1. (A) Some tests listed in Subchapter 6 of the Independent Diagnostic Testing Facility Manual are designated "I.C.," an abbreviation for individual consideration. A fee has not been established for these services. Payment for an individual-consideration service is determined by the MassHealth agency's professional advisers, based on the IDTF’s description of the test, which must be included with the claim.
2. (B) If a service is not listed in Subchapter 6 of the Independent Diagnostic Testing Facility Manual, an IDTF may submit a claim by using the appropriate "unlisted service" service code. Payment for an unlisted service is determined by individual consideration, based on the facility's description of the service, which must be included with the claim.

3. (C) The MassHealth agency considers the following factors when determining the appropriate payment for an individual-consideration service:

   1. (1) the amount of time required to perform the service;
   2. (2) the degree of skill required to perform the service;
   3. (3) the policies, procedures, and practices of other third-party payers;
   4. (4) the prevailing diagnostic testing ethics and accepted custom of the diagnostic testing community; and
   5. (5) other standards and criteria as may be adopted by EOHHS or the MassHealth agency.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-4

Provider Manual Series (130 CMR 431.000)

Transmittal Letter Date

Independent Diagnostic Testing

Facility Manual

IDTF-16 09/09/16