised payment calculated according to the shortfall methodology in 101 CMR 614.03(2)(b)2.a. through e.

(c) Final Settlement. The Health Safety Net Office may implement a final settlement between the Health Safety Net and an Acute Hospital for the Fiscal Year. The final settlement is calculated based on the Health Safety Net's gross liability to the Acute Hospital calculated pursuant to 101 CMR 614.06, and the payments made to the Acute Hospital during the Fiscal Year. The final settlement may occur when the Health Safety Net Office determines that it has sufficiently completed relevant claims adjudication and audit activity. For the purposes of the final settlement, the Health Safety Net Office may cease paying for claims that exceed the billing deadlines or other billing rules established at 101 CMR 613.00: Health Safety Net Eligible Services.

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

101 CMR, § 614.04 Acute Hospital and Non-acute Hospital Assessment Liability to the Health Safety Net Trust Fund

(1) Acute Hospital Assessment Calculation. Each Acute Hospital's gross liability to the Health Safety Net Trust Fund is equal to the product of

(a) the ratio of its Assessed Charges to all Acute Hospitals' Assessed Charges; and

(b) the Total Acute Hospital Assessment Amount.

(2) Non-acute Hospital Assessment Calculation. Each Non-acute Hospital's gross liability to the Health Safety Net Trust Fund is equal to the product of

(a) the Non-acute Hospital's Assessed Charges in that Fiscal Year; and

(b) the ratio of the calculated acute hospital assessment in 101 CMR 614.04(1).

(3) Penalties for Non-payment.

(a) If an Acute Hospital or Non-acute Hospital does not pay the amount calculated pursuant to 101 CMR 614.04(1) or (2), respectively, or a specified portion thereof, by the due date established by the Health Safety Net Office, the Health Safety Net Office may assess up to a 3% penalty on the outstanding balance. The Health Safety Net Office will calculate the penalty on the outstanding balance as of the due date. The Health Safety Net Office may assess up to an additional 3% penalty against the outstanding balance and prior penalties for each month that a Hospital remains delinquent. The Health Safety Net Office will credit partial payments from delinquent Hospitals to the current outstanding liability. If any amount remains from the partial payment, the Health Safety Net Office will then credit such amount to the penalty amount.

(b) In determining the penalty amount, the Health Safety Net Office may consider factors including, but not be limited to, the Hospital's payment history, financial situation, and relative share of the payments.

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

101 CMR, § 614.05 Surcharge on Acute Hospital Payments

(1) General. There is a surcharge on certain payments to Acute Hospitals and Ambulatory Surgical Centers. The surcharge amount equals the product of payments subject to surcharge as defined in 101 CMR 614.05(1)(b) and the Surcharge Percentage as defined in 101 CMR 614.05(2).

(a) Surcharge Payer.

A Surcharge Payer is an individual or entity that makes payments for the purchase of health care Hospital Services and Ambulatory Surgical Center Services, including a Managed Care Organization; provided, however, that the term "surcharge payer" does not include Title XVIII and Title XIX of the Social Security Act programs and their beneficiaries or recipients, except Managed Care Organizations; other governmental programs of public assistance and their beneficiaries or recipients; and the workers' compensation program established pursuant to M.G.L. c. 152.
The same entity that pays that Acute Hospital or Ambulatory Surgical Center for services must pay the surcharge. If an entity such as a Third Party Administrator acts on behalf of a client plan and uses the client plan's funds to pay for the services, or advances funds to pay for the services for which it is reimbursed by the client plan, it must also act on behalf of the client plan and use the client plan's funds to pay the surcharge or advance funds to pay the surcharge for which it will be reimbursed by the client plan.

(b) Payments Subject to Surcharge. Payments subject to surcharge include

direct and indirect payments made by Surcharge Payers to Massachusetts Acute Hospitals for the purchase of Acute Hospital Services and to Massachusetts Ambulatory Surgical Centers for the purchase of Ambulatory Surgical Center Services, with the following exceptions:

a. except for Managed Care Organization payments for MassHealth members and Commonwealth Care enrollees, the surcharge applies to all payments made on or after January 1, 1998, regardless of the date services were provided; and

b. for Managed Care Organization payments for MassHealth members younger than 65 years old and for Commonwealth Care enrollees, the surcharge applies to all payments made on or after December 1, 2010, regardless of the date services were provided;

2.. payments made by national health insurance plans operated by foreign governments and payments made by an embassy on behalf of a foreign national not employed by the embassy;

direct payments made under an employer health plan by a health care reimbursement arrangement funded by the employer; and
payments made by Medicare supplemental plans and other health insurance plans secondary to Medicare.

payments, settlements, and judgments arising out of third party liability claims for bodily injury that are paid under the terms of property or casualty insurance policies;
payments made on behalf of MassHealth members by MassHealth, Medicare beneficiaries by Medicare (including Medicare Advantage plans) except as provided in 101 CMR 614.05(1)(b), persons enrolled in the Premium Assistance Payment Program Operated by the Health Connector, or persons enrolled in policies issued pursuant to M.G.L. c. 176K or similar policies issued on a group basis, except that payments made by Managed Care Organizations on behalf of MassHealth members younger than 65 years old who are not enrolled in an integrated care organization and Commonwealth Care enrollees are subject to surcharge;
payments made by an Acute Hospital to a second Acute Hospital for services that the first Acute Hospital billed to a Surcharge Payer;
payments made by a group of Providers, including one or more Massachusetts Acute Hospitals or Ambulatory Surgical Centers, to member Acute Hospitals or Ambulatory Surgical Centers for services that the group billed to an entity licensed or approved under M.G.L. chs. 175, 176A, 176B, 176G, or 176I;
payments made on behalf of an individual covered under the Federal Employees Health Benefits Act at 5 U.S.C. 8901 et seq. ;
payments made on behalf of an individual covered under the workers' compensation program under M.G.L. c. 152; and
payments made on behalf of foreign embassy personnel who hold a Tax Exemption Card issued by the United States Department of State.

(d) The surcharge is distinct from any other amount paid by a Surcharge Payer for the services provided by an Acute Hospital or Ambulatory Surgical Center. Surcharge amounts paid are deposited in the Health Safety Net Trust Fund.

(e) The Health Safety Net Office may issue additional guidance to clarify policies and understanding of substantive provisions of 101 CMR 614.05(1).

(2) Calculation of the Surcharge Percentage. The Health Safety Net Office uses the following methodology to calculate the percentage of the surcharge to be assessed on certain payments to Acute Hospitals and Ambulatory Surgical Centers, established in M.G.L. c. 118E, § 68. The Health Safety Net Office establishes the Surcharge Percentage before September 1^st of each year, as follows.

(a) The Health Safety Net Office determines the total amount to be collected by adjusting the Total Surcharge Amount for any over or under collections from Institutional Payers and individuals in previous years, including audit adjustments, as well as any over or under collections projected for October or November of the coming year.

(b) The Health Safety Net Office projects annual aggregate payments subject to the surcharge based on historical data, excluding projected annual aggregate payments made by Managed Care Organizations on behalf of MassHealth members and Commonwealth Care enrollees, with any adjustments the Health Safety Net Office deems necessary.

(c) The Health Safety Net Office divides the amount determined in 101 CMR 614.05(2)(a) by the amount determined in 101 CMR 614.05(2)(b).

(3) Payer Registration.

(a) Except for non-United States national insurers that have made fewer than ten payments per year in the prior three years to Massachusetts Acute Hospitals and/or Ambulatory Surgical Centers, all Institutional Payers must register with the Health Safety Net Office by completing and submitting the Surcharge Payer Registration form. These payers must submit the registration form to the Health Safety Net Office within 30 days after making a payment to any Massachusetts Acute Hospital or Ambulatory Surgical Center.

(b) The Health Safety Net Office compiles lists of registered Institutional Payers, and updates the lists quarterly. The Health Safety Net Office distributes these lists to Acute Hospitals and Ambulatory Surgical Centers upon request.

(c) Institutional Payers must register only once, except that an Institutional Payer that is also a Managed Care Organization must register separately as a Managed Care Organization. A registered payer is automatically registered for the next Fiscal Year.

(4) Billing Process for Institutional Payers.

(a) Each Acute Hospital and Ambulatory Surgical Center must send a bill for the Health Safety Net surcharge to Surcharge Payers, as required by M.G.L. c. 118E, § 68. Acute Hospitals and Ambulatory Surgical Centers must send this bill to Surcharge Payers from whom they have received payment for services in the most recent four quarters for which data is available. The bill must state the Surcharge Percentage. Acute Hospitals and Ambulatory Surgical Centers must send this bill to payers before September 1^st of each Fiscal Year and before the effective date of any Surcharge Percentage.

(b) Each Acute Hospital and Ambulatory Surgical Center must also send a bill for the surcharge at the same time as the bill for services provided to Institutional Payers who have not registered with the Health Safety Net Office pursuant to 101 CMR 614.05(3)(a) and from whom they have received payment. The bill must be sent within 30 days of receiving the payment from the unregistered payer. The bill must state the Surcharge Percentage, but not the dollar amount owed, and must include notification of the surcharge payment process set forth below, as well as a registration form specified by the Health Safety Net Office. Until the Acute Hospital or Ambulatory Surgical Center receives the Registered Payer List, it must send a bill for the surcharge at the same time as the bill for services provided to Institutional Payers that it did not already bill pursuant to 101 CMR 614.05(4)(a).

