101 CMR 317.00 — Rates for Medicine Services

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Section 317.01: General Provisions 317.02: General Definitions 317.03: General Rate Provisions 317.04: Maximum Allowable Fees - Medical Services 317.05: Severability

101 CMR 317.00 Rates for Medicine Services

317.01 General Provisions

317.01: General Provisions

(1) Scope and Purpose. 101 CMR 317.00 governs the payment rates used by all governmental units for medical services provided to publicly aided patients. Rates for services provided to individuals covered by the Workers’ Compensation Act, M.G.L. c. 152, are not set forth in 101 CMR 317.00, but are at 114.3 CMR 40.00: Rates for Services under M.G.L. c. 152, Worker’s Compensation Act.

(2) Applicable Dates of Service. Rates contained in 101 CMR 317.00 apply for dates of service on or after January 1, 2026, except as otherwise noted.

(3) Coverage. (a) Payment rates in 101 CMR 317.00 are used to pay for medical services rendered to patients in a private medical office, licensed clinic, hospital, or other inpatient or outpatient facility or department, independent diagnostic testing facility, patient's residence, or other appropriate setting by an individual eligible provider, when an eligible provider bills for the medical services rendered and no other payment method applies. (b) The rates of payment under 101 CMR 317.00 are full compensation for patient care rendered to publicly aided patients as well as for any related administrative or supervisory duties in connection with patient care. The rates of payment also reimburse all overhead expenses associated with the service provided, without regard to where the care is rendered.

(4) Disclaimer of Authorization of Services. 101 CMR 317.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 317.00. Governmental units that purchase care are responsible for the definition, authorization, coverage policies, and approval of care and services provided to publicly aided patients.

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including but not limited to the American Medical Association’s Current Procedural Terminology (CPT). (a) The publication of such updates and corrections will list

codes for which the code numbers change, with the corresponding cross references between the new codes and the codes being replaced. Rates for such updated codes are set at the rate of the code that is being replaced;
deleted codes for which there are no corresponding new codes; and
codes for entirely new services that require pricing. EOHHS will list these codes and apply Individual Consideration (IC) reimbursement for these codes until appropriate rates can be developed.

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

(b) For entirely new codes that require new pricing and have Medicare-assigned relative value units (RVUs) (or, for applicable services, Medicare rates), EOHHS may list these codes and price them according to the rate methodology used in setting physician rates. When Medicare RVUs (or, for applicable services, Medicare rates) are not available, EOHHS may apply Individual Consideration in reimbursing for these new codes until appropriate rates can be developed.

(6) Administrative Bulletins. EOHHS may issue administrative bulletins to add, delete, or otherwise update codes or modifiers, and to clarify its policy on and understanding of substantive provisions of 101 CMR 317.00. EOHHS may also issue administrative bulletins to clarify to which duly licensed or certified health care professionals or students the rate methods in this regulation apply, including in the event that the Department of Public Health issues an Order pursuant to M.G.L. c. 94C and 105 CMR 700.003(H).

317.02 General Definitions

317.02: General Definitions

The five-digit procedure codes and two-digit modifier codes included in 101 CMR 317.00, and their corresponding descriptions, utilize the Healthcare Common Procedure Code System (HCPCS) for Level I and Level II coding. Level I CPT-4 codes are obtained from the Physicians’ 2023 Current Procedural Terminology (CPT), copyright 2022, by the American Medical Association (AMA), unless otherwise specified. Level II codes are obtained from the 2023 HCPCS, maintained jointly by the Centers for Medicare & Medicaid Services (CMS), the Blue Cross and Blue Shield Association, and the Health Insurance Association of America. HCPCS is a listing of descriptive terms and identifying codes and modifiers for reporting medical services and procedures performed by physicians and other health care professionals, as well as associated nonphysician services. No fee schedules, basic unit value, relative value guides, conversion factors, or scales are included in any part of the Physicians’ Current Procedure Terminology. For code descriptions, see the medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine.

In addition, terms used in 101 CMR 317.00 have the meanings set forth in 101 CMR 317.02.

Child and Adolescent Needs and Strengths (CANS). A tool that provides a standardized way to organize information gathered during a psychiatric diagnostic assessment and is a treatment and service decision support tool for children and adolescents younger than 21 years old.

CMS. Centers for Medicare & Medicaid Services.

Correctional Facility. Any building, enclosure, space or structure used for the custody, control, and rehabilitation of committed offenders and of such other persons as may be placed in custody therein in accordance with law.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT). A program of health screening and other medical services for publicly assisted individuals younger than 21 years old as required by federal law.

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Eligible Provider. The rates established in 101 CMR 317.00 apply in accordance with 101 CMR 317.01 to the following types of providers who meet conditions of participation of the governmental unit purchasing such services, and to the extent specified by such governmental unit. Eligible providers must provide such services in accordance with generally accepted professional standards and in accordance with state licensing requirements and certification by national credentialing bodies as required by law. A licensed physician (other than an intern, resident, fellow, or house officer), licensed podiatrist, licensed dentist, licensed chiropractor, and licensed optometrist. A provider of diagnostic medical services. Such medical diagnostic services may be rendered by eligible providers such as, but not limited to, independent diagnostic testing facilities (IDTFs). These eligible providers must be physically and financially independent of a hospital or a physician’s office. A provider of radiation oncology services. Radiation oncology services may be rendered by eligible providers such as, but not limited to, independent radiation oncology centers. These eligible providers must be physically and financially independent of a hospital or a physician’s office. A clinic licensed by the Massachusetts Department of Public Health in accordance with 105 CMR 140.000: Licensure of Clinics to provide medical diagnostic services. A freestanding birth center facility that is not operating under a hospital’s license and is licensed as a birth center by the Massachusetts Department of Public Health pursuant to 105 CMR 140.000. An advanced practice registered nurse who is authorized by the Board of Registration in Nursing to practice as a certified nurse practitioner, certified nurse midwife, clinical nurse specialist, psychiatric clinical nurse specialist, or a certified registered nurse anesthetist (CRNA). A licensed physician assistant who is authorized by the Board of Registration for Physician Assistants to practice as a physician assistant. A registered nurse providing tobacco cessation services. A tobacco cessation counselor who has completed appropriate training in tobacco cessation counseling according to the qualification criteria established by the purchasing governmental unit. A pharmacist who is registered by the Board of Registration in Pharmacy. An acupuncturist who is licensed by the Board of Registration in Medicine to practice acupuncture. A correctional facility operating in the Commonwealth of Massachusetts.

Eligible Provider for Administration of Vaccines. A licensed physician, certified nurse practitioner, certified nurse midwife, clinical nurse specialist, psychiatric clinical nurse specialist, physician assistant, registered pharmacist, correctional facility, or other health care professional certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C, and any home health agency certified as a provider of home health services under the Medicare Health Insurance Program for the Aged (Title XVIII) is eligible to administer vaccines, if it otherwise meets such conditions of participation and coverage set forth by a purchasing governmental unit. Any other providers authorized by the Massachusetts Department of Public Health to possess and administer vaccines are also eligible if they otherwise meet such conditions of participation and coverage set forth by a purchasing governmental unit.

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Facility Setting Fee. Payments for services provided by an individual eligible provider in a hospital (including without limitation a hospital inpatient department, outpatient department, emergency department, and hospital licensed health center), or skilled nursing facility or freestanding ambulatory surgical center (ASC), will be made according to a facility setting fee when an applicable facility setting fee has been established for that procedure.

Governmental Unit. The Commonwealth, any department, agency, board, or commission of the Commonwealth and any political subdivision of the Commonwealth.

Individual Consideration. Medical services that are authorized but not listed in 101 CMR 317.00, medical services performed in unusual circumstances, and services designated “IC” are individually considered items. The governmental unit or purchaser analyzes the eligible provider’s report of services rendered and charges submitted under the appropriate unlisted services or procedures category. The governmental unit or purchaser determines appropriate payment for procedures designated IC in accordance with the following standards and criteria: (a) the amount of time required to perform the service; (b) the degree of skill required to perform the service; (c) the severity or complexity of the patient’s disease, disorder, or disability; (d) any applicable relative-value studies; (e) any complications or other circumstances that may be deemed relevant; (f) the policies, procedures, and practices of other third party insurers; (g) the payment rate for prescribed drugs as set forth in 101 CMR 331.00: Prescribed Drugs; and (h) a copy of the current invoice from the supplier.

Modifiers. Listed services may be modified under certain circumstances. When applicable, the modifying circumstances should be identified by the addition of the appropriate two-digit number or letters.

Participating Correctional Facility. Any correctional facility that is a Department of Corrections state prison, county jail or house of correction, or a Department of Youth Services hardware secure or staff secure track 1 facility or unit that is not an institution of mental diseases as defined in 42 CFR 435.1010: Definitions relating to institutional status, and that is enrolled as a MassHealth provider.

Physical Medicine. The physical medicine procedure codes apply only when (a) the physician prescribed the needed therapy; and (b) the services are provided by the physician or a licensed physical or occupational therapist employed by the physician.

Primary Care Clinician (PCC) Plan. A managed care option administered by the MassHealth agency through which enrolled members receive primary care and certain other medical services.

Publicly Aided Individual (or Publicly Aided Patient). A person who receives health care and services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Referral. The transfer of the total or specific care from one eligible provider to another.

Separate Procedure. Some of the listed procedures are commonly carried out as an integral part of a total service, and as such do not warrant a separate identification. When, however, such a procedure is performed independently of, and is not immediately related to, other services, it may be listed as a separate procedure in the procedure description. Thus, when a procedure that is ordinarily a component of a larger procedure is performed alone for a specific purpose, it may be considered to be a separate procedure.

Unlisted Procedure or Service. A service or procedure may be provided that is not listed in 101 CMR 317.04. When reporting such a service, the appropriate "Unlisted Procedure" code may be used to indicate the service.

317.03 General Rate Provisions

317.03: General Rate Provisions

(1) Rate Determination. Rates of payment for services for which 101 CMR 317.00 applies are the lowest of (a) the eligible provider's usual fee to patients other than publicly aided individuals; (b) the eligible provider's actual charge submitted; or (c) 1. the schedule of allowable fees set forth in 101 CMR 317.04(4), taking into account appropriate modifiers and any other applicable rate provision(s) in accordance with 101 CMR 317.03 or 317.04(1); or 2. for drugs, vaccines, and immune globulins administered in a physician’s office, the fee specified in 101 CMR 317.04(1)(a), taking into account any other applicable rate provision(s) in accordance with 101 CMR 317.04(1).

