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-31 - Federally Qualified Health Center Services
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Procedure & Revenue Codes |
Description |
Unit of Service |
Maximum Allowance |
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|
T1015 |
Clinic visit/encounter, all inclusive |
Per visit |
By report |
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|
0521 |
FQHC |
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|
T1015 HE |
Clinic visit/encounter, all inclusive |
Per visit |
By report |
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|
0521 |
FQHC |
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|
T1015 |
Home visit/encounter, all inclusive |
Per visit |
By report |
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|
0522 |
FQHC |
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|
T1015 |
Visit to SNF (Part A*) |
Per visit |
By report |
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|
0524 |
FQHC |
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|
*A covered Part A stay means that Medicare A will pay the services as the primary carrier |
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|
T1015 |
Visit to SNF (Non-covered*) |
Per visit |
By report |
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|
0525 |
FQHC |
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|
*A non-covered stay means that Medicare A is not paying for the inpatient stay/services |
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|
T1015 |
Visit to Other Site |
Per visit |
By report |
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|
0528 |
FQHC |
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|
T1015 |
Ambulatory Clinic Visit |
Per visit |
By report |
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|
0529 |
FQHC |
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|
S9441 |
Asthma education, nonphysician provider, per session |
Per visit |
By report |
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|
0521 |
FQHC |
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|
G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
Per 30 minutes |
By report |
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|
0521 |
FQHC |
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|
G0109 |
Diabetes outpatient self-management training services, group session (2 or more) per 30 minutes |
Per 30 minutes |
By report |
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|
0521 |
FQHC |
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|
FQHCs are reimbursed for all Food and Drug Administration (FDA) approved pharmacotherapy for tobacco dependence treatment. |
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|
99406 |
Smoking and Tobacco Cessation Counseling; individual, intermediate |
3-10 minutes |
$8.67 |
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|
0521 |
FQHC |
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|
99407 |
Smoking and Tobacco Cessation Counseling; individual, intensive |
Greater than 10 minutes |
$16.81 |
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|
0521 |
FQHC |
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|
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 |
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|
0521 |
FQHC |
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|
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 |
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|
0521 |
FQHC |
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|
G0009 |
Administration of Pneumococcal Vaccine |
1 unit |
$5.00 |
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|
0521 |
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|
G0008 |
Administration of Influenza virus Vaccine |
1 unit |
$5.00 |
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|
0521 |
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|
FQHCs are reimbursed for all Food and Drug Adminsitration (FDA) approved Intrauterine Devices at the rate listed on the MaineCare UCR: https://mainecare.maine.gov/ |
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|
J1050 |
Injection, medroxyprogestrone acetate, 1 mg. |
1 unit |
By report |
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|
Modifiers |
Description |
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|
GT |
Via interactive audio and video telecommunication systems |
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|
HE |
Behavioral health |
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|
SL |
State supplied vaccine |
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UF |
Services provided in the morning (6 a.m. to 11:59 a.m.) |
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|
UG |
Services provided in the afternoon (12 p.m. to 5:59 p.m.) |
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