​Reminder: State Funded Abortion

Nov 06, 2023

Effective September 19, 2019, MaineCare began covering abortion services that are not eligible for reimbursement from Centers of Medicare and Medicaid Services (CMS). It is important to submit claims with information that identifies the service because this service is only covered by State funds.   

When submitting claims for State funded abortions to MaineCare, you must report the SE modifier on all lines of the claim when billing on the CMS-1500 claim forms. For UB-04 claim forms, you need to ensure the AH condition code is used and apply the SE modifier to lines where you are populating a CPT/HCPC code. Providers need to sign a Provider Agreement for State-Funded Health Programs to be paid for the service. Abortion service claims are audited and will be denied or rejected if these steps are not taken. 

Over the past several months there have been many inquiries regarding denied claims because the abortion service did not take place with the specific provider who submitted the claim. If the service begins with one provider and then a different provider supplies services to the member due to complications or follow up care, all related services are still considered a State funded abortion. The modifier, condition code, and State-Funded Agreement form is required if you are seeking payment for the service. 

Please contact Tiffany.Norton@Maine.gov with questions.