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-7 - Free-standing Dialysis Services
Universal Citation: 10 ME Code Rules ยง 144-101-III-7
Current through 2024-38, September 18, 2024
| CODE | HCPCS *** CODE | DESCRIPTION | MAXIMUM ALLOWANCE | |
| 0821 | 90999 | HEMODIALYSIS/COMPOSITE | BY REPORT | |
| 0825 | 90993, 90989 | SUPPORT SERVICES (HEMODIALYSIS | BY REPORT | |
| 0831 | 90999 | PERITONEAL DIALYSIS/COMPOSITE | BY REPORT | |
| 0835 | 90993, 90989 | SUPPORT SERVICES (IP) | BY REPORT | |
| 0841 | 90999 | CAPD/COMPOSITE | BY REPORT | |
| 0845 | 90993, 90989 | SUPPORT SERVICES/CAPD | BY REPORT | |
| 0849 | 90945 | OTHER CAPD DIALYSIS | BY REPORT | |
| 0851 | 90999 | CONTINUOUS CYCLING PERITONEAL DIALYSIS (CCPD) | BY REPORT | |
| 0855 | 90993, 90989 | SUPPORT SERVICES (CCPD) | BY REPORT | |
| 0634 * | EPO- INJECTION, EPOETIN ALFA, under 10,000 UNITS | BY REPORT | ||
| 0635 * | EPO- INJECTION, EPOETIN ALFA, above 10,000 UNITS | |||
| 0636** | ARANESP- INJECTION, DARBEPOETIN ALFA, 1 MCG | BY REPORT | ||
* Providers must also put HCPCS Q4081 on claim form.
* * Providers must also put HCPCS JO882 on claim form.
*** These HCPCS codes will become effective upon implementation of MIHMS. (APA Office Note: This occurred on September°1, 2010.)
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