Nonpayable Services

The following are not payable: (A) drugs and durable medical equipment prescribed for take-home use that are readily available from pharmacies or medical providers; (B) the cost of any treatment or testing provided to a member who is an inpatient at another hospital, whether of the member or of a specimen from the member. Payment will be made to the hospital where the member is an inpatient and not to the provider where this treatment or testing occurs; (C) leaves of absence; (D) research or the provision of experimental, unproven, cosmetic, or otherwise medically unnecessary procedures or treatments; (E) cosmetic surgery; (F) the provision of whole blood (however, administrative and processing costs associated with the provision of blood and its derivatives are reimbursable); (G) private hospital rooms, except when the member is being treated for an infectious disease that requires a private room, or in other circumstances in which a private room would be medically necessary; and (H) 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 male or female infertility.