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-109 - Speech and Hearing Services

Current through 2024-29, July 17, 2024
MaineCare coverage of Speech and Hearing Services is
					 limited. Refer to Chapter II, Section 109.08 for specific limitations. Use the
					 following modifiers whenever appropriate, as well as any other HIPAA compliant
					 billing modifiers not listed below that apply to the service.
The Modifier(s) column below is for reference only.
					 Professional judgment of Qualified Professional Staffing in accordance with
					 109-09.3 should make the final determination.
Modifier GN if services are delivered under an
					 outpatient speech-language pathology plan of care.
Modifier TF applicable for Assistant services.
Modifier HQ for group services (two (2) to four (4)
					 members with one clinician).
Modifier 52 if the service is reduced, or applied to
					 one ear and not both.
Modifier TL for services performed under an
					 Individualized Family Service Plan (IFSP).
Modifier TM if performed under an Individualized
					 Education Plan(IEP) with MaineCare Addendum.
Modifier 22 if the work required to provide a service
					 is substantially greater than typically required. (Documentation must be
					 submitted with the provider claim that supports the substantial additional work
					 and the reason for that additional work. If so, after manual clinical review by
					 the Department or authorized agent, the provider will receive an additional
					 twenty-percent (20%) reimbursement for the service.
The Independent Rate applies to organizations with
					 either one or more Speech Language Pathologist or Audiologist.
Billing Code
Modifier(s)
Description
Agency Rate
Independent Rate
HIPAA compliant unit defined as
92507
GN
Treatment of speech, language, voice,
								  communication, and/or auditory processing disorder; individual
$53.05*
$47.74*
per session
92507
TF,GN
Treatment of speech, language, voice,
								  communication, and/or auditory processing disorder; individual intermediate
								  level of care (Assistant)
$44.55
$40.10*
per session
92508
HQ,GN
Treatment of speech, language, voice,
								  communication, and/or auditory processing disorder; group, 2 or more
								  individuals
$19.80
$17.82*
per member per session
92508
TF,HQ,GN
Treatment of speech, language, voice,
								  communication, and/or auditory processing disorder; group, 2 or more
								  individuals (Assistant)
$19.80
$17.82*
per member per session
92521
GN
Evaluation of speech fluency (eg, stuttering,
								  cluttering)
$76.93*
$69.24*
per session
92522
GN
Evaluation of speech sound production (eg,
								  articulation, phonological process, apraxia, dysarthria)
$62.33
$56.10*
per session
92523
GN
Evaluation of speech sound production (eg,
								  articulation, phonological process, apraxia, dysarthria)with evaluation of
								  language comprehension and expression (eg, receptive and expressive
								  language)
$133.38*
$120.04*
per session
92524
GN
Behavioral and qualitative analysis of voice and
								  resonance
$64.52
$58.07*
per session
92526
GN
Treatment of swallowing dysfunction and/or oral
								  function for feeding
$69.35
$62.42*
per session
92537**
Caloric vestibular test with recording,
									 bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a
									 total of four irrigations)
$27.26
$19.69
per session
92538**
Caloric vestibular test with recording,
									 monothermal (ie, one irrigation in each ear for a total of two
									 irrigations)
$13.83
$9.98
per session
92540**
Basic vestibular evaluation, includes
									 spontaneous nystagmus test with eccentric gaze fixation nystagmus, with
									 recording, positional nystagmus test, minimum of 4 positions, with recording,
									 optokinetic nystagmus test, bidirectional foveal and peripheral stimulation,
									 with recording, and oscillating tracking test, with recording
$65.87
$47.57
per session
92541**
Spontaneous nystagmus test, including gaze and
									 fixation
$36.30
$26.21
per session
92542**
Positional nystagmus test, minimum of 4
									 positions, with recording
$37.56
$27.13
per session
92544**
Optokinetic nystagmus test, bidirectional,
									 foveal or peripheral stimulation, with recording
$30.16
$21.78
per session
92545**
Oscillating tracking test, with
									 recording
$28.27
$20.42
per session
92546**
Sinusoidal vertical axis rotational
									 testing
$50.53
$36.49
per session
92547**
Use of vertical electrodes
$3.00
$2.17
per session
92548**
Computerized dynamic posturography
$57.32
$41.40
per session
92550
Tympanometry and reflex threshold
									 measurements
$20.13
$20.13
per session
92551
Screening test, pure tone, air only
$12.12
$8.76
per session
92552
Pure tone audiometry (threshold); air
									 only
$18.36
$13.26
per session
92553
Pure tone audiometry (threshold); air and
									 bone
$23.28
$16.81
per session
92555
Speech audiometry threshold;
$13.43
$9.70
per session
92556
Speech audiometry threshold; with speech
									 recognition
$20.83
$15.04
per session
92557
Comprehensive audiometry threshold evaluation
									 and speech recognition (92553 and 92556 combined)
$29.83
$21.54
per session
92561
Bekesy audiometry; diagnostic
$23.53
$16.99
per session
92562
Loudness balance test, alternate binaural or
									 monaural
$22.79
$16.46
per session
92564
Short increment sensitivity index (SISI)
$16.14
$11.66
per session
92565
Stenger test, pure tone
$9.26
$6.69
per session
92567
Tympanometry (impedance testing)
$9.28
$6.70
per session
92568
Acoustic reflex testing, threshold
$11.65
$11.65
per session
92570**
Acoustic immittancetesting, includes
									 tympanometry (impedance testing), acoustic reflex threshold testing, and
									 acoustic reflex decay testing.
$21.78
$15.73
per session
92579
Visual reinforcement audiometry (VRA)
$32.19
$23.25
per session
92582
Conditioning play audiometry
$37.07
$26.77
per session
92583
Select picture audiometry
$25.75
$18.59
per session
92585
Auditory evoked potentials for evoked response
									 audiometryand/or testing of the central nervous system; comprehensive
$75.46
$54.34
per session
92586
Auditory evoked potentials for evoked response
									 audiometryand/or testing of the central nervous system; limited
$37.14
$26.82
per session
92587
Distortion product evoked otoacoustic
									 emissions; limited evaluation (to confirm the presence or absence of hearing
									 disorder, 3-6 frequencies) or transient evoked optoacoustic emissions, with
									 interpretation and report
$20.88
$19.37
per session
92588
Distortion product evoked otoacoustic
									 emissions; comprehensive or diagnostic evaluation (quantitative analysis of
									 outer hair cell function by cochlear mapping, minimum of 12 frequencies), with
									 interpretation and report
$31.98
$31.98
per session
92592
Hearing aid check; monaural
$25.79
$18.62
per session
92593
Hearing aid check; binaural
$25.79
$18.62
per session
92601
Diagnostic analysis of cochlear implant,
									 patient younger than 7 years of age, with programming
$107.70
$77.78
per session
92602
Diagnostic analysis of cochlear implant,
									 patient younger than 7 years of age, subsequent reprogramming
$66.33
$47.90
per session
92603
Diagnostic analysis of cochlear implant, age 7
									 years or older, with programming
$105.15
$75.94
per session
92604
Diagnostic analysis of cochlear implant, age 7
									 years or older; subsequent reprogramming
$62.27
$44.97
per session
92607
GN
Evaluation for prescription for speech-generating
								  augmentative and alternative communication device, face-to-face with the
								  patient; first hour
$88.11*
$79.30*
60 mins
92608
GN
Evaluation for prescription for speech-generating
								  augmentative and alternative communication device, face-to-face with the
								  patient; each additional 30 minutes (List separately in addition to code for
								  primary procedure)
$35.36*
$31.82*
30 mins
92609
GN
Therapeutic services for the use of
								  speech-generating device, including programming and modification
$73.85
$66.47*
per session
92610
Evaluation of oral and pharyngeal swallowing
									 function
$57.79*
$52.01*
per session
92611**
Motion fluoroscopic evaluation of swallowing
									 function by cine or video recording
$58.89
$53.00
per session
92612**
Flexible endoscopic evaluation of swallowing by
									 cine or video recording
$125.93
$113.33
per session
92620
Evaluation of central auditory function, with
									 report; initial 60 minutes
$34.11
$29.20
60 mins
92621
Evaluation of central auditory function, with
									 report; each additional 15 minutes
$8.62
$7.38
15 mins
92630
GN
Auditory rehabilitation; prelingual hearing
								  loss
$55.50
$40.08
per session
92630
HQ,GN
Auditory rehabilitation; prelingual hearing loss
								  (Group)
$36.63
$26.45
per member per session
92633
GN
Auditory rehabilitation; postlingual hearing
								  loss
$55.50
$40.08
per session
92633
HQ,GN
Auditory rehabilitation; postlingual hearing loss
								  (Group)
$36.63
$26.45
per member per session
96110
GN
Developmental screening (eg,developmental
								  milestone survey, speech and language delay screen) with scoring and
								  documentation, per standardized instrument
$5.32
$3.85
per session
V5008
Hearing screening
$17.02
$12.86
15 mins
V5008
TF
Hearing screening (Assistant)
15.32
$11.57
15 mins
V5010
Assessment for hearing aid
$17.75
$12.78
15 mins
V5011**
Fitting/orientation/checking of hearing
									 aid
$56.85
$51.17
per session
V5264
Ear mold/insert, not disposable, any
									 type
$45.50
$32.86
per unit
V5362
Speech screening
$17.76
$12.87
15 mins
V5362
TF
Speech screening (Assistant)
$14.65
$10.58
15 mins
V5363
Language screening
$17.76
$12.87
15 mins
V5363
TF
Language screening (Assistant)
$14.65
$10.58
15 mins
V5364
Dysphagia screening
$17.76
$12.87
15 mins
V5364
TF
Dysphagia screening (Assistant)
$14.65
$10.58
15 mins
* The Department is seeking and anticipates receiving
					 approval from the federal Centers for Medicare and Medicaid Services of these
					 changes with a January 12, 2019 effective date
**The Department is seeking and anticipates receiving
					 approval from the federal Centers for Medicare and Medicaid Services of these
					 changes with a May 19, 2019 effective date