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-4 - Behavioral Health Services
Subsection 144-101-II-4.04 - COVERED SERVICES
Current through 2024-38, September 18, 2024
Covered services are those items and services, stated below, which are furnished by an ASC in connection with a covered surgical procedure. Unless otherwise stated below, only covered surgical procedures currently on the Medicare-approved list of ASC covered procedures are allowed. See the Federal Registrar for the annual ASC final rule or http://www.cms.hhs.gov/ASCPayment/ for the current listing. Covered surgical procedures are those that would not be expected to pose a significant safety risk to a member when performed in an ASC, and for which standard medical practice dictates that the member would not typically be expected to require active medical monitoring and care at midnight following the procedure.
Coding for covered services is based on the latest version of the American Medical Association's standard Current Procedural Terminology (CPT) codes and can be accessed through the Department's website at: https://mainecare.maine.gov/.
A. The following items and services are covered services and are included in the all-inclusive rates for reimbursement in this Section of the MaineCare Benefits Manual:
These include all services in connection with covered procedures furnished by nurses, technical personnel and other support staff involved in patient care who are employees of the ASC.
B. Ancillary Services
Ancillary items and services that are integral to a covered surgical procedure (defined above) and for which separate payment is allowed, include the following:
When an ASC bills for services covered under this Section of the MaineCare Benefits Manual for a given operative procedure, the physician(s) involved in performing the operative procedure is to bill for his or her professional services only under Chapter II, Section 90, and not for related ancillary services such as anesthesia supplies, which are covered services under this Section.
