Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-101 - Medical Imaging Services
Subsection 144-101-II-101.05 - NON-COVERED SERVICES

Universal Citation: 10 ME Code Rules ยง 144-101-II-101.05

Current through 2024-38, September 18, 2024

When repeat x-ray examinations of the same body part for the same condition are required because of technical or professional error in the original x-rays, such repeat x-rays are not a covered service and are not reimbursable by the MaineCare Program if performed twice by the same provider.

101.05-1 Mammography Performed in Non-Compliance with the MQSA

Mammograms are not covered services when provided in:

(1) a mammography facility which does not possess a Certificate issued by an accrediting body or is out of compliance with State of Maine Radiation Regulations;

(2) a mammography facility with a Certificate that has expired; or

(3) a mammography facility whose Certificate has been revoked or denied. Mammography facilities may not charge a member for a service denied by the MaineCare Program due to the mammography facility's non-compliance with the Mammography Quality Standards Act (MQSA), Public Law - 102-539.

101.05-2 Scope of Portable X-Ray Benefits

The scope of portable x-ray procedures that are covered is limited to services that can be safely performed outside an imaging facility, including skeletal films involving arms and legs, pelvis, vertebral column and skull; and chest and abdominal films that do not involve the use of contrast media.

Exclusion from Coverage as Portable X-ray Benefits:

Procedures and examinations that are not covered under the portable x-ray provision include the following:

i. procedures involving fluoroscopy;

ii. procedures involving the use of contrast media;

iii. procedures requiring the administration of a substance to the patient or injection of a substance into the patient; and/or special manipulation of the patient;

iv. procedures that require special medical skill or knowledge possessed by a physician or which require that medical judgment be exercised;

v. procedures requiring special technical competency and/or special equipment or materials; or

vi. procedures that are not of a diagnostic nature.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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