Revision of Medicare Standardization Rates

Jan 16, 2025

Effective January 1, 2025, the Centers for Medicare & Medicaid Services (CMS) revised certain rates. To align with these changes, MaineCare is in the process of revising reimbursement rates for Medicare covered codes and services, in the sections listed below. The new rates will reflect 72.4% of the Medicare rates with a retroactive effective date of January 1, 2025, to align with Medicare. Providers can expect these new rates to be implemented by the end of January 2025.

As new rates are implemented, the Department will update the fee schedules posted to the Rate Setting webpage of the Health PAS Online Portal.

Adjustment of Claims 

• The Department will reprocess claims that were submitted at or above the new rates for dates of service January 1, 2025, through the date of implementation and no provider action is required. 
• Providers who billed claims with charges below the new rates for the same date span noted previously, will be responsible for adjusting claims as you deem appropriate.   

Affected sections of policy:

Section 14	Advanced Practice Registered Nursing Services
Section 15	Chiropractic Services
Section 30	Family Planning Services
Section 68	Occupational Therapy Services
Section 75	Vision Services
Section 85	Physical Therapy Services
Section 90	Physician Services (*see exception below for Enhanced Primary Care Providers)
Section 95	Podiatry Services
Section 101	Medical Imaging Services
Section 109	Speech & Hearing Services

* Reimbursement for Enhanced Primary Care Provider services under Section 90, Physician Services will receive 100% of the current Medicare rate.

Note: these adjustments only apply to services benchmarked to Medicare under the specified Sections of Policy for eligible services above. When a Section of Policy cross-references rates in a separate Section of Policy, the reimbursement provisions in the cross-referenced section of policy dictates the reimbursement amount (e.g. reimbursement for laboratory services under Section 95, Podiatry, is dictated by reimbursement methodology and rates set forth in Section 55, Laboratory Services. Podiatry providers will continue to receive reimbursement for Laboratory services in accordance with Section 55). 

For additional billing guidance, please see the How to Adjust Claims for Retro Rate Increases (PDF) document. 

Please contact your Provider Relations Specialist with questions.