(2) Supplemental Payment. (a) Eligibility. An eligible provider who is a physician, certified nurse practitioner, physician assistant, or CRNA is eligible for a supplemental payment for services to publicly aided individuals eligible under Titles XIX and XXI of the Social Security Act if the following conditions are met:

the eligible provider is employed by a nonprofit group practice that was established in accordance with St. 1997, c.163 and is affiliated with a Commonwealth-owned medical school;
such nonprofit group practice must have been established on or before January 1, 2000, in order to support the purposes of a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school; and
the services are provided at a teaching hospital affiliated with and appurtenant to a Commonwealth-owned medical school. (b) Payment Method. This supplemental payment may not exceed the difference between
payments to the eligible provider made pursuant to the rates applicable under 101 CMR 316.03(1): Rate Determination, 101 CMR 317.03(1), and 101 CMR 318.03(1): Rate Determination; and
the federal upper payment limit established by the Centers for Medicare & Medicaid Services.

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

(3) Rate Variations Based on Practice Site. Payments for certain services provided by individual eligible providers that can be routinely furnished in physicians’ offices are reduced when such services are furnished in facility settings. 101 CMR 317.04 establishes facility setting fees applied to services rendered in a facility when a practice site differential is warranted.

(4) The sum of the professional and technical components of an individual procedure will not be greater than the allowable global fee set forth in 101 CMR 317.04(4).

(5) Allowable Fee for Certain Eligible Providers. Payment for services provided by eligible providers who are certified nurse practitioners, psychiatric clinical nurse specialists, clinical nurse specialists, physician assistants, registered nurses, tobacco cessation counselors, pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C, and home health agencies as specified in 101 CMR 317.02 is 85% of the fees contained in 101 CMR 317.04. 101 CMR 317.03(5) does not apply to the EPSDT add-on code S0302 described in 101 CMR 317.03(7) or for tobacco cessation services, for medical nutrition therapy (97802, 97803, 97804, G0270, G0271), for diabetes self- management training (G0108, G0109), for the administration of behavioral health or developmental screenings (96110, 96127, and related modifiers), or for the perinatal depression screening (S3005 and related modifiers) services listed in 101 CMR 317.04(4). The rates listed in 101 CMR 317.04(4) for tobacco cessation services performed by certain eligible providers already reflect the appropriate rate and no further rate adjustment applies (see codes 99407, 99407-SA, -TD, -TF, -HQ, -U1, -U2, and -U3).

(6) Behavioral Health and Developmental Screening Services. Payment for the administration and scoring of standardized behavioral health and developmental screening tools is available to certain eligible providers (physicians, certified nurse midwives, certified nurse practitioners, physician assistants, community health centers, hospital outpatient departments, or such eligible providers employed by a physician or community health center if authorized by the governmental unit) and is allowed for MassHealth purchase only when accompanied by a modifier. Appropriate codes and related modifiers for the standardized behavioral health screening tools are listed in a separate fee table in 101 CMR 317.04(4). For purposes of these modifiers, “Behavioral health need identified” or “Developmental services need identified” means the provider administering the screening tool, in her or his professional judgment, identifies a child with a potential behavioral health or developmental services need.

(7) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Add-on Code. To identify a completed well child office visit including all age-appropriate components of the EPSDT schedule, use code S0302 in addition to the appropriate preventive medicine service in 101 CMR 317.04(4). S0302 is always performed in addition to the primary procedure and must never be reported as a stand-alone code.

(8) Services and Payments Covered Under Other Regulations. Rules and reimbursement rates for the Medicine service codes listed in the chart below are contained in other EOHHS regulations, except when an eligible provider that is a licensed physician is billing those codes in conjunction with a medical (non-routine) diagnosis code.

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Regulation Title Regulation Number Affected Services

Rates for Hearing Services 101 CMR 323.00 Audiologic Codes 92590 to 92595 Rates for Vision Care Services and Ophthalmic Materials 101 CMR 315.00 Ophthalmological Service Codes 92002, 92004, 92012, 92014, 92015; Spectacle Service Codes 92340-92342, 92370 and Screening Code 99173

(9) CPT Category III Codes. All medicine-related CPT category III codes are included as a part of 101 CMR 317.00 and have an assigned fee of IC

(10) PCC Plan Enhanced Fee. Primary Care Clinicians (PCCs) receive an enhanced rate for certain types of primary and preventive care visits provided to PCC Plan members enrolled with the PCC on the date of service. The enhanced fee specified in 101 CMR 353.03: General Payment Provisions is added to the rate for the procedure code billed. The MassHealth agency pays PCCs an enhanced fee for delivering primary care services in accordance with the terms of the PCC provider contract.

(11) Child and Adolescent Needs and Strengths (CANS): Psychiatric Diagnostic Interview Examination for Children and Adolescents Younger than 21 Years Old. Psychiatrists or psychiatric clinical nurse specialists who complete the CANS for a MassHealth child or adolescent younger than 21 years old during a Psychiatric Diagnostic Interview Examination should bill using procedure code 90791 accompanied by modifier HA.

317.04 Maximum Allowable Fees – Medical Services

317.04: Maximum Allowable Fees – Medical Services

(1) Drugs, Medications, Supplies, and Laboratory Specimen Collections. (a) Payment rates for drugs, vaccines, and immune globulins administered in a physician’s office are equal to the fee listed in the Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File. For drugs, vaccines, and immune globulins administered in a physician’s office that are not listed in the Quarterly ASP Medicare Part B Drug Pricing File, codes are listed in 101 CMR 317.04(4) with payment set by IC, which will apply until such time as the code is listed in the Quarterly ASP Medicare Part B Drug Pricing File. (b) Supplies and materials used in preparation for or as part of a procedure (e.g., bandages, laboratory kits, syringes, or disposable gloves) are not reimbursed separately, but are included in the office visit rate. In addition, no supplemental charge can be submitted nor payment allowed for routine specimen collection in a physician's office and preparation for clinical laboratory analysis (and activities related thereto), e.g., venipuncture, urine, fecal and sputum samples, culturing, swabbing, and scraping for removal of tissues. (c) Where applicable, payments for drugs, medicines, supplies, and related materials dispensed to patients are in accordance with rates that are the subject matter of other regulations that may be in effect and germane to the item in question (e.g., laboratory, pharmacy, medical supplies, etc.). In other instances where the use of another regulation is not appropriate, certain supplies and materials (except eyeglasses), provided by the physician over and above those usually included with the office visit or other services rendered should be billed under code 99070.

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

(d) Payment for drugs and/or biologicals may be claimed in addition to an office visit. Drugs that are considered routine and integral to the delivery of a physician’s professional services in the course of diagnosis or treatment are not reimbursable. Such drugs are commonly provided without charge or are included in the physician’s fee for the service. Drugs and/or biologicals available free of charge from the Massachusetts Department of Public Health are not payable items. When an immunization or injection is the primary purpose of an office or other outpatient visit, the provider may bill only for the injectable material and its administration. Payment for both vaccine administration and an office visit is allowable only when the vaccine administration is a medically necessary, separately identifiable service. (e) Allowable Fee for COVID-19 Treatment. The allowable fees for monoclonal antibodies and their administration for the treatment of COVID-19 are 100% of the corresponding Medicare Part B payment rates, without geographic adjustment. Payment for the administration of monoclonal antibodies provided by eligible providers who are certified nurse practitioners, psychiatric clinical nurse specialists, clinical nurse specialists, physician assistants, registered nurses, pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C, and home health agencies as specified in 101 CMR 317.02 is 85% of the allowable fee. (f) Allowable Fee for COVID-19 Vaccine and Vaccine Administration. The allowable fees for COVID-19 vaccines and their administration are 100% of the corresponding Medicare Part B payment rates, without geographic adjustment. Payment for administration of the COVID-19 vaccine provided by eligible providers who are certified nurse practitioners, psychiatric clinical nurse specialists, clinical nurse specialists, physician assistants, registered nurses, pharmacies that utilize pharmacists, or other health care professionals certified in accordance with 105 CMR 700.000: Implementation of M.G.L. c. 94C, and home health agencies as specified in 101 CMR 317.02 is 85% of the allowable fee.

(2) Unless otherwise specified, guidelines, notes, and definitions provided in the 2023 CPT Coding Handbook are applicable to the use of the procedure codes and modifiers listed below, as well as their corresponding descriptions. For code descriptions, see the medicine services code spreadsheet at www.mass.gov/regulations/101-CMR-31700-medicine.

