On April 24, Massachusetts finalized 101 CMR 347.00, the regulation that tells freestanding ASCs what MassHealth will pay them per procedure. The new rates applied to dates of service on or after May 1, 2026.
The rule doesn’t set one price, it sets thousands. A 117-page fee schedule assigns a dollar figure to nearly every CPT and HCPCS code an ASC might bill, from a $29.15 wound repair to a $12,356.71 device-based procedure. Skin substitute grafts run $700 to $1,300 depending on size and site. Several codes tied to implantable technology top $8,000. Others are priced at $0.00, services the state treats as bundled rather than separately billable.
The methodology matters as much as the numbers. MassHealth pays the lowest of three amounts: the center’s usual fee to the public, its actual submitted charge or the state’s schedule rate. Anything unlisted, or performed under unusual circumstances, gets “individual consideration,” a case-by-case rate based on the operative report, complexity, and equipment cost.
Billing mechanics are built into the rule. Bilateral procedures pay at 150% of the single-procedure rate under modifier 50. A second procedure in the same session drops to 50% of its listed fee under modifier 51. Cases stopped before anesthesia use modifier 73; after anesthesia or an incision, modifier 74. Never events, wrong body part, wrong patient, wrong procedure, carry their own modifiers: PA, PB, PC.
The rule covers facility costs only, not a physician’s, dentist’s or podiatrist’s separate professional fee. It excludes workers’ comp cases, office-based procedures, and hospital-based facilities.
Noncompliance carries a penalty. A center that fails required cost reporting under 957 CMR 6.00 can lose up to 15% of its payments, after advance notice.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
