MassHealth implemented edit 9974 “PM: deny-service not covered/payable by MassHealth” in May 2025 to deny crossover claims billed with modifier JW ‘drug amount discarded/not administered to any patient’. Use of this modifier is not permitted under MassHealth policy, as outlined in Subchapter 6 of the Provider Manual.
In October 2025, MassHealth identified a system issue that caused crossover claims for Qualified Medicare Beneficiaries (QMB) to deny incorrectly. This issue was corrected on 10/20/25 and all affected crossover claims have been adjusted. These adjustments will appear on subsequent remittance advices.
Please note, edit 9974 applies only to crossover claims for members who are not QMB. Crossover claims for QMB members will continue to pay in accordance with federal regulations.
If you have questions, please contact MassHealth at provider@masshealthquestions.com or (800) 841-2900. LTSS providers, please contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.