General Definitions

As used in 101 CMR 312.00, unless the context clearly otherwise requires, the following terms have the meanings in 101 CMR 312.02. Center. The Center for Health Information and Analysis established under M.G.L. c. 12C. Comprehensive Family Planning Agency. A public or private agency that demonstrates the capability of providing family planning medical services, family planning counseling services, follow-up health care, outreach, and community education. Eligible Provider. A comprehensive family planning agency which meets such conditions of participation as may be required by a governmental unit purchasing such services. EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A. Established Patient. A patient who has received professional services from the provider within the past three years. Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth. Individual Consideration (IC). For specified drugs, injectables/vaccines, and medical and related supplies that are listed in 101 CMR 312.03(4) with IC, payment will be at cost, subject to any documentation requirements of the governmental unit. New Patient. A patient who has not received any professional services from the provider within the past three years. Publicly Aided Individual. A person for whose medical and other services a governmental unit is in whole or in part liable under a statutory program. Separate Procedure. Some of the listed procedures are commonly performed as an integral part of a total service and, as such, do not warrant a separate identification or payment. When, however, such a procedure is performed independently of, and is not immediately related to other services, it may be listed separately in the procedure description. Thus, when a procedure that is ordinarily a component of a larger procedure is performed alone for a specific purpose, it may be considered a separate procedure. There are certain procedures designated as "(SP)" which are in addition to those procedures designated "separate procedure" by the AMA-CPT coding structure. These "(SP)" procedures were designated "Independent Procedures" (IP) in the former six-digit coding structure.