Massachusetts Regulations 40.01
From Wcc
§ 40.01 General Provisions
| (1) Scope, Purpose and Effective Date. 114.3 CMR 40.00 shall govern the rates of payment by all purchasers of health care services under M.G.L. c. 152, the Worker's Compensation Act, effective September 1, 2004. 114.3 CMR 40.00 is not authorization for or approval of the substantive services for which rates are determined pursuant to 114.3 CMR 40.00. Program policies relating to medical necessity and clinical appropriateness shall be determined pursuant to M.G.L. c. 152 and 452 CMR 6.00 thereunder.
(2) Coding Updates and Corrections. The Division may publish code updates and corrections in the form of an Informational Bulletin. Updates may reference coding systems including but not limited to the American Medical Association's Current Procedural Terminology (CPT). The publication of such updates and corrections will list: (a) codes for which only the code numbers change, with the corresponding cross references between existing and new codes; (b) deleted codes for which there are no corresponding new codes; and (c) codes for entirely new services that require pricing. The Division will list these codes and apply individual consideration (I.C.) reimbursement for these codes until appropriate rates can be developed. (3) Administrative Information Bulletins. The Division may, from time to time, issue administrative information bulletins to clarify provisions of 114.3 CMR 40.00. (4) Authority. 114.3 CMR 40.00 is adopted pursuant to M.G.L. c. 118G and M.G.L. c. 152, § 13. |
