Procedure Code Lookup
- The look up includes procedure codes for physicians, physician assistants, nurse practitioners, and other practitioners under Section 90 Physician Services and durable medical equipment and supply providers.
- The look up does not include procedure codes for all provider types.
- It shows MaineCare rates.
- Caution: Always check that the code is MaineCare covered, even if a MaineCare rate is listed
- It shows whether a Prior Authorization is required. (No indicator in the PA column means that PA is not required.)
- For DME dealers, policy requires PA if the service costs more than a specified dollar amount.
- For Out-of-State providers, all non-emergency care requires Prior Authorization. See MaineCare’s Prior Authorization page for more details.
- It does not include G codes.
- It highlights special requirements, such as sterilization consent forms, or anesthesia units.
Questions? Comments?
For questions about claim payments, denials and covered services, please contact MaineCare Customer Service at 1-800-321-5557.
To request code corrections or changes, you can send an e-mail to bms.referencefile@maine.gov. This e-mail box is only for requesting changes or corrections to:
- procedure codes,
- revenue codes,
- ICD9 surgical codes,
- ICD9 diagnosis codes,
- place of service, or
- rates
- If the service has published rates in policy, then staff cannot make changes. If you are being paid the incorrect rate, please contact Customer Service at 1-800-321-5557.
- Rate questions will be forwarded to rate setting staff.
Please include the following information in your e-mail:
- Provider name and Provider ID#
- Contact name and telephone number
- Detailed information about your request, including codes, and why the change is needed.
- Dates of service (if appropriate)
- Note: Specific member information is not needed.
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