Section 428.408 - Noncovered ServicesThe MassHealth agency does not pay for any of the following:
(A) any prosthetic services for which, under comparable circumstances, the provider does not customarily bill private patients who do not have health insurance;(B) nonmedical prosthetic services. Equipment that is used primarily and customarily for a nonmedical purpose is not considered medical equipment, even if such equipment has a medically related use;(C) storage of prosthetic equipment or associated items; and(D) prosthetic services that are not both medically necessary in accordance with 130 CMR 450.204: Medical Necessity and reasonable for the treatment of a member's condition. This includes services that:(1) cannot reasonably be expected to make a meaningful contribution to the treatment of a member's condition or the performance of the member's activities of daily living; and(2) are more costly than a medically comparable and suitable alternative or that serve essentially the same purpose as equipment already available to the member.Amended by Mass Register Issue 1354, eff. 12/15/2017.Amended by Mass Register Issue 1494, eff. 4/28/2023.