130 CMR, § 426.407

Current through Register 1538, January 3, 2025

Section 426.407 - Individual Consideration

Services designated "I.C." in the list of service codes and descriptions in Subchapter 6 of the Audiologist Manual are given individual consideration by the MassHealth agency to determine the amount of payment to be made to the audiologist. The MassHealth agency determines the amount of payment 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 audiologists.

130 CMR, § 426.407

Amended by Mass Register Issue S1277, eff. 1/2/2015.