Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 401.000 - Independent Clinical Laboratory Services
Section 401.418 - Maximum Allowable Fees
Universal Citation: 130 MA Code of Regs 130.401
Current through Register 1531, September 27, 2024
(A) The Division of Health Care Finance and Policy (DHCFP) determines the maximum allowable fees for independent clinical laboratory services. The maximum allowable payment for a service is the lowest of the following:
(1) the amount listed in the applicable DHCFP
fee schedule;
(2) the independent
clinical laboratory's usual and customary fee; or
(3) the amount that would be recognized under
42 U.S.C. § 13951(h) for tests performed for a person with Medicare Part B
benefits.
(B) The maximum allowable payment is full compensation for the laboratory service and any related administrative or supervisory duties in connection with the service, regardless of where the service was provided.
(C) An independent clinical laboratory cannot bill for more than its usual and customary fee for a service.
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