(3) Modifiers. (a) 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During Postoperative Period. (b) 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service. Modifier 25 is used to facilitate billing of evaluation and management services on the day of a procedure for which separate payment may be made. The physician or other qualified health care professional may indicate that on the day a procedure or service code was performed, the patient’s condition required a significant, separately identifiable evaluation and management service above and beyond the usual preoperative and postoperative care associated with the procedure or service that was performed. (c) 26: Professional Component. The component of a service or procedure representing the physician’s or other qualified health care professional’s work interpreting or performing the service or procedure. (When the physician or other qualified health care professional component is reported separately, the addition of modifier 26 to the appropriate procedure

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

code will allow payment of the professional component allowable fee (PC Fee) contained in 101 CMR 317.04(4), adjusted by 101 CMR 317.03 as applicable.) (d) 50: Bilateral Procedures. Payment for bilateral procedures performed at the same operative session must be identified by the appropriate service code and modifier 50. Only one claim line is billed for both procedures. (The addition of modifier 50 to the bilateral code will allow payment of 150% of the allowable fee contained in 101 CMR 317.04(4), adjusted by 101 CMR 317.03 as applicable, to the eligible provider for performance of both bilateral procedures.) (e) 51: Multiple Procedures. This modifier must be used to report multiple procedures performed at the same session. The service code for the major procedure or service must be reported without a modifier. The secondary, additional, or lesser procedure(s) must be identified by adding modifier 51 to the end of the service code for the secondary procedure(s). (The addition of modifier 51 to the second and subsequent procedure codes allows payment of 50% of the allowable fee contained in 101 CMR 317.04(4), adjusted by 101 CMR 317.03 as applicable, to the eligible provider. Note: This modifier should not be used with designated “add-on” codes or with codes in which the narrative begins with “each additional.”) (f) 52: Reduced Services. Under certain circumstances a service or procedure is partially reduced or eliminated at the physician's or other qualified health care professional’s election. Under these circumstances, the service provided can be identified by its usual procedure number and addition of modifier 52 signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. (g) 57: Decision for Surgery. (h) 59: Distinct Procedural Service. To identify a procedure distinct or independent from other services performed on the same day, add modifier 59 to the end of the appropriate service code. Modifier 59 is used to identify services/procedures that are not normally reported together, but are appropriate under certain circumstances, for example, different site or organ system. However, when another already established modifier is appropriate, it should be used rather than modifier 59. (i) GO: Services Delivered Personally by an Occupational Therapist or under an Outpatient Occupational Therapy Plan of Care. (j) GP: Services Delivered Personally by a Physical Therapist or under an Outpatient Physical Therapy Plan of Care. (k) HA: Child and Adolescent Needs and Strengths (CANS): Psychiatric Diagnostic Interview Examination for Children and Adolescents Younger than 21 Years Old. This modifier should only be applied to service code 90791 billed by psychiatrists or psychiatric clinical nurse specialists to identify a Psychiatric Diagnostic Interview Examination for a MassHealth child or adolescent younger than 21 years old using the CANS. (l) LM: Left Main Coronary Artery. (m) PA: Surgical or Other Invasive Procedure Performed on the Wrong Body Part. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26, and results in nonpayment for services. (n) PB: Surgical or Other Invasive Procedure Performed on the Wrong Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26, and results in nonpayment for services.

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

(o) PC: Wrong Surgical or Other Invasive Procedure Performed on a Patient. This modifier is applied to report Provider Preventable Conditions in accordance with 42 CFR 447.26, and results in nonpayment for services. (p) RI: Ramus Intermedius Coronary Artery. (q) SA: Nurse Practitioner Rendering Service in Collaboration with a Physician. This modifier is to be applied to service codes billed by a physician that were performed by a certified nurse practitioner employed by the physician (the physician employer must be practicing as an individual and not practicing as a professional corporation or as a member of a group practice). A certified nurse practitioner billing under his/her own individual provider number, or a group practice, should not use this modifier. (r) SL: State-supplied Vaccine. This modifier is to be applied to the vaccine code to identify the administration of vaccines provided at no cost by the Massachusetts Department of Public Health for individuals younger than 18 years old, including those administered under the Vaccine for Children Program (VFC). (s) TC: Technical Component. The component of a service or procedure representing the cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits, and other overhead expenses of the service or procedures, excluding the physician’s or other qualified health care professional’s professional component. (When the technical component is reported separately, the addition of modifier TC to the procedure code will allow payment of the technical component allowable fee (TC Fee) contained in 101 CMR 317.04(4), as adjusted by 101 CMR 317.03 as applicable.) (t) XE: Separate Encounter. A service that is distinct because it occurred during a separate encounter. (u) XS: Separate Structure. A service that is distinct because it was performed on a separate organ/structure. (v) XP: Separate Practitioner. A service that is distinct because it was performed by a different practitioner. (w) XU: Unusual Non-overlapping Service. The use of a service that is distinct because it does not overlap usual components of the main service.

(4) Fee Schedule. (a) NFAC – “Nonfacility.” These amounts apply when the service is performed in a nonfacility setting. (b) FAC – “Facility.” These amounts, also known as the Facility Setting Fee, apply when the service is performed in a facility setting (c) Global Fee. These amounts apply when no site of service differential rate is specified.

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 0121A - - IC - - 0141A - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 0142A - - IC - - 0151A - - IC - - 0171A - - IC - - 0172A - - IC - - 0173A - - IC - - 0174A - - IC - - 90281 - - IC - -

90283 - - IC - -

90284 - - IC - -

90287 - - IC - - 90288 - - IC - - 90291 - - IC - - 90296 - - IC - - 90377 - - IC - - 90378 - - IC - - 90384 - - IC - - 90385 - - IC - - 90386 - - IC - - 90389 - - IC - - 90393 - - IC - - 90396 - - IC - - 90399 - - IC - - 90460 - - $20.45 - - 90461 - - $9.84 - - 90471 - - $20.45 - - 90472 - - $9.84 - - 90473 - - $20.45 - - 90474 - - $9.84 - - 90476 - - IC - - 90477 - - IC - - 90581 - - IC - - 90586 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 90587 - - IC - - 90589 - - IC - - 90619 - - IC - - 90620 - - IC - - 90621 - - IC - - 90623 - - IC - - 90625 - - IC - - 90626 - - IC - - 90627 - - IC - - 90630 - - IC - - 90633 - - IC - - 90634 - - IC - - 90636 - - $122.36 - - 90644 - - IC - - 90647 - - IC - - 90648 - - IC - - 90649 - - IC - - 90650 - - IC - - 90651 - - IC - - 90653 - - IC - - 90654 - - IC - - 90655 - - IC - - 90656 - - IC - - 90657 - - IC - - 90658 - - IC - - 90660 - - IC - - 90661 - - IC - - 90664 - - IC - - 90666 - - IC - - 90667 - - IC - - 90668 - - IC - - 90671 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 90672 - - IC - - 90673 - - IC - - 90674 - - IC - - 90676 - - IC - - 90677 - - IC - - 90678 - - IC - - 90680 - - IC - - 90681 - - IC - - 90682 - - IC - - 90683 - - IC - - 90685 - - IC - - 90687 - - IC - - 90689 - - IC - - 90690 - - IC - - 90694 - - IC - - 90696 - - IC - - 90697 - - IC - - 90698 - - IC - - 90700 - - IC - - 90702 - - IC - - 90707 - - IC - - 90710 - - IC - - 90713 - - IC - - 90716 - - IC - - 90717 - - IC - - 90723 - - IC - - 90733 - - IC - - 90734 - - IC - - 90736 - - IC - - 90738 - - IC - - 90739 - - IC - - 90743 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 90744 - - IC - - 90748 - - IC - - 90749 - - IC - - 90750 - - IC - - 90756 - - IC - - 90758 - - IC - - 90759 - - IC - - 90785 $10.96 $9.62 - - - 90791 $128.70 $109.68 - - - 90792 $144.56 $125.28 - - - 90832 $55.55 $48.32 - - - 90833 $51.05 $45.16 - - - 90834 $73.46 $64.08 - - - 90836 $64.73 $57.23 - - - 90837 $108.09 $94.16 - - - 90838 $85.64 $76.00 - - - 90839 $103.82 $90.96 - - - 90840 $51.45 $45.56 - - - 90845 $69.49 $60.92 - - - 90846 $69.54 $69.27 - - - 90847 $72.52 $72.26 - - - 90849 $27.97 $21.27 - - - 90853 $19.67 $16.99 - - - 90863 $18.71 $17.64 - - - 90865 $122.02 $89.88 - - - 90867 - - IC - - 90868 - - IC - - 90869 - - IC - - 90870 $130.44 $76.87 - - - 90875 $43.64 $43.10 - - - 90876 $76.58 $68.54 - - - 90880 $77.05 $63.66 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 90882 - - IC - - 90885 - - $35.13 - - 90887 $63.68 $53.50 - - - 90889 - - IC - - 90899 - - IC - - 90901 $31.67 $13.99 - - - 90912 $61.94 $31.41 - - - 90913 $24.29 $17.86 - - - 90935 - - $52.43 - - 90937 - - $74.69 - - 90940 - - IC - - 90945 - - $63.23 - - 90947 - - $89.67 - - 90951 - - $861.41 - - 90952 - - IC - - 90953 - - IC - - 90954 - - $738.30 - - 90955 - - $383.14 - - 90956 - - $256.16 - - 90957 - - $565.67 - - 90958 - - $368.30 - - 90959 - - $239.78 - - 90960 - - $260.54 - - 90961 - - $216.95 - - 90962 - - $149.93 - - 90963 - - $446.55 - - 90964 - - $383.43 - - 90965 - - $367.46 - - 90966 - - $216.68 - - 90967 - - $12.99 - - 90968 - - $12.74 - - 90969 - - $12.50 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 90970 - - $7.02 - - 90989 - - IC - - 90993 - - IC - - 90997 - - $64.39 - - 90999 - - IC - - 91010 - - $174.09 $47.27 $126.82 91013 - - $20.14 $6.75 $13.39 91020 - - $216.71 $53.20 $163.51 91022 - - $133.68 $53.20 $80.48 91030 - - $113.21 $33.80 $79.41 91034 - - $151.77 $36.47 $115.30 91035 - - $366.69 $59.54 $307.14 91037 - - $132.62 $35.80 $96.82 91038 - - $325.44 $40.59 $284.85 91040 - - $420.41 $36.13 $384.28 91065 - - $66.90 $7.24 $59.66 91110 - - $592.39 $82.50 $509.90 91111 - - $685.67 $33.28 $652.39 91112 - - $1,318.43 $77.66 $1,240.77 91113 - - $726.59 $89.00 $637.59 91117 - - $100.28 - - 91120 - - $407.76 $35.26 $372.50 91122 - - $215.28 $64.35 $150.93 91132 - - $356.43 $19.29 $337.14 91133 - - $374.86 $24.33 $350.53 91200 - - $23.75 $7.75 $16.00 91299 - - IC - - 91318 - - IC - - 91319 - - IC - - 91320 - - IC - - 91321 - - IC - - 91322 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 92002 $65.87 $34.00 - - - 92004 $114.47 $69.74 - - - 92012 $69.13 $37.52 - - - 92014 $96.90 $56.46 - - - 92018 - - $102.85 - - 92019 - - $53.23 - - 92020 $21.04 $15.15 - - - 92025 - - $27.99 $14.39 $13.59 92060 - - $48.63 $27.27 $21.36 92065 - - $30.91 $24.28 $6.63 92066 - - $20.56 - - 92071 $27.39 $23.91 - - - 92072 $95.78 $69.80 - - - 92081 - - $25.69 $11.83 $13.86 92082 - - $36.17 $15.35 $20.82 92083 - - $48.53 $19.94 $28.59 92100 $66.49 $23.91 - - - 92132 - - $24.35 $12.10 $12.25 92133 - - $28.14 $15.89 $12.25 92134 - - $30.97 $18.45 $12.52 92136 - - $36.12 $22.53 $13.59 92145 - - $9.81 $3.99 $5.82 92201 $18.50 $16.62 - - - 92202 $11.66 $10.85 - - - 92227 - - $13.32 - - 92228 - - $22.43 $12.32 $10.11 92229 - - $36.09 - - 92230 $88.08 $25.67 - - - 92235 - - $107.69 $31.42 $76.27 92240 - - $149.95 $34.85 $115.10 92242 - - $204.25 $40.40 $163.85 92250 - - $28.67 $15.62 $13.06

