Type of Service | Payment Rules | Payment Source |
Medical Visit - Urgent Care (code 99051) | Payable separately from an Individual Medical Visit. | Rate for 99050 in 101 CMR 304.00: Rates for Community Health Centers |
Pulmonary Diagnostic (technical component only) | Payable separately only if not occurring on the same day as an Individual Medical Visit. | 101 CMR 317.00: Rates for Medicine Services. |
Cardiology Diagnostic (technical component only) | Payable separately from an Individual Medical Visit. | 101 CMR 317.00: Rates for Medicine Services. |
Obstetrical Services | Payable separately from an Individual Medical Visit | 101 CMR 316.00: Rates for Surgery and Anesthesia Services |
Behavioral Health (group treatment, medication management, psychological testing, and methadone services) | Payable separately from an Individual Medical Visit. | For group treatment and medication visits, rates in 101 CMR 306.00: Rates of Payment for Mental Health Services Provided in Community Health Centers and Mental Health Centers; for psychological testing, rates in 101 CMR 329.00: Psychological Testing, Treatment, and Related Services; for methadone services, rates in 101 CMR 346.00: Rates for Certain Substance-related and Addictive Disorders Programs |
Radiology | Payable separately from an Individual Medical Visit. | 101 CMR 318.00: Rates for Radiology Services |
Clinical Laboratory | Payable separately from an Individual Medical Visit. | 101 CMR 320.00: Rates for Clinical Laboratory Services |
Dental | Payable separately from an Individual Medical Visit. | Lesser of allowable charges billed to the HSN, or fees established in 101 CMR 314.00: Rates for Dental Services |
340B Pharmacy Services | Payment will be reduced by the amount of Patient cost-sharing set forth in 101 CMR 613.00: Health Safety Net Eligible Services. | 101 CMR 331.00: Prescribed Drugs |
Vision Care (dispensing and repair) | Payable separately from an Individual Medical Visit. | 101 CMR 315.00: Vision Care Services and Ophthalmic Materials |
Family Planning Services | Family planning counseling, prescribed drugs, family planning supplies, and related laboratory tests can be billed in addition to an Individual Medical Visit. An Individual Medical Visit is not payable for the sole purpose of replenishing a Patient's supply of contraceptives. | 101 CMR 312.00: Rates for Family Planning Services |
Preventive Services/Risk Factor Reduction (code 99402) | Payable separately from an Individual Medical Visit. | 101 CMR 312.00: Rates for Family Planning Services |
Immunization Visits | Payable separately only if not occurring on the same day as an Individual Medical Visit. | 101 CMR 317.00: Rates for Medicine Services |
Vaccines Not Included in the Individual Medical Visit or Supplied by the Department of Public Health | Payable separately from an Individual Medical Visit. | 101 CMR 317.00: Rates for Medicine Services |
101 CMR 614.07