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-19 - Home and Community Benefits for the Elderly and Adults with Disabilities

Current through 2024-29, July 17, 2024
PROCEDURE CODE
MODIFIER
REVENUE CODE
DESCRIPTION
UNIT
Rates Effective 4/1/2020*
H2014
U7
Skills Training and Development (Participant
								Directed Option)
15 minutes
$14. 03
T2040
U7
Financial Management, self-directed, waiver
								(Participant Directed Option)
Monthly
$85. 09
S5125
U7
Attendant Care Services (Personal Care Services,
								Participant Directed Option)
15 minutes
$4. 86*
S5125
U7 UN
Attendant Care Services (Personal Care Services,
								Participant Directed Option)-2 members served
15 minutes
$2. 67*
S5125
U7 UP
Attendant Care Services (Personal Care Services,
								Participant Directed Option)-3 members served
15 minutes
$1. 94*
T1019
U7
0589
Personal Care Services (Agency PSS)
15 minutes
$6. 55*
T1019
U7 UN
0589
Personal Care Services (Agency PSS)- 2 members
								served
15 minutes
$3. 60*
T1019
U7 UP
0589
Personal Care Services (Agency PSS)-3 members
								served
15 minutes
$2. 62*
T2022
U7
Care Coordination
per month
$136. 00**
S5160
U7
Personal Emergency Response System, Installation
								and Testing
1 unit
Customary Charge, Not to Exceed $45. 00
S5161
U7
Personal Emergency Response System, Service
								Fee
Monthly
Customary Charge, Not to Exceed $35. 00
H0045
U7
Respite Care Services, not in the home
Per Diem
$219. 76*
T1005
U7
Respite Care Services, in the home (PSS)
15 minutes
$6. 55, Cost Not to Exceed Cap*
T1005
U7 UN
Respite Care Services, in the home (PSS)- 2 members
								served
15 minutes
$3. 60 Cost Not to Exceed Cap*
T1005
U7 UP
Respite Care Services, in the home (PSS)-3 members
								served
15 minutes
$2. 62 Cost Not to Exceed Cap*
T1005
U7
Respite Care Services, in the home-Participant
								Directed Option
15 minutes
$4. 86 Cost Not to Exceed Cap*
T1005
U7 UN
Respite Care Services, in the home-Participant
								Directed Option- 2 members served
15 minutes
$2. 67 Cost Not to Exceed Cap*
T1005
U7 UP
Respite Care Services, in the home-Participant
								Directed Option-3 members served
15 minutes
$1. 94 Cost Not to Exceed Cap*
S5165
U7
Environmental Modifications
Per Service
By report
A9279
U7
Assistive Technology-(Monitoring feature/device,
								stand alone or integrated, any type, includes all accessories, components and
								electronics, not otherwise classified)
1 unit
Per device
A9279
U7 QC
Assistive Technology-Remote Monitoring-Monthly
								fee
Monthly
Up to $ 500. 00
T2035
U7
Assistive Technology-Transmission (Utility
								Services)
Monthly
Up to $ 50. 00
T1005
U7
0669
Respite Care, in the home by CNA/Home Health
								Aide
15 minutes
$7. 06*
T1005
U7 UN
0669
Respite Care, in the home by CNA/Home Health Aide-
								2 members served
15 minutes
$3. 88*
T1005
U7 UP
0669
Respite Care, in the home by CNA/Home Health Aide-3
								members served
15 minutes
$2. 82*
0551
Skilled Nursing Visit (RN)
Per Visit
$53. 60
0551
Skilled Nursing Visit (RN)-2 members served
Per Visit
$29. 48
0551
Skilled Nursing Visit (RN)-3 members served
Per Visit
$21. 44
0559
Other Nursing (LPN)
Per visit
$39. 05
0559
Other Nursing (LPN)-2 members served
Per Visit
$21. 48
0559
Other Nursing (LPN)-3 members served
Per Visit
$15. 62
0421
Physical Therapy Visit
Per visit
$92. 94
0431
Occupational Therapy Visit
Per visit
$98. 76
0441
Speech Therapy Visit- Home Health Services
Per visit
$97. 34
G0151
U7 TF
0421
