Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth

Table of Contents iv

Provider Manual Series

Transmittal Letter Date

Urgent Care Clinic Manual

UCC-1 01/21/22

4. Program Regulations:

130 CMR 455.000: Urgent Care Clinic Services

455.401: Introduction ........................................................................................... 4-1 455.402: Definitions ............................................................................................. 4-1 455.403: Eligible Members .................................................................................... 4-2 455.404: Provider Eligibility................................................................................... 4-2 455.405: Maximum Allowable Fees......................................................................... 4-3 455.406: Individual Consideration ........................................................................... 4-3 455.407: Report Requirements…………………………………………………………….. 4-3 (130 CMR 455.408 through 455.412 Reserved) 455.413: Covered Services………………………………………………………………… 4-4 455.414: Noncovered Services ................................................................................ 4-4 455.415: Urgent Care Visits: Service Limitations....................................................... 4-4 455.416: Laboratory Services: Introduction ……………………………………………….. 4-4 455.417: Laboratory Services: Eligibility to Provide Services ............................................. 4-4 455.418: Laboratory Services: Service Limitations ……………………………………….. 4-5 455.419: Laboratory Services: Services Performed by Outside Laboratories …………….. 4-6 455.420: Radiology Services: Introduction ………………………………………………… 4-6 455.421: Radiology Services: Service Limitations ……………………………………… . 4-6 455.422: Recordkeeping Requirements..................................................................... 4-7

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-1

Provider Manual Series (130 CMR 455.000)

Transmittal Letter Date

Urgent Care Clinic Manual

UCC-1 01/21/22