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-90 - Physician Services
Subsection 144-101-II-90.01 - DEFINITIONS

90.01-1 Cosmetic Procedures and Surgery

Cosmetic procedures and cosmetic surgery are any procedure or surgery done primarily to improve or change appearance without improving the way the body works.

90.01-2 Elective Surgery

Elective surgery is surgery that can be scheduled in advance, is not an emergency, and, if delayed, would not result in death or permanent impairment of health.

90.01-3 Physician services

Physician services are those services provided by a licensed physician or other qualified rendering provider, within the scope of practice of his or her profession as defined by state law in the state where services are provided, or under the personal supervision of an individual licensed under state law to practice medicine or osteopathy.

90.01-4 Rendering Provider

The rendering provider is the trained and appropriately licensed professional who actually renders the medical service to a member.

90.01-5 Supplies and Materials

Supplies and materials are items provided by the rendering provider, such as sterile trays, drugs, dressings, wadding, and plaster. Providers must use the appropriate Healthcare Common Procedure Coding System (HCPCS) code for supplies and materials, and the charges must not exceed the total acquisition costs. MaineCare does not reimburse for shipping, handling, and related costs. Requirements for financial record keeping are detailed in MaineCare Benefits Manual (MBM), Chapter I, Section 1.03-8.