Certified Physical Therapy Assistant- Home Health
								Services Visit Charge
Per visit
$65. 72
G0152
U7 TF
0431
Occupational Therapy Assistant- Home Health
								Services Visit Charge
Per visit
$69. 83
G0156
U7 TF
0571
Home Health Aide Visit - Home Health
								Services
Per visit
$28. 43*
G0156
U7 TF UN
0571
Home Health Aide Visit- Home Health Services-2
								members served
Per visit
$15. 64*
G0156
U7 TFUP
0571
Home Health Aide Visit- Home Health Services-3
								members served
Per visit
$11. 37*
G0155
U7 TF
0561
Medical Social Services Visit- Home Health
								Services
Per visit
$84. 10
G0299
U7
0551
Skilled Nursing Visit (R. N. ) (Non-Medicare
								Certified Home Health Agency) - Home Health Services
15 minutes
$13. 74
G0299
U7 UN
0551
Skilled Nursing Visit (RN) (Non-Medicare Certified
								Home Health Agency) - Home Health Services- 2 members served
15 minutes
$7. 56
S5170
U7
Home Delivered Meals
Per Meal
$7. 64
98960
U7 59
Living Well (Chronic Disease Management)
30 Minutes
$17. 09
98960
U7 33
Matter of Balance (Falls Prevention)
30 Minutes
$14. 83
G0299
U7 UP
0551
Skilled Nursing Visit (RN) (Non-Medicare Certified
								Home Health Agency) - Home Health Services-3 members served
15 minutes
$5. 50
G0300
U7
0559
Nursing Visit (LPN) (Non-Medicare Certified Home
								Health Agency) - Home Health Services
15 minutes
$9. 75
G0300
U7 UN
0559
Nursing Visit (LPN) (Non-Medicare Certified Home
								Health Agency) - Home Health Services-2 members served
15 minutes
$5. 37
G0300
U7 UP
0559
Nursing Visit (LPN) (Non-Medicare Certified Home
								Health Agency) - Home Health Services-3 members served
15 minutes
$3. 90
G0151
U7
0421
Physical Therapy Visit- Home Health Services
15 minutes
$12. 36
G0152
U7
0431
Occupational Therapy Visit- Home Health
								Services
15 minutes
$12. 87
G0153
U7
0441
Speech Therapy Visit- Home Health Services
15 minutes
$12. 87
T1004
U7
0581
Certified Nurse's Aide- Home Health Services
15 minutes
$7. 06*
T1004
U7 UN
0581
Certified Nurse's Aide- Home Health Services- 2
								members served
15 minutes
$3. 88*
T1004
U7 UP
0581
Certified Nurse's Aide- Home Health Services-3
								members served
15 minutes
$2. 82*
G0156
U7
0571
Home Health Aide- Home Health Services
15 minutes
$7. 06*
G0156
U7 UN
0571
Home Health Aide- Home Health Services- 2 members
								served
15 minutes
$3. 88*
G0156
U7 UP
0571
Home Health Aide- Home Health Services- 3 members
								served
15 minutes
$2. 82*
G0155
U7
0561
Medical Social Services Visit- Home Health
								Services
15 minutes
$11. 48
INDEPENDENT PRACTITIONERS ONLY
PROCEDURE CODE
MODIFIER
REVENUE CODE
DESCRIPTION
UNIT
Rates Effective 4/1/2020*
INDEPENDENT PRACTITIONERS ONLY
G0299
U7
Skilled Nursing Visit (R. N. ) - Home Health
								Services
15 minutes
$13. 74
G0299
U7 UN
Skilled Nursing Visit (RN) - Home Health Services-2
								members served
15 minutes
$7. 56
G0299
U7 UP
Skilled Nursing Visit (RN) - Home Health Services-3
								members served
15 minutes
$5. 50
G0151
U7
Physical Therapy Visit- Home Health Services
15 minutes
$10. 80
G0152
U7
Occupational Therapy Visit- Home Health
								Services
15 minutes
$10. 60
G0153
U7
Speech Therapy Visit- Home Health Services
15 minutes
$11. 75
Modifiers
Description
QC
Monthly Fee
U7
Indicates Section 19 Services
TF
Intermediate Level of Care
U1
Other Qualified Staff
59
Living Well
33
Matter of Balance
UN
2 members served
UP
3 members served
**
The PMPM reimbursement for care coordination shall
					 be effective prospectively (not 4/1/2020).