Appendix D for a list of J codes. If the code is not available, use an unlisted

procedures category (such as code 90749 for immunizations or code 99070 under miscellaneous services). Immunization injections are usually given in conjunction with a medical service. When an immunization is the only service performed, a minimal service (such as codes 90471, 90472 or 96400) may be listed in addition to the injection; an office visit should not be separately billed. Immunization procedures include the supply of materials. 5. Physical Medicine. Service provisions pertaining to physical and restorative medicine are set forth in 114.3 CMR 40.05(13) and codes and fees for physical medicine procedures are listed in 114.3 CMR 40.06(12). (11) Psychology. (a) Eligible Providers. An Eligible Provider is: 1. a psychologist licensed by the Massachusetts Board of Registration of Psychologists in accordance with the provisions of M.G.L. c. 112; or 2. a social worker (LICSW) licensed by the Massachusetts Board of Registration of Social Work in accordance with the provisions of M.G.L. c. 112. Psychiatric Services provided by a licensed physician are set in accordance with 114.3 CMR 40.05(10). (b) Psychological Services. Psychological Services include: 1. diagnostic services, which are evaluative interviews to determine a client's emotional and psychological disability for the purpose of developing a treatment plan; 2. individual therapy, which is a meeting between an Eligible Provider and the client to help to ameliorate problems, conflicts and disturbances; 3. group therapy, which is a treatment session conducted by an Eligible Provider for the application of psychotherapeutic or counseling techniques to a group of people each of whom manifests an emotional problem or disturbance. Groups are usually five people but are limited to a maximum of ten clients. 4. psychological testing, which is performed with the use of standard test instruments to evaluate aspects of a client's functioning, aptitudes and educational ability, cognitive processes, emotional conflicts and type and degree of psychopathology. All fees for psychological tests cover the complete cost of interviewing, testing, scoring, interpreting and writing reports of test outcomes. (c) Fees. Payment rates for psychological services are set forth in 114.3 CMR 40.06(11). (12) Radiology. (a) Eligible Providers. Eligible Providers include: 1. a physician or osteopath other than an intern, resident, or house officer licensed by the Board of Registration in Medicine in accordance with the provisions of M.G.L. c. 112. 2. a podiatrist other than an intern, resident, or house officer licensed by the Board of Registration in Medicine or the Board of Registration in Podiatry in accordance with the provisions of M.G.L. c. 112, whose eligibility is limited to those procedures specified by the purchaser of the services. 3. an oral and/or maxillofacial surgeon licensed by the Board of Registration in Dentistry in accordance with the provisions of M.G.L. c. 112. 4. a chiropractor licensed by the Board of Registration of Chiropractors under and meeting the requirements of M.G.L. c. 112, §§ 89 through 97, whose eligibility is limited to those procedures within the scope and limitations of chiropractic medicine services. (b) Radiological Services. Services include all diagnostic and therapeutic imaging. Most radiological services are comprised of a professional component and a technical component. The professional component is the physician's interpretation of the procedure, and the technical component is the equipment, supplies and technician's services used to perform the procedure. Fees and requirements for certain technical component services are set forth in the regulatory section entitled Freestanding Diagnostic Services. (c) Fees. Rates of payment for radiological services are set forth in 114.3 CMR 40.06(7). (d) Contrast Media. Complete procedures, interventional radiological procedures or diagnostic studies involving injection of contrast media include all usual pre-injection and post-injection services, eg, necessary local anesthesia, placement of needle catheter, injection of contrast media, supervision of the study, and interpretation of the results. Providers must determine whether the use of ionic or non-ionic contrast media is appropriate for the individual patient. (13) Rehabilitation Clinic Services, Audiological Services, Restorative Services. (a) Eligible Providers. Eligible Providers include: 1. a physical therapist (PT) currently licensed by the Board of Allied Health Professionals; 2. an occupational therapist (OT) currently licensed by the Board of Allied Health Professionals; 3. a speech therapist (ST) currently licensed by the Board of Speech and Language Pathology and Audiology; 4. an audiologist currently licensed by the Board of Speech and Language Pathology and Audiology; 5. a freestanding clinic licensed by DPH providing rehabilitative services; 6. a hospital outpatient clinic licensed by the Department of Public Health and not subject to provisions of 114.1 CMR 41.00; 7. any speech and hearing center (proprietorship, partnership or corporation) that provides authorized speech or language services by a qualified speech pathologist that does not bill separately from such facility for professional services rendered; or 8. a chiropractor whose eligibility as it pertains to 114.3 CMR 40.05(13) is limited to modalities and therapeutic procedures. (b) Rehabilitation, Restorative, Speech/Language Pathology and Audiological Services. 