Provider payment guidelines
IMPORTANT COVID-19 INFORMATION: During the COVID-19 public health emergency, some of our payment policies may be superseded by the information on our COVID-19 FAQ.
Response to ED Boarding Crisis
Mass General Brigham Health Plan will comply with regulatory guidance to ensure Hospitals are reimbursed for behavioral health crisis evaluations and stabilization services provided in the Emergency Department in response to the ED Boarding crisis.
This will apply to:
- Commercial members, for dates of service 11/01/2022 and forward per MA DOI Bulletin 2022-08.
- MassHealth members, for dates of service 01/03/2023 and forward per EOHHS guidance issued by the Office of Behavioral Health and per MCE bulletin 93.
Policy payment guideline listing
-
A - E
Acupuncture Services
Allergy Testing and Allergy Immunotherapy
Ambulance
Ambulatory Surgical Centers
Anesthesia
Bariatric Surgery
Chiropractic Services
Community Health Centers
Covid-19 Payment Policy – RETIRED 05/11/2023
Crisis Intervention – ED Boarding
Dermatology
Durable Medical Equipment
Early Intensive Behavioral Intervention Services
Enteral Formulae Parenteral Nutritional Solutions
Evaluation and Management Services -
F- M
Fee Schedule Update Policy
General Coding and Billing
Hearing Aids
Home Health Care Agency
Home Infusion Therapy
Hospital at Home
Hospice
Imaging Services
Inpatient Hospital Admissions
Inpatient Rehabilitation and Long-term Acute Care (LTAC)
Laboratory and Pathology
Late Charge Billing
Maximum Units
Medical Nutritional Counseling and Diabetes
Mid-Level Practitioners
Modifiers -
N - Z
Nail Debridement
Newborn Care (Inpatient)
Observation
Obstetrical Services
Oral Maxillofacial Surgery
Out of Network Provider Services
Outpatient Clinic Services - Facility
Outpatient Physical, Occupational & Speech Therapy
Payment Disputes
Physician Administered Medication
Preventive Services
Provider Audit Policy
Provider Payment Disputes
Retail Clinic
Robotic Assisted Surgery
Routine Foot Care
Serious Reportable Events & Provider Preventable Conditions
Skilled Nursing Facilities
Sleep Studies and Therapy Management
Spine Surgery
Standard Blood Products and Services
Telemedicine
Urine Drug Testing
Vaccines and Immunizations
Vision Services
