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 III - Allowances for Services
Section 144-101-III-103 - Principles of Reimbursement for Psychiatric Residential Treatment Facility Services
|
PROCEDURE CODE/ REVENUE CODE |
DESCRIPTION |
UNIT OF SERVICE |
MAXIMUM ALLOWANCE |
|
T1015 |
Clinic visit/encounter, all inclusive |
per visit |
by report |
|
0521 |
Rural Health Clinic |
||
|
T1015 HE |
Clinic visit/encounter, all inclusive |
per visit |
by report |
|
0521 |
Rural Health Clinic |
||
|
T1015 |
Home visit/encounter, all inclusive |
per visit |
by report |
|
0522 |
Rural Health Clinic |
||
|
T1015 |
Visit to SNF (Part A*) |
per visit |
by report |
|
0524 |
Rural Health Clinic |
||
|
*A covered part A stay means that Medicare A will pay the services as the primary carrier |
|||
|
T1015 |
Visit to SNF (non-covered*) |
per visit |
by report |
|
0525 |
Rural Health Clinic |
||
|
*A non-covered stay means that Medicare A is not paying for the inpatient stay/services |
|||
|
T1015 |
Visit to other site |
per visit |
by report |
|
0528 |
Rural Health Clinic |
||
|
RHCs are reimbursed for all Food and Drug Administration (FDA) approved intrauterine devices at the rate listed on the MaineCare UCR: https://mainecare.maine.gov/ |
|||
|
J1050 |
Injection, medroxyprogesterone acetate1 mg |
1 unit |
by report |
|
0636 |
Pharmacy |
||
|
G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
30 minutes |
by report |
|
0521 |
Rural Health Clinic |
||
|
G0109 |
Diabetes outpatient self-management training services, group session (2 or more) per 30 minutes |
30 minutes |
by report |
|
0521 |
Rural Health Clinic |
||
|
RHCs are reimbursed for all Food and Drug Administration (FDA) approved pharmacotherapy for tobacco dependence treatment |
|||
|
99406 |
Smoking and tobacco cessation counseling; individual, intermediate |
3-10 minutes |
$8.67 |
|
0521 |
Rural Health Clinic |
||
|
99407 |
Smoking and tobacco cessation counseling; individual, intensive |
greater than 10 minutes |
$16.81 |
|
0521 |
Rural Health Clinic |
||
|
99411 |
[Tobacco cessation] preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure), approximately 30 minutes |
per session |
$11.54 |
|
0521 |
Rural Health Clinic |
||
|
99412 |
[Tobacco cessation] preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes |
per session |
$15.04 |
|
0521 |
Rural Health Clinic |
||
|
G0008 |
Administration of influenza virus vaccine |
per unit |
$5.00 |
|
0521 |
Rural Health Clinic |
||
|
G0009 |
Administration of pneumococcal vaccine |
per unit |
$5.00 |
|
0521 |
Rural Health Clinic |
|
MODIFIERS |
DESCRIPTION |
|
GT |
VIA INTERACTIVE AUDIO AND VIDEO TELECOMMUNICATION SYSTEMS |
|
HE |
BEHAVIORAL HEALTH |
|
SL |
STATE SUPPLIED VACCINE |
|
UF |
SERVICES PROVIDED IN THE MORNING (6 A.M. TO 11:59 A.M.) |
|
UG |
SERVICES PROVIDED IN THE AFTERNOON (12 P.M. TO 5:59 P.M.) |
|
UH |
SERVICES PROVIDED IN THE EVENING (6 P.M. TO 11:59 P.M.) |
|
UJ |
SERVICES PROVIDED AT NIGHT (12 A.M. TO 5:59 A.M.) |
