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-90.07 - NON-COVERED SERVICES
Current through 2024-38, September 18, 2024
When MaineCare does not cover specific procedures, all services related to that procedure are not covered, including physician, facility, and anesthesia services. Services that are not reimbursable by MaineCare include, but are not limited to:
90.07-1 Cosmetic Surgery
Surgeries that are performed solely for cosmetic reasons are not covered by MaineCare. MaineCare defines cosmetic surgery as any surgery done primarily to improve or change appearance without improving the way the body works.
Procedures that may potentially performed for either cosmetic or medical reasons require prior authorization documenting the medical indication for the procedure.
MaineCare does cover some potentially cosmetic procedures when done to correct deformities resulting from cancer, disease, trauma, or birth defects, as detailed in Section 90.05. Examples of non-covered cosmetic surgery are:
90.07-2 Infertility Services
Treatments and procedures solely for the purpose of evaluation or treatment of infertility are not covered. In addition, MaineCare does not cover reversal of sterilization.
90.07-3 Other Non-Covered Services
