Prior Authorization

(A) Services designated "P.A." in the list of service codes and descriptions in Subchapter 6 of the Speech and Hearing Center Manual require prior authorization from the MassHealth agency. Such services include, but are not limited to: (1) more than 35 speech and language pathology visits, including group-therapy visits, for a member in a 12-month period; and (2) continuing therapy when payment has been discontinued by any other third-party payer, including Medicare. (B) All prior-authorization requests must be submitted in accordance with the billing instructions in Subchapter 5 of the Speech and Hearing Center Manual. Prior authorization determines only the medical necessity of the authorized service and does not establish or waive any other prerequisites for payment such as member eligibility or resort to health insurance payment. (130 CMR 413.409 through 130 CMR 413.415 Reserved)