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-19 - Home and Community Benefits for the Elderly and Adults with Disabilities
|
PROCEDURE CODE |
MODIFIER |
REVENUE CODE |
DESCRIPTION |
UNIT |
Rates Effective 4/1/2020* |
|
H2014 |
U7 |
Skills Training and Development (Participant Directed Option) |
15 minutes |
$14. 03 |
|
|
T2040 |
U7 |
Financial Management, self-directed, waiver (Participant Directed Option) |
Monthly |
$85. 09 |
|
|
S5125 |
U7 |
Attendant Care Services (Personal Care Services, Participant Directed Option) |
15 minutes |
$4. 86* |
|
|
S5125 |
U7 UN |
Attendant Care Services (Personal Care Services, Participant Directed Option)-2 members served |
15 minutes |
$2. 67* |
|
|
S5125 |
U7 UP |
Attendant Care Services (Personal Care Services, Participant Directed Option)-3 members served |
15 minutes |
$1. 94* |
|
|
T1019 |
U7 |
0589 |
Personal Care Services (Agency PSS) |
15 minutes |
$6. 55* |
|
T1019 |
U7 UN |
0589 |
Personal Care Services (Agency PSS)- 2 members served |
15 minutes |
$3. 60* |
|
T1019 |
U7 UP |
0589 |
Personal Care Services (Agency PSS)-3 members served |
15 minutes |
$2. 62* |
|
T2022 |
U7 |
Care Coordination |
per month |
$136. 00** |
|
|
S5160 |
U7 |
Personal Emergency Response System, Installation and Testing |
1 unit |
Customary Charge, Not to Exceed $45. 00 |
|
|
S5161 |
U7 |
Personal Emergency Response System, Service Fee |
Monthly |
Customary Charge, Not to Exceed $35. 00 |
|
|
H0045 |
U7 |
Respite Care Services, not in the home |
Per Diem |
$219. 76* |
|
|
T1005 |
U7 |
Respite Care Services, in the home (PSS) |
15 minutes |
$6. 55, Cost Not to Exceed Cap* |
|
|
T1005 |
U7 UN |
Respite Care Services, in the home (PSS)- 2 members served |
15 minutes |
$3. 60 Cost Not to Exceed Cap* |
|
|
T1005 |
U7 UP |
Respite Care Services, in the home (PSS)-3 members served |
15 minutes |
$2. 62 Cost Not to Exceed Cap* |
|
|
T1005 |
U7 |
Respite Care Services, in the home-Participant Directed Option |
15 minutes |
$4. 86 Cost Not to Exceed Cap* |
|
|
T1005 |
U7 UN |
Respite Care Services, in the home-Participant Directed Option- 2 members served |
15 minutes |
$2. 67 Cost Not to Exceed Cap* |
|
|
T1005 |
U7 UP |
Respite Care Services, in the home-Participant Directed Option-3 members served |
15 minutes |
$1. 94 Cost Not to Exceed Cap* |
|
|
S5165 |
U7 |
Environmental Modifications |
Per Service |
By report |
|
|
A9279 |
U7 |
Assistive Technology-(Monitoring feature/device, stand alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified) |
1 unit |
Per device |
|
|
A9279 |
U7 QC |
Assistive Technology-Remote Monitoring-Monthly fee |
Monthly |
Up to $ 500. 00 |
|
|
T2035 |
U7 |
Assistive Technology-Transmission (Utility Services) |
Monthly |
Up to $ 50. 00 |
|
|
T1005 |
U7 |
0669 |
Respite Care, in the home by CNA/Home Health Aide |
15 minutes |
$7. 06* |
|
T1005 |
U7 UN |
0669 |
Respite Care, in the home by CNA/Home Health Aide- 2 members served |
15 minutes |
$3. 88* |
|
T1005 |
U7 UP |
0669 |
Respite Care, in the home by CNA/Home Health Aide-3 members served |
15 minutes |
$2. 82* |
|
0551 |
Skilled Nursing Visit (RN) |
Per Visit |
$53. 60 |
||
|
0551 |
Skilled Nursing Visit (RN)-2 members served |
Per Visit |
$29. 48 |
||
|
0551 |
Skilled Nursing Visit (RN)-3 members served |
Per Visit |
$21. 44 |
||
|
0559 |
Other Nursing (LPN) |
Per visit |
$39. 05 |
||
|
0559 |
Other Nursing (LPN)-2 members served |
Per Visit |
$21. 48 |
||
|
0559 |
Other Nursing (LPN)-3 members served |
Per Visit |
$15. 62 |
||
|
0421 |
Physical Therapy Visit |
Per visit |
$92. 94 |
||
|
0431 |
Occupational Therapy Visit |
Per visit |
$98. 76 |
||
|
0441 |
Speech Therapy Visit- Home Health Services |
Per visit |
$97. 34 |
||
|
G0151 |
U7 TF |
0421 |
Certified Physical Therapy Assistant- Home Health Services Visit Charge |
