Individual Consideration

(A) Some services listed in Subchapter 6 of the Oxygen and Respiratory Therapy Equipment Manual are designated “I.C.”, an abbreviation for individual consideration. Individual consideration means that a fee could not be established by the Division of Health Care Finance and Policy. The payment for an individual-consideration service will be determined by the Division’s professional advisors. Before making a determination, the Division's professional advisors will analyze the provider’s report of services submitted, the cost of constructing or adapting the device, and the adjusted acquisition cost of the materials. (B) Providers must maintain adequate records to determine the appropriateness of individual- consideration claims and must provide these documents to the Division upon demand. Payment to a provider for an individual-consideration claim shall be in accordance with 130 CMR 427.000.