(5) Payment Process for Institutional Payers.

(a) Monthly Surcharge Liability. After the end of each calendar month, each Institutional Payer must determine the surcharge amount it owes to the Health Safety Net Trust Fund for that month. The amount owed is the product of the amount of payments subject to surcharge, as defined in 101 CMR 614.05(1)(b), by the Surcharge Percentage in effect during that month. The Institutional Payer may adjust the surcharge amount owed for any surcharge over- or under-payments in a previous period.

Institutional Payers that pay a global fee or capitation for services that include Acute Hospital or Ambulatory Surgical Center Services, as well as other services not subject to the surcharge, must develop a reasonable method for allocating the portion of the payment intended to be used for services provided by Acute Hospitals or Ambulatory Surgical Centers. Such Institutional Payers must file this allocation method by October 1^st of each Fiscal Year. If there is a significant change in the global fee or capitation payment arrangement that necessitates a change in the allocation method, the Institutional Payer must file the new method with the Health Safety Net Office before the new payment arrangement takes effect. Institutional Payers may not change the allocation method later in the year unless there is a significant change in the payment arrangement.

a. The Health Safety Net Office will review allocation plans within 90 days of receipt. During this review period the Health Safety Net Office may require an Institutional Payer to submit supporting documentation or to make changes in this allocation method if it finds that the method does not reasonably allocate the portion of the global payment or capitation intended to be used for services provided by Acute Hospitals or Ambulatory Surgical Centers.

b. An Institutional Payer must include the portion of the global payment or capitation intended to be used for services provided by Acute Hospitals or Ambulatory Surgical Centers, as determined by this allocation method, in its determination of payments subject to surcharge.

An Institutional Payer must include all payments made as a result of settlements, judgments, or audits in its determination of payments subject to surcharge. An Institutional Payer may include payments made by Massachusetts Acute Hospitals or Ambulatory Surgical Centers to the Institutional Payer as a result of settlements, judgments, or audits as a credit in its determination of payments subject to surcharge.

(b) Monthly Payments. Institutional Payers must make payments to the Health Safety Net Trust Fund monthly. Each Institutional Payer must remit the surcharge amount it owes to the Health Safety Net Trust Fund, determined pursuant to 101 CMR 614.05(5)(a), to the Health Safety Net Office for deposit in the Health Safety Net Trust Fund. Institutional Payers must remit the surcharge payment by the first business day of the second month following the month for which the surcharge amount was determined. For example, surcharge payments based on payments made to Acute Hospitals and Ambulatory Surgical Centers in January are due by March 1^st.

An Ambulatory Surgical Center may request a biannual surcharge payment option if

a. it has remitted four or fewer payments during the previous Fiscal Year;

b. it has remitted all required surcharge payments and submitted all monthly coupons;

c. it submitted a Surcharge Verification Form for the previous Fiscal Year; and

d. it has reported less than $10,000 in surcharge payments in the Surcharge Verification Form.

The Health Safety Net Office notifies payers eligible for the biannual option. The Payer may elect to receive biannual surcharge notices or to continue to receive monthly notices. Each biannual surcharge payment equals the product of the appropriate surcharge percentage and all payments made by the payer to Massachusetts Acute Hospitals and Ambulatory Surgical Centers for the prior six months.

(d) All surcharge payments must be payable in United States dollars and drawn on a United States bank. The Health Safety Net Office assesses a $30.00 penalty on any Surcharge Payer whose check is returned for insufficient funds.

(e) Any Institutional Payer, except Third Party Administrators, that has a surcharge liability of less than $5.00 in any month or biannual payment period may delay payment until its surcharge liability is at least $5.00. For example, XYZ Company's surcharge liability for July is $3.50 and its liability for August is $2.00. XYZ Company may delay payment in July but must remit a check for $5.50 in August.

(6) Payment Process for Individual Payers (Self-pay). There is a surcharge on certain payments made by Individual Payers to Acute Hospitals and Ambulatory Surgical Centers.

(a) Billing.

Acute Hospitals and Ambulatory Surgical Centers must include the surcharge amount on all bills to Individual Payers unless

a. the Patient's liability is less than the individual payment threshold of $10,000;

b. the Patient is a non-Massachusetts resident for whom the Acute Hospital or Ambulatory Surgical Center can verify that the Patient's income would otherwise qualify the Patient as a Low Income Patient under 101 CMR 613.04: Eligible Services to Low Income Patients; or

c. the Patient is approved for Medical Hardship in accordance with the requirements of 101 CMR 613.05: Medical Hardship. The bill must direct Individual Payers to pay the surcharge to the Acute Hospital or Ambulatory Surgical Center when making payment for services.

The amount of the surcharge billed is the product of the Patient's liability to the Acute Hospital or Ambulatory Surgical Center, and the Surcharge Percentage in effect on the billing date.
The amount of the surcharge owed by an Individual Payer is the product of the total amount paid by the individual to an Acute Hospital or Ambulatory Surgical Center and the Surcharge Percentage in effect on the payment date. Payments greater than or equal to the threshold received by Acute Hospitals and Ambulatory Surgical Centers from Individual Surcharge Payers are subject to the surcharge.

(b) Acute Hospitals and Ambulatory Surgical Centers must remit to the Health Safety Net Office the surcharge amount owed by Individual Payers for every payment greater than or equal to the threshold made by Individual Payers. If an Individual Payer makes separate payments over a 12-month period that are equal to or greater than the threshold and relate to an outpatient visit or inpatient stay, the surcharge amount due applies to the aggregate amount paid for the outpatient visit or inpatient stay. The first surcharge payment is due to the Health Safety Net Office when the total Individual Payer payment amount reaches the threshold.

(c) Acute Hospitals and Ambulatory Surgical Centers must remit such surcharge payments by the first business day of the second month following the month during which the surcharge was received. For example, surcharge payments received by Acute Hospitals and Ambulatory Surgical Centers in January are due to the Health Safety Net Office on March 1^st. Acute Hospitals and Ambulatory Surgical Centers may deduct collection agency fees for the collection of surcharge payments from Individual Payers from the total amount of surcharge payments forwarded to the Health Safety Net Office.

(d) All payments must be payable in United States dollars and drawn on a United States bank. The Health Safety Net Office assesses a $30.00 penalty on any Surcharge Payer whose check is returned for insufficient funds.

(e) If an embassy of a foreign government pays an Acute Hospital or Ambulatory Surgical Center bill on behalf of an individual, the Provider may either bill the embassy for the individual's surcharge according to the billing and payment process for Individual Payers set forth in 101 CMR 614.05(6) or bill the embassy according to the billing process for Institutional Payers as set forth in 101 CMR 614.05(4). If the Provider chooses to bill the embassy as an Institutional Payer and the embassy is not listed on the Registered Payer List, the Provider must include the embassy on the Unmatched Payer Report and send surcharge payer registration information to the embassy.

(7) Penalties. If an Acute Hospital, Ambulatory Surgical Center, or Surcharge Payer fails to forward surcharge payments pursuant to 101 CMR 614.05, the Health Safety Net Office imposes an additional 1.5% interest penalty on the outstanding balance. The interest is calculated from the due date. For each month a payment remains delinquent, an additional 1.5% penalty accrues against the outstanding balance, including prior penalties.

(a) The Health Safety Net Office credits partial payments first to the current outstanding liability, and second to the amount of the penalties.

(b) The Health Safety Net Office may reduce the penalty at the Health Safety Net Office's discretion. In determining a waiver or reduction, the Health Safety Net Office's consideration includes, but is not limited to, the entity's payment history, financial situation, and relative share of the payments to the Health Safety Net Trust Fund.

(8) Administrative Review. The Health Safety Net Office may conduct an administrative review of surcharge payments at any time.

(a) The Health Safety Net Office reviews data submitted by Acute Hospitals, Ambulatory Surgical Centers, and Institutional Payers pursuant to 101 CMR 614.08, the Surcharge Payer Registration forms submitted by Institutional Payers pursuant to 101 CMR 614.05(3)(a), and any other pertinent data. All information provided by, or required from, any Surcharge Payer, pursuant to 101 CMR 614.00 is subject to audit by the Health Safety Net Office. For surcharge payments based upon a global fee or capitation allocated according to an allocation method accepted by the Health Safety Net Office pursuant to 101 CMR 614.05(5)(a)1., the Health Safety Net Office's review is limited to determining whether this method was followed accurately and whether the amounts reported were accurate.

(b) The Health Safety Net Office may require the Surcharge Payer to submit additional documentation reconciling the data it submitted with data received from Acute Hospitals.

(c) If the Health Safety Net Office determines through its review that a Surcharge Payer's payment to the Health Safety Net Trust Fund was materially incorrect, the Health Safety Net Office may require a payment adjustment. Payment adjustments are subject to interest penalties and late fees, pursuant to 101 CMR 614.05(7), from the date the original payment was owed to the Health Safety Net Trust Fund.

(d) Processing of Payment Adjustments.

Notification. The Health Safety Net Office notifies a Surcharge Payer of its proposed adjustments. The notification is in writing and contains a complete listing of all proposed adjustments, as well as the Health Safety Net Office's explanation for each adjustment.

