Rounding Rule Clarification
The purpose of this notice is to clarify the MaineCare Benefits Manual (MBM), Chapter I, Section 1, Rounding Rule. MBM Chapter I, Section 1.03-8 (J) advises how to apply the Rounding Rule when partial units are delivered.
The Rounding Rule does not apply when a service code requires a minimum amount of time that must be met or exceeded. For example, Evaluation and Management (E&M) code sets 99202-99205 and 99212-99215 are defined by a minimum time duration met or exceeded on the Date of Service (DOS) as shown in the table below.
|
E & M Service Code |
Minimum Total Time on the DOS to be Met or Exceeded |
|
99202 |
15 |
|
99203 |
30 |
|
99204 |
45 |
|
99205 |
60 |
|
99212 |
10 |
|
99213 |
20 |
|
99214 |
30 |
|
99215 |
45 |
For questions, please contact your Provider Relations Specialist.