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;
(c) deleted codes for which there are no
crosswalks; and
(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.
Notes
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