Objection Process. If a Surcharge Payer wishes to object to a Health Safety Net Office proposed adjustment contained in the notification letter, it must do so in writing, within 15 business days of the mailing of the notification letter. The Surcharge Payer may request an extension of this period for cause. The written objection must, at a minimum, contain

a. each adjustment to which the Surcharge Payer is objecting;

b. the Fiscal Year for each disputed adjustment;

c. the specific reason for each objection; and

d. all documentation that supports the Surcharge Payer's position.

Upon review of the Surcharge Payer's objections, the Health Safety Net Office notifies the Surcharge Payer of its determination in writing. If the Health Safety Net Office disagrees with the Surcharge Payer's objections, in whole or in part, the Health Safety Net Office provides the Surcharge Payer with an explanation of its reasoning.
The Surcharge Payer may request a conference on objections after receiving the Health Safety Net Office's explanation of reasons. The Health Safety Net Office schedules such conference on objections only when it believes that further articulation of the Surcharge Payer's position is beneficial to the resolution of the disputed adjustments.

(e) Payment of Adjustment Amounts. Adjustment amounts and any interest penalty and late fee amounts are due to the Health Safety Net Trust Fund 30 calendar days following the mailing of the notification letter. If the Surcharge Payer submitted a written objection, then adjustment amounts and any interest penalty and late fee amounts are due to the Health Safety Net Trust Fund 30 calendar days following the mailing of the Health Safety Net Office's determination. The Health Safety Net Office may establish a payment schedule for adjustment amounts.

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

101 CMR, § 614.06 Payments to Acute Hospitals

(1) General Provisions.

(a) The Health Safety Net pays Acute Hospitals based on claims in accordance with the requirements of 101 CMR 613.00: Health Safety Net Eligible Services. The Health Safety Net Office monitors the volume of claims submitted and may adjust or withhold payments if it appears that there has been a substantial change in the Provider's service delivery patterns and/or billing activity including, but not limited to, unbundling of services, upcoding, or other billing maximization activities.

(b) Payment Types.

The Health Safety Net Office calculates Health Safety Net payments for each Acute Hospital for the following categories of claims for which the Health Safety Net is the primary payer:

a. Inpatient - Medical (under 101 CMR 614.06(2)(a) and (b)) ;

b. Inpatient - Psychiatric (under 101 CMR 614.06(2)(c)) ;

c. Inpatient - Rehabilitation (under 101 CMR 614.06(2)(d)) ;

d. Outpatient Services (under 101 CMR 614.06(3));

e. Physician Services (under 101 CMR 614.06(4));

f. Dental Services (under 101 CMR 614.06(5));

g. Acute Hospital Outpatient Pharmacies (under 101 CMR 614.06(6));

h. Vaccine Administration (under 101 CMR 614.06(7));

i. Emergency Bad Debt - Inpatient Medical (under 101 CMR 614.06(9));

j. Emergency Bad Debt - Inpatient Psychiatric (under 101 CMR 614.06(9));

k. Emergency Bad Debt - Outpatient (under 101 CMR 614.06(9)); and

l. Medical Hardship (under 101 CMR 614.06(10)).

Under 101 CMR 614.06(8), the Health Safety Net Office establishes payments for claims which the Health Safety Net is the secondary payer.
The Health Safety Net Office reduces payments by the amount of Emergency Bad Debt recoveries and investment income on free care endowment funds. The Health Safety Net Office determines the offset of free care endowment funds by allocating free care endowment income between Massachusetts residents and nonresidents using the best data available and offsetting the Massachusetts portion against Health Safety Net claims.

(c) Method of Payment. The Health Safety Net may make payments to Acute Hospitals for Eligible Services through a safety net care payment under the Massachusetts Section 1115 Demonstration Waiver, a MassHealth supplemental Acute Hospital rate payment, or a combination thereof. The Health Safety Net Office may limit an Acute Hospital's payment for Eligible Services to comply with requirements under the Massachusetts Section 1115 Demonstration Waiver governing safety net care, including cost limits or any other federally required limit on payments under 42 U.S.C. § 1396a(a)(13) or 42 CFR 447.

(d) Provider Preventable Conditions. The Health Safety Net does not pay for services related to Provider Preventable Conditions defined in 42 CFR 447.26. The Health Safety Net Office may issue administrative bulletins clarifying billing requirements and payment specifications for Provider Preventable Conditions.

(2) Pricing for Inpatient Services. The Health Safety Net Office prices Acute Hospital claims in accordance with the Medicare Inpatient Prospective Payment System (IPPS) for non-psychiatric claims and the Inpatient Psychiatric Facility Prospective Payment System (IPF-PPS) for psychiatric claims for the current Fiscal Year. Medicare pricing data is published in the Federal Register and pricing methodologies are described in 42 CFR 412. Claims from Acute Hospitals classified by Medicare as Critical Access Hospitals (CAHs), PPS-exempt Hospitals, Medicare Dependent Rural Hospitals, and Sole Community Hospitals are priced in accordance with 101 CMR 614.06(2)(b).

(a) Inpatient Medical Pricing - Standard. The Health Safety Net Office uses Medicare pricing data and the most current version of the Medicare severity diagnostic related group (MS-DRG) weights to calculate the inpatient medical pricing according to the IPPS for all Acute Hospitals except other Acute Hospitals in accordance with 101 CMR 614.06(2)(b). The Health Safety Net Office may update values as needed to conform to changes implemented by the Medicare program during the Fiscal Year. The pricing calculation includes Medicare adjustments for items such as high-cost outliers, transfer cases, special pay post-acute DRGs, partially eligible stays, and participation in the Acute Hospital Inpatient Quality Reporting program.

(b) Inpatient Medical Pricing - Other Acute Hospitals.

Critical Access Hospitals and PPS-exempt Hospitals. The Health Safety Net Office calculates a per discharge payment for discharges occurring at Medicare Critical Access Hospitals and PPS-exempt cancer and Pediatric Hospitals as follows.

a. The Health Safety Net Office determines the average charge per discharge using adjudicated and eligible Health Safety Net claims data from the Source Year that is available at the time of rate calculation.

b. The Health Safety Net Office determines an average cost per discharge by multiplying the average charge per discharge by an inpatient cost to charge ratio using data as reported on the Hospital Cost Report for the Source Year.

c. The average cost per discharge is increased by a cost adjustment factor determined by the percent change from the IPPS index level for the Source Year and the IPPS index level forecast for the Fiscal Year, as calculated by the Health Safety Net Office as of October 1^st of the Fiscal Year, and an additional factor of 1%. The product of this calculation is the per discharge payment applicable to all discharges occurring during the current Fiscal Year, except that partially eligible stays are paid pursuant to 101 CMR 614.06(2)(b)3.

d. If the Acute Hospital has fewer than 20 discharges in the Source Year, the Health Safety Net Office sets a payment on account factor for the Acute Hospital.

e. If a case qualifies as a transfer case under Medicare rules, the Health Safety Net Office calculates a per diem rate, capped at the full discharge payment. The per diem rate is the hospital-specific payment calculated under 101 CMR 614.06(2)(b)1., divided by the Acute Hospital's average length of stay.

Sole Community Hospitals. The Health Safety Net Office calculates a hospital specific per discharge amount for Acute Hospitals classified as Sole Community Hospitals, rather than the adjusted standardized amount. This amount is based on the hospital-specific rate provided by the Medicare fiscal intermediary, adjusted for inflation. The payments may include transfer, outlier, and special pay amounts, using the hospital-specific rate in these calculations, for qualifying cases. Partially eligible stays are paid pursuant to 101 CMR 614.06(2)(b)3.

Medicare Dependent Rural Hospitals. The Health Safety Net Office calculates a blended payment consisting of 75% of a hospital-specific payment and 25% of the Operating DRG Payment for Acute Hospitals classified by Medicare as Medicare Dependent Rural Hospitals. The payments may include transfer, outlier, and special pay amounts, using the hospital-specific blended rate in these calculations, for qualifying cases. Partially eligible stays are paid pursuant to 101 CMR 614.06(2)(b)3.

Psychiatric Case. A case is classified as psychiatric if

a. the Acute Hospital has a Medicare psychiatric unit;

b. the primary diagnosis is related to a psychiatric disorder; and

c. the claim includes psychiatric accommodation charges.

Psychiatric Pricing. The Health Safety Net Office uses Medicare pricing data to calculate a per diem price according to the IPF-PPS. The Health Safety Net Office may update values as needed to conform to changes implemented by the Medicare Program during the Fiscal Year. The pricing calculation includes Medicare adjustments such as a teaching hospital adjustment, electroconvulsive therapy (ECT) adjustment, high-cost outliers, adjustments for participation in the Inpatient Psychiatric Facilities Quality Reporting program, and any other adjustments in accordance with Medicare pricing provisions pursuant to 42 CFR 412.424, including adjustments for specific DRGs, the presence of comorbidities, Patient age, and length of stay.

(d) Inpatient Rehabilitation Pricing.

Rehabilitation Case. A case is classified as rehabilitation if

a. the Acute Hospital has a Medicare rehabilitation unit; and

b. the claim includes rehabilitation accommodation charges.