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 92260 $15.27 $7.78 - - - 92265 - - $67.11 $33.96 $33.14 92270 - - $84.98 $31.01 $53.97 92273 - - $99.45 $27.01 $72.45 92274 - - $69.44 $24.51 $44.93 92283 - - $42.60 $6.51 $36.09 92284 - - $36.89 - - 92285 - - $18.23 $2.23 $16.00 92286 - - $30.01 $15.89 $14.13 92287 - - $114.38 $27.67 $86.71 92310 $76.65 $42.10 - - - 92311 $81.28 $38.43 - - - 92312 $94.26 $44.44 - - - 92313 $77.37 $31.83 - - - 92314 $67.51 $24.93 - - - 92315 $64.79 $15.50 - - - 92316 $79.79 $23.28 - - - 92317 $68.27 $15.50 - - - 92325 - - $36.09 - - 92326 - - $31.00 - - 92352 $34.37 $13.21 - - - 92353 $39.02 $18.13 - - - 92354 - - $10.65 - - 92355 - - $16.54 - - 92358 - - $8.77 - - 92371 - - $9.31 - - 92499 - - IC - - 92502 - - $71.11 - - 92504 $22.82 $7.02 - - - 92507 - - $57.81 - - 92508 - - $18.19 - - 92511 $93.14 $28.32 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 92512 $49.09 $20.16 - - - 92516 $55.52 $16.95 - - - 92517 $59.76 $31.37 - - - 92518 $61.90 $31.64 - - - 92519 $103.30 $47.59 - - - 92520 $66.04 $29.61 - - - 92521 - - $100.51 - - 92522 - - $83.77 - - 92523 - - $172.36 - - 92524 - - $82.70 - - 92526 - - $64.41 - - 92531 - - IC - - 92532 - - IC - - 92533 - - IC - - 92534 - - IC - - 92537 - - $30.63 $22.93 $7.70 92538 - - $17.12 $11.83 $5.29 92540 - - $82.99 $57.62 $25.38 92541 - - $19.03 $15.62 $3.41 92542 - - $21.80 $18.38 $3.41 92544 - - $13.44 $10.56 $2.88 92545 - - $12.68 $9.80 $2.88 92546 - - $100.64 $11.05 $89.59 92547 - - $8.57 - - 92548 - - $36.02 $24.84 $11.18 92549 - - $49.56 $33.29 $16.27 92550 - - $16.81 - - 92551 - - $9.57 - - 92552 - - $28.32 - - 92553 - - $34.75 - - 92555 - - $21.89 - - 92556 - - $33.95 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 92557 $27.95 $23.66 - - - 92558 $7.04 $6.24 - - - 92562 - - $38.23 - - 92563 - - $26.45 - - 92565 - - $16.00 - - 92567 $12.60 $8.04 - - - 92568 $11.52 $11.25 - - - 92570 $24.31 $21.63 - - - 92571 - - $24.04 - - 92572 - - $37.70 - - 92575 - - $59.59 - - 92576 - - $31.80 - - 92577 - - $16.27 - - 92579 $34.15 $27.72 - - - 92582 - - $65.55 - - 92583 - - $43.32 - - 92584 - - $87.96 - - 92587 - - $16.47 $13.32 $3.15 92588 - - $25.65 $21.43 $4.22 92596 - - $58.59 - - 92597 - - $54.15 - - 92601 $122.87 $91.53 - - - 92602 $78.16 $51.92 - - - 92603 $114.95 $88.97 - - - 92604 $69.71 $49.62 - - - 92605 $67.81 $63.26 - - - 92606 $59.45 $50.34 - - - 92607 - - $94.31 - - 92608 - - $37.09 - - 92609 - - $78.78 - - 92610 $64.50 $52.45 - - - 92611 - - $69.50 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 92612 $154.16 $49.44 - - - 92613 - - $27.29 - - 92614 $114.19 $48.83 - - - 92615 - - $24.26 - - 92616 $174.45 $73.48 - - - 92617 $30.32 $30.05 - - - 92618 $23.68 $23.41 - - - 92620 $66.85 $59.09 - - - 92621 $16.54 $13.86 - - - 92622 $60.24 $49.28 - - - 92623 $15.47 $13.06 - - - 92625 $51.46 $45.56 - - - 92626 $65.88 $55.70 - - - 92627 $15.51 $13.10 - - - 92630 - - IC - - 92633 - - IC - - 92640 $83.27 $69.87 - - - 92650 - - $21.52 - - 92651 - - $65.19 - - 92652 - - $86.54 - - 92653 - - $64.67 - - 92700 - - IC - - 92920 - - $374.88 - - 92921 - - IC - - 92924 - - $447.76 - - 92925 - - IC - - 92928 - - $417.83 - - 92929 - - IC - - 92933 - - $468.25 - - 92934 - - IC - - 92937 - - $417.32 - - 92938 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 92941 - - $468.87 - - 92943 - - $469.21 - - 92944 - - IC - - 92950 $249.10 $132.32 - - - 92953 - - $0.71 - - 92960 $117.99 $79.69 - - - 92961 - - $175.61 - - 92970 - - $133.61 - - 92971 - - $71.69 - - 92972 - - $105.80 - -

92973 - - $124.70 - - 92974 - - $114.23 - - 92975 - - $266.55 - - 92977 - - $41.50 - - 92978 - - - $67.48 - 92979 - - - $53.85 - 92986 - - $949.60 - - 92987 - - $982.07 - - 92990 - - $785.14 - - 92997 - - $454.34 - - 92998 - - $225.95 - - 93000 - - $10.99 - - 93005 - - $5.02 - - 93010 - - $5.97 - - 93015 - - $54.25 - - 93016 - - $15.50 - - 93017 - - $28.52 - - 93018 - - $10.22 - - 93024 - - $84.35 $40.16 $44.19 93025 - - $94.96 $27.07 $67.90 93040 - - $9.70 - - 93041 - - $4.75 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 93042 - - $4.94 - - 93050 - - $12.06 $5.97 $6.09 93150 $77.57 $31.30 - - -

93151 $67.52 $29.54 - - -

93152 $121.09 $69.20 - - -

93153 $40.18 $15.84 - - -

93224 - - $57.02 - - 93225 - - $14.66 - - 93226 - - $28.86 - - 93227 - - $13.50 - - 93228 - - $18.71 - - 93229 - - $670.79 - - 93241 - - $209.90 - - 93242 - - $9.57 - - 93243 - - $183.13 - - 93244 - - $17.20 - - 93245 - - $221.04 - - 93246 - - $9.57 - - 93247 - - $192.51 - - 93248 - - $18.96 - - 93260 - - $59.04 $30.99 $28.06 93261 - - $54.34 $26.55 $27.79 93264 $38.09 $25.77 - - - 93268 - - $141.29 - - 93270 - - $6.63 - - 93271 - - $116.98 - - 93272 - - $17.69 - - 93278 - - $22.32 $9.00 $13.32 93279 - - $52.67 $23.01 $29.66 93280 - - $61.77 $27.29 $34.48 93281 - - $65.74 $30.72 $35.02 93282 - - $62.52 $30.72 $31.80

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 93283 - - $76.03 $41.28 $34.75 93284 - - $81.96 $44.80 $37.16 93285 - - $47.35 $18.76 $28.59 93286 - - $36.14 $10.76 $25.38 93287 - - $41.68 $16.31 $25.38 93288 - - $44.14 $15.01 $29.13 93289 - - $56.33 $26.93 $29.39 93290 - - $41.93 $15.48 $26.45 93291 - - $38.92 $13.28 $25.64 93292 - - $39.79 $15.21 $24.57 93293 - - $35.58 $10.47 $25.11 93294 - - $21.92 - - 93295 - - $26.95 - - 93296 - - $17.88 - - 93297 - - $18.89 - - 93298 - - $19.16 - - 93303 - - $172.97 $44.95 $128.02 93304 - - $122.41 $26.40 $96.02 93306 - - $153.05 $50.21 $102.85 93307 - - $107.02 $31.90 $75.13 93308 - - $77.25 $18.20 $59.06 93312 - - $183.13 $77.74 $105.39 93313 - - $8.11 - - 93314 - - $176.79 $64.97 $111.82 93315 - - - $92.24 $397.67 93316 - - $18.44 - - 93317 - - - $64.19 - 93318 - - - $74.33 $397.67 93319 $42.77 $17.60 - - - 93320 - - $39.43 $12.99 $26.45 93321 - - $19.68 $5.21 $14.46 93325 - - $18.59 $2.25 $16.34

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 93350 - - $144.62 $50.21 $94.41 93351 - - $180.91 $60.39 $120.52 93352 - - $26.48 - - 93355 - - $163.15 - - 93356 $29.04 $8.42 - - - 93451 - - $687.51 $93.45 $594.06 93452 - - $707.11 $167.96 $539.16 93453 - - $898.18 $224.56 $673.61 93454 - - $709.76 $169.54 $540.23 93455 - - $789.85 $197.66 $592.19 93456 - - $882.25 $220.96 $661.29 93457 - - $960.55 $248.10 $712.45 93458 - - $814.18 $209.13 $605.05 93459 - - $874.71 $237.26 $637.45 93460 - - $971.40 $265.65 $705.75 93461 - - $1,071.17 $293.51 $777.67 93462 - - $149.50 - - 93463 - - $71.12 - - 93464 - - $170.21 $64.22 $106.00 93503 - - $63.28 - - 93505 - - $503.03 $162.21 $340.82 93563 - - $37.26 - - 93564 - - $39.19 - - 93565 - - $19.19 - - 93566 - - $19.06 - - 93567 - - $26.97 - - 93568 - - $33.65 - - 93569 - - $27.53 - - 93571 - - - $51.64 - 93572 - - - $37.39 - 93573 - - $45.88 - - 93574 - - $50.65 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 93575 - - $67.76 - - 93580 - - $692.85 - - 93581 - - $939.34 - - 93582 - - $469.27 - - 93583 - - $526.06 - - 93584 - - $42.77 - -

