Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 409.000 - Durable Medical Equipment Services
Section 409.427 - Payment for Durable Medical Equipment

Universal Citation: 130 MA Code of Regs 130.409

Current through Register 1531, September 27, 2024

(A) MassHealth pays for DME for eligible members as required by 130 CMR 450.231: General Conditions of Payment and in accordance with the applicable payment methodology and rate schedule established by EOHHS at 101 CMR 322.00: Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment.

(B) Payments are subject to the conditions, exclusions, and limitations set forth in 130 CMR 409.000, and 130 CMR 450.000: Administrative and Billing Regulations.

(C) MassHealth pays for DME only if:

(1) medically necessary and, if subject to PA, the MassHealth agency or its designee determines that the DME is medically necessary;

(2) the member meets applicable clinical eligibility criteria for the DME;

(3) the provider has obtained a prescription or letter of medical necessity for the purchase or rental of DME in accordance with 130 CMR 409.416; and, if necessary, prior authorization for purchase, rental or repair of DME in accordance with the requirements set forth in 130 CMR 409.418; and

(4) provider has diligently sought payment from all other liable parties in accordance with 130 CMR 409.418(D), and 130 CMR 450.316: Third-party Liability: Requirements.

(D) The MassHealth agency pays for DME provided to MassHealth members in another state by a MassHealth DME provider in accordance with 42 CFR 431.52(b), and 130 CMR 450.109: Out-of-state Services. The DME provider must keep a record for each member in accordance with 130 CMR 409.430, and 130 CMR 450.205: Recordkeeping and Disclosure, and make this record available to the MassHealth agency or its designee upon request.

Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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