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 I - Specific Policies By Service › Sec2 144-101-I-5 - COVID-19 Public Health Emergency Services › Subsection 144-101-I-5.07 - TELEHEALTH

Current through 2024-29, July 17, 2024
A.
Waiver of Advance Written
					 Notice
The Department is waiving the requirement under Ch. 1,
						Section 4, Telehealth, Sec. 4.06-2(B), requiring advance written notice/consent
						prior to services.
B.
Waiver of Comparability
The Department, at its discretion, may waive the
						requirement under Ch. 1, Section 4, Telehealth, Sec. 4.04-1(2), requiring
						Interactive Telehealth Services be of comparable quality to what they would be
						were they delivered in person.* Requests will be handed on a case-by-case basis
						through a clinical review by the Department to determine whether members may
						face imminent harm in the absence of a telehealth mode of delivery for a
						particular service, given the inability due to the public health emergency for
						that member to receive the service in-person.
*
The Department shall seek and anticipates
						receiving approval of this change from CMS retroactive to March 18, 2020.
						Pending approval, these changes are effective upon adoption.
C.
Telephone-Only Evaluation
					 and Management
The Department will reimburse providers for telephone
						evaluation and management services provided to members. The restrictions set
						forth in the MaineCare Benefits Manual, Ch. I, Sec. 4.04-2 are waived for this
						purpose.
Telephonic evaluation and management services must be
						rendered by a qualified professional actively enrolled in MaineCare or
						contracted through an enrolled MaineCare provider.
Relevant CPT codes are:
CPT/HCPC Code
Short Description
Long Description
Unit
Non- Facility Rate
Facility Rate
98966
nonphysician telephone assessment 5-10 min
Telephone assessment and management service
								  provided by a qualified nonphysician health care professional to an established
								  patient, parent, or guardian not originating from a related assessment and
								  management service provided within the previous 7 days nor leading to an
								  assessment and management service or procedure within the next 24 hours or
								  soonest available appointment; 5-10 minutes of medical discussion
5-10 minutes of medical discussion
$10.33
$8.95
98967
nonphysician telephone assessment 11-20
								  min
Telephone assessment and management service
								  provided by a qualified nonphysician health care professional to an established
								  patient, parent, or guardian not originating from a related assessment and
								  management service provided within the previous 7 days nor leading to an
								  assessment and management service or procedure within the next 24 hours or
								  soonest available appointment; 11-20 minutes of medical discussion
11-20 minutes of medical discussion
$20.59
$18.29
98968
nonphysician telephone assessment 21-30
								  min
Telephone assessment and management service
								  provided by a qualified nonphysician health care professional to an established
								  patient, parent, or guardian not originating from a related assessment and
								  management service provided within the previous 7 days nor leading to an
								  assessment and management service or procedure within the next 24 hours or
								  soonest available appointment; 21-30 minutes of medical discussion
21-30 minutes of medical discussion
$33.27
$29.13
99421
online digital e/m svc est pt<7 d 5-10
								  minutes
Online digital evaluation and management service,
								  for an established patient, for up to 7 days, cumulative time during the 7
								  days; 5-10 minutes
5-10 minutes
$10.33
$8.95
99422
online digital e/m svc est pt<7 d 11-20
								  minutes
Online digital evaluation and management service,
								  for an established patient, for up to 7 days, cumulative time during the 7
								  days; 11-20 minutes
11-20 minutes
$20.59
$18.29
99423
online digital e/m svc est pt<7 d 21+
								  minutes
Online digital evaluation and management service,
								  for an established patient, for up to 7 days, cumulative time during the 7
								  days; 21 or more minutes
21 or more minutes
$33.27
$29.13
99441
phys/qhp telephone evaluation 5-10 min
Telephone evaluation and management service by a
								  physician or other qualified health care professional who may report evaluation
								  and management services provided to an established patient, parent, or guardian
								  not originating from a related E/M service provided within the previous 7 days
								  nor leading to an E/M service or procedure within the next 24 hours or soonest
								  available appointment; 5-10 minutes of medical discussion
5-10 minutes of medical discussion
$11.89
99442
phys/qhp telephone evaluation 11-20 min
Telephone evaluation and management service by a
								  physician or other qualified health care professional who may report evaluation
								  and management services provided to an established patient, parent, or guardian
								  not originating from a related E/M service provided within the previous 7 days
								  nor leading to an E/M service or procedure within the next 24 hours or soonest
								  available appointment; 11-20 minutes of medical discussion
11-20 minutes of medical discussion
$23.16
99443
phys/qhp telephone evaluation 21-30 min
								  evaluation and management service;
Telephone evaluation and management service by a
								  physician or other qualified health care professional who may report evaluation
								  and management services provided to an established patient, parent, or guardian
								  not originating from a related E/M service provided within the previous 7 days
								  nor leading to an E/M service or procedure within the next 24 hours or soonest
								  available appointment; 21-30 minutes of medical discussion
21-30 minutes of medical discussion
$33.95
G2012*
Brief check in by md/qhp, 5-10 minutes
Brief communication technology-based service,
								  e.g. virtual check-in, by a physician or other qualified health care
								  professional who can report evaluation and management services, provided to an
								  established patient, not originating from a related e/m service provided within
								  the previous 7 days nor leading to an e/m service or procedure within the next
								  24 hours or soonest available appointment; 5-10 minutes of medical
								  discussion
(5-10 min)
$9.90
$8.97
G2010*
Remot image submit by pt
Remote evaluation of recorded video and/or images
								  submitted by an established patient (e.g., store and forward), including
								  interpretation with follow-up with the patient within 24 business hours, not
								  originating from a related e/m service provided within the previous 7 days nor
								  leading to an e/m service or procedure within the next 24 hours or soonest
								  available appointment
$8.43
$6.34
G2061*
Qual nonmd est pt 5-10 minutes
Qualified nonphysician healthcare professional
								  online assessment and management service, for an established patient, for up to
								  seven days, cumulative time during the 7 days; 5-10 minutes
5-10 minutes
$8.32
G2062*
Qual nonmd est pt 11-20 minutes
Qualified nonphysician healthcare professional
								  online assessment and management service, for an established patient, for up to
								  seven days, cumulative time during the 7 days; 11-20 minutes
11-20 minutes
$14.67
G2063*
Qual nonmd est pt 21>minutes
Qualified nonphysician qualified healthcare
								  professional assessment and management service, for an established patient, for
								  up to seven days, cumulative time during the 7 days; 21 or more minutes
21 or more minutes
$22.99
$22.76
G0071*
Comm svcs by rhc/fqhc 5 minutes
Payment for communication technology-based
								  services for 5 minutes or more of a virtual (non-face-to-face) communication
								  between an rural health clinic (rhc) or federally qualified health center
								  (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote
								  evaluation of recorded video and/or images by an rhc or fqhc practitioner,
								  occurring in lieu of an office visit; rhc or fqhc only
5 minutes or more
$9.17
Telephone evaluation management services are not to be
						billed if clinical decision-making dictates a need to see the member for an
						office visit within 24 hours or at the next available appointment. In those
						circumstances, the telephone service shall be considered a part of the
						subsequent office visit. If the telephone call follows an office visit
						performed and reported within the past seven (7) days for the same diagnosis,
						then the telephone services are considered part of the previous office visit
						and are not separately billable.