101 CMR, § 323.01

Current through Register 1538, January 3, 2025

Section 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;

(c) deleted codes for which there are no corresponding new codes; and

(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.