Section 30, Family Planning, REVISED 2024 Base Rates and Resulting Final Rates, CR 123812

Apr 12, 2024

In coordination with the Centers for Medicare & Medicaid Services (CMS) revision of rates effective March 9, 2024, MaineCare has updated the base rates and resulting final rates for certain Family Planning Services delivered by eligible providers. These new rates were implemented for billing on April 3, 2024.

Only providers engaged primarily in the delivery of sexual and reproductive health care services, as described in 42 United States Code, Section 1396d(a)(4)(c) are eligible to bill add-on rates. 

You may view the full fee schedule, including the base, add-on, and final rates, on the Health PAS Online Portal.

Adjustment of Claims

• For claims submitted with charges at or above, the new rates, the Department will reprocess dates of service March 9, 2024, through April 3, 2024. No provider action is needed. 
• For claims submitted with charges below the new rates for the same date span above, providers will be responsible for adjusting claims as is deemed appropriate by the provider. Please work the oldest dates first.

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

For questions, please contact your Provider Relations Specialist.