Maximum Allowable Fees
Effective Jul 1, 2006M.G.L. c. 118E, s. 7 M.G.L. c. 118E, s. 12MassHealth
(A) The Massachusetts Executive Office of Health and Human Services (EOHHS) determines the maximum allowable fees for all IDTF services purchased by government agencies. EOHHS publishes a comprehensive listing of IDTF services and rates. Payment is always subject to the conditions, exclusions, and limitations set forth in 130 CMR 431.000. Payment for a service will be the lower of the following:
- (1) the provider’s usual and customary fee to the general public for the same or a similar service; or
- (2) the maximum allowable fee listed in the applicable EOHHS fee schedule.
- (B) The maximum allowable payment is full compensation for the IDTF service and any related administrative or supervisory duties in connection with the services, regardless of where the service is provided.