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-45 - HOSPITAL SERVICES
Subsection 144-101-III-45.13 - CLINICAL LABORATORY AND IMAGING SERVICES
Hospital laboratory, imaging, and physician services provided to a member not currently a patient of the hospital are considered outpatient hospital services. These services are covered in accordance with requirements, and utilization limitations (including prior authorizations) described in the following sections of the MaineCare Benefits Manual and are reimbursable in accordance with MBM Chapter II, Section 55, Laboratory Services, Chapter II, Section 90, Physician Services, or Chapter II, Section 101, Medical Imaging Services. Rates for those services are posted on the Department's website.
In the case of tissues, blood samples or specimens taken by personnel that are not employed by the hospital but are sent to a hospital for performance of tests, the tests are not considered outpatient hospital services since the member does not receive services directly from the hospital.
Certain clinical diagnostic laboratory tests must be performed by a physician and are, therefore, exempt from the fee schedule. Medicare periodically sends updated lists of exempted tests to hospitals. Laboratory services must comply with the rules implementing the Clinical Laboratory Improvement Amendments (CLIA 88) and any applicable amendments.
