Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 401.000 - Independent Clinical Laboratory Services
Section 401.411 - Noncovered Services and Payment Limitations
Universal Citation: 130 MA Code of Regs 130.401
Current through Register 1531, September 27, 2024
(A) The MassHealth agency does not pay separately for routine specimen collection and preparation for the purpose of clinical laboratory analysis (for example, venipunctures; urine, fecal, and sputum samples; Pap smears; cultures; and swabbing and scraping for removal of tissue). The cost for such services is included in the payment for conducting the test and analysis.
(B) The MassHealth agency does not pay for the following services:
(1) laboratory tests associated with male or
female infertility, unless those tests are for diagnostic purposes;
(2) calculations (for example, red cell
indices, A/G ratio, creatinine clearance), and ratios calculated as part of a
profile;
(3) tests performed for
experimental or clinical investigational purposes (e.g., to
establish safety and effectiveness), or that are themselves experimental or
clinically investigational;
(4)
tests performed only for purposes of civil, criminal, administrative, or social
service agency investigations, proceedings, or monitoring activities;
(5) tests performed for residential
monitoring purposes;
(6) tests
performed to establish paternity;
(7) post-mortem examinations;
(8) tests where the request is not in
accordance with
130 CMR
401.416;
(9) tests that are not medically necessary as
defined in
130 CMR
450.204: Medical Necessity;
and
(10) any other tests or
activities performed for any purpose other than those described in
130 CMR
401.410.
(C) The MassHealth agency does not pay independent clinical laboratories for services that the laboratory is not certified by the Centers for Medicare and Medicaid Services (CMS) to perform.
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