Medicare Standardization Rate Updates for Calendar Year 2025 (CY25)

Dec 24, 2025

Effective January 1, 2026, MaineCare will update reimbursement rates for Medicare covered codes and services for the sections of policy noted below. The new rates will reflect 72.4% of the most recent 2026 Medicare rates.

As new rates are implemented, MaineCare will provide adjustment billing guidance as necessary and include updated fee schedules on the Rate Setting webpage of the Health PAS Online Portal.  

Section 14	Advanced Practice Registered Nursing Services
Section 15	Chiropractic Services
Section 30	Family Planning Services
Section 65	Behavioral Health Services
Section 68	Occupational Therapy Services
Section 75	Vision Services
Section 85	Physical Therapy Services
Section 90	Physician Services (*see exception below for Enhanced Primary Care Providers)
Section 95	Podiatry Services
Section 101	Medical Imaging Services
Section 109	Speech & Hearing Services

 

* Reimbursement for Enhanced Primary Care Provider services under Section 90, Physician Services will receive 100% of the current Medicare rate.

The Department provides this notice pursuant to Rate Reform law, which requires advance notice for planned Medicare fee schedule changes that do not require rulemaking.

For questions, please contact your Provider Relations Specialist.

Note: these adjustments only apply to services benchmarked to Medicare under the specified Sections of Policy for eligible services above. When a Section of Policy cross-references rates in a separate Section of Policy, the reimbursement provisions in the cross-referenced section of policy dictates the reimbursement amount (for example, reimbursement for laboratory services under Section 95, Podiatry, is dictated by reimbursement methodology and rates set forth in Section 55, Laboratory Services. Podiatry providers will continue to receive reimbursement for Laboratory services in accordance with Section 55).