Payable Surgical Procedures

The MassHealth agency pays surgical centers for those services listed in Subchapter 6 of the Freestanding Ambulatory Surgery Center Manual (see 130 CMR 423.401 for further requirements). All prosthetic devices, except intraocular lenses, whether implanted, inserted, or otherwise related to procedures on the current list of payable surgical procedures, are paid separately from the surgical center facility component. The above notwithstanding, providers must comply with the requirements specified in 130 CMR 423.401, which state that payment is provided only for services that are medically necessary and furnished in the least costly medically appropriate setting.