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-65 - Behavioral Health Services

Current through 2024-29, July 17, 2024
Crisis Resolution
					 Services:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H2011
15 min
Crisis Resolution
*$61.82
*7/1/22
N
H2011
HA
15 min
Crisis Resolution - Children
*$61.82
*7/1/22
N
Crisis Residential
					 Services:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H0018
Per Diem
Crisis Residential
*By Report
*7/1/22
Y
H0018
HA
Per Diem
Crisis Residential - Children
*By Report
*7/1/22
Y
S9482
15 min
Crisis Residential - In Home
*$18.65
*7/1/22
N
S9482
HA
15 min
Crisis Residential - In Home -
								Children
*$18.65
*7/1/22
N
Outpatient Services - Comprehensive
					 Assessment:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H2000
15 min
Independent - Psychologist
*$23.55
*7/1/22
Y
H2000
15 min
Mental Health Agency
*$22.48
*7/1/22
Y
H2000
HH
15 min
Mental Health Agency - Co-occurring
*$22.48
*7/1/22
Y
H2000
15 min
Mental Health Agency Deaf & Home-Based
								Treatment for Adults
*$32.92
*7/1/22
Y
H2000
15 min
Independent - LCSW, LCPC, LMFT
*$14.72
*7/1/22
Y
H2000
15 min
Substance Use Agency
*$22.48
*7/1/22
Y
H2000
15 min
Substance Use Agency - Non-Master's Level
								LADC
*$21.41
*7/1/22
Y
H2000
15 min
Substance Use Agency - CADC
*$15.52
*7/1/22
Y
Outpatient Services - Individual/Family
					 Therapy:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H0004
15 min
Independent - Psychologist
*$23.55
*7/1/22
Y
H0004
15 min
Mental Health Agency
*$22.48
*7/1/22
Y
H0004
HH
15 min
Mental Health Agency-Co-occurring
*$22.48
*7/1/22
Y
H0004
15 min
Mental Health Agency-Deaf & Home-Based
								Treatment for Adults
*$32.92
*7/1/22
Y
H0004
15 min
Independent - LCSW, LCPC, LMFT
*$14.72
*7/1/22
Y
H0004
15 min
Substance Use Agency
*$22.48
*7/1/22
Y
H0004
15 min
Substance Use Agency-Non-Master's Level
								LADC
*$21.41
*7/1/22
Y
H0004
15 min
Substance Use Agency - CADC
*$15.52
*7/1/22
Y
*H0004
ST
15 min
Trauma Focused-Cognitive Behavioral Therapy
								(TF-CBT)
*$27.21
*7/1/22
Y
Outpatient Services - Group
					 Therapy:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H0004
HQ
15 min
Psychologist-Independent
*$5.89
*7/1/22
Y
H0004
HQ
15 min
Mental Health Agency
*$5.62
*7/1/22
Y
H0004
HQ HH
15 min
Mental Health Agency-Co-occurring
*$5.62
*7/1/22
Y
H0004
HQ
15 min
Substance Use Agency
*$9.63
*7/1/22
Y
H0004
HQ
15 min
Substance Use Agency-Non-Master's Level
								LADC
*$9.10
*7/1/22
Y
H0004
HQ
15 min
Substance Use Agency - CADC
*$7.49
*7/1/22
Y
H0004
HQ
15 min
Independent - LCSW, LCPC and LMFT
*$3.68
*7/1/22
Y
Family Psychoeducational
					 Treatment:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H0025
Monthly
Treatment Services- Children
*$79.03
*7/1/22
Y
H2027
15 min
Treatment Services- Adult
*$10.12
*7/1/22
Y
Intensive Outpatient Program (IOP)
					 Services:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H0015
Per Diem
Substance Use
*$192.83
*1/1/22
Y
*H0015
HE
Per Diem
Mental Health
*$231.11
*11/9/22
Y
*H0015
HI
Per Diem
Dev. Disabilities /Behavioral
								Health
*$316.53
*11/9/22
Y
*H0015
HC
Per Diem
Geriatric
*$231.11
*11/9/22
Y
*H0015
HK
Per Diem
Dialectical Behavior Therapy
*$188.84
*11/9/22
Y
*H0015
HT
Per Diem
Eating Disorder - Level I
*$247.81
*11/9/22
Y
*H0015
HT AT
Per Diem
Eating Disorder - Level II
*$407.60
*11/9/22
Y
Medication Management Services:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H2010
15 min
Adult Services
$82.64
10/1/21
Y
H2010
HA
15 min
Children's Services
$94.46
10/1/21
Y
H2010
AF
15 min
Adult Services - Physicians
$82.64
10/1/21
Y
H2010
HA AF
15 min
Children's Services - Physicians
$94.46
10/1/21
Y
H2010
HF
15 min
Medication Services - Suboxone
$82.64
10/1/21
Y
H2010
HF AF
15 min
Medication Services-Suboxone -
								Physician
$82.64
10/1/21
Y
Neurobehavioral Status Exam, Neuropsychological
					 Testing, Psychological Testing, and Adaptive Assessments:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
96116
HE
1-hour
Neurobehavioral Status Exam, Psychologist or
								  Physician (includes face-to-face time with the member, time interpreting test
								  results, and preparing the report) - First Hour