93585 - - $40.26 - -

93586 - - $50.92 - -

93587 - - $75.13 - -

93588 - - $75.89 - -

93590 - - $775.77 - - 93591 - - $639.81 - - 93592 - - $282.00 - - 93593 - - - $137.73 - 93594 - - - $215.10 - 93595 - - - $193.85 - 93596 - - - $236.03 - 93597 - - - $312.83 - 93598 - - - $51.06 - 93600 - - - $84.54 - 93602 - - - $82.34 - 93603 - - - $82.34 - 93609 - - - $197.42 - 93610 - - - $116.34 - 93612 - - - $114.41 - 93613 - - $210.50 - - 93615 - - - $27.09 - 93616 - - - $42.68 - 93618 - - - $156.53 - 93619 - - - $277.46 - 93620 - - - $446.44 - 93621 - - - $59.27 -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 93622 - - - $122.32 - 93623 - - - $61.81 - 93624 - - - $177.95 - 93631 - - - $282.12 - 93640 - - - $126.70 - 93641 - - - $222.16 - 93642 - - $247.13 $181.25 $65.88 93644 - - $144.40 $104.02 $40.38 93650 - - $421.65 - - 93653 - - $604.45 - - 93654 - - $728.43 - - 93655 - - $221.80 - - 93656 - - $685.45 - - 93657 - - $221.80 - - 93660 - - $123.00 $67.03 $55.97 93662 - - - $54.27 - 93668 - - $11.45 - - 93701 - - $21.09 - - 93702 - - $102.71 - - 93724 - - $212.01 $174.85 $37.16 93740 - - $5.72 - - 93745 - - IC - - 93750 $37.64 $29.07 - - - 93770 - - $5.72 - - 93784 - - $35.35 - - 93786 - - $17.88 - - 93788 - - $4.22 - - 93790 - - $13.25 - - 93792 - - $55.97 - - 93793 - - $8.62 - - 93797 $12.91 $6.48 - - - 93798 $19.58 $9.93 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 93799 - - IC - - 93880 - - $150.89 $27.95 $122.93 93882 - - $97.88 $17.39 $80.48 93886 - - $214.05 $33.53 $180.52 93888 - - $102.90 $18.40 $84.50 93890 - - $220.00 $37.07 $182.93 93892 - - $127.79 $43.29 $84.50 93893 - - $128.25 $43.95 $84.30 93895 - - IC - - 93922 - - $64.91 $8.80 $56.11 93923 - - $101.27 $15.70 $85.57 93924 - - $124.59 $17.46 $107.13 93925 - - $190.33 $27.22 $163.11 93926 - - $101.03 $16.52 $84.50 93930 - - $154.57 $27.62 $126.95 93931 - - $97.54 $16.79 $80.75 93970 - - $149.04 $24.23 $124.81 93971 - - $94.44 $15.57 $78.88 93975 - - $210.12 $40.58 $169.54 93976 - - $112.39 $27.89 $84.50 93978 - - $142.11 $27.48 $114.63 93979 - - $92.45 $16.79 $75.66 93980 - - $89.46 $43.46 $46.00 93981 - - $54.90 $15.59 $39.30 93985 - - $196.35 $27.34 $169.00 93986 - - $101.63 $17.12 $84.50 93990 - - $101.29 $16.79 $84.50 93998 - - IC - - 94002 - - $66.59 - - 94003 - - $46.73 - - 94004 - - $34.66 - - 94005 - - $67.39 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 94010 - - $20.90 $5.97 $14.93 94011 - - $62.39 - - 94012 - - $101.17 - - 94013 - - $13.78 - - 94014 - - $42.53 - - 94015 - - $24.57 - - 94016 - - $17.95 - - 94060 - - $30.16 $7.46 $22.70 94070 - - $47.16 $20.18 $26.98 94150 - - $19.52 $2.72 $16.81 94200 - - $11.53 $1.96 $9.57 94375 - - $29.69 $10.47 $19.22 94450 - - $64.43 $14.48 $49.95 94452 - - $37.99 $10.20 $27.79 94453 - - $51.84 $13.41 $38.43 94610 - - $41.25 - - 94617 - - $67.83 $23.23 $44.59 94618 - - $25.48 $16.17 $9.31 94619 - - $59.67 $16.42 $43.25 94621 - - $118.06 $49.49 $68.56 94625 $45.24 $12.29 - - - 94626 $60.04 $19.87 - - - 94640 - - $7.16 - - 94642 - - IC - - 94644 - - $47.61 - - 94645 - - $12.52 - - 94660 $48.20 $27.04 - - - 94662 - - $25.43 - - 94664 - - $13.59 - - 94667 - - $18.61 - - 94668 - - $29.06 - - 94669 - - $15.40 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 94680 - - $41.18 $9.18 $32.00 94681 - - $36.83 $6.97 $29.86 94690 - - $37.74 $2.72 $35.02 94726 - - $42.59 $8.71 $33.88 94727 - - $34.09 $8.71 $25.38 94728 - - $30.87 $8.98 $21.89 94729 - - $44.69 $6.46 $38.23 94760 - - $1.81 - - 94761 - - $2.88 - - 94762 - - $20.29 - - 94772 - - IC - - 94774 - - IC - - 94775 - - IC - - 94776 - - IC - - 94777 - - IC - - 94780 $39.87 $17.37 - - - 94781 $15.88 $5.97 - - - 94799 - - IC - - 95004 - - $3.12 - - 95012 - - $14.93 - - 95017 $6.73 $2.72 - - - 95018 $15.68 $5.23 - - - 95024 $6.34 $0.71 - - - 95027 - - $3.93 - - 95028 - - $10.11 - - 95044 - - $3.95 - - 95052 - - $5.02 - - 95056 - - $40.58 - - 95060 - - $29.93 - - 95065 - - $22.16 - - 95070 - - $27.45 - - 95076 $92.57 $54.27 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 95079 $63.65 $49.99 - - - 95115 - - $7.97 - - 95117 - - $9.31 - - 95120 - - IC - - 95125 - - IC - - 95130 - - IC - - 95131 - - IC - - 95132 - - IC - - 95133 - - IC - - 95134 - - IC - - 95144 $13.19 $2.47 - - - 95145 $26.31 $2.20 - - - 95146 $48.54 $2.20 - - - 95147 $46.93 $2.20 - - - 95148 $69.43 $2.20 - - - 95149 $91.93 $2.20 - - - 95165 $11.85 $2.47 - - - 95170 $8.90 $2.20 - - - 95180 $103.85 $75.46 - - - 95199 - - IC - - 95249 - - $48.47 - - 95250 - - $115.97 - - 95251 - - $25.44 - - 95700 - - IC - - 95705 - - IC - - 95706 - - IC - - 95707 - - IC - - 95708 - - IC - - 95709 - - IC - - 95710 - - IC - - 95711 - - IC - - 95712 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 95713 - - IC - - 95714 - - IC - - 95715 - - IC - - 95716 - - IC - - 95717 $74.94 $74.14 - - - 95718 $99.30 $97.42 - - - 95719 $116.42 $114.82 - - - 95720 $153.54 $150.60 - - - 95721 $153.08 $149.86 - - - 95722 $186.22 $182.47 - - - 95723 $187.05 $183.30 - - - 95724 $235.52 $231.24 - - - 95725 $214.07 $209.25 - - - 95726 $299.51 $293.62 - - - 95782 - - $752.45 $90.44 $662.01 95783 - - $796.98 $98.61 $698.37 95800 - - $116.83 $29.65 $87.18 95801 - - $71.83 $29.65 $42.18 95803 - - $108.88 $31.28 $77.61 95805 - - $330.75 $41.70 $289.05 95806 - - $70.84 $32.14 $38.70 95807 - - $305.46 $43.12 $262.34 95808 - - $434.30 $60.68 $373.62 95810 - - $478.75 $86.52 $392.24 95811 - - $500.82 $89.77 $411.05 95812 - - $273.38 $41.44 $231.95 95813 - - $338.88 $62.74 $276.14 95816 - - $303.38 $41.44 $261.94 95819 - - $352.40 $41.44 $310.96 95822 - - $329.90 $41.71 $288.19 95824 - - - $28.56 - 95829 - - $1,400.03 $242.03 $1,157.99

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 95830 $550.37 $67.19 - - - 95836 - - $77.79 - - 95851 $16.44 $5.72 - - - 95852 $13.61 $3.96 - - - 95857 $48.33 $21.01 - - - 95860 - - $87.18 $37.16 $50.02 95861 - - $124.21 $59.46 $64.75 95863 - - $161.69 $72.56 $89.12 95864 - - $181.36 $77.24 $104.12 95865 - - $115.37 $60.27 $55.11 95866 - - $98.03 $46.94 $51.09 95867 - - $83.55 $30.59 $52.96 95868 - - $108.37 $45.50 $62.87 95869 - - $75.82 $14.55 $61.27 95870 - - $65.64 $14.28 $51.36 95872 - - $149.65 $109.81 $39.84 95873 - - $56.67 $14.35 $42.32 95874 - - $60.95 $14.35 $46.60 95875 - - $106.41 $42.46 $63.95 95885 - - $48.68 $13.32 $35.35 95886 - - $75.69 $33.37 $42.32 95887 - - $65.06 $27.29 $37.77 95905 - - $27.34 $1.96 $25.38 95907 - - $68.88 $38.68 $30.20 95908 - - $85.71 $48.28 $37.43 95909 - - $102.94 $58.02 $44.93 95910 - - $134.60 $77.09 $57.52 95911 - - $162.25 $96.16 $66.09 95912 - - $189.55 $115.23 $74.32 95913 - - $218.66 $136.57 $82.09 95919 - - $11.77 $7.29 $4.49 95921 - - $67.50 $32.75 $34.75