1. Rehabilitation services are comprehensive services deemed appropriate to the needs of an injured person, in a program designed to achieve objectives of improved health and welfare with the realization of optimal physical, social and vocational potential. 2. Restorative services are PT, OT, or ST services for the purpose of maximum reduction of physical and/or speech disability and restoration of optimal functional levels. 3. Speech/Language Pathology services include the evaluation and treatment of communicative disorders with regard to the functions of articulation (including aphasia and dysarthria, language, voice and fluency.) 4. Audiological services include testing related to the determination of hearing loss, evaluation of hearing aids, the prescription of hearing aid devices, and aural rehabilitation which includes lip-reading and auditory training. Complete audiological evaluation includes a routine audiological evaluation plus site of Lesion Testing (Impedance Testing and/or Recruitment Testing) as needed or recommended by a physician. (c) Fees. Payment rates for restorative services are set forth in 114.3 CMR 40.06(12). (d) Functional Capacity Assessments. To report a functional capacity assessment (or Key functional assessment), providers must use CPT code 97750 that may be billed up to a maximum of nine units per session. (e) Work Hardening and Work Conditioning. Work Hardening and Work Conditioning are goal-oriented therapies designed to prepare injured workers for their return to work. Providers must use CPT codes 97545 and 97456 to report these services. 97456 must be used in conjunction with 97545. (f) Visits. The number of visits and duration of treatment are the subject of DIA treatment guidelines for various injuries. Providers should seek prior approval for treatment regimens that deviate from these guidelines. (g) Therapeutic Procedures. Pre-approval should be obtained if a provider believes that more than two therapeutic procedures should be performed at a session. The number of units allowed per session is limited only by medical necessity. (h) Modalities. A charge may be assessed for supportive services (CPT codes 97012 through 97039) only in conjunction with a procedure performed during the course of the same visit. Pre-approval should be obtained if a provider believes that more than three modalities should be performed in a given session. The number of units allowed per session is limited only by medical necessity. When determining the correct units allowed, round partial units to one decimal place. No fee will be paid for the application of hot and cold packs (CPT code 97010). (i) Durable Medical Equipment, Prosthetics/Orthotics, and Supplies (DMEPOS). Rates of payment for durable medical equipment, prosthetic/orthotics and supplies are listed in 114.3 CMR 40.06(6) and subject to the provisions and guidelines in 114.3 CMR 40.05(6). (14) Surgery. (a) Eligible Providers. An Eligible Provider is: 1. a physician or osteopath other than an intern, resident, or house officer licensed by the Board of Registration in Medicine in accordance with the provisions of M.G.L. c. 112. A physician assistant (PA) licensed by the Board of Registration for Physician Assistants in accordance with the provisions of M.G.L. c. 112 may not bill separately for services rendered; 2. a podiatrist other than an intern, resident, or house officer licensed by the Board of Registration in Medicine in accordance with the provisions of M.G.L. c. 112, whose eligibility is limited to those procedures specified by the purchaser of the services; 3. a registered nurse licensed by the Board of Registration in Nursing in accordance with the provisions of M.G.L. c. 112 to practice as a nurse practitioner (NP), limited to those procedures within the scope of NP services and subject to the rules of physician relationship for reimbursement defined by the Commonwealth's Nurse Practice Act, M.G.L. c. 112, §§ 74 through 81; or 4. a dentist licensed by the Board of Registration in Dentistry in accordance with the provisions of M.G.L. c. 112. (b) Payment for Surgical Procedures Includes: 1. the immediate preoperative care performed on the same day as surgery, completion of hospital records and initiation of the treatment program; 2. local anesthesia, such as infiltration, metacarpal/digital or topical anesthesia, 3. the surgical procedure; 4. supplies and materials usually included in the office visit or procedure; 5. normal, uncomplicated postoperative care performed on the same day as surgery at the facility. 6. up to two normal post operative follow up visits when indicated by an "I" in the fee schedule. (c) First Assistants. Non-physician providers who act as first assistants during surgical procedures must be identified by adding the modifier -81, Minimum Assistant Surgeon, to the usual procedure number and will be reimbursed at 15% of the fee stipulated in 114.3 CMR 40.06(16)(f). The non-physician must be an employee of the eligible physician provider and not salaried by a facility. (d) Fees. Rates of payment for surgical services are set forth in 114.3 CMR 40.06(8). (e) Payments for Qualified NP's and PA's. Payment to employers billing for eligible NPs and PAs as specified in 114.3 CMR 40.06(16)(a)3 is 85% of the fees set forth in 114.3 CMR 40.06. Providers must use the appropriate two-digit modifier listed in 114.3 CMR 40.07: Appendix A to denote services rendered by a non-physician provider. (f) Modifiers. See 114.3 CMR 40.07(1): Appendix A for a list of Level 1 CPT modifiers. (g) Add-on Codes. 114.3 CMR 40.07(2): Appendix B lists procedures that are commonly carried out in addition to the primary procedure performed and must never be reported as stand-alone codes. These codes are exempt from the multiple procedure modifier '51'.