*$84.77
*7/1/22
N
96121
HE
1-hour
Neurobehavioral Status Exam,
Psychologist or Physician (includes face-to-face
								  time with the member, time interpreting test results, and preparing the report)
								  . Each Additional Hour
*$84.77
*7/1/22
N
96130
HE
1-hour
Psychological testing, Psychologist or Physician
								  (includes face-to-face time administering tests to the member and time
								  interpreting these results and preparing the report) - First
								  Hour
*$84.77
*7/1/22
N
96131
HE
1-hour
Psychological testing, Psychologist or Physician
								  (includes face-to-face time administering tests to the member, time
								  interpreting these results, and preparing the report) - Each Additional
								  Hour
*$84.77
*7/1/22
N
96132
HE
1-hour
Neuropsychological testing (e.g., Halstead Reitan
								  Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting
								  Test), Psychologist or Physician (includes face-to-face time administering
								  tests to the member, time interpreting these test results, and preparing the
								  report) - First Hour
*$84.77
*7/1/22
N
96133
HE
1-hour
Neuropsychological testing (e.g., Halstead Reitan
								  Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting
								  Test), Psychologist or Physician (includes face-to-face time administering
								  tests to the member, time interpreting these test results, and preparing the
								  report) . Each Additional Hour
*$84.77
*7/1/22
N
96136
HE
30 min
Psychological or Neuropsychological test
								  administration - two or more tests - Psychologist or Physician (includes
								  face-to-face time administering tests to the member, time interpreting these
								  test results, and preparing the report) - First 30 Minutes
*$42.39
*7/1/22
N
96137
HE
30 min
Psychological or Neuropsychological test
								  administration - two or more tests - Psychologist or Physician (includes
								  face-to-face time administering tests to the member, time interpreting these
								  results, and preparing the report) - Each Additional 30 Minutes
*$42.39
*7/1/22
N
96138
HE
30 min
Neuropsychological and Psychological testing-
								  Psychological Examiner (interpretation and report, administered by a
								  technician, face-to-face) - First 30 Minutes
*$26.88
*7/1/22
N
96139
HE
30 min
Neuropsychological and Psychological testing-
								  Psychological Examiner (interpretation and report, administered by a
								  technician, face-to-face) - Each Additional 30 Minutes
*$26.88
*7/1/22
N
When using any of the above
								  Neurobehavioral Status Exam, Neuropsychological Testing, and Psychological
								  Testing codes (96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138,
								  96139), the following modifiers may also be required in order to access the
								  child's educational related services under IDEA, if
								  indicated:
TL
Early intervention/individualized family service
								  plan (IFSP).
TM
Individualized education plan (IEP)
*96112
HE
1-hour
Adaptive Assessment - First Hour
*$88.87
*7/1/22
N
*96113
HE
30 min
Adaptive Assessment - Each Add. 30
								  min
*$44.44
*7/1/22
N
Children's Assertive Community Treatment
					 (ACT):
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
*H0040
HA
Per Diem
Children's ACT
*111.46
*7/1/22
Y
Children's Comprehensive Community Support Services
					 - Home and Community Based Treatment (HCT)
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H2021
HO
15 min
HCT-Master's level
*$24.92
*7/1/22
Y
H2021
HU
15 min
HCT -Master's level (OCFS)
*$24.92
*7/1/22
Y
*H2021
ST
15 min
HCT-Master's level (TF-CBT)
*$24.92
*11/9/22
Y
*G9007
HO
15 min
HCT Collateral Services - Master's
								level
*$24.92
*7/1/22
Y
*G9007
HU
15 min
HCT Collateral Services - OCFS
*$24.92
*7/1/22
Y
H2021
HN
15 min
HCT-BHP level
*$17.40
*7/1/22
Y
H2021
HU U1
15 min
HCT-BHP level (OCFS)
*$17.40
*7/1/22
Y
G9007
HN
15 min
HCT Collateral Services - BHP
*$17.40
*7/1/22
Y
Children's Comprehensive Community Support Services
					 - Functional Family Therapy (FFT), Multi-Systemic Therapy (MST) and MST for
