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 II - Specific Policies By Service › Section 144-101-II-4 - Behavioral Health Services › Subsection 144-101-II-4.04 - COVERED SERVICES

Current through 2024-29, July 17, 2024
Covered services are those items and services, stated
						below, which are furnished by an ASC in connection with a covered surgical
						procedure. Unless otherwise stated below, only covered surgical procedures
						currently on the Medicare-approved list of ASC covered procedures are allowed.
						See the Federal Registrar for the annual ASC final rule or
						http://www.cms.hhs.gov/ASCPayment/ for the current listing. Covered surgical
						procedures are those that would not be expected to pose a significant safety
						risk to a member when performed in an ASC, and for which standard medical
						practice dictates that the member would not typically be expected to require
						active medical monitoring and care at midnight following the procedure.
Coding for covered services is based on the latest
						version of the American Medical Association's standard Current Procedural
						Terminology (CPT) codes and can be accessed through the Department's website
						at: https://mainecare.maine.gov/.
A.
					 The following items and services are covered services and are included in the
					 all-inclusive rates for reimbursement in this Section of the MaineCare Benefits
					 Manual:
(1) Nursing, technical personnel and
					 other related services;
These include all services in connection with covered
						procedures furnished by nurses, technical personnel and other support staff
						involved in patient care who are employees of the ASC.
(2) Use of surgical center
					 facilities;
(3). Drugs and
					 biologicals for which separate payments are not allowed under the hospital
					 outpatient prospective payment system (OPPS);
(4) Any laboratory testing performed under a
					 Clinical Laboratory Improvement Amendments of 1988 (CLIA) certificate of
					 waiver.
(5) Medical and surgical
					 supplies not on pass-through status under
					 42 CFR
					 419.66 Subpart G;
(6) Equipment;
(7) Surgical dressings;
(8) Implanted prosthetic devices, including
					 intraocular lenses (lOLs), (payment for presbyopia-correcting intraocular lens
					 and astigmatism-correcting intraocular lens will be a the rate of a
					 conventional intraocular lens) and related accessories and supplies not on
					 pass-through status under
					 42 CFR
					 419.66 Subpart G;
(9) Implanted DME and related accessories and
					 supplies not on pass-through status under
					 42 CFR
					 419.66 Subpart G;
(10) Splints and casts and related
					 devices;
(11) Radiology services
					 for which separate payment is not allowed under the OPPS, and other diagnostic
					 tests or interpretive services that are integral to a surgical
					 procedure;
(12) Administrative,
					 recordkeeping and housekeeping items and services;
(13) Materials, including supplies and
					 equipment for the administration and monitoring of anesthesia; and
(14) Supervision of the services of an
					 anesthetist by the operating surgeon.