Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter III - Allowances for Services › Section 144-101-III-85 - PHYSICAL THERAPY SERVICES

Current through 2024-29, July 17, 2024
MaineCare coverage of Physical Therapy Services is limited.
					 Refer to Chapter II, Section 85.06 for specific limitations.
Use the following modifiers when
					 appropriate:
TF - Intermediate Level of care - used for PT
					 Assistants and priced 10% below the Allowance rate
GP - Services delivered under an outpatient physical
					 therapy plan of care
TL - Services delivered under an Individualized
					 Family Service Plan (IFSP)
TM - Services delivered under an Individualized
					 Education Plan (IEP) with MaineCare Addendum denoting medical necessity of the
					 service
CODE
SERVICE
UNIT
MAXIMUM ALLOWANCE
97001
Physical Therapy Evaluation
per evaluation
$35.94
97002
Physical Therapy Re-evaluation (Ongoing therapy)
per session
$19.40
97150 GP
Therapeutic procedure(s), group (2 or more
								individuals)
per member per session
$11.98
THERAPEUTIC MODALITIES SUPERVISED
97012
Application of a modality to one or more areas;
								traction, mechanical
per service
$6.24
97014
Application of a modality to one or more areas;
per service
$5.61
97016
Application of a modality to one or more areas;
								vasopneumatic devices
per service
$6.28
97018
Application of a modality to one or more areas;
								paraffin bath
per service
$3.05
97022
Application of a modality to one or more areas;
								whirlpool
per service
$7.06
97024
Application of a modality to one or more areas;
								diathermy
per service
$2.10
97026
Application of a modality to one or more areas;
								infrared
per service
$1.94
97028
Application of a modality to one or more areas;
								ultraviolet
per service
$2.62
THERAPEUTIC MODALITIES CONSTANT
								ATTENDANCE
97032
Application of a modality to one or more areas;
								electrical stimulation (manual)
15 minutes
$6.88
97033
Application of a modality to one or more areas;
								iontophoresis
15 minutes
$9.90
97034
Application of a modality to one or more areas;
								contrast baths
15 minutes
$6.00
97035
Application of a modality to one or more areas;
								ultrasound
15 minutes
$4.89
97036
Application of a modality to one or more areas;
								Hubbard tank
15 minutes
$10.58
THERAPEUTIC PROCEDURES
97110
Therapeutic procedure, one or more areas;
								therapeutic exercises to develop strength and endurance, range of motion and
								flexibility
15 minutes
$11.93
97112
Neuromuscular re-education of movement, balance,
								coordination, kinesthetic sense, posture, and proprioception for sitting and/or
								standing activities
15 minutes
$12.46
97113
Aquatic therapy with therapeutic exercises
15 minutes
$14.34
97116
Gait training (includes stair climbing)
15 minutes
$10.46
97124
Massage, including effleurage, petrissage and/or
								tapotement (stroking, compression, percussion)
15 minutes
$9.59
97140
Manual therapy techniques (e.g.,
								mobilization/manipulation, manual lymphatic drainage, manual traction), one or
								more regions
15 minutes
$11.15
97760
Orthotic(s) management and training (including
								assessment and fitting when not otherwise reported), upper extremity(s), lower
								extremity(s) and/or trunk
15 minutes
$13.45
97761
Prosthetic training, upper and/or lower extremity(s)
15 minutes
$12.09
97530
Therapeutic activities, direct (one-on-one) patient
								contact by the provider (use of dynamic activities to improve functional
								performance)
15 minutes
$12.60
97532
Development of cognitive skills to improve
								attention, memory, problem solving, (includes compensatory training,) direct
								(one-on-one) patient contact by the provider
15 minutes
$10.38
97533
Sensatory integrative techniques to enhance sensory
								processing and promote adaptive responses to environmental demands, direct
								(one-on-one) patient contact by provider
15 minutes
$11.02
97535
Self/care/home management training (e.g. activities
								of daily living (ADL) and compensatory training, meal preparation, safety
								procedures, and instructions in use of assistive technology devices/adaptive
								equipment) direct one-on-one contact by provider
15 minutes
$12.78
97542
Wheelchair management(eg, assessment, fitting,
								training)
15 minutes
$11.67
ACTIVE WOUND CARE MANAGEMENT
97597
Removal of devitalized tissue from wound(s),
								selective debridement, without anesthesia (e.g. high pressure water jet
								with/without suction, sharp selective debridement with scissors, scalpel and
								forceps), with or without topical application(s) for ongoing care, may include
								use of a whirlpool, per session; total wound(s) surface area less than or equal
								to 20 square centimeters
per service
$23.54
97598
Removal of devitalized tissue from wound(s),
								selective debridement, without anesthesia (e.g. high pressure water jet
								with/without suction, sharp selective debridement with scissors, scalpel, and
								forceps), with or without topical application(s), wound assessment, and
								instruction(s) for ongoing care, may include use of a whirlpool, per session;
								total wound(s) surface area greater than 20 square centimeters
per service
$23.54
97602
Removal of devitalized tissue from wound(s),
								non-selective debridement, without anesthesia (e.g., wet-to-moist dressings,
								enzymatic, abrasion), including topical applications(s), wound assessment and
								instructions(s) for ongoing care
per service
$16.86
TESTS AND MEASUREMENTS
97762
Check out for orthotic/prosthetic use, established
								patient
15 minutes
$13.31
97750
Physical performance test or measurement (e.g.,
								musculoskeletal, functional capacity), with written report
15 minutes
$12.39
97755
Assistive technology assessment (e.g. to restore,
								augment or compensate for existing function, optimize functional tasks and/or
								maximize environmental accessibility), direct one-on-one contact by provider,
								with written report
15 minutes
$14.44
92605
Evaluation for prescription of non-speech-generating
								augmentative and alternative communication device
per service
$34.26
92607
Evaluation for prescription for speech-generating
								augmentative and alternative communication device, face-to-face with patient;
								first hour
60 minutes
$61.67
92608
Evaluation for prescription for speech-generating
								augmentative and alternative communication device, face-to-face with patient;
								each additional 30 minutes
30 minutes
$11.91
MUSCLE AND RANGE OF MOTION TESTING
95831
Muscle testing, manual (separate procedure) with
								report; extremity (excluding hand) or trunk
per service
$11.37
95832
Muscle testing, manual (separate procedure) with
								report; extremity - hand, with or without comparison with normal side
per service
$10.38
95833
Muscle testing, manual (separate procedure) with
								report; - total evaluation of body, excluding hands
per service
$16.07
95834
Muscle testing, manual (separate procedure) with
								report; extremity (excluding hand) or trunk - total evaluation of body,
								including hands
per service
$18.94
95851
Range of motion measurements and report (separate
								procedure); each extremity (excluding hand) or each trunk section (spine)
per service
$7.51
95852
Range of motion measurements and report (separate
								procedure); each extremity - hand, with or without comparison with normal side
per service
$5.84
CENTRAL NERVOUS SYSTEM ASSESSMENTS/TESTS (e.g.
								NEURO-COGNITIVE, MENTAL STATUS, SPEECH TESTING)
96110
Developmental testing; limited (e.g. Developmental
								Screening Test II, Early Language Milestone Screen) with interpretation and
								report
per service
$4.64
96111
Developmental testing; limited (e.g. Developmental
								Screening Test II, Early Language Milestone Screen) with interpretation and
								report - extended (includes assessment of motor, language, social, adaptive
								and/or cognitive functioning by standardized developmental instruments (e.g.,
								Bayley Scales of Infant Development) with interpretation and report
per service
$56.39