Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 432.000 - Therapist Services
Section 432.415 - Prescription Requirements

Universal Citation: 130 MA Code of Regs 130.432

Current through Register 1531, September 27, 2024

(A) The MassHealth agency pays for only those treatments and evaluations for which the therapist has obtained written prescriptions from the member's prescribing provider. Electronic prescriptions (escripts) are allowable if they comply with state and federal requirements and are transmitted by the member's prescribing provider in accordance with the MassHealth agency's administrative and billing instructions.

(B) Initial Prescription. The initial prescription must be written on the prescribing provider's letterhead, must be dated prior to the initiation of the prescribed services, and must contain the following information:

(1) the member's name;

(2) the member's diagnosis that requires therapy services;

(3) the reason for the prescription;

(4) the date of prescription; and

(5) the prescribing provider's signature and contact information, including name, NPI, and telephone number.

(C) Prescription Renewal. The MassHealth agency pays for continuing physical, occupational, or speech/language therapy only when the prescription or plan of care is signed by the member's prescribing provider every 60 days, and the therapist has obtained prior authorization from the MassHealth agency, as applicable, in accordance with 130 CMR 432.417.

(D) A prescription from the prescribing provider does not authorize payment. The therapy performed by a therapist pursuant to the evaluation described in 130 CMR 432.416 must constitute medically necessary and appropriate and effective treatment, within accepted medical standards for the member's condition.

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