MaineCare Code and Rate Changes - January 13, 2017

MaineCare Code Changes

Effective December 31, 2016, certain codes covered by MaineCare Services were discontinued. Effective January 1, 2017, they were replaced by new codes. Below is a listing of code openings and closings. The policy unit will conduct rulemaking in the upcoming months to add these changes to the MaineCare Benefits Manual.

SECTION 68, