Rate Updates

Apr 08, 2022

Rate Update for 2022 Ambulatory Surgical Centers (ASC) Rates, CR 107519 

On February 10, 2022, as part of a regular annual update, we updated the rates for MaineCare Benefits Manual, Chapter II, Section 4, Ambulatory Surgical Center Services, in MIHMS retroactively to January 1, 2022. 

See this spreadsheet for the list of new codes with their rates, which is also available on the Codes & Rates webpage or the fee schedule.

Adjustments for affected claims: 

• If you have been billing these codes at a higher rate than is indicated in the spreadsheet, 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 spreadsheet, 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. 

Please contact your Provider Relations Specialist with questions.

 

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).

This impacts the following Sections of policy:

• 25: Dental Services
• 30: Family Planning Agency Services
• 45: Hospital Services
• 55: Laboratory Services
• 60: Medical Supplies and Durable Equipment
• 75: Vision Services
• 90: Physician Services
• 95: Podiatric Services
• 101: Medical Imaging Services

See the table below for the effective dates and new rates or 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

• 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. 

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 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.

Please contact your Provider Relations Specialist with questions.