The Centers for Medicare and Medicaid Services (CMS) approved MassHealth’s deactivation request for the National Correct Coding Initiative (NCCI) Medicaid Durable Medical Equipment (DME) Medically Unlikely Edits (MUEs) for HCPCS codes A4224, A4338, A4349, A4351, A4352, A4353, A4357, A4358, A4606, A5120, A7031, A7032, A7033, A7038, and A7507.
CMS also approved MassHealth’s deactivation request for the NCCI Medicaid DME Procedure-to-Procedure (PTP) edits* for HCPCS codes:
(T4521-T4533), (T4522-T4534), (T4523-T4521), (T4524-T4522), (T4525-T4523), (T4526-T4525), (T4527-T4526), (T4528-T4527), (T4530-T4529), (T4532-T4531), (T4533-T4530), (T4534-T4532), (T4544-T4528)
* NCCI Medicaid DME Procedure-to-Procedure (PTP) edits refer to a specific pair of codes identified by the NCCI that shouldn’t typically be billed together for the same patient on the same day. This is because one code is a component of the other or because the codes are mutually exclusive, with the Column 1 code usually paid and the Column 2 denied unless a specific modifier is identified.
Please refer to the most recent version of the MassHealth DME and OXY Payment and Coverage Guideline Tool at https://www.mass.gov/info-details/masshealth-payment-and-coverage-guideline-tools for further instructions regarding service description, coverage, limits, prior authorization, place-of-service codes, and applicable modifier requirements.
If you have questions regarding this message, please contact the LTSS Provider Service Center at support@masshealthltss.com or call (844) 368-5184.