C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-90, subsec. 144-101-II-90.07

Current through 2024-51, December 18, 2024

Subsection 144-101-II-90.07 - NON-COVERED SERVICES

When MaineCare does not cover specific procedures, all services related to that procedure are not covered, including physician, facility, and anesthesia services. Services that are not reimbursable by MaineCare include, but are not limited to:

90.07-1Cosmetic Surgery

Surgeries that are performed solely for cosmetic reasons are not covered by MaineCare. MaineCare defines cosmetic surgery as any surgery done primarily to improve or change appearance without improving the way the body works.

Procedures that may potentially performed for either cosmetic or medical reasons require prior authorization documenting the medical indication for the procedure.

MaineCare does cover some potentially cosmetic procedures when done to correct deformities resulting from cancer, disease, trauma, or birth defects, as detailed in Section 90.05. Examples of non-covered cosmetic surgery are:

A. Circumcision, which is usually a cosmetic procedure, is not covered unless medically necessary. Circumcision that is routine or cosmetic including routine newborn circumcision is not covered. Circumcision for preventative, social, ethnic, or religious reasons, regardless of age, is not covered. MaineCare covers some circumcisions with an appropriate medical indication.

B. Piercings and removal of tattoos.

90.07-2 Infertility Services

Treatments and procedures solely for the purpose of evaluation or treatment of infertility are not covered. In addition, MaineCare does not cover reversal of sterilization.

90.07-3Other Non-Covered Services

A. Garren-Edwards Gastric Bubble;

B. Acupuncture;

C. Medical care provided by mail, telephone or internet, except as provided in accordance with Chapter I, Section 4, Telehealth Services;

D. Autopsy examinations;

E. Preparation and duplication of records, forms, and reports;

F. Hypnosis;

G. Reversal of sterilization procedures; and

H. Any service described in 90.04 that exceeds the stated restrictions.

C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-90, subsec. 144-101-II-90.07