Payment. Rehabilitation cases are paid on a per diem basis. The payment is determined using the Acute Hospital's most recently filed CMS-2552 Cost Report. The rate is the sum of total rehabilitation PPS payments and reimbursable bad debts, divided by total rehabilitation days.

(e) Hospital-acquired Conditions.

All Acute Hospitals, including but not limited to PPS-exempt Acute Hospitals, are required to report the present on admission indicator for all diagnosis codes on inpatient claims.
The Health Safety Net Office does not assign an inpatient case to a higher paying MS-DRG if a hospital-acquired condition that was not present on admission occurs during the stay. For Hospital Services paid pursuant to 101 CMR 614.06(2)(a) and (b), the DRG payment is reduced in accordance with Medicare principles.

(f) Serious Reportable Events. The Health Safety Net does not pay for services related to Serious Reportable Events as defined in 105 CMR 130.332(A): Definitions Applicable to 105 CMR 130.332 based on standards by the National Quality Forum. The Health Safety Net Office may issue administrative bulletins clarifying billing requirements and payment specifications for such services.

(g) Administrative Days. The Health Safety Net pays Administrative Days at the per diem rate established by MassHealth pursuant to the Acute Hospital Request for Applications for the current Fiscal Year when the Health Safety Net is the primary payer. When the Health Safety Net is not the primary payer, Administrative Days are paid per 101 CMR 614.06(8).

(3) Pricing for Outpatient Services. The Health Safety Net pays a per visit amount for each outpatient visit that exceeds $20.00. An outpatient visit includes all outpatient services, excluding hospital-based physician services provided in a single day, except for dental and pharmacy services, as described in 101 CMR 614.06(5) and (6). The outpatient per visit amount is determined as follows.

(a) For each Acute Hospital, the Health Safety Net Office calculates an average outpatient charge per visit, using such adjudicated and eligible Health Safety Net claims data from the Source Year as of June 15, 2016. Charges for dental claims, charges for claims that are $20.00 or below, and charges for outpatient claims within 72 hours of an inpatient admission are excluded. For Critical Access Hospitals and PPS-exempt Hospitals, only charges for claims within 24 hours of an inpatient admission are excluded.

(b) The Health Safety Net Office determines a hospital-specific Medicare payment on account factor (PAF), defined as the percent of Medicare outpatient charges that are paid on average. The PAF is calculated using the best available data and subject to review and adjustment by the Health Safety Net Office.

(c) The Health Safety Net Office determines an outpatient payment per visit by multiplying the average outpatient charge per visit by the Medicare PAF. This product is further increased by a cost adjustment factor as calculated in 101 CMR 614.06(2)(b)1.c.

(d) Disproportionate Share Hospitals and non-teaching Acute Hospitals receive a transitional add-on of 25% of the outpatient per visit payment rate.

(e) The per visit payment for PPS-exempt cancer and Pediatric Hospitals and Medicare Critical Access Hospitals are determined using the ratio of costs to charges as reported on the Hospital Cost Report for the Source Year rather than the Medicare payment on account factor data.

(f) Claims for visits that are less than or equal to $20.00 are paid by multiplying the Medicare payment on account factor by the billed charges.

(4) Pricing for Physician Services. The Health Safety Net Office prices hospital-based physician service claims according to the Medicare Physician Fee Schedule.

(5) Dental Services. The Health Safety Net Office prices claims from Acute Hospitals for outpatient dental services provided at Acute Hospitals and Hospital Licensed Health Centers using the lesser of the allowable charges billed to the HSN, or the fees established in 101 CMR 314.00: DentalServices. No additional outpatient per visit payment is paid for dental services.

(6) Acute Hospital Outpatient Pharmacies.

(a) Prescribed Drugs. For Acute Hospitals with outpatient pharmacies, the Health Safety Net Office prices prescribed drugs using rates set forth in 101 CMR 331.00: Prescribed Drugs. The rate is reduced by the amount of Patient cost-sharing set forth in 101 CMR 613.00: Health Safety Net Eligible Services. Claims are adjudicated by the MassHealth Pharmacy Online Payment System.

(b) Part B Covered Services. Medical supplies normally covered by the Medicare Part B program that are dispensed by Acute Hospital outpatient pharmacies that are not Part B Providers are priced at 20% of the rates set forth in 101 CMR 322.00: Durable Medical Equipment, Oxygen, and Respiratory Therapy Equipment and 101 CMR 331.00: Prescribed Drugs.

(7) Vaccine Administration. The Health Safety Net Office allows for separate payment for a vaccine administration and an individual medical visit only if the vaccine administration is not occurring on the same day as the office visit. A separate fee for the administration of vaccines is payable only when the sole purpose for a visit is vaccine administration. The fee is priced in accordance with the provisions of 101 CMR 317.00: Rates for Medicine Services.

(8) Secondary Payer. The Health Safety Net pays claims for which it is not the primary payer as follows.

(a) 95% Rule. If a claim billed to the Health Safety Net has a ratio of total billed net charges to total claim charges that is greater than 95%, the Health Safety Net pays the claim in accordance with the applicable primary payment rules.

(b) Medicare as Primary Payer. For any allowable claim for which Medicare or a Medicare Advantage plan (as defined in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) is the primary payer, the Health Safety Net pays in accordance with 101 CMR 613.03(1)(c)8. If Medicare or a Medicare Advantage plan denied services on a claim as non-covered services and those services are Eligible Services, the payment for the services is the product of the net billed charges and the Medicare payment on account factor as defined in 101 CMR 614.06(3)(b), except as provided at 101 CMR 614.06(8)(e).

(c) MassHealth as Primary Payer. Health Safety Net pays allowable claims with MassHealth as the primary payer in accordance with 101 CMR 613.03(1)(c).

(d) Premium Assistance Payment Program Operated by the Health Connector as the Primary Payer. Health Safety Net pays allowable claims with Premium Assistance Payment Program Operated by the Health Connector as the primary payer in accordance with 101 CMR 613.03(1)(c).

(e) Private Insurance and Other Primary Payers. For any allowable claim for which a payer other than the payers discussed in 101 CMR 614.06(8)(b) through (d) is the primary payer, the Health Safety Net pays claims in accordance to 101 CMR 613.03(1)(c)4. The payment is the product of the net billed charges and the Medicare payment on account factor as defined in 101 CMR 614.06(3)(b). For inpatient services, the payment will not exceed the amount the Health Safety Net Office would have paid if it were the primary payer.

(9) Bad Debt Pricing. Except as provided at 101 CMR 614.06(9)(a), the Health Safety Net Office calculates Emergency Bad Debt payments for inpatient, psychiatric, and outpatient Eligible Services, using the methodology in 101 CMR 614.06(2) and (3), except that the Emergency Bad Debt outpatient rate does not include the transitional add-on cited in 101 CMR 614.06(3)(d).

(a) If an Acute Hospital has fewer than 20 Emergency Bad Debt claims during the Source Year, the Health Safety Net Office sets the Emergency Bad Debt rate as the outpatient primary per visit rate established in 101 CMR 614.06(3), excluding the transitional add-on under 101 CMR 614.06(3)(d).

(b) The Health Safety Net Office pays Hospital Licensed Health Centers 75% of the PPS Rate as published by Medicare for Bad Debt claims for Urgent Care Services that meet the requirements in 101 CMR 613.00: Health Safety Net Eligible Services.

(10) Medical Hardship. The Health Safety Net pays for claims for Patients deemed eligible for Medical Hardship pursuant to 101 CMR 613.00: Health Safety Net Eligible Services. The Health Safety Net Office reduces the amount of the billed charges by any third-party payments, third-party contractual discounts, Patient payments, and the amount of the Medical Hardship contribution. If the adjusted charges are less than the total claim charges, the claim is paid as a secondary claim in accordance with the provisions of 101 CMR 614.06(8). If the billed charges are not reduced, the Health Safety Net pays the claim as if it were a primary Health Safety Net claim.

(11) Other. The Health Safety Net makes an additional payment of $3.85 million to freestanding Pediatric Hospitals with more than 1,000 Medicaid discharges during the Source Year for which a standard payment amount per discharge was paid by MassHealth pursuant to the Acute Hospital Request for Applications, as determined by paid claims in the Medicaid Management Information System as of June 15, 2016, and for which MassHealth was the primary payer. The Health Safety Net may make an additional payment adjustment for the two Disproportionate Share Hospitals with the highest relative volume of free care costs in FY2006.

(12) Remediated Claims. Remediated claims include claims that were paid or voided during a prior Fiscal Year, but due to hospital resubmission or actions of the Health Safety Net Office were remediated by a payment or void during the current Fiscal Year. The Health Safety Net Office adjusts the payment or void amounts to reflect the applicable payment methods that would have been in use at the time of the original claim payment.

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

101 CMR, § 614.07 Payments to Community Health Centers

(1) General Provisions.

(a) The Health Safety Net pays Community Health Centers based on claims submitted to the Health Safety Net Office, less applicable cost sharing amount, in accordance with the requirements of 101 CMR 613.00: Health Safety Net Eligible Services and claims specifications determined by the Health Safety Net Office. The Health Safety Net Office monitors the volume of claims submitted and may adjust or withhold payments if it appears that there has been a substantial change in the Provider's service delivery patterns including, but not limited to, unbundling of services, upcoding, or other billing maximization activities.

(b) The Health Safety Net will pay a Community Health Center for prescribed drugs only if the Community Health Center is providing prescribed drugs in accordance with 101 CMR 613.03(2).

(2) Payments for Services.

(a) The Health Safety Net will pay Community Health Centers a Medicare-based rate per Patient per day for Reimbursable Health Services unless otherwise specified by the table below. Payment will be either the PPS Rate, or the total charges applicable under the PPS Rate for services furnished, whichever is less. The PPS Rate will be adjusted for geographic differences in the cost of services based on the Medicare FQHC PPS Geographic Adjustment Factors. In addition, the PPS Rate will be increased according to 42 CFR 405.2467 when a Community Health Center furnishes care to a Patient that is new to the Community Health Center or to a Patient receiving a comprehensive initial visit or an annual wellness visit.

(b) The PPS Rate applies to Individual Medical Visits, surgical procedures, behavioral health diagnostic and treatment services, diagnostic vision care, medical nutrition therapy, diabetes self-management treatment, and tobacco cessation services. Only one visit per Patient per day can be billed with the following exceptions:

when a mental health visit occurs on the same day as a medical visit; or

when an illness or injury necessitating a visit occurs on the same day as another visit.

(c) For Reimbursable Health Services not included in the PPS Rate, the Health Safety Net pays Community Health Centers according to the following table, except for claims for Bad Debt for Urgent Care Services. Payments are based on regulations named. Some Reimbursable Health Services under 101 CMR 614.07(2) may be listed as individual consideration in the regulations named. For individual consideration codes billable to the Health Safety Net, the payment rate is calculated as (total payments made to Community Health Centers by MassHealth for the code) / (total number of claims paid by MassHealth for the code) during the Source Year. If MassHealth payment and claims information for a code is not available for Source Year, the rate for the code will be based on Medicare fee schedules or other relevant sources. The Health Safety Net pays only for services listed in the HSN CHC Billable Procedure Codes list.

| Type of Service | Payment Rules | Payment Source | | --- | --- | --- | | Medical Visit - Urgent Care (code 99051) | Payable separately from an Individual Medical Visit. | Rate for 99050 in 101 CMR 304.00: Rates for Community Health Centers | | Pulmonary Diagnostic (technical component only) | Payable separately only if not occurring on the same day as an Individual Medical Visit. | 101 CMR 317.00: Rates for Medicine Services. | | Cardiology Diagnostic (technical component only) | Payable separately from an Individual Medical Visit. | 101 CMR 317.00: Rates for Medicine Services. | | Obstetrical Services | Payable separately from an Individual Medical Visit | 101 CMR 316.00: Rates for Surgery and Anesthesia Services | | Behavioral Health (group treatment, medication management, psychological testing, and methadone services) | Payable separately from an Individual Medical Visit. | For group treatment and medication visits, rates in 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health Centers and Mental Health Centers; for psychological testing, rates in 101 CMR 329.00: Psychological Testing, Treatment, and Related Services; for methadone services, rates in 101 CMR 346.00: Rates for Certain Substance-related and Addictive Disorders Programs | | Radiology | Payable separately from an Individual Medical Visit. | 101 CMR 318.00: Rates for Radiology Services | | Clinical Laboratory | Payable separately from an Individual Medical Visit. | 101 CMR 320.00: Rates for Clinical Laboratory Services | | Dental | Payable separately from an Individual Medical Visit. | Lesser of allowable charges billed to the HSN, or fees established in 101 CMR 314.00: Rates for Dental Services | | 340B Pharmacy Services | Payment will be reduced by the amount of Patient cost-sharing set forth in 101 CMR 613.00: Health Safety Net Eligible Services. | 101 CMR 331.00: Prescribed Drugs | | Vision Care (dispensing and repair) | Payable separately from an Individual Medical Visit. | 101 CMR 315.00: Vision Care Services and Ophthalmic Materials | | Family Planning Services | Family planning counseling, prescribed drugs, family planning supplies, and related laboratory tests can be billed in addition to an Individual Medical Visit. An Individual Medical Visit is not payable for the sole purpose of replenishing a Patient's supply of contraceptives. | 101 CMR 312.00: Rates for Family Planning Services | | Preventive Services/Risk Factor Reduction (code 99402) | Payable separately from an Individual Medical Visit. | 101 CMR 312.00: Rates for Family Planning Services | | Immunization Visits | Payable separately only if not occurring on the same day as an Individual Medical Visit. | 101 CMR 317.00: Rates for Medicine Services | | Vaccines Not Included in the Individual Medical Visit or Supplied by the Department of Public Health | Payable separately from an Individual Medical Visit. | 101 CMR 317.00: Rates for Medicine Services |

(3) Bad Debt Payments for Urgent Care Services. The Health Safety Net pays Community Health Centers at 75% of the payment rates in 101 CMR 614.07(2) for Bad Debt claims for Urgent Care Services that meet the requirements in 101 CMR 613.00: Health Safety Net Eligible Services.

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

101 CMR, § 614.08 Reporting Requirements

(1) General. Each Provider, Surcharge Payer, and Ambulatory Surgical Center must file with or make available to the Health Safety Net Office or to an entity designated by the Health Safety Net Office to collect data, as applicable, information that is required or that the Health Safety Net Office deems reasonably necessary for implementation of 101 CMR 614.00.

(a) The Health Safety Net Office may revise the data specifications, the data collection scheduled, or other administrative requirements by administrative bulletin.

(b) The Health Safety Net Office or its designee may audit data submitted under 101 CMR 614.00 to ensure accuracy. The Health Safety Net Office may adjust payments to reflect audit findings. Providers must maintain records sufficient to document compliance with all documentation requirements of 101 CMR 613.00: Health Safety Net Eligible Services and 614.00.

(2) Acute Hospitals.

(a) The Health Safety Net Office may require Acute Hospitals to submit interim data on revenues and costs to the Health Safety Net or to an entity designated by the Health Safety Net Office to collect data to monitor compliance with federal upper limit, cost limit, and disproportionate share payment limits. Such data may include, but not be limited to, gross and net patient service revenue for Medicaid non-managed care, Medicaid managed care, the Premium Assistance Payment Program Operated by the Health Connector, and all payers combined; and total patient service expenses for all payers combined.

(b) Surcharge Payment Data.

Unmatched Payer Report. Each Acute Hospital must submit to the Health Safety Net Office a quarterly Unmatched Payer Report. The Acute Hospital must report the total amount of payments for services received from each Institutional Payer that does not appear on the Registered Payer List. The Acute Hospital must report these data in an electronic format specified by the Health Safety Net Office.

Quarterly Report for Private Sector Payments. Each Acute Hospital must report to the Health Safety Net Office total payments made by the largest Institutional Surcharge Payers. The Health Safety Net Office specifies the Institutional payers for which reporting is required, the periods for which reporting is required, and the reporting format. The Health Safety Net Office may modify the reporting requirements by administrative bulletin.

(c) Penalties. The Health Safety Net Office may deny payment for Eligible Services to any Acute Hospital that fails to comply with the reporting requirements of 101 CMR 613.00: Health Safety Net Eligible Services or 614.00 until such Acute Hospital complies with the requirements. The Health Safety Net Office notifies such Acute Hospital in advance of its intention to withhold payment.

(3) Community Health Centers. The Health Safety Net Office may deny payment for Eligible Services to any Community Health Center that fails to comply with the reporting requirements of 101 CMR 613.00: Health Safety Net Eligible Services or 614.00 until such Community Health Center complies with the requirements. The Health Safety Net Office notifies such Community Health Center in advance of its intention to withhold payment.

(4) Surcharge Payers.

(a) Monthly Surcharge Payment Report. The Health Safety Net Office may require that an Institutional Payer submit to the Health Safety Net Office monthly reports of payments to Acute Hospitals and Ambulatory Surgical Centers.

(b) Third Party Administrators. A Third Party Administrator Surcharge Payer that makes payments to Acute Hospitals and Ambulatory Surgical Centers on behalf of one or more insurance carriers must file an annual report with the Health Safety Net Office. The report must include the name of each insurance carrier for which it makes surcharge payments. The Health Safety Net Office may also specify additional reporting requirements concerning payments made on behalf of self-insured plans. Reports must be in an electronic format specified by the Health Safety Net Office. Said reports must be filed by July 1^st of each year for the time period requested by the Health Safety Net Office.

(c) Penalties. Any Surcharge Payer that fails to file data, statistics, schedules, or other information with the Health Safety Net Office pursuant to 101 CMR 614.08(4) or that falsifies same, is subject to a civil penalty of not more than $5,000 for each day on which such violation occurs or continues, which penalty may be assessed in an action brought on behalf of the Commonwealth in any court of competent jurisdiction. The Attorney General brings any appropriate action, including injunction relief, as may be necessary for the enforcement of the provisions of 101 CMR 614.00.

(5) Ambulatory Surgical Centers.

(a) Unmatched Payer Report. Each Ambulatory Surgical Center must submit a quarterly Unmatched Payer Report to the Health Safety Net Office in accordance with a schedule specified by the Health Safety Net Office. The Ambulatory Surgical Center must report the total amount of payments for services received from each Institutional Surcharge Payer that does not appear on the Registered Payer List. The Ambulatory Surgical Center must report these data in an electronic format specified by the Health Safety Net Office.

(b) Quarterly Report for Private Sector Payments. Each Ambulatory Surgical Center must report to the Health Safety Net Office total payments made by the largest Institutional Surcharge Payers. The Health Safety Net Office specifies the Institutional Payers for which reporting is required, the periods for which reporting is required, and the reporting format. The Health Safety Net Office may modify the reporting requirements by administrative bulletin.

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

101 CMR, § 614.09 Special Provisions

(1) Financial Hardship. An Acute Hospital or Surcharge Payer may request a deferment or partial payment schedule due to financial hardship.

(a) In order to qualify for such relief, the Acute Hospital or Surcharge Payer must demonstrate that its ability to continue as a financially viable going concern will be seriously impaired if payments pursuant to 101 CMR 614.05 were made.

(b) If the Health Safety Net Office finds that payments would be a financial hardship, the Health Safety Net Office may, at its discretion, establish the terms of any deferment or partial payment plan deferment. The deferment or payment schedule may include an interest charge.

The interest rate used for the payment schedule does not exceed the prime rate plus 2%. The prime rate used is the rate reported in the Wall Slreel Journal dated the last business day of the month preceding the establishment of the payment schedule.
A Surcharge Payer may make a full or partial payment of its outstanding liability at any time without penalty.
If a Surcharge Payer fails to meet the obligations of the payment schedule, the Health Safety Net Office may assess penalties pursuant to 101 CMR 614.05.

(2) Severability. The provisions of 101 CMR 614.00 are severable. If any provision or the application of any provision to any Acute Hospital, Community Health Center, surcharge payer, or Ambulatory Surgical Center or circumstances is held to be invalid or unconstitutional, and such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 614.00 or the application of such provisions to Acute Hospitals, Community Health Centers, or circumstances other than those held invalid.

(3) Administrative Bulletins. The Health Safety Net Office may issue administrative bulletins to clarify policies and understanding of substantive provisions of 101 CMR 614.00 and specify information and documentation necessary to implement 101 CMR 614.00.

History

Adopted by Mass Register Issue 1263, eff. 6/20/2014.

COMMUNITY HOSPITAL REINVESTMENT TRUST FUND PAYMENTS AND FUNDING COMMUNITY HOSPITAL REINVESTMENT TRUST FUND PAYMENTS AND FUNDING

101 CMR, § 701.01 General Provisions

(1) Scope and Purpose. 101 CMR 701.00 governs the Community Hospital Reinvestment Trust Fund payments and funding, including payments to eligible acute care hospitals and payments from the Center. 101 CMR 701.00 does not govern other payments to acute care hospitals, including payments pursuant to contracts under the Acute Care Hospital Request for Applications.

(2) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 701.00.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 701.02 General Definitions

As used in 101 CMR 701.00, terms will have the meanings set forth in 101 CMR 701.02, except where the context clearly indicates otherwise.

Acute Care Hospital. A hospital licensed under M.G.L. c. 111, § 51 that contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the Department of Public Health.

Center. The Center for Health Information and Analysis established under M.G.L. c. 12C.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Gross Patient Service Revenue (GPSR). The total dollar amount of a hospital's charges for the provision of patient care rendered in a hospital rate year.

Hospital Cost Report. The Hospital Statement of Costs, Revenues, and Statistics reported to the Center pursuant to 957 CMR 9.00: Hospital Financial Data Reporting Requirements .

Hospital Rate Year. The time period of 12 months beginning on October 1^st of any calendar year and ending on September 30^th of the following calendar year.

State Fiscal Year. The time period of 12 months beginning on July 1^st of any calendar year and ending on June 30^th of the following calendar year.

Statewide Relative Price (SRP). A metric calculated by the Center pursuant to M.G.L. c. 29, § 2TTTT and c. 12C, § 10. The SRP measures the total payments, including non-claims, made to acute care hospitals by health plans, expressed in the aggregate relative to a statewide average within a given insurance category.

Trust Fund. The Community Hospital Reinvestment Trust Fund established under M.G.L. c. 29, § 2TTTT, effective October 1, 2016, to provide annual financial support to eligible acute care hospitals, as specified in 101 CMR 701.00. The Secretary of EOHHS, as trustee, will administer the fund and will make expenditures from the fund consistent with M.G.L. c. 29, § 2TTTT.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 701.03 Sources and Uses of Fund

(1) General. The Trust Fund may include money from public and private sources, including gifts, grants and donations, interest earned on such money, any other money authorized by the general court and specifically designated to be credited to the fund (including, but not limited to, transfers from the Center), and any funds provided from other sources.

(2) Transfers from the Center.

(a) State Fiscal Year 2017. Subject to appropriation, and not later than June 30, 2017, the Center will transfer $5,000,000 to the Trust Fund.

(b) State Fiscal Years 2018 Through 2021. Subject to appropriation, and not later than June 30^th of each year, beginning with State Fiscal Year 2018 through State Fiscal Year 2021, the Center will annually transfer $10,000,000 to the Trust Fund.

(3) Payment to Acute Care Hospitals. In each state fiscal year in which funding is available in the Trust Fund, such funding shall be used to provide payments to eligible acute care hospitals, pursuant to 101 CMR 701.04.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 701.04 General Payment Provisions

(1) Payment Eligibility. To be eligible to receive payment from the Trust Fund, an acute care hospital must be:

(a) licensed under M.G.L. c. 111, § 51, as defined by the Department of Public Health; and

(b) a hospital with SRP below 120% of the median SRP, as determined by the Center.

(2) Payment Conditions.

(a) As a condition of receiving payments from the Trust Fund, EOHHS may require an eligible acute care hospital to provide an attestation, in a format prescribed by EOHHS, agreeing to an independent financial and operational audit to recommend steps to increase sustainability and efficiency of the acute care hospital.

(b) EOHHS may also require that eligible acute care hospitals utilize payments received from the Trust Fund to conduct the independent financial and operational audit described in 101 CMR 701.04(2)(a) and/or to advance steps recommended in the audit for improving or continuing health care services that benefit the uninsured, underinsured, and MassHealth populations.

(c) EOHHS may, via administrative bulletin or other written issuance, establish rules governing various conditions of payment, including, but not limited to, attestations, reporting requirements, compliance with payment conditions, penalties for noncompliance, and recovery.

(3) Timing of Payments. EOHHS will direct payments to eligible acute care hospitals from the Trust Fund each state fiscal year in which funding is available in the Trust Fund, and may make such payments in installments.

(4) Payment Methodology.

(a) Data Source.

Determination of GPSR. GPSR is determined using Hospital Cost Reports submitted to the Center pursuant to 957 CMR 9.00: Hospital Financial Data Reporting Requirements .

Determination of SRP. SRP is determined using data submitted to the Center pursuant to 957 CMR 2.00: Payer Data Reporting .

(b) Calculation of Median SRP. The Center will calculate annually a median SRP and identify acute care hospitals with SRP below 120% of the median SRP.

EOHHS will allocate payments to eligible acute care hospitals based on:

a. the proportion of each eligible acute care hospital's GPSR to the combined GPSR of all eligible acute care hospitals; and

b. The distance of each eligible acute care hospital's SRP from 120 % of the median SRP such that eligible Acute Care Hospitals with SRP that fall further below 120 % of the median SRP receive proportionally greater payments.

Calculation of payments for eligible acute care hospitals.

a. Calculate a hospital-specific GPSR weight, which is equal to 100 % plus the hospital's percent of the combined GPSR of all eligible hospitals, using the following formula:

[Hospital_n GPSR weight = 100% + (Hospital_n GPSR / [SIGMA] All hospitals GPSR)]

b. Calculate a hospital-specific SRP weight, which is equal to the difference between the hospital's SRP and 120 % of the median SRP, divided by the hospital's SRP, using the following formula:

[Hospital_n SRP weight = (120% of the median SRP - Hospital_n SRP) / Hospital_n SRP]

Example: A hospital-specific SRP weight of 1.0 corresponds to a hospital with an SRP that is 60 % of the median SRP; that is:

[(120 % of the median SRP) - (60% of the median SRP)] / (60% of the median SRP) = 1.0

For each hospital, a total weight is calculated by multiplying the hospital-specific GPSR weight calculated in 101 CMR 701.04(4)(c)2.a. by the hospital-specific SRP weight calculated in 101 CMR 701.04(4)(c)2.b., according to the following formula:

[Total weight for Hospital_n = Hospitaln GPSR weight * Hospital_n SRP weight]

For each hospital, a normalized total weight is calculated by dividing the hospital-specific total weight described in 101 CMR 701.04(4)(c)3. by the combined total weight of all eligible acute care hospitals according to the following formula:

[Normalized total weight for Hospital_n = Hospitaln total weight / [SIGMA]Total weight of all hospitals]

The potential payment for each hospital is calculated by multiplying the total funding available from the Trust Fund in a state fiscal year by the hospital's normalized total weight calculated in 101 CMR 701.04(4)(c)4., according to the following formula:

[Potential Payment for Hospital_n = Total funding available from the Trust Fund in a state fiscal year * Hospital_n normalized total weight]

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 701.05 Filing and Reporting Requirements

(1) General Provisions.

