Services designated "I.C." in the list of service codes and descriptions in Subchapter 6 of the Audiologist Manual are given individual consideration by the MassHealth agency to determine the amount of payment to be made to the audiologist. The MassHealth agency determines the amount of payment using the following criteria:

1. (A) the time required to perform the procedure;
2. (B) the degree of skill required to perform the procedure;
3. (C) the severity or complexity of the member's hearing disorder or disability;
4. (D) the policies, procedures, and practices of other third-party purchasers of health care; and
5. (E) the reasonable and customary practices of audiologists.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-5

Provider Manual Series (130 CMR 426.000)

Transmittal Letter Date

Audiologist Manual

AUD-17 01/02/15