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Codes

 

Procedure Code Look Up

 

Procedure Code Look Up for MaineCare Codes for Physician and Durable Medical Equipment and Supply Items/Services

Physicians, physician assistants, nurse practitioners, and other practitioners who are directed to Section 90 Physician Services for billing, and durable medical equipment and supply providers can now look up procedure codes for their services. This listing will provide rates as well as any special requirements for the service.

Caution: Always check that the code is MaineCare covered, even if a MaineCare rate is listed

In addition, the absence of a Prior Authorization indicator means a prior authorization is not required. For DME dealers, you must adhere to the dollar amount in policy that states if the service is over a specified amount, a prior authorization is required.

Please note that the listing does not include G codes. MaineCare has also established an email address bms.referencefile@maine.gov to assist you in requesting changes to procedure codes, revenue codes, ICD9 surgical codes, and ICD9 diagnosis codes. These changes include, but are not limited to, place of service changes. Submitting a request does not guarantee that the change requested will be made. The requester will be notified of all decisions.

Rate setting requests will be forwarded to appropriate staff, who will notify the requester when the change is made. If you are billing under Sections of policy that have published rates, staff at rate setting cannot make changes unless the rate does not match what is published in policy.

Please do not use this email address to ask questions about denied claims or to verify data on file. You will need to continue to contact Customer Service for assistance.

Please include the following information in your request:

• Provider name and Provider ID#
• Contact name and telephone number/Email address
• Detailed information about what is being requested, including codes, and when appropriate, why the change is being requested.
• Dates of service
• Specific member information is not needed to request a change to data.

If you are requesting a non-covered service be considered, additional medical justification will be required. Please be as detailed as possible. Both policy and clinical staff will have to review these requests.

 

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