Section 45, Hospitals & Section 90, Physicians: 2024 & 2025 Drug Rate Updates
MaineCare updated multiple codes and rates retroactively due to a rate update from the Centers for Medicare & Medicaid Services (CMS). The new rates are effective April 1, 2024, through March 31, 2025.
See the table of affected codes below for the effective dates and new rates.
|
Procedure Code |
Start Date |
End Date |
Previous Rate |
Revised Rate |
|
J0475 |
4/1/2024 |
6/30/2024 |
$177.87 |
$177.46 |
|
J7614 |
4/1/2024 |
6/30/2024 |
$0.04 |
$0.09 |
|
Q5125 |
4/1/2024 |
6/30/2024 |
$0.53 |
$0.45 |
|
Q5126 |
4/1/2024 |
6/30/2024 |
$58.81 |
$55.39 |
|
Q5126 |
7/1/2024 |
9/30/2024 |
$57.72 |
$52.42 |
|
Q5126 |
10/1/2024 |
12/31/2024 |
$56.86 |
$48.70 |
|
Q5126 |
1/1/2025 |
3/31/2025 |
$58.23 |
$48.79 |
|
J9204 |
1/1/2025 |
3/31/2025 |
$243.32 |
$243.19 |
|
J7213 |
1/1/2025 |
3/31/2025 |
$2.20 |
$1.86 |
Adjustment of affected claims:
MaineCare will reprocess claims that were billed with charges at or above the new rates indicated in the table above. No provider action is needed.
For questions, please contact your Provider Relations Specialist.