130 CMR, § 413.407

Current through Register 1538, January 3, 2025

Section 413.407 - Individual Consideration

Services designated "I.C." in the list of service codes and descriptions in Subchapter 6 of the Speech and Hearing Center Manual are given individual consideration to determine the amount of payment. The amount of payment is determined by using the following criteria:

(A) the time required to perform the procedure;

(B) the degree of skill required to perform the procedure;

(C) the severity or complexity of the member's hearing disorder or disability;

(D) the policies, procedures, and practices of other third-party purchasers of health care; and

(E) the reasonable and customary practices of speech and hearing centers.

130 CMR, § 413.407