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

(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) 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.

Notes

101 CMR, § 347.01

Adopted by Mass Register Issue 1379, eff. 11/30/2018. Amended by Mass Register Issue 1453, eff. 10/1/2021. Amended by Mass Register Issue 1514, eff. 2/2/2024.