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 95922 - - $74.79 $33.68 $41.11 95923 - - $96.16 $32.75 $63.41 95924 - - $116.54 $63.91 $52.63 95925 - - $140.71 $20.72 $119.99 95926 - - $122.63 $20.05 $102.58 95927 - - $131.20 $19.78 $111.42 95928 - - $184.50 $57.95 $126.55 95929 - - $187.51 $57.75 $129.77 95930 - - $52.09 $13.59 $38.50 95933 - - $64.19 $23.01 $41.18 95937 - - $82.54 $25.29 $57.25 95938 - - $288.89 $33.11 $255.78 95939 - - $430.72 $86.55 $344.17 95940 - - $23.79 - - 95941 - - IC - - 95954 - - $316.16 $78.79 $237.37 95955 - - $151.35 $38.92 $112.42 95957 - - $214.80 $74.45 $140.34 95958 - - $524.64 $164.40 $360.24 95961 - - $240.69 $117.09 $123.61 95962 - - $207.07 $125.78 $81.29 95965 - - - $302.54 - 95966 - - - $154.60 - 95967 - - - $135.46 - 95970 $13.92 $13.65 - - - 95971 $35.76 $28.53 - - - 95972 $42.48 $29.62 - - - 95976 $29.45 $28.65 - - - 95977 $38.87 $38.34 - - - 95980 - - $33.03 - - 95981 $29.70 $13.10 - - - 95982 $44.56 $26.62 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 95983 $37.14 $36.33 - - - 95984 $32.17 $31.90 - - - 95990 - - $71.51 - - 95991 $85.94 $29.42 - - - 95992 $32.56 $26.66 - - - 95999 - - IC - - 96000 - - $61.34 - - 96001 - - $81.22 - - 96002 - - $15.93 - - 96003 - - $12.21 - - 96004 - - $79.90 - - 96020 - - - $116.25 - 96040 - - $38.83 - - 96105 - - $72.97 - - 96110 - - $10.27 - - 96112 $93.34 $92.27 - - - 96113 $44.33 $41.39 - - - 96116 $68.84 $58.66 - - - 96121 $55.79 $48.83 - - - 96125 - - $77.38 - - 96127 - - $10.27 - - 96130 $88.52 $79.41 - - - 96131 $63.79 $55.76 - - - 96132 $96.29 $77.27 - - - 96133 $73.43 $55.76 - - - 96136 $32.35 $17.08 - - - 96137 $29.94 $13.07 - - - 96138 - - $26.98 - - 96139 - - $27.79 - - 96146 - - $1.81 - - 96156 $70.03 $61.46 - - - 96158 $47.82 $41.66 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 96159 $16.46 $14.32 - - - 96160 - - $2.14 - - 96161 - - $2.14 - - 96164 $7.22 $6.41 - - - 96165 $3.25 $2.98 - - - 96167 $50.81 $44.11 - - - 96168 $17.95 $15.54 - - - 96170 $58.01 $54.26 - - - 96171 $20.99 $19.65 - - - 96202 $17.49 $15.88 - - - 96203 - - $4.48 - - 96360 - - $25.52 - - 96361 - - $9.90 - - 96365 - - $50.40 - - 96366 - - $15.86 - - 96367 - - $22.53 - - 96368 - - $15.34 - - 96369 - - $111.20 - - 96370 - - $11.84 - - 96371 - - $45.00 - - 96372 - - $10.79 - - 96373 - - $14.00 - - 96374 - - $29.18 - - 96375 - - $12.02 - - 96376 - - IC - - 96377 - - $14.27 - - 96379 - - IC - - 96380 - - $17.56 - -

96381 - - $15.31 - -

96401 - - $57.37 - - 96402 - - $26.48 - - 96405 $65.76 $21.57 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 96406 $102.75 $33.11 - - - 96409 - - $79.66 - - 96411 - - $43.46 - - 96413 - - $103.34 - - 96415 - - $21.93 - - 96416 - - $101.62 - - 96417 - - $50.67 - - 96420 - - $81.43 - - 96422 - - $125.35 - - 96423 - - $57.73 - - 96425 - - $134.39 - - 96440 $597.89 $99.70 - - - 96446 $150.39 $18.08 - - - 96450 $127.58 $56.33 - - - 96521 - - $100.02 - - 96522 - - $92.25 - - 96523 - - $20.20 - - 96542 $101.52 $31.08 - - - 96547 - - IC - -

96548 - - IC - -

96549 - - IC - - 96567 - - $112.69 - - 96570 - - $39.57 - - 96571 - - $18.28 - - 96573 - - $183.57 - - 96574 - - $223.20 - - 96900 - - $19.48 - - 96902 $16.33 $14.72 - - - 96904 - - $56.18 - - 96910 - - $94.41 - - 96912 - - $80.55 - - 96913 - - $122.00 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 96920 $122.17 $47.17 - - - 96921 $134.01 $53.39 - - - 96922 $181.71 $86.36 - - - 96931 - - $135.22 - - 96932 - - $102.51 - - 96933 - - $32.71 - - 96934 - - $93.33 - - 96935 - - $62.41 - - 96936 - - $30.93 - - 96999 - - IC - - 97010 - - $4.88 - - 97012 - - $10.87 - - 97014 - - $9.43 - - 97016 - - $8.89 - - 97018 - - $4.35 - - 97022 - - $13.20 - - 97024 - - $5.69 - - 97026 - - $5.15 - - 97028 - - $6.44 - - 97032 - - $10.87 - - 97033 - - $15.14 - - 97034 - - $10.97 - - 97035 - - $10.97 - - 97036 - - $27.14 - - 97037 - - IC - -

97039 - - IC - - 97110 - - $22.47 - - 97112 - - $25.83 - - 97113 - - $28.29 - - 97116 - - $22.47 - - 97124 - - $23.23 - - 97129 $16.73 $16.46 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 97130 - - $15.97 - - 97139 - - IC - - 97140 - - $20.64 - - 97150 - - $13.46 - - 97151 - - IC - - 97152 - - IC - - 97153 - - IC - - 97154 - - IC - - 97155 - - IC - - 97156 - - IC - - 97157 - - IC - - 97158 - - IC - - 97161 - - $76.54 - - 97162 - - $76.54 - - 97163 - - $76.54 - - 97164 - - $53.23 - - 97165 - - $76.54 - - 97166 - - $76.54 - - 97167 - - $76.54 - - 97168 - - $52.96 - - 97169 - - IC - - 97170 - - IC - - 97171 - - IC - - 97172 - - IC - - 97530 - - $28.65 - - 97533 - - $49.72 - - 97535 - - $25.15 - - 97537 - - $24.27 - - 97542 - - $24.27 - - 97545 - - IC - - 97546 - - IC - - 97550 - - $39.97 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 97551 $19.79 $18.19 - - -

97552 - - $17.31 - -

97597 $78.44 $25.95 - - - 97598 $34.33 $18.00 - - - 97602 - - IC - - 97605 $32.68 $18.22 - - - 97606 $39.26 $19.71 - - - 97607 $292.13 $15.99 - - - 97608 $292.89 $18.35 - - - 97610 $355.78 $13.21 - - - 97750 - - $25.95 - - 97755 - - $29.24 - - 97760 - - $37.62 - - 97761 - - $32.26 - - 97763 - - $41.42 - - 97799 - - IC - - 97802 $27.91 $24.43 - - - 97803 $24.34 $20.59 - - - 97804 $12.75 $11.68 - - - 97810 $28.88 $22.72 - - - 97811 $21.61 $19.20 - - - 97813 $34.39 $24.75 - - - 97814 $27.93 $20.96 - - - 98925 $23.58 $17.15 - - - 98926 $33.72 $25.68 - - - 98927 $43.59 $33.68 - - - 98928 $53.53 $42.81 - - - 98929 $62.79 $51.28 - - - 98940 $20.84 $16.28 - - - 98941 $29.91 $25.08 - - - 98942 $38.71 $33.88 - - - 98943 $19.56 $16.88 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 98960 - - $23.17 - - 98961 - - $11.18 - - 98962 - - $8.24 - - 98966 $9.80 $8.20 - - - 98967 $17.73 $16.12 - - - 98968 $24.66 $22.78 - - - 98970 - - $8.46 - - 98971 $14.99 $14.72 - - - 98972 $22.92 $22.65 - - - 98975 - - $15.13 - - 98976 - - $39.57 - - 98977 - - $39.57 - - 98978 - - IC - - 98980 $37.41 $22.68 - - - 98981 $29.66 $22.16 - - - 99000 - - IC - - 99001 - - IC - - 99002 - - IC - - 99024 - - IC - - 99026 - - IC - - 99027 - - IC - - 99050 - - IC - - 99051 - - IC - - 99053 - - IC - - 99056 - - IC - - 99058 - - IC - - 99060 - - IC - - 99070 - - IC - - 99071 - - IC - - 99075 - - IC - - 99078 - - IC - - 99080 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 99082 - - IC - - 99091 - - $39.78 - - 99100 - - IC - - 99116 - - IC - - 99135 - - IC - - 99140 - - IC - - 99151 $46.79 $17.86 - - - 99152 $39.33 $9.06 - - - 99153 - - $8.70 - - 99155 - - $59.63 - - 99156 - - $54.98 - - 99157 - - $45.39 - - 99170 $124.80 $62.39 - - - 99172 - - IC - - 99174 - - $4.75 - - 99175 - - $24.04 - - 99177 - - $3.68 - - 99183 - - $77.48 - - 99184 - - $157.16 - - 99188 - - $28.00 - - 99190 - - IC - - 99191 - - IC - - 99192 - - IC - - 99195 - - $77.27 - - 99199 - - IC - - 99202 $59.34 $38.76 - - - 99203 $84.36 $60.79 - - - 99204 $128.18 $99.46 - - - 99205 $164.48 $133.14 - - - 99211 $18.35 $7.10 - - - 99212 $42.98 $26.11 - - - 99213 $68.11 $48.56 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 99214 $96.15 $71.77 - - - 99215 $134.43 $105.50 - - - 99221 - - $60.92 - - 99222 - - $95.65 - - 99223 - - $127.59 - - 99231 - - $36.39 - - 99232 - - $58.20 - - 99233 - - $87.54 - - 99234 - - $72.39 - - 99235 - - $117.14 - - 99236 - - $153.34 - - 99238 - - $59.82 - - 99239 - - $84.70 - - 99242 $57.31 $41.50 - - - 99243 $85.38 $65.29 - - - 99244 $121.76 $99.80 - - - 99245 $157.82 $133.18 - - - 99252 - - $52.65 - - 99253 - - $73.87 - - 99254 - - $102.94 - - 99255 - - $137.48 - - 99281 - - $8.53 - - 99282 - - $30.39 - - 99283 - - $52.15 - - 99284 - - $87.75 - - 99285 - - $127.50 - - 99288 - - IC - - 99291 $204.56 $155.81 - - - 99292 $88.42 $78.24 - - - 99304 - - $59.55 - - 99305 - - $98.56 - - 99306 - - $134.56 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 99307 - - $29.46 - - 99308 - - $55.26 - - 99309 - - $79.14 - - 99310 - - $113.60 - - 99315 - - $60.42 - - 99316 - - $96.95 - - 99341 - - $36.00 - - 99342 - - $57.27 - - 99344 - - $106.01 - - 99345 - - $149.55 - - 99347 - - $33.01 - - 99348 - - $56.27 - - 99349 - - $94.21 - - 99350 - - $137.34 - - 99358 $67.76 $66.69 - - - 99359 - - $31.82 - - 99360 - - $43.10 - - 99366 $30.25 $29.45 - - - 99367 - - $39.85 - - 99368 - - $25.93 - - 99374 $50.83 $39.85 - - - 99375 $75.43 $62.30 - - - 99377 $50.83 $39.85 - - - 99378 $75.43 $62.30 - - - 99379 $50.83 $39.85 - - - 99380 $75.43 $62.30 - - - 99381 $86.71 $59.30 - - - 99382 $90.60 $63.35 - - - 99383 $94.36 $67.12 - - - 99384 $106.53 $79.29 - - - 99385 $103.30 $76.05 - - - 99386 $119.26 $92.30 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 99387 $129.72 $99.28 - - - 99391 $78.16 $54.40 - - - 99392 $83.15 $59.30 - - - 99393 $82.86 $59.30 - - - 99394 $90.89 $67.12 - - - 99395 $93.08 $69.03 - - - 99396 $99.00 $75.23 - - - 99397 $106.53 $79.29 - - - 99401 $29.43 $17.64 - - - 99402 $47.16 $35.37 - - - 99403 $64.53 $53.01 - - - 99404 $82.02 $70.50 - - - 99406 $11.10 $8.69 - - - 99407 $58.08 $54.04 - - - 99408 $25.82 $23.41 - - - 99409 $49.23 $46.82 - - - 99411 $15.66 $5.48 - - - 99412 $19.38 $9.20 - - - 99415 - - $14.93 - - 99416 - - $6.90 - - 99417 $22.97 $22.16 - - - 99418 - - $28.94 - - 99421 $11.07 $9.47 - - - 99422 $21.88 $18.67 - - - 99423 $34.98 $29.63 - - - 99424 $60.27 $54.11 - - - 99425 $43.29 $37.40 - - - 99426 $45.64 $35.99 - - - 99427 $35.46 $25.55 - - - 99429 - - IC - - 99437 $44.63 $37.13 - - - 99439 $35.62 $25.71 - - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 99441 $42.58 $25.71 - - - 99442 $68.11 $48.56 - - - 99443 $95.75 $71.37 - - - 99446 - - $13.12 - - 99447 - - $26.11 - - 99448 - - $39.76 - - 99449 - - $52.82 - - 99450 - - IC - - 99451 - - $26.24 - - 99452 - - $24.37 - - 99453 - - $15.13 - - 99454 - - $39.57 - - 99455 - - IC - - 99456 - - IC - - 99457 $36.90 $22.16 - - - 99458 $29.66 $22.16 - - - 99459 - - $18.19 - -

99460 - - $100.99 - - 99461 $69.28 $45.17 - - - 99462 - - $43.82 - - 99463 - - $125.76 - - 99464 - - $53.46 - - 99465 - - $160.43 - - 99466 - - $170.09 - - 99467 - - $85.93 - - 99468 - - $656.51 - - 99469 - - $284.11 - - 99471 - - $568.08 - - 99472 - - $287.98 - - 99473 - - $10.11 - - 99474 $11.57 $6.48 - - - 99475 - - $409.16 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 99476 - - $246.71 - - 99477 - - $248.89 - - 99478 - - $97.92 - - 99479 - - $89.19 - - 99480 - - $85.93 - - 99483 $205.02 $142.88 - - - 99484 $32.34 $21.63 - - - 99485 - - $54.26 - - 99486 - - $46.82 - - 99487 $100.29 $66.81 - - - 99489 $52.94 $36.87 - - - 99490 $46.78 $37.13 - - - 99491 $63.10 $55.60 - - - 99492 $114.05 $68.25 - - - 99493 $107.23 $74.56 - - - 99494 $43.51 $29.85 - - - 99495 $154.70 $103.01 - - - 99496 $209.49 $140.38 - - - 99497 $61.49 $55.60 - - - 99498 $52.88 $52.62 - - - 99499 - - IC - - 99500 - - IC - - 99501 - - IC - - 99502 - - IC - - 99503 - - IC - - 99504 - - IC - - 99505 - - IC - - 99506 - - IC - - 99507 - - IC - - 99509 - - IC - - 99510 - - IC - - 99511 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 99512 - - IC - - 99600 - - IC - - 99601 - - IC - - 99602 - - IC - - 99605 - - IC - - 99606 - - IC - - 99607 - - IC - - A9593 - - IC - - A9594 - - IC - - A9595 - - IC - - A9596 - - IC - - A9800 - - IC - - G0108 - - $41.05 - - G0109 - - $11.68 - - G0270 $24.34 $20.59 - - - G0271 $12.75 $11.68 - - - G0310 $29.43 $17.64 - - - G0311 $47.16 $35.37 - - - G0312 $29.43 $17.64 - - - G0313 $47.16 $35.37 - - - G0314 $47.16 $35.37 - - - G0315 $29.43 $17.64 - - - G0399 - - IC - - S0302 - - IC - - S3005- U1

- $10.27 - - S3005- U2
- $10.27 - - T1023 - - IC - - T2023 - - $241.88 - - T2023- U1
- $269.99 - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J0131 - - IC - - J0134 - - IC - - J0135 - - IC - - J0136 - - IC - - J0172 - - IC - - J0173 - - IC - - J0177 - - IC - - J0179 - - IC - - J0184 - - IC - -