(a) Accurate Data. All reports, schedules, additional information, books, and records that are filed or made available to EOHHS must be certified under pains and penalties of perjury as true, correct, and accurate by the Executive Director or Chief Financial Officer of the eligible acute care hospital.

(b) Examination of Records. Each eligible acute care hospital must make available all records relating to its operation and all records relating to a realty service or holding company or any entity in which there may be a common ownership or interrelated directorate upon request of EOHHS for examination.

(c) Field Audits. EOHHS or its designee may conduct field audits of eligible acute care hospitals to verify compliance with any aspect of 101 CMR 701.00.

(2) Required Reports.

(a) Each eligible acute care hospital that receives payments from the Trust Fund must file or make available all records and information necessary to demonstrate compliance with 101 CMR 701.00 upon EOHHS request, including documentation of the uses of such payments.

(b) Following the audit described in 101 CMR 701.04(2), eligible acute care hospitals must submit a report to EOHHS in a format prescribed by EOHHS documenting the audit's findings, steps recommended to increase sustainability and efficiency of the acute care hospital, and the acute care hospital's proposal to use payments received from the Trust Fund to advance steps recommended in the audit for improving or continuing health care services that benefit the uninsured, underinsured, and MassHealth populations.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 701.06 Noncompliance

EOHHS may deny, reduce, or withhold payment to an eligible acute care hospital that fails to comply with any condition of payment or reporting requirement set forth in 101 CMR 701.00. EOHHS will notify the acute care hospital of its intention to deny, reduce, or withhold payment.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

101 CMR, § 701.07 Severability

The provisions of 101 CMR 701.00 are severable. If any provision of 101 CMR 701.00 or the application of such provision of 101 CMR 701.00 is held invalid or unconstitutional, such determination will not be construed to affect the validity or constitutionality of any other provision of 101 CMR 701.00 or the application of any other provision.

History

Adopted by Mass Register Issue 1340, eff. 6/2/2017.

Drug Manufacturer Negotiations and Accountability Drug Manufacturer Negotiations and Accountability

101 CMR, § 801.01 General Provisions

(1) Scope and Purpose. 101 CMR 801.00 governs the process for direct negotiations between the Executive Office of Health and Human Services (EOHHS) and manufacturers for supplemental rebate agreements (SRAs), the public process for determining a drug's target value, and referrals of manufacturers to the Health Policy Commission (HPC).

(2) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 801.00.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 801.02 Definitions

As used in 101 CMR 801.00, terms will have the meanings set forth in 101 CMR 801.02, except where the context clearly indicates otherwise.

Covered Drug. A pharmaceutical product for which coverage is, or is reasonably anticipated to become, available from MassHealth for eligible members.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Health Policy Commission (HPC). The commission established under M.G.L. c. 6D.

High-cost Drug. A covered drug projected by EOHHS to exceed a post-rebate cost per utilizer of $25,000 annually or an aggregate annual post-rebate cost to MassHealth of $10,000,000, based on factors including actual or expected utilization, prevalence of the disease or condition that is treated by the coved drug, dosing information, duration of therapy, and price of the covered drug after application of the manufacturer's mandated rebate under the MDRP.

Manufacturer. An entity that manufactures a covered drug.

MassHealth. The medical assistance and benefit programs administered by EOHHS pursuant to Title XIX of the Social Security Act ( 42 U.S.C. §§ 1396 et seq .), Title XXI of the Social Security Act ( 42 U.S.C. §§ 1397aa et seq .), M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services to eligible members.

Medicaid Drug Rebate Program (MDRP). The program authorized by Section 1927 of the Social Security Act ( 42 U.S.C. §§ 1396r-8 et seq .) under which participating manufacturers are required to enter and have in place a national rebate agreement with the Secretary of the federal Department of Health and Human Services in exchange for state Medicaid coverage of most of the manufacturer's drugs, and under which such manufacturers are required to pay a rebate to states for such drugs paid for by the state's Medicaid program pursuant to a statutory formula.

Secretary. The Secretary of the Massachusetts Executive Office of Health and Human Services.

Supplemental Rebate Agreement (SRA). An agreement authorized by Section 1927 of the Social Security Act ( 42 U.S.C. §§ 1396r-8 et seq .) and in a format approved by the federal Centers for Medicare & Medicaid Services between EOHHS and a manufacturer memorializing the terms and conditions for payments by the manufacturer for covered drugs dispensed or administered for use by MassHealth members and included on claims paid by EOHHS or a participating MassHealth managed care entity, as applicable. The payment is in addition to the manufacturer's mandated rebate under the MDRP and may be structured as a traditional or value-based arrangement, as appropriate.

Third-party. An entity that is not:

(a) a manufacturer;

(b) EOHHS;

(c) another state department, agency, subdivision, office, board, commission, or institution of the executive, judicial, or legislative branches of the Commonwealth; or

(d) an individual employed by an entity described in 101 CMR 801.02: Third-party(a) through (c).

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 801.03 Direct Negotiations

(1) General.

(a) EOHHS may enter into direct negotiations with any manufacturer for an SRA for any covered drug(s) manufactured by the manufacturer. Such negotiations may be initiated by EOHHS or by the manufacturer, provided that nothing obligates EOHHS to engage in negotiations with any manufacturer.

(b) EOHHS will seek to prioritize direct negotiations in a manner that maximizes value to the Commonwealth, and will only enter into an SRA if EOHHS determines that doing so will maximize value to the Commonwealth in a manner consistent with the concept of "best value" as defined at 801 CMR 21.02: Definitions and consideration of the factors described in 101 CMR 801.03(3), as appropriate.

(c) Nothing precludes EOHHS from utilizing the processes described at 801 CMR 21.00: Procurement of Commodities or Services, including Human and Social Services , or any other process allowed under state law, to enter into an SRA as an alternative to a direct negotiation.

(2) Possible Outcomes.

(a) A direct negotiation is considered successful if it results in an executed SRA between EOHHS and the manufacturer.

(b) An actual or attempted direct negotiation is considered to have failed if:

EOHHS and the manufacturer do not execute an SRA as a result of the actual or attempted direct negotiation;
EOHHS has presented the manufacturer with an offer or counteroffer including, at minimum, the material SRA terms desired by EOHHS, and the manufacturer has had a reasonable opportunity to accept or reject such terms; and
EOHHS has provided written notice to the manufacturer of the agency's determination that the actual or attempted direct negotiation has failed, provided that such notice must be sent at least 30 days before EOHHS initiates the process described in 101 CMR 801.04, and provided further that EOHHS identifies in the notice if the covered drug is a high-cost drug eligible for the process described in 101 CMR 801.04.

(c) If neither the condition of 101 CMR 801.03(2)(a) nor the conditions of 101 CMR 801.03(2)(b) are satisfied, the direct negotiation is considered to be open, unless EOHHS notifies the manufacturer in writing of its withdrawal from the negotiation.

(3) Factors for Consideration.

(a) In determining whether to enter into direct negotiations with a manufacturer, or whether to enter into an SRA as a result of such negotiations, EOHHS may consider the following factors, as applicable, provided that EOHHS's consideration of such factors is consistent with the principles set forth in 801 CMR 21.01: Purpose, Application and Authority :

Information regarding the clinical efficacy, effectiveness, and outcomes of the covered drug;
Information relating to the pricing of the covered drug including, but not limited to, information relating to prices paid in other countries;
The covered drug's post-rebate price to the Medicaid program as compared to its therapeutic benefits including, but not limited to, the seriousness and prevalence of the disease or condition that is treated by the drug, and the extent to which the drug addresses an unmet medical need or impacts affected patient subpopulations;
The extent of utilization or expected utilization of the covered drug within the Medicaid population;
The likelihood that the use of the covered drug will reduce the need for other care, reduce caregiver burden, or enhance quality of life;
Whether there are therapeutic equivalents of the covered drug, and the number of such equivalents available;

Characteristics of the covered drug, including means and setting of administration, dosing frequency, duration of therapy, side effects, interactions and contraindications, and potential for misuse or abuse;

Analyses by independent third parties, provided that EOHHS will consider, as available, the methodologies and models used in the analysis, any assumptions and potential limitations of the analysis, and outcomes for specific subpopulations, if applicable;
The extent to which the manufacturer of the covered drug has entered into other SRAs;
Any information supplied by the manufacturer; and
Other appropriate measures or analysis related to the value, efficacy, or outcomes of the covered drug.

(b) If EOHHS engages a third-party to provide a cost-effectiveness analysis in evaluating whether to enter into an SRA, the analysis must include:

a description of the methodologies and models used in the analysis;
any assumptions and potential limitations of the analysis; and
outcomes for specific subpopulations, if applicable.

(c) EOHHS may, provided that doing so is consistent with its obligations under 101 CMR 801.03(1)(b), share with the manufacturer for review and input during the course of a direct negotiation any information, analyses, or reports regarding a covered drug relied on by EOHHS in developing an offer or counter offer for an SRA, and will consider any information provided by the manufacturer in response. Subject to 101 CMR 801.04(2)(e), nothing will compel EOHHS to share such information with the manufacturer during the direct negotiation process.

