Noncovered Services

(A) The MassHealth agency does not pay for any of the following services: (1) nonmedical services, such as social, educational, and vocational services; (2) cosmetic surgery; (3) canceled or missed appointments; (4) telephone conversations and consultations; (5) court testimony; (6) research or the provision of experimental, unproven, cosmetic, or otherwise medically unnecessary procedures or treatments; (7) the provision of whole blood; however, administrative and processing costs associated with the provision of blood and its derivatives are covered; and (8) the treatment of male or female infertility (including, but not limited to, laboratory tests, drugs, and procedures associated with such treatment); however, MassHealth does pay for the diagnosis of infertility. 4. Program Regulations (B) The MassHealth agency does not pay for mental health services such as, but not limited to, the following (see 130 CMR 410.472): (1) vocational rehabilitation services; (2) sheltered workshops; (3) recreational services (play therapy, the use of play activities with a child in an identified treatment setting as an alternative to strictly verbal expression of conflicts and feelings, is not considered a recreational service and is covered); (4) life-enrichment services; and (5) alcohol or drug drop-in centers. (C) The MassHealth agency does not pay for pharmacy services such as, but not limited to, the following (see 130 CMR 406.000: Pharmacy Services): (1) any drug used for the treatment of obesity or overweight; (2) cough and cold preparations; (3) less-than-effective drugs; and (4) drugs related to the treatment of male or female infertility. (D) The MassHealth agency does not pay for certain vision care services and materials as specified in MassHealth regulations at 130 CMR 402.000: Vision Care Services. (E) The MassHealth agency does not pay an independent practitioner for services provided to members in an outpatient department except when that practitioner has an active provider number issued by the MassHealth agency and meets one of the following criteria. (1) The practitioner serves in an attending, visiting, or supervisory role at the hospital where the services are provided, is legally responsible for the management of the member's care, is physically present and actively involved in the treatment for which payment is claimed, and provides a service for which the MassHealth agency pays an independent practitioner when provided in an outpatient hospital setting. Supervisory surgeons must be scrubbed and physically present during the major portion of an operation. (2) The independent practitioner, if serving as a salaried intern, resident, fellow, or house officer, provides services during off-duty hours at an institution that does not pay their salary. (3) The independent practitioner receives a salary from an institution for administrative or teaching services, but not for delivery of care, and provides direct medical care to a member that meets the conditions set forth in 130 CMR 410.405(E)(1).