Drug Rate Updates

Jul 20, 2022

Additional 2021 Drug Rate Updates, CR 106867 

On January 12, 2022, we updated certain drug code rates retroactively to either January 1, 2021, or July 1, 2021, in MIHMS based on updates from the Centers for Medicare & Medicaid Services (CMS).  

See the table below for the effective dates and new rates, or you can see all the codes and rates in the fee schedule for more detail. 

Start Date	End Date	Procedure Code	Rate = $
1/1/2021	3/31/2021	J2353	$205.41
7/1/2021	9/30/2021	J2353	$203.94
7/1/2021	9/30/2021	J7518	$1.46

 

Adjustments for affected claims:  

• If you have been billing these codes at a higher rate than is indicated in the table above, we will reprocess your claims and no provider action is needed.    

• If you have been billing these codes at a lower rate than is indicated in the table above, please adjust the affected claims. Providers will have 120 days from the date of this notice to submit corrected adjustments; please focus on the oldest dates of service first.  

For guidance about adjusting verses straight reversing claims and instructions on how to do each, see the How to Adjust Claims for Retro Rate Increases (PDF). 

Please contact your Provider Relations Specialist with questions. 

Quarterly Drug Rates Update, CR 106861 

On February 2, 2022, we implemented a regular quarterly update for some rates in MaineCare Benefits Manual, Chapter II, Sections 25, 30, 45, 55, 60, 75, and 90 in MIHMS retroactively to January 1, 2022.  

See this spreadsheet for a list of codes with new rates, which is also available on the Codes & Rates webpage, or you can see all the codes and rates in the fee schedule. 

We will reprocess claims submitted from January 1, 2022, to February 1, 2022, that paid at the incorrect rates, and no provider action is needed. Claims submitted on or after February 2, 2022, processed at the correct rate.  

For guidance about adjusting verses straight reversing claims and instructions on how to do each, see the How to Adjust Claims for Retro Rate Increases (PDF). 

Please contact your Provider Relations Specialist with questions.