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To Therapy Providers Regarding Limits on Therapy Service Codes

April 1, 2019

In March 2019, the Medicaid National Correct Coding Initiative (NCCI) released edit files for Medically Unlikely Edits (MUEs). MassHealth has updated the MMIS system and these edits will be effective on April 1, 2019. These MUEs will limit the maximum number of units per service code that a therapy provider is able to bill for a MassHealth member's therapy visit. The addition of the MUE limits do not affect any other MassHealth authorization or billing rules. Please see below for the MUE values and service codes affected.

Service code: 97010; MUE limit = 1; Service description: Application of a modality to one or more areas; hot or cold packs

Service code: 97012; MUE limit = 1; Service description: Application of a modality to one or more areas; traction, mechanical

Service code: 97014; MUE limit = 1; Service description: Application of a modality to one or more areas; electrical stimulation (unattended)

Service code: 97016; MUE limit = 1; Service description: Application of a modality to one or more areas; vasopneumatic devices

Service code: 97018; MUE limit = 1; Service description: Application of a modality to one or more areas; paraffin bath

Service code: 97024; MUE limit = 1; Service description: Application of a modality to one or more areas; diathermy (e.g., microwave)

Service code: 97026; MUE limit = 1; Service description: Application of a modality to one or more areas; infrared

Service code: 97028; MUE limit = 1; Service description: Application of a modality to one or more areas; ultraviolet

Service code: 97034; MUE limit = 2; Service description: Application of a modality to one or more areas contrast baths, each 15 minutes

Service code: 97035; MUE limit = 2; Service description: Application of a modality to one or more areas; ultrasound, each 15 minutes

Service code: 97150; MUE limit = 2; Service description: Therapeutic procedure(s), group (two or more individuals) (services delivered under an outpatient plan of care) (maximum one unit per visit)

If you have any questions regarding this message, please contact the LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.