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-75 - Vision Services
Subsection 144-101-II-75.07 - REIMBURSEMENT & BILLING
Current through 2024-38, September 18, 2024
75.07-1 Reimbursement
The provider must accept as payment in full the amounts established by MaineCare for covered services. Therefore, in accordance with State and federal laws, providers cannot charge a member an amount in addition to the payment received, or to be received, from MaineCare for a covered service. The MaineCare rates of reimbursement are posted in the fee schedule on the MaineCare website. Rates other than drug prices for new or changed codes (any CPT or HCPCS code) are determined based on the following lowest benchmark:
If a MaineCare member has coverage for eyeglasses from Medicare or any other third party, the provider must follow his/her customary practice for the acquisition of these items rather than the above rules relating to acquisition from the Vision Care Volume Purchase Contractor. If these items are to be covered by MaineCare only, however, then they must be acquired in accordance with the above rules relating to acquisitions from the Contractor.
75.07-2 Vision Care Volume Purchasing Plan
All items covered under the Vision Care Volume Purchasing Plan contract shall be reimbursed at the contract rate.
75.07-3 Billing
Providers must bill in accordance with the Department's billing requirements. The Department may require accordance with specific billing instructions including use of the CMS-1500 claim form. Providers must bill using the allowances for vision services listed by procedure code on the OMS website.