					 Problem Sexualized Behaviors (MST-PSB):
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H2021
HE
Weekly
FFT
*$302.26
*7/1/22
Y
H2033
Weekly
MST
*$601.05
*7/1/22
Y
H2033
HK
Weekly
MST-PSB
*$776.61
*7/1/22
Y
Opioid Treatment Program Services:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H0020
Weekly
Opioid Treatment Program Services
*$115.43
*7/1/22
N
Children's Behavioral Health Day
					 Treatment:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H2012
HN
Hourly
BHP Level
*$62.72
*7/1/22
Y
H2012
HN UN
Hourly
BHP Level-Two patients served
*$31.37
*7/1/22
Y
H2012
HN UP
Hourly
BHP Level-Three patients served
*$20.90
*7/1/22
Y
H2012
HN UQ
Hourly
BHP Level-Four patients served
*$15.68
*7/1/22
Y
H2012
HO
Hourly
Master's Level
*$101.69
*7/1/22
Y
H2012
HO UN
Hourly
Master's Level-Two patients served
*$50.84
*7/1/22
Y
H2012
HO UP
Hourly
Master's Level-Three patients served
								(School-Children)
*$33.83
*7/1/22
Y
H2012
HO UQ
Hourly
Master's Level-Four patients served
								(School-Children)
*$25.43
*7/1/22
Y
When using any of the above Children's
								Behavioral Health Day Treatment codes (H2012 HN, H2012 HN UN, H2012 HN UP,
								H2012 HN UQ, H2012 HO, H2012 HO UN, H2012 HO UP, or H2012 HO UQ), the following
								modifiers may also be required in order to access the child's educational
								related services under IDEA, if indicated:
TL
Early intervention/individualized family service
								plan (IFSP).
TM
Individualized education plan (IEP)
Tobacco Cessation Treatment Services:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
99406
3-10 min
Smoking and Tobacco Cessation Counseling;
								individual, intermediate
*$9.28
*7/1/22
N
99407
10 min
Smoking and Tobacco Cessation Counseling;
								individual, intensive
*$18.00
*7/1/22
N
99411
30 min
Preventive Medicine, Tobacco Cessation Group
								Counseling
*$12.35
*7/1/22
N
99412
60 min
Preventive Medicine, Tobacco Cessation Group
								Counseling
*$16.10
*7/1/22
N
Mental Health Psychosocial Clubhouse
					 Services:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
*H2030
15 min
Mental Health Clubhouse Services
*$6.33
*7/1/22
Y
Specialized Group Services:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
H2019
15 min
Wellness Recovery Action Planning
*$11.21
*7/1/22
Y
H2019
15 min
Recovery Workbook
*$11.21
*7/1/22
Y
H2019
15 min
Trauma Recovery and Empowerment
*$11.21
*7/1/22
Y
H2019
15 min
Dialectical Behavior Therapy
*$11.21
*7/1/22
Y
Behavioral Therapies for Children with Disruptive
					 Behavior Disorders:
Procedure Code
Modifier(s)
Unit
Service Description
Maximum Allowance Per Unit
Rate Effective Date
PA/UR
T1027
HA
15 min
Triple P 1:1
*$22.48
*7/1/22
Y
T1027
HA HQ UN
15 min
Triple P - Group 2-4 members
*$11.53
*7/1/22
Y
T1027
HA HQ UR
15 min
Triple P - Group 5-7 members
*$4.84
*7/1/22
Y
T1027
HA HQ US
15 min
Triple P - Group 8+ members
*$3.12
*7/1/22
Y
T1027
TJ HQ UN
15 min
Incredible Years - Group 2-4
								members
*$13.13
*7/1/22
Y
T1027
TJ HQ UR
15 min
Incredible Years - Group 5-7
								members
*$5.48
*7/1/22
Y
T1027
TJ HQ US
15 min
Incredible Years - Group 8+ members
*$3.55
*7/1/22
Y
T1027
HO
15 min
Parent-Child Interaction Therapy
								(PCIT)
*$25.12
*7/1/22
Y
*The Department shall submit to CMS and anticipates?
					 approval for a State Plan Amendment related to these provisions.
Modifiers
AF-Specialty physician
AT-Acute treatment
HA-Child/adolescent program
HC-Adult program, geriatric
HE-Mental health program
HF-Substance abuse program
HH-Integrated mental health/substance abuse program
HI-Integrated mental health and intellectual
					 disability/developmental disabilities program
HK-Specialized mental health program for high-risk
					 populations
HN-Bachelor's degree level
HO-Master's degree level
HQ-Group Setting
HT-Multi-disciplinary team
HU-Funded by child welfare
ST-Related to trauma or injury
TJ-Program group, child and/or adolescent
TL-Early intervention/individualized family service plan
					 (IFSP)
TM-Individualized education program (IEP)
U1-Level of care 1
UN-Two patients served
UP-Three patients served
UQ-Four patients served
UR-Five patients served
US-Six or more patients served