10-144-101 Me. Code R. § III-103
PROCEDURE CODE/ REVENUE CODE | DESCRIPTION | UNIT OF SERVICE | MAXIMUM ALLOWANCE |
T1015 | Clinic visit/encounter, all inclusive | per visit | by report |
0521 | Rural Health Clinic | ||
T1015 HE | Clinic visit/encounter, all inclusive | per visit | by report |
0521 | Rural Health Clinic | ||
T1015 | Home visit/encounter, all inclusive | per visit | by report |
0522 | Rural Health Clinic | ||
T1015 | Visit to SNF (Part A*) | per visit | by report |
0524 | Rural Health Clinic | ||
*A covered part A stay means that Medicare A will pay the services as the primary carrier | |||
T1015 | Visit to SNF (non-covered*) | per visit | by report |
0525 | Rural Health Clinic | ||
*A non-covered stay means that Medicare A is not paying for the inpatient stay/services | |||
T1015 | Visit to other site | per visit | by report |
0528 | Rural Health Clinic | ||
RHCs are reimbursed for all Food and Drug Administration (FDA) approved intrauterine devices at the rate listed on the MaineCare UCR: https://mainecare.maine.gov/ | |||
J1050 | Injection, medroxyprogesterone acetate1 mg | 1 unit | by report |
0636 | Pharmacy | ||
G0108 | Diabetes outpatient self-management training services, individual, per 30 minutes | 30 minutes | by report |
0521 | Rural Health Clinic | ||
G0109 | Diabetes outpatient self-management training services, group session (2 or more) per 30 minutes | 30 minutes | by report |
0521 | Rural Health Clinic | ||
RHCs are reimbursed for all Food and Drug Administration (FDA) approved pharmacotherapy for tobacco dependence treatment | |||
99406 | Smoking and tobacco cessation counseling; individual, intermediate | 3-10 minutes | $8.67 |
0521 | Rural Health Clinic | ||
99407 | Smoking and tobacco cessation counseling; individual, intensive | greater than 10 minutes | $16.81 |
0521 | Rural Health Clinic | ||
99411 | [Tobacco cessation] preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure), approximately 30 minutes | per session | $11.54 |
0521 | Rural Health Clinic | ||
99412 | [Tobacco cessation] preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes | per session | $15.04 |
0521 | Rural Health Clinic | ||
G0008 | Administration of influenza virus vaccine | per unit | $5.00 |
0521 | Rural Health Clinic | ||
G0009 | Administration of pneumococcal vaccine | per unit | $5.00 |
0521 | Rural Health Clinic |
MODIFIERS | DESCRIPTION |
GT | VIA INTERACTIVE AUDIO AND VIDEO TELECOMMUNICATION SYSTEMS |
HE | BEHAVIORAL HEALTH |
SL | STATE SUPPLIED VACCINE |
UF | SERVICES PROVIDED IN THE MORNING (6 A.M. TO 11:59 A.M.) |
UG | SERVICES PROVIDED IN THE AFTERNOON (12 P.M. TO 5:59 P.M.) |
UH | SERVICES PROVIDED IN THE EVENING (6 P.M. TO 11:59 P.M.) |
UJ | SERVICES PROVIDED AT NIGHT (12 A.M. TO 5:59 A.M.) |
10-144 C.M.R. ch. 101, § III-103
12/1/2016 - filing 2016-195