Maximum Allowable Fees
Effective Apr 1, 2010M.G.L. c. 118E, s. 7 M.G.L. c. 118E, s. 12MassHealth
(A) The Division of Health Care Finance and Policy (DHCFP) determines the maximum allowable fees for independent clinical laboratory services. The maximum allowable payment for a service is the lowest of the following:
- (1) the amount listed in the applicable DHCFP fee schedule;
- (2) the independent clinical laboratory's usual and customary fee; or
- (3) the amount that would be recognized under 42 U.S.C. § 13951(h) for tests performed for a person with Medicare Part B benefits.
- (B) The maximum allowable payment is full compensation for the laboratory service and any related administrative or supervisory duties in connection with the service, regardless of where the service was provided.
- (C) An independent clinical laboratory cannot bill for more than its usual and customary fee for a service.