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
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(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.