(4) Implications of Executed SRA. In the event EOHHS and the manufacturer execute an SRA for a covered drug, whether through the process described in 101 CMR 801.03 or otherwise, EOHHS will not subject the covered drug to the process described in 101 CMR 801.04 or a referral under 101 CMR 801.05 during the term of the SRA with the intent of securing an enhanced rebate for the covered drug from the manufacturer, provided that nothing prohibits EOHHS and the manufacturer from agreeing in good faith to amend or terminate the SRA as otherwise allowed under the terms of the SRA.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 801.04 Determination of Target Value

(1) General. EOHHS may determine a target value for any covered drug that meets the following requirements:

(a) The covered drug must be a high-cost drug; and

(b) The covered drug must have been the subject of a failed direct negotiation under 101 CMR 801.03(2)(b).

(2) Process for Determining Target Value.

(a) EOHHS may publicly post a proposed target value for any covered drug that meets the requirements of 101 CMR 801.04(1).

(b) At least 30 days before finalizing the proposed target value, EOHHS will afford interested persons an opportunity to present data, views or arguments in regard to the proposed target value.

(c) At the sole discretion of the Secretary, EOHHS may hold a public hearing on the proposed target value, provided that EOHHS provides notice to the public at least 30 days prior to the hearing. Any testimony at the public hearing will be given under oath.

(d) In order to provide public notice of the opportunity to comment, and advertise a public hearing, if applicable, EOHHS will, on a dedicated location of the EOHHS website, post a notice, including the following:

the proposed target value of the covered drug;
a summary of the rationale for the proposed target value;
a list of any third-party cost-effectiveness analysis relied on in setting the proposed target value;
the manner in which data, views, or arguments regarding the proposed target value may be submitted to the agency by any interested person, including the deadline for such comments; and
the time and place of a public hearing, if applicable.

EOHHS may file a copy of such notice with the Secretary of the Commonwealth for publication in the Massachusetts Register .

(e) Not later than concurrently with the posting of the public notice described in 101 CMR 801.04(2)(d), EOHHS will provide written notice to the manufacturer of its proposed target value, a copy of the public notice described at 101 CMR 801.04(2)(d), and will share with the manufacturer for review and input any information, analyses or reports regarding a covered drug relied on by EOHHS in developing the proposed target value described in 101 CMR 801.04(2)(a) and, if different, any information, analyses or reports regarding a covered drug relied on by EOHHS in developing any proposed supplemental rebate amount included in the offer or counteroffer described in 101 CMR 801.03(2)(b)2.

(f) Prior to finalizing the proposed target value, EOHHS will consider any comments or testimony received by the specified deadline, including any comments, clarifications, or data submitted by the manufacturer of the covered drug, and will make updates to the proposed target value, as appropriate, and consider whether to reopen negotiations with the manufacturer under 101 CMR 801.04(2)(a).

(g) After completion of the analysis described in 101 CMR 801.04(2)(f), and subject to 101 CMR 801.04(4), if applicable, EOHHS may post a final target value for the covered drug on a dedicated location of the EOHHS website, and also may file a copy of the target value with the Secretary of the Commonwealth for publication in the Massachusetts Register .

(3) Factors for Consideration.

(a) In establishing a target value for a covered drug, EOHHS may consider the following factors, as applicable:

Information regarding the clinical efficacy, effectiveness, and outcomes of the covered drug;

Information relating to the pricing of the covered drug including, but not limited to, information relating to prices paid in other countries;
The covered drug's net price to the Medicaid program as compared to its therapeutic benefits including, but not limited to, the seriousness and prevalence of the disease or condition that is treated by the drug, and the extent to which the drug addresses an unmet medical need or benefits particular patient subpopulations;
The extent of utilization or expected utilization of the covered drug within the Medicaid population;
The likelihood that the use of the covered drug will reduce the need for other care, reduce caregiver burden, or enhance quality of life;
Whether there are therapeutic equivalents of the covered drug, and the number of such equivalents available;

Characteristics of the drug, including means and setting of administration, dosing frequency, duration of therapy, side effects, interactions and contraindications, and potential for misuse or abuse;

Analyses by independent third parties, provided that EOHHS will consider, as available, the methodologies and models used in the analysis, any assumptions and potential limitations of the analysis, and outcomes for specific subpopulations, if applicable;
Any information supplied by the manufacturer or the public; and

Other appropriate measures or analysis related to the value, efficacy or outcomes of the covered drug.

(b) If EOHHS engages a third-party to provide a cost-effectiveness analysis in establishing a target value, the analysis must include:

a description of the methodologies and models used in the analysis;
any assumptions and potential limitations of the analysis; and
outcomes for specific subpopulations, if applicable.

(4) Opportunity to Reopen Negotiations.

(a) At any time prior to posting a final target value for a covered drug under 101 CMR 801.04(2)(g), EOHHS may reopen direct negotiations with a manufacturer by presenting the manufacturer with an updated offer or counteroffer including, at minimum, the material SRA terms desired by EOHHS, provided that the manufacturer has a reasonable opportunity to accept or reject such terms.

(b) In the event that EOHHS and the manufacturer do not execute an SRA for the covered drug after direct negotiations are reopened under 101 CMR 801.04(4)(a), EOHHS may post a final target value for the covered drug under 101 CMR 801.04(2)(g).

(c) EOHHS may also initiate a request, or consider a request by a manufacturer to reopen direct negotiations at any time prior to referring a covered drug to the HPC under 101 CMR 801.05, provided that nothing obligates EOHHS to enter into such further negotiations.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 801.05 Referral to the Health Policy Commission

(1) General.

(a) EOHHS may refer a manufacturer to the HPC for review of a covered drug under M.G.L. c. 6D, § 8A, provided that the following conditions are met:

The covered drug meets the requirements of 101 CMR 801.04(1), and EOHHS and the manufacturer have not subsequently executed an SRA for the covered drug under 101 CMR 801.04(4) or otherwise;

EOHHS has posted a final target value for the covered drug under 101 CMR 801.04(2)(g) and not more than 180 days have passed since EOHHS has posted said final target value; and

The Secretary has provided written notice of the referral to the HPC, with a copy to the manufacturer.

(b) EOHHS may publicly post a copy of the referral notice on a dedicated location of the EOHHS website.

(2) Referral Contents.

(a) Upon referral of a manufacturer under 101 CMR 801.05(1), and notwithstanding 101 CMR 801.06, EOHHS may share or make available to the HPC any records that describe or relate to manufacturer's pricing of the covered drug, including any information shared with the manufacturer under 101 CMR 801.04(2)(e), and any information received from the manufacturer under 101 CMR 801.04(2)(f), provided that the status of any information subject to 101 CMR 801.06 will not be impacted by making such information available to the HPC.

(b) EOHHS considers any information shared with the HPC under 101 CMR 801.05(2)(a) to be a disclosure made for the express purpose of carrying out Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq. ).

(3) Opportunity to Reopen Negotiations.

(a) EOHHS may initiate a request, or consider a request by a manufacturer to reopen direct negotiations at any time after referring a covered drug to the HPC under 101 CMR 801.05, provided that nothing obligates EOHHS to enter into such further negotiations.

(b) The fact that EOHHS enters into direct negotiations with a manufacturer under 101 CMR 801.05(3)(a) will have no impact on the referral of that manufacturer to the HPC unless EOHHS withdraws the referral under 101 CMR 801.05(4).

(4) Withdrawal of Referral.

(a) At any time prior to the issuance of the determination described in M.G.L. c. 6D, § 8A(h), EOHHS may withdraw the referral of a manufacturer to the HPC under 101 CMR 801.05(1)(a) upon written notice to the HPC, with a copy to the manufacturer.

(b) If EOHHS has publicly posted a copy of the referral notice under 101 CMR 801.05(1)(b), EOHHS will post a copy of the withdrawal notice on a dedicated location of the EOHHS website.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 801.06 Confidentiality

Subject to 101 CMR 801.05(2), any non-public information shared with EOHHS by the manufacturer during the course of a direct negotiation under 101 CMR 801.03 or during the process for determining a target value under 101 CMR 801.04, or by the HPC under M.G.L. c. 6D, § 8A, will not be a public record under M.G.L. c. 4, § 7 or M.G.L. c. 66, and EOHHS will regard any records expressly designated as such by the manufacturer or HPC as confidential and proprietary.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 801.07 Interaction with Other Regulations

The application of any provision of 101 CMR 801.00, including the determination of a target value under 101 CMR 801.04, does not constitute a determination of medical necessity for a covered drug by the MassHealth agency for any individual MassHealth member, a determination that payment is available for a covered drug from the MassHealth agency to any MassHealth provider, or establish the rate of payment for any covered drug by EOHHS, and does not otherwise supersede any other applicable provision of another MassHealth or EOHHS regulation, including 101 CMR 331.00: Prescribed Drugs , 130 CMR 406.000: Pharmacy Services , or 130 CMR 450.000: Administrative and Billing Regulations .

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.

101 CMR, § 801.08 Severability

The provisions of 101 CMR 801.00 are severable. If any provision or subprovision of 101 CMR 801.00 or the application of such provision or subprovision of 101 CMR 801.00 is held invalid or unconstitutional, such determination will not be construed to affect the validity or constitutionality of any other provision or subprovision of 101 CMR 801.00 or the application thereof.

History

Adopted by Mass Register Issue 1412, eff. 3/6/2020.