The MassHealth agency only pays UCCs for those laboratory services listed in Subchapter 6 of the Urgent Care Clinic Manual. The MassHealth agency pays a UCC for laboratory services that are medically necessary for the diagnosis, treatment, and prevention of disease, and for the maintenance of the health of MassHealth members, subject to all the restrictions and limitations described in 130 CMR 455.000 and 130 CMR 450.000: Administrative and Billing Regulations. In order for a UCC to be paid for any laboratory service, a written request for that service from an authorized prescriber must be present in the member’s medical record.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-5

Provider Manual Series (130 CMR 455.000)

Transmittal Letter Date

Urgent Care Clinic Manual

UCC-1 01/21/22