Noncovered Services

The MassHealth agency does not pay for any of the following: (A) any prosthetic services for which, under comparable circumstances, the provider does not customarily bill private patients who do not have health insurance; (B) nonmedical prosthetic services. Equipment that is used primarily and customarily for a nonmedical purpose is not considered medical equipment, even if such equipment has a medically related use; (C) storage of prosthetic equipment or associated items; and (D) prosthetic services that are not both medically necessary in accordance with 130 CMR 450.204: Medical Necessity and reasonable for the treatment of a member's condition. This includes services that: (1) cannot reasonably be expected to make a meaningful contribution to the treatment of a member's condition or the performance of the member's activities of daily living; and (2) are more costly than a medically comparable and suitable alternative or that serve essentially the same purpose as equipment already available to the member.