Section 455.406 - Individual Consideration(A) The MassHealth agency has designated certain services in Subchapter 6 of the Urgent Care Clinic Manual as requiring individual consideration. This means that the MassHealth agency will establish the appropriate rate for these services based on the standards and criteria set forth in 130 CMR 455.406(B). Providers claiming payment for any service requiring individual consideration must submit with such claim a report that includes a detailed description of the service, and is accompanied by supporting documentation that may include, but is not limited to, an operative report or pathology report. The MassHealth agency does not pay claims for services requiring individual consideration, unless it is satisfied that the report and documentation submitted by the provider are adequate to support the claim. See130 CMR 455.407 for report requirements.(B) The MassHealth agency considers the following factors when determining the appropriate payment for an individual consideration service: (1) the amount of time required to perform the service;(2) the degree of skill required to perform the service;(3) the policies, procedures, and practices of other third-party insurers, both governmental and private;(4) other standards and criteria as may be adopted by EOHHS or the MassHealth agency.Adopted by Mass Register Issue 1461, eff. 1/21/2022.