Per visit |
$65. 72 |
|
G0152 |
U7 TF |
0431 |
Occupational Therapy Assistant- Home Health Services Visit Charge |
Per visit |
$69. 83 |
|
G0156 |
U7 TF |
0571 |
Home Health Aide Visit - Home Health Services |
Per visit |
$28. 43* |
|
G0156 |
U7 TF UN |
0571 |
Home Health Aide Visit- Home Health Services-2 members served |
Per visit |
$15. 64* |
|
G0156 |
U7 TFUP |
0571 |
Home Health Aide Visit- Home Health Services-3 members served |
Per visit |
$11. 37* |
|
G0155 |
U7 TF |
0561 |
Medical Social Services Visit- Home Health Services |
Per visit |
$84. 10 |
|
G0299 |
U7 |
0551 |
Skilled Nursing Visit (R. N.) (Non-Medicare Certified Home Health Agency) - Home Health Services |
15 minutes |
$13. 74 |
|
G0299 |
U7 UN |
0551 |
Skilled Nursing Visit (RN) (Non-Medicare Certified Home Health Agency) - Home Health Services- 2 members served |
15 minutes |
$7. 56 |
|
S5170 |
U7 |
Home Delivered Meals |
Per Meal |
$7. 64 |
|
|
98960 |
U7 59 |
Living Well (Chronic Disease Management) |
30 Minutes |
$17. 09 |
|
|
98960 |
U7 33 |
Matter of Balance (Falls Prevention) |
30 Minutes |
$14. 83 |
|
|
G0299 |
U7 UP |
0551 |
Skilled Nursing Visit (RN) (Non-Medicare Certified Home Health Agency) - Home Health Services-3 members served |
15 minutes |
$5. 50 |
|
G0300 |
U7 |
0559 |
Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency) - Home Health Services |
15 minutes |
$9. 75 |
|
G0300 |
U7 UN |
0559 |
Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency) - Home Health Services-2 members served |
15 minutes |
$5. 37 |
|
G0300 |
U7 UP |
0559 |
Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency) - Home Health Services-3 members served |
15 minutes |
$3. 90 |
|
G0151 |
U7 |
0421 |
Physical Therapy Visit- Home Health Services |
15 minutes |
$12. 36 |
|
G0152 |
U7 |
0431 |
Occupational Therapy Visit- Home Health Services |
15 minutes |
$12. 87 |
|
G0153 |
U7 |
0441 |
Speech Therapy Visit- Home Health Services |
15 minutes |
$12. 87 |
|
T1004 |
U7 |
0581 |
Certified Nurse's Aide- Home Health Services |
15 minutes |
$7. 06* |
|
T1004 |
U7 UN |
0581 |
Certified Nurse's Aide- Home Health Services- 2 members served |
15 minutes |
$3. 88* |
|
T1004 |
U7 UP |
0581 |
Certified Nurse's Aide- Home Health Services-3 members served |
15 minutes |
$2. 82* |
|
G0156 |
U7 |
0571 |
Home Health Aide- Home Health Services |
15 minutes |
$7. 06* |
|
G0156 |
U7 UN |
0571 |
Home Health Aide- Home Health Services- 2 members served |
15 minutes |
$3. 88* |
|
G0156 |
U7 UP |
0571 |
Home Health Aide- Home Health Services- 3 members served |
15 minutes |
$2. 82* |
|
G0155 |
U7 |
0561 |
Medical Social Services Visit- Home Health Services |
15 minutes |
$11. 48 |
|
INDEPENDENT PRACTITIONERS ONLY |
|||||
|
PROCEDURE CODE |
MODIFIER |
REVENUE CODE |
DESCRIPTION |
UNIT |
Rates Effective 4/1/2020* |
|
INDEPENDENT PRACTITIONERS ONLY |
|||||
|
G0299 |
U7 |
Skilled Nursing Visit (R. N.) - Home Health Services |
15 minutes |
$13. 74 |
|
|
G0299 |
U7 UN |
Skilled Nursing Visit (RN) - Home Health Services-2 members served |
15 minutes |
$7. 56 |
|
|
G0299 |
U7 UP |
Skilled Nursing Visit (RN) - Home Health Services-3 members served |
15 minutes |
$5. 50 |
|
|
G0151 |
U7 |
Physical Therapy Visit- Home Health Services |
15 minutes |
$10. 80 |
|
|
G0152 |
U7 |
Occupational Therapy Visit- Home Health Services |
15 minutes |
$10. 60 |
|
|
G0153 |
U7 |
Speech Therapy Visit- Home Health Services |
15 minutes |
$11. 75 |
|
| Modifiers | Description |
|
QC |
Monthly Fee |
|
U7 |
Indicates Section 19 Services |
|
TF |
Intermediate Level of Care |
|
U1 |
Other Qualified Staff |
|
59 |
Living Well |
|
33 |
Matter of Balance |
|
UN |
2 members served |
|
UP |
3 members served |
** The PMPM reimbursement for care coordination shall be effective prospectively (not 4/1/2020).
