Subsection 144-101-II-101.04 - COVERED SERVICES A covered service is a service for which payment can be made by the Department. Medical imaging services include, but are not limited to, computed tomography (CT), x-rays, magnetic resonance imaging (MRI), mammography, nuclear medicine, PET scans, and ultrasonography. These services must be medically necessary for screening, diagnosis or control of a medical condition to be a covered service. These services must be ordered by a physician or other licensed practitioner authorized to order medical imaging services within the scope of his or her licensure.
Services must be performed under the general supervision of a licensed physician or other authorized, licensed practitioner within the scope of his or her licensure and must be medically necessary. For purposes of this Section only, general supervision may occur in person, by telephone or by some other method consistent with instant communication.
A. Mammography must be provided in a mammography facility in possession of a current Certificate (issued by an appropriate accrediting body) and in compliance with the State of Maine Radiation Regulations or the licensing regulations of the state or province in which the services are provided.B. CT scans of the head and full body are reimbursable if medically necessary.C. MRI is a MaineCare covered service for currently acceptable medical indications supportable in literature and nationwide experience. This service will be covered only when sufficient information is available in the member's record to justify the medical necessity of the procedure.D. Diagnostic x-ray tests are covered services. Certain diagnostic x-ray procedures are also covered when performed by technicians without direct personal physician supervision. Such covered procedures include skeletal films involving the extremities, pelvis, vertebral column or skull and chest or abdominal films that do not involve the use of contrast media. To be covered, the technician's general supervision and training, as well as the maintenance of the necessary equipment and supplies, must be the continuing responsibility of a physician.E. Mobile medical imaging and portable diagnostic x-ray services are covered services only when it is medically necessary for the service to be furnished in a place or residence used as the member's home. Providers must maintain documentation indicating why it is medically contra-indicated for the member to travel to the imaging facility. Mobile medical imaging services provided in vehicles that are routinely scheduled to move between hospital locations are covered services. Documentation of the member's medical contra-indication for travel to the facility is not required. All services must be performed under the written order of a physician. The provider must meet all federal, state and/or provincial health and safety standards and licensing.F. Nuclear medicine is a covered service if medically necessary.G. Ultrasound and sonography are covered services if medically necessary. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-101, subsec. 144-101-II-101.04