Payment for Prosthetic Services

(A) Payment to a provider for prosthetic equipment and supplies is subject to the conditions and limitations in 130 CMR 428.000 and 450.000: Administrative and Billing Regulations, and will be the lower of: (1) the provider's usual and customary charge to the general public; or (2) the fee set forth in the schedule of maximum allowable fees established by the Massachusetts Executive Office of Health and Human Services. (B) Payment for the following services is included in the provider payment under 130 CMR 428.420(A). No separate payment is allowed for: (1) the fitting of the prosthesis; (2) instructing the member in the use of the prosthesis; (3) the cost of the component parts and accessory equipment; (4) repairs due to normal wear and tear within 90 days of the date of delivery; and (5) adjustments to the prosthesis and any prosthetic component made when fitting the prosthesis and for 90 days from the date of delivery, when the adjustments are not necessitated by changes in the member's functional abilities.