Conditions of Payment

(A) The MassHealth agency pays for orthotics in accordance with the applicable payment methodology and rate schedule established by EOHHS at 101 CMR 334.00: Prostheses, Prosthetic Devices and Orthotic Devices. (B) Providers of orthotics must accept MassHealth payment as payment in full for orthotics and orthotic services according to the rates established by EOHHS at 101 CMR 334.00: Prostheses, Prosthetic Devices and Orthotic Devices. (C) Payments are subject to the conditions, exclusions, and limitations set forth in 130 CMR 442.000 and 130 CMR 450.000: Administrative and Billing Regulations. (D) An Initial Order is not a condition of payment. As set forth in 130 CMR 442.420(D)(1) through (5), a Detailed Written Order is a condition of payment. MassHealth pays for orthotics only if: (1) the MassHealth agency, or its designee determines that the orthotics are medically necessary; (2) the member meets the clinical eligibility criteria for the orthotics; (3) the provider has obtained a detailed written order in accordance with 130 CMR 442.409; (4) the provider has obtained prior authorization, if necessary, in accordance with the requirements set forth in 130 CMR 442.412; and (5) the provider has diligently sought payment from all other liable parties in accordance with 130 CMR 442.405(I) and 130 CMR 450.000: Administrative and Billing Regulations.