MaineCare School-Based Services Reminders - November 2, 2016


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School-Based Services Provider Reminders 

All services are categorized as School-Based Services must meet the following minimum requirements:

1.       Be medically necessary;

2.       Be ordered, prescribed or recommended by a physician or other licensed practitioner;

3.       Be included in the Member’s IEP or IFSP; and

4.       Be medical in nature (as opposed to educational).

It is the responsibility of the provider to verify a member’s eligibility for MaineCare prior to providing services, as described in Chapter 1, Section 1 of the MBM. 

504 Plans

MaineCare reimbursement is not available for students receiving services from an Accommodation Plan in accordance with Section 504 of the Rehabilitation Act.  Section 504 Plans do not meet federal or state requirements for Medicaid Reimbursement. 


For OT, PT, Speech, and Section 65 Services, it is required that providers utilize the modifiers below for School-based claims.  This indicates which claims should match a student’s IFSP or IEP. 

“TL” – Services delivered under an Individualized Family Service Plan (IFSP)

“TM” –Services delivered under an Individualized Education Plan (IEP) with MaineCare Addendum denoting medical necessity of service. 

Community-Based vs. School-Based Services

Please remember that if you are providing a service in any school, the claim for the service must indicate the correct place of service.  

MaineCare School-Based Services Billing Guide

Please review the MaineCare in Education 2016 School-Based Services Billing Guide which is now posted on MaineCare’s School-based policy page.

All Questions relating to MaineCare School-Based Services can be directed to