Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 315.00 - Rates for Vision Care Services and Ophthalmic Materials
Section 315.01 - General Provisions

Universal Citation: 101 MA Code of Regs 101.315

Current through Register 1531, September 27, 2024

(1) Scope. 101 CMR 315.00 governs the rates of payment used by governmental units and purchasers under M.G.L. c. 152, § 1 et seq. (the Workers' Compensation Act) for vision-care services and ophthalmic materials provided to publicly aided and industrial accident patients.

(2) Applicable Dates of Service. Rates contained in 101 CMR 315.00 are effective for dates of service on or after February 1, 2023.

(3) Disclaimer of Authorization of Services. 101 CMR 315.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 315.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care and services provided to publicly aided clients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify provisions of 101 CMR 315.00, or to issue coding updates and corrections under 101 CMR 315.01(5).

(5) Coding Updates and Corrections. EOHHS may publish service code updates and corrections in the form of administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association's Current Procedural Terminology (CPT) and the 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 the new codes and the codes being replaced. Rates for such updated codes are set at the rate of the code that is being replaced;

(b) codes for which the code numbers remain 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.

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