J0208 - - IC - -

J0215 - - IC - - J0217 - - IC - - J0219 - - IC - - J0222 - - IC - - J0223 - - IC - - J0224 - - IC - - J0225 - - IC - - J0282 - - IC - - J0283 - - IC - - J0291 - - IC - - J0364 - - IC - - J0391 - - IC - - J0400 - - IC - - J0401 - - IC - - J0402 - - IC - - J0491 - - IC - - J0565 - - IC - - J0567 - - IC - - J0570 - - IC - - J0571 - - IC - - J0572 - - IC - - J0573 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J0574 - - IC - - J0575 - - IC - - J0576 - - IC - - J0577 - - IC - - J0578 - - IC - - J0584 - - IC - - J0593 - - IC - - J0599 - - IC - - J0604 - - IC - - J0611 - - IC - - J0636 - - IC - - J0650 - - IC - - J0651 - - IC - - J0652 - - IC - - J0687 - - IC - - J0688 - - IC - - J0689 - - IC - - J0691 - - IC - - J0692 - - IC - - J0695 - - IC - - J0699 - - IC - - J0701 - - IC - - J0703 - - IC - - J0706 - - IC - - J0714 - - IC - - J0715 - - IC - - J0716 - - IC - - J0720 - - IC - - J0739 - - IC - - J0741 - - IC - - J0742 - - IC - - J0750 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J0751 - - IC - - J0799 - - IC - - J0841 - - IC - - J0872 - - IC - - J0873 - - IC - - J0877 - - IC - - J0878 - - IC - - J0879 - - IC - - J0883 - - IC - - J0884 - - IC - - J0889 - - IC - - J0890 - - IC - - J0891 - - IC - - J0892 - - IC - - J0893 - - IC - - J0898 - - IC - - J0899 - - IC - - J1010 - - IC - - J1094 - - IC - - J1096 - - IC - - J1097 - - IC - - J1105 - - IC - - J1130 - - IC - - J1201 - - IC - - J1202 - - IC - - J1203 - - IC - - J1246 - - IC - - J1260 - - IC - - J1290 - - IC - - J1301 - - IC - - J1302 - - IC - - J1304 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J1305 - - IC - - J1306 - - IC - - J1320 - - IC - - J1322 - - IC - - J1323 - - IC - - J1324 - - IC - - J1412 - - IC - - J1413 - - IC - - J1426 - - IC - - J1427 - - IC - - J1428 - - IC - - J1429 - - IC - - J1437 - - IC - - J1438 - - IC - - J1444 - - IC - - J1445 - - IC - - J1448 - - IC - - J1455 - - IC - - J1456 - - IC - - J1554 - - IC - - J1562 - - IC - - J1573 - - IC - - J1574 - - IC - - J1595 - - IC - - J1596 - - IC - - J1599 - - IC - - J1610 - - IC - - J1611 - - IC - - J1628 - - IC - - J1631 - - IC - - J1643 - - IC - - J1655 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J1700 - - IC - - J1710 - - IC - - J1726 - - IC - - J1741 - - IC - - J1744 - - IC - - J1746 - - IC - - J1790 - - IC - - J1812 - - IC - - J1814 - - IC - - J1815 - - IC - - J1823 - - IC - - J1826 - - IC - - J1830 - - IC - - J1840 - - IC - - J1850 - - IC - - J1890 - - IC - - J1939 - - IC - - J1941 - - IC - - J1943 - - IC - - J1951 - - IC - - J1952 - - IC - - J1956 - - IC - - J1990 - - IC - - J2021 - - IC - - J2060 - - IC - - J2062 - - IC - - J2170 - - IC - - J2182 - - IC - - J2183 - - IC - - J2184 - - IC - - J2186 - - IC - - J2212 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J2246 - - IC - - J2247 - - IC - - J2249 - - IC - - J2250 - - IC - - J2251 - - IC - - J2265 - - IC - - J2272 - - IC - - J2277 - - IC - - J2281 - - IC - - J2311 - - IC - - J2326 - - IC - - J2327 - - IC - - J2354 - - IC - - J2356 - - IC - - J2358 - - IC - - J2401 - - IC - - J2402 - - IC - - J2403 - - IC - - J2404 - - IC - - J2406 - - IC - - J2425 - - IC - - J2426 - - IC - - J2427 - - IC - - J2440 - - IC - - J2460 - - IC - - J2468 - - IC - - J2470 - - IC - - J2471 - - IC - - J2502 - - IC - - J2506 - - IC - - J2508 - - IC - - J2561 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J2679 - - IC - - J2680 - - IC - - J2760 - - IC - - J2777 - - IC - - J2779 - - IC - - J2782 - - IC - - J2786 - - IC - - J2793 - - IC - - J2794 - - IC - - J2798 - - IC - - J2799 - - IC - - J2801 - - IC - - J2840 - - IC - - J2910 - - IC - - J2919 - - IC - - J2940 - - IC - - J2941 - - IC - - J2998 - - IC - - J3030 - - IC - - J3031 - - IC - - J3032 - - IC - - J3055 - - IC - - J3110 - - IC - - J3145 - - IC - - J3241 - - IC - - J3244 - - IC - - J3245 - - IC - - J3263 - - IC - - J3302 - - IC - - J3303 - - IC - - J3316 - - IC - - J3360 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J3371 - - IC - - J3372 - - IC - - J3393 - - IC - - J3394 - - IC - - J3397 - - IC - - J3398 - - IC - - J3401 - - IC - - J3424 - - IC - - J3425 - - IC - - J3470 - - IC - - J3471 - - IC - - J3472 - - IC - - J3490 - - IC - - J3590 - - IC - - J3591 - - IC - - J7131 - - IC - - J7165 - - IC - - J7168 - - IC - - J7175 - - IC - - J7177 - - IC - - J7178 - - IC - - J7179 - - IC - - J7181 - - IC - - J7192 - - IC - - J7202 - - IC - - J7203 - - IC - - J7207 - - IC - - J7209 - - IC - - J7210 - - IC - - J7211 - - IC - - J7212 - - IC - - J7294 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J7295 - - IC - - J7296 - - IC - - J7297 - - IC - - J7298 - - IC - - J7301 - - IC - - J7304 - - IC - - J7307 - - IC - - J7309 - - IC - - J7310 - - IC - - J7314 - - IC - - J7315 - - IC - - J7318 - - IC - - J7320 - - IC - - J7322 - - IC - - J7328 - - IC - - J7329 - - IC - - J7331 - - IC - - J7332 - - IC - - J7340 - - IC - - J7342 - - IC - - J7345 - - IC - - J7351 - - IC - - J7352 - - IC - - J7353 - - IC - - J7354 - - IC - - J7402 - - IC - - J7501 - - IC - - J7599 - - IC - - J7633 - - IC - - J7665 - - IC - - J7669 - - IC - - J7676 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J7677 - - IC - - J7699 - - IC - - J7799 - - IC - - J7999 - - IC - - J8499 - - IC - - J8562 - - IC - - J8611 - - IC - - J8612 - - IC - - J8670 - - IC - - J8999 - - IC - - J9015 - - IC - - J9020 - - IC - - J9021 - - IC - - J9022 - - IC - - J9023 - - IC - - J9025 - - IC - - J9034 - - IC - - J9037 - - IC - - J9046 - - IC - - J9048 - - IC - - J9049 - - IC - - J9052 - - IC - - J9057 - - IC - - J9061 - - IC - - J9070 - - IC - - J9072 - - IC - - J9073 - - IC - - J9074 - - IC - - J9075 - - IC - - J9118 - - IC - - J9144 - - IC - - J9145 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J9172 - - IC - - J9173 - - IC - - J9176 - - IC - - J9177 - - IC - - J9198 - - IC - - J9203 - - IC - - J9205 - - IC - - J9210 - - IC - - J9212 - - IC - - J9213 - - IC - - J9215 - - IC - - J9216 - - IC - - J9219 - - IC - - J9223 - - IC - - J9227 - - IC - - J9229 - - IC - - J9247 - - IC - - J9248 - - IC - - J9249 - - IC - - J9255 - - IC - - J9258 - - IC - - J9259 - - IC - - J9262 - - IC - - J9268 - - IC - - J9269 - - IC - - J9272 - - IC - - J9273 - - IC - - J9274 - - IC - - J9281 - - IC - - J9286 - - IC - - J9295 - - IC - - J9296 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) J9298 - - IC - - J9302 - - IC - - J9304 - - IC - - J9316 - - IC - - J9317 - - IC - - J9318 - - IC - - J9319 - - IC - - J9320 - - IC - - J9321 - - IC - - J9322 - - IC - - J9323 - - IC - - J9324 - - IC - - J9325 - - IC - - J9331 - - IC - - J9332 - - IC - - J9333 - - IC - - J9334 - - IC - - J9340 - - IC - - J9348 - - IC - - J9349 - - IC - - J9352 - - IC - - J9353 - - IC - - J9356 - - IC - - J9358 - - IC - - J9371 - - IC - - J9376 - - IC - - J9380 - - IC - - J9393 - - IC - - J9394 - - IC - - J9999 - - IC - - Q0220 - - IC - - Q0240 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) Q0243 - - IC - - Q0244 - - IC - - Q0245 - - IC - - Q0247 - - IC - - Q0249 - - IC - - Q0516 - - IC - - Q0517 - - IC - - Q0518 - - IC - - Q2009 - - IC - - Q2017 - - IC - - Q2028 - - IC - - Q2036 - - IC - - Q2038 - - IC - - Q2041 - - IC - - Q2042 - - IC - - Q2049 - - IC - - Q2053 - - IC - - Q2054 - - IC - - Q2055 - - IC - - Q2056 - - IC - - Q4101 - - IC - - Q4103 - - IC - - Q4104 - - IC - - Q4108 - - IC - - Q4110 - - IC - - Q4161 - - IC - - Q4162 - - IC - - Q4163 - - IC - - Q4164 - - IC - - Q4165 - - IC - - Q4183 - - IC - - Q4184 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) Q4185 - - IC - - Q4187 - - IC - - Q4188 - - IC - - Q4189 - - IC - - Q4190 - - IC - - Q4191 - - IC - - Q4192 - - IC - - Q4193 - - IC - - Q4194 - - IC - - Q4197 - - IC - - Q4198 - - IC - - Q4199 - - IC - - Q4200 - - IC - - Q4201 - - IC - - Q4202 - - IC - - Q4203 - - IC - - Q4204 - - IC - - Q4205 - - IC - - Q4206 - - IC - - Q4208 - - IC - - Q4209 - - IC - - Q4210 - - IC - - Q4211 - - IC - - Q4212 - - IC - - Q4213 - - IC - - Q4214 - - IC - - Q4215 - - IC - - Q4216 - - IC - - Q4217 - - IC - - Q4218 - - IC - - Q4219 - - IC - - Q4220 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) Q4221 - - IC - - Q4222 - - IC - - Q4226 - - IC - - Q4251 - - IC - - Q4252 - - IC - - Q4253 - - IC - - Q4262 - - IC - - Q4263 - - IC - - Q4264 - - IC - - Q4279 - - IC - - Q4287 - - IC - - Q4288 - - IC - - Q4289 - - IC - - Q4290 - - IC - - Q4291 - - IC - - Q4292 - - IC - - Q4293 - - IC - - Q4294 - - IC - - Q4295 - - IC - - Q4296 - - IC - - Q4297 - - IC - - Q4298 - - IC - - Q4299 - - IC - - Q4300 - - IC - - Q4301 - - IC - - Q4302 - - IC - - Q4303 - - IC - - Q4304 - - IC - - Q5101 - - IC - - Q5107 - - IC - - Q5109 - - IC - - Q5112 - - IC - -

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) Q5113 - - IC - - Q5114 - - IC - -

Q5115 - - IC - - Q5116 - - IC - - Q5117 - - IC - - Q5118 - - IC - - Q5119 - - IC - - Q5121 - - IC - - Q5122 - - IC - - Q5123 - - IC - - Q5125 - - IC - - Q5126 - - IC - -

Q5131 - - IC - - Q5132 - - IC - - Q9950 - - IC - -

Q9980 - - IC - - S0013 - - IC - -

Behavioral Health and Developmental Screening Services

Code NFAC FAC Global PC TC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101- CMR-31700-medicine) 96110 U1

- $10.27

96110 U2

- $10.27

96127 U1 - - $10.27

96127 U2 - - $10.27

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

Tobacco Cessation Codes

Code NFAC FAC Description (see medicine services code spreadsheet at www.mass.gov/regulations/101-CMR-31700-medicine) 99407 $58.08 $54.04

99407 SA $58.08 $54.04 99407 TD $49.37 $45.93 99407 U1 $49.37 $45.93 99407 TF $87.12 $81.06

99407 U2 $74.05 $68.90

99407 HQ $37.03 $34.45 99407 U3 $31.47 $29.28

Final Adoption Date Published in Mass. Register: May 8, 2026

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 317.00: RATES FOR MEDICINE SERVICES

317.05 Severability

317.05: Severability

The provisions of 101 CMR 317.00 are severable. If any provision of 101 CMR 317.00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of 101 CMR 317.00 or application of those provisions to applicable individuals, entities, or circumstances.

REGULATORY AUTHORITY

101 CMR 317.00: M.G.L. c. 118E.

101 CMR 317.00 — Rates for Medicine Services

101 CMR 317.00 Rates for Medicine Services

317.01 General Provisions

317.02 General Definitions

317.03 General Rate Provisions

317.04 Maximum Allowable Fees – Medical Services

317.05 Severability

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