Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 420.000 - Dental Services
Section 420.412 - Individual Consideration

Universal Citation: 130 MA Code of Regs 130.420

Current through Register 1531, September 27, 2024

(A) Certain services, including unspecified procedures, are designated "IC" (individual consideration) in Subchapter 6 of the Dental Manual and in the EOHHS pricing regulation for dental services, 101 CMR 314.00: Dental Services. This means that a fee could not be established for these services. The MassHealth agency determines appropriate payment for individual-consideration services from the provider's detailed report of services provided (see Subchapter 6 of the Dental Manual for report requirements). The MassHealth agency does not pay claims for "IC" services without a complete report (see 130 CMR 420.415) . If the documentation is illegible or incomplete, the MassHealth agency denies the claim.

(B) The MassHealth agency determines the appropriate payment for an individual-consideration service in accordance with the following standards and criteria:

(1) the amount of time required to perform the service;

(2) the degree of skill required to perform the service;

(3) the severity and complexity of the member's disease, disorder, or disability; and

(4) any extenuating circumstances or complications.

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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.