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-101 - Medical Imaging Services › Subsection 144-101-II-101.04 - COVERED SERVICES

Current through 2024-29, July 17, 2024
A covered service is a service for which payment can be
						made by the Department. Medical imaging services include, but are not limited
						to, computed tomography (CT), x-rays, magnetic resonance imaging (MRI),
						mammography, nuclear medicine, PET scans, and ultrasonography. These services
						must be medically necessary for screening, diagnosis or control of a medical
						condition to be a covered service. These services must be ordered by a
						physician or other licensed practitioner authorized to order medical imaging
						services within the scope of his or her licensure.
Services must be performed under the general supervision
						of a licensed physician or other authorized, licensed practitioner within the
						scope of his or her licensure and must be medically necessary. For purposes of
						this Section only, general supervision may occur in person, by telephone or by
						some other method consistent with instant communication.
A. Mammography must be provided in a
					 mammography facility in possession of a current Certificate (issued by an
					 appropriate accrediting body) and in compliance with the State of Maine
					 Radiation Regulations or the licensing regulations of the state or province in
					 which the services are provided.
B.
					 CT scans of the head and full body are reimbursable if medically
					 necessary.
C. MRI is a MaineCare
					 covered service for currently acceptable medical indications supportable in
					 literature and nationwide experience. This service will be covered only when
					 sufficient information is available in the member's record to justify the
					 medical necessity of the procedure.
D. Diagnostic x-ray tests are covered
					 services. Certain diagnostic x-ray procedures are also covered when performed
					 by technicians without direct personal physician supervision. Such covered
					 procedures include skeletal films involving the extremities, pelvis, vertebral
					 column or skull and chest or abdominal films that do not involve the use of
					 contrast media. To be covered, the technician's general supervision and
					 training, as well as the maintenance of the necessary equipment and supplies,
					 must be the continuing responsibility of a physician.
E. Mobile medical imaging and portable
					 diagnostic x-ray services are covered services only when it is medically
					 necessary for the service to be furnished in a place or residence used as the
					 member's home. Providers must maintain documentation indicating why it is
					 medically contra-indicated for the member to travel to the imaging facility.
					 Mobile medical imaging services provided in vehicles that are routinely
					 scheduled to move between hospital locations are covered services.
					 Documentation of the member's medical contra-indication for travel to the
					 facility is not required. All services must be performed under the written
					 order of a physician. The provider must meet all federal, state and/or
					 provincial health and safety standards and licensing.
F. Nuclear medicine is a covered service if
					 medically necessary.
G. Ultrasound
					 and sonography are covered services if medically necessary.