Adopted Regulation February 18, 2010

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C9716

1,127.56	Creations of thermal anal lesions by radiofrequency energy
C9724	921.91	Endoscopic full-thickness plication in the gastric cardia using endoscopic plication system (EPS); includes endoscopy
C9725	212.59	Placement of endorectal intracavitary applicator for high intensity brachytherapy
C9726	780.47	Placement and removal (if performed) of applicator into breast for radiation therapy
C9727	273.65	Insertion of implants into the soft palate; minimum of 3 implants
C9728	491.00	Placement of interstitial device(s) for radiation therapy/surgery guidance (e.g., fiducial markers, dosimeter), other than prostate (any approach), single or multiple
G0104	78.88	Colorectal cancer screening; flexible sigmoidoscopy
G0105	340.90	Colorectal cancer screening; colonoscopy on individual at high risk
G0121	340.90	Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
G0127	11.03	Trimming of dystrophic nails, any number
G0186	211.70	Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions)
G0247	20.12	Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) to include the local care of superficial wounds (i.e., superficial to muscle and fascia) and at least the following, if present: (1) local
G0260	276.38	Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography
G0364	5.19	Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service
G0392	1,465.88	Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; arterial
G0393	1,465.88	Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; venous

(d) Modifiers.

50	Bilateral procedure
51	Multiple procedures
73	Discontinued outpt hospital/ambulatory surgery center (ASC) procedure prior to administration of anesthesia
74	Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia

47.04: Reporting Requirements
(1) Required Reports. Upon request of the Division, each provider within 90 days following the end of its fiscal year, shall forward to the Division a complete and accurate cost report (FDSF-1) and certified financial statements. The provider shall also make available within 30 days all records and books relating to said operations, including such data, statistics, and records as the Division may from time to time request.
(2) Extension of Filing Date. The Division may grant an extension of time for the submission of cost reports or other information, data or statistics upon written request from the provider demonstrating that good cause exists for such an extension.
(3) Failure to File Timely Reports. Failure to submit accurate information within the time required by 114.3 CMR 47.04(1) and (2) or to submit within the stated time other acceptable data and statistics requested by the Division, may result in the delay, reduction or non-payment of the provider's rates, as well as application of other sanctions and penalties provided by law subject to the approval of the purchasing Governmental Unit.
47.05: Severability
The provisions of 114.3 CMR 47.00 are severable, and if any provision of 114.3 CMR 47.00 or application of such provision to any freestanding surgical facility or any circumstances shall be held to be invalid or unconstitutional, such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions to eligible freestanding surgical facilities or circumstances other than those held invalid.
REGULATORY AUTHORITY
114.3 CMR 47.00: M.G.L. c. 118G.

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