Prior authorization (PA) is not required for the services listed in Subchapter 6 of the MassHealth Renal Dialysis Clinic Manual, including CPT code 90999. Please do not submit an unnecessary PA for these services as it will delay claims processing. However, per the Subchapter 6 guidance, providers may request a PA for a MassHealth Standard or CommonHealth member under 21 years of age if the service is medically necessary, reimbursable under the Federal Medicaid Act, and not listed as covered in Subchapter 6.
If you have questions, please contact MassHealth at (800) 841-2900 or provider@masshealthquestions.com.