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-85 - PHYSICAL THERAPY SERVICES
Universal Citation: 10 ME Code Rules ยง 144-101-III-85
Current through 2024-38, September 18, 2024
MaineCare coverage of Physical Therapy Services is limited. Refer to Chapter II, Section 85.06 for specific limitations.
Use the following modifiers when appropriate:
TF - Intermediate Level of care - used for PT Assistants and priced 10% below the Allowance rate
GP - Services delivered under an outpatient physical therapy plan of care
TL - Services delivered under an Individualized Family Service Plan (IFSP)
TM - Services delivered under an Individualized Education Plan (IEP) with MaineCare Addendum denoting medical necessity of the service
| CODE | SERVICE | UNIT | MAXIMUM ALLOWANCE |
| 97001 | Physical Therapy Evaluation | per evaluation | $35.94 |
| 97002 | Physical Therapy Re-evaluation (Ongoing therapy) | per session | $19.40 |
| 97150 GP | Therapeutic procedure(s), group (2 or more individuals) | per member per session | $11.98 |
| THERAPEUTIC MODALITIES SUPERVISED | |||
| 97012 | Application of a modality to one or more areas; traction, mechanical | per service | $6.24 |
| 97014 | Application of a modality to one or more areas; | per service | $5.61 |
| 97016 | Application of a modality to one or more areas; vasopneumatic devices | per service | $6.28 |
| 97018 | Application of a modality to one or more areas; paraffin bath | per service | $3.05 |
| 97022 | Application of a modality to one or more areas; whirlpool | per service | $7.06 |
| 97024 | Application of a modality to one or more areas; diathermy | per service | $2.10 |
| 97026 | Application of a modality to one or more areas; infrared | per service | $1.94 |
| 97028 | Application of a modality to one or more areas; ultraviolet | per service | $2.62 |
| THERAPEUTIC MODALITIES CONSTANT ATTENDANCE | |||
| 97032 | Application of a modality to one or more areas; electrical stimulation (manual) | 15 minutes | $6.88 |
| 97033 | Application of a modality to one or more areas; iontophoresis | 15 minutes | $9.90 |
| 97034 | Application of a modality to one or more areas; contrast baths | 15 minutes | $6.00 |
| 97035 | Application of a modality to one or more areas; ultrasound | 15 minutes | $4.89 |
| 97036 | Application of a modality to one or more areas; Hubbard tank | 15 minutes | $10.58 |
| THERAPEUTIC PROCEDURES | |||
| 97110 | Therapeutic procedure, one or more areas; therapeutic exercises to develop strength and endurance, range of motion and flexibility | 15 minutes | $11.93 |
| 97112 | Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception for sitting and/or standing activities | 15 minutes | $12.46 |
| 97113 | Aquatic therapy with therapeutic exercises | 15 minutes | $14.34 |
| 97116 | Gait training (includes stair climbing) | 15 minutes | $10.46 |
| 97124 | Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) | 15 minutes | $9.59 |
| 97140 | Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions | 15 minutes | $11.15 |
| 97760 | Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk | 15 minutes | $13.45 |
| 97761 | Prosthetic training, upper and/or lower extremity(s) | 15 minutes | $12.09 |
| 97530 | Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance) | 15 minutes | $12.60 |
| 97532 | Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training,) direct (one-on-one) patient contact by the provider | 15 minutes | $10.38 |
| 97533 | Sensatory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by provider | 15 minutes | $11.02 |
| 97535 | Self/care/home management training (e.g. activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider | 15 minutes | $12.78 |
| 97542 | Wheelchair management(eg, assessment, fitting, training) | 15 minutes | $11.67 |
| ACTIVE WOUND CARE MANAGEMENT | |||
| 97597 | Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g. high pressure water jet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters | per service | $23.54 |
| 97598 | Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g. high pressure water jet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area greater than 20 square centimeters | per service | $23.54 |
| 97602 | Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical applications(s), wound assessment and instructions(s) for ongoing care | per service | $16.86 |
| TESTS AND MEASUREMENTS | |||
| 97762 | Check out for orthotic/prosthetic use, established patient | 15 minutes | $13.31 |
| 97750 | Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report | 15 minutes | $12.39 |
| 97755 | Assistive technology assessment (e.g. to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact by provider, with written report | 15 minutes | $14.44 |
| 92605 | Evaluation for prescription of non-speech-generating augmentative and alternative communication device | per service | $34.26 |
| 92607 | Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with patient; first hour | 60 minutes | $61.67 |
| 92608 | Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with patient; each additional 30 minutes | 30 minutes | $11.91 |
| MUSCLE AND RANGE OF MOTION TESTING | |||
| 95831 | Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk | per service | $11.37 |
| 95832 | Muscle testing, manual (separate procedure) with report; extremity - hand, with or without comparison with normal side | per service | $10.38 |
| 95833 | Muscle testing, manual (separate procedure) with report; - total evaluation of body, excluding hands | per service | $16.07 |
| 95834 | Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk - total evaluation of body, including hands | per service | $18.94 |
| 95851 | Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine) | per service | $7.51 |
| 95852 | Range of motion measurements and report (separate procedure); each extremity - hand, with or without comparison with normal side | per service | $5.84 |
| CENTRAL NERVOUS SYSTEM ASSESSMENTS/TESTS (e.g. NEURO-COGNITIVE, MENTAL STATUS, SPEECH TESTING) | |||
| 96110 | Developmental testing; limited (e.g. Developmental Screening Test II, Early Language Milestone Screen) with interpretation and report | per service | $4.64 |
| 96111 | Developmental testing; limited (e.g. Developmental Screening Test II, Early Language Milestone Screen) with interpretation and report - extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments (e.g., Bayley Scales of Infant Development) with interpretation and report | per service | $56.39 |
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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