Targeted Case Management (TCM) Services Provided by Section 9, Indian Health Services (IHS)

Jan 29, 2024

Effective December 15, 2023, providers enrolled under Section 9 of the MaineCare Benefits Manual (MBM) may provide TCM Services to eligible MaineCare members. IHS providers must comply with all requirements set forth in MBM, Section 13 TCM including those regarding member eligibility, record keeping, and covered services. IHS providers are not required to hold a mental health license to provide TCM Services.

There is no limit to the number of services a member may receive. All TCM Services are subject to a Prior Authorization (PA); PA forms are located on the Health PAS Online Portal. Services should be billed with the following HCPC/Modifier combinations and will be reimbursed at a rate of $24.55 per 15-minutes for claims with dates of service in calendar year 2023, and at a rate of $25.17 per 15-minutes for claims with dates of service beginning January 1, 2024.

If you have questions please contact your Provider Relations Specialists, Shannon Beggs and John Repecko