Reprocessing Certain Outpatient Claims Submitted with Modifier SL

MassHealth identified certain outpatient claims with dates of service on or after January 1, 2024, through September 29, 2026, that were incorrectly reimbursed for injectable materials or biologicals billed with modifier SL.

Per the Acute Hospital Request for Applications (RFA), MassHealth does not reimburse for the injectable materials or biologicals provided at no cost by the Massachusetts Department of Public Health. Hospitals are required to bill the applicable code for the injectable material or biological with modifier SL, along with the appropriate administration code.

Corrections have been implemented in MMIS, and affected claims will be adjusted and appear on this and subsequent remittance advices.

If you have questions regarding this message, please contact MassHealth at (800) 841-2900 or provider@masshealthquestions.com.