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-15 - Chiropractic Services
Subsection 144-101-II-15.08 - REIMBURSEMENT

A. The amount listed in the "Allowances for Chiropractic Services," Chapter III, Section 15, MBM; or

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

C. The provider's usual and customary charge; or

D. The amount, if any, by which the MaineCare rate of reimbursement for services billed exceeds the amount of the third-party payment as set in Chapter I of the MBM. MaineCare considers a claim paid in full if the third-party payment amount received exceeds the MaineCare rate of reimbursement.

E. Payment for x-ray services rendered medically necessary for diagnosis and treatment of a spinal condition shall be: the lowest of the amounts set forth in 15.08 (A)-(C); OR, the fee-for-service rate is set at seventy (70%) of the lowest level in the 2009 Medicaid fee schedule for Maine area "99" for services under this policy, including adjustments for place of service and modifiers.