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-101.07 - REIMBURSEMENT

A. Upon implementation of MIHMS, the fee for service rate is set at seventy percent (70%) of the lowest level in the 2009 Medicare fee schedule for Maine area "99" for all services under this policy including adjustments for place of service and modifiers; or

B. the lowest amount allowed by the Medicare Part B carrier; or

C. the provider's usual and customary charge.

a) the professional component, and

b) the administrative and technical component. If no modifier is used, standard CPT coding guidelines assume that the provider has provided and is billing for both components of service, and MaineCare reimburses 100% of the global rate. When a provider only performs part of the procedure and seeks reimbursement for only that component, HCPCS/CPT modifiers must identify the component of service provided.

In accordance with Chapter I of the MBM, it is the responsibility of the provider to seek payment from all other sources that are available for payment of a rendered service prior to billing MaineCare.