Subsection 144-101-X-4.04 - COVERED SERVICESA covered service is a service for which payment to a provider is permitted under this section of the MaineCare Benefits Manual. The services covered under this policy are listed below:
A. Office visits for family planning.B. FDA-approved oral contraceptives, devices, and supplies.C. Over-the-counter contraceptives, including condoms, spermicides, and sponges, if prescribed.D. Patient family planning education and counseling.E. Follow-up visits for complications associated with contraceptive methods.F. Breast and pelvic exams and cancer screening.G. Pap smears, colposcopies, biopsies, and cryotherapies for cervical dysplasia.H. Treatment of genital tract and genital skin infections and disorders.I. Diagnosis and treatment of Sexually Transmitted Infections (STIs).J. Testing, prevention education, counseling and referral for Human Immunodeficiency Virus (HIV).K. Limited pharmacy services, consisting of birth control supplies and medications, vaccines, and supplies to prevent and treat STIs and other reproductive health infections.L. Limited laboratory services, consisting of testing for STIs, HIV, anemia, sickle cell disease, cervical and testicular cancer screening, and pap smears.M. Anesthesia services when medically necessary for a procedure that is covered under the Limited Family Planning Benefit.N. Sterilization if a properly completed sterilization consent form in accordance with the requirements of 42 C.F.R. 441, Subpart F, is attached to the billing claim.O. Provision of immunization services for STIs, including but not limited to, Hepatitis B where medically indicated.P. Treatment of major complications related to family planning services and family planning-related services (e.g., treatment of perforated uterus due to IUD insertion; severe menstrual bleeding by Depo-Provera injection, requiring dilation and curettage; or treatment of surgical; or anesthesia-related complications during a sterilization procedure). C.M.R. 10, 144, ch. 101, ch. X, § 144-101-X-4, subsec. 144-101-X-4.04