Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 334.00 - Rates for Prostheses, Prosthetic Devices, and Orthotic Devices
Section 334.01 - General Provisions
Current through Register 1518, March 29, 2024
(1) Scope and Purpose. 101 CMR 334.00 governs the payment rates to be used by all governmental units for prostheses, prosthetic devices, and orthotic devices provided to publicly aided individuals. The rates set forth in 101 CMR 334.00 do not apply to individuals covered by M.G.L. c. 152 (the Workers' Compensation Act). Rates for services provided to these individuals are set forth in 114.3 CMR 40.03(2): Services and Rates Covered by Other Regulations.
(2) Applicable Dates of Service. Rates contained in 101 CMR 334.00 apply for dates of service provided on or after April 1, 2024, unless otherwise specified.
(3) Coverage. 101 CMR 334.00 and the payment rates established under 101 CMR 334.00 apply to the direct purchase and repair of prescribed custom-made prostheses and prosthetic devices manufactured and supplied by providers, including the cost of customized fitting and client service. 101 CMR 334.00 also applies to the purchase and repair of orthotic devices. These rates are full payment for prostheses, prosthetic devices, and orthotic devices provided by sale, as well as full payment for any related supervisory or administrative duties, fittings and adjustments rendered in connection with the provision of prostheses, prosthetic devices, and orthotic devices.
(4) Disclaimer of Authorization of Services. 101 CMR 334.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 334.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care to publicly aided individuals.
(5) Coding Updates and Corrections. The Executive Office of Health and Human Services (EOHHS) may publish procedure code updates and corrections in the form of an Administrative Bulletin. The publication of such updates and corrections will list:
For new codes without Medicare fees as of the date of the Administrative Bulletin EOHHS will apply individual consideration in establishing payment for such codes. Rates established by administrative bulletin will remain in effect until such time EOHHS adopts a revised regulation or superseding administrative bulletin.
