C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-5, subsec. 144-101-III-5.03
MaineCare will accept the two character modifiers listed on the following pages. Although CPT guidelines allow for the use of numeric modifiers up to five characters long (in addition to the procedure code), MaineCare only accepts and processes two character modifiers.
As with the procedure codes, there are two types of modifiers: CPT modifiers, which are numerical; and HCPCS modifiers, which are alphabetical. Modifiers can be used interchangeably with all codes; that is CPT modifiers can be used with HCPCS codes, etc. Some modifiers are meant to affect the fee payable for a particular service. These are called pricing modifiers.
Other modifiers do not affect the pricing of a particular code, but they do describe more accurately the service being provided. These are called descriptive modifiers.
There are several modifiers that define services not covered by MaineCare. These modifiers have not been included in the following list. Modifier(s) listed in this section must be selected to describe the appropriate service.
Single letter modifiers must be combined to indicate the origin and destination of the trip. For example, base transport from the member's home to the hospital would be coded A0428RH, while base transport from the hospital to the member's home would be coded A0428HR.
| Modifier | Definition |
| D | Diagnostic or therapeutic site other than "P" or "H" when these are used as origin codes. |
| E | Residential, domiciliary, custodial facility. |
| G | Hospital-based dialysis facility (hospital or hospital-related). |
| H | Hospital. |
| I | Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport. |
| J | Non hospital-based dialysis facility. |
| N | Nursing facility. |
| P | Physician's office (includes HMO non-hospital facility, clinic, etc.) |
| R | Residence. |
| S | Scene of accident or acute event. |
| X | (Destination code only) intermediate stop at physician's office enroute to the hospital (includes HMO non-hospital facility; clinic, etc.) |
| QL | Patient pronounced dead after ambulance called. |
| Modifier | Definition |
| H9 | Court-ordered. [This modifier is to be used to designate when reimbursement should be paid at the Emergency Involuntary Admission to a Psychiatric Facility (Blue Paper) ambulance run and mileage rates]. |
C.M.R. 10, 144, ch. 101, ch. III, 144-101-III-5, subsec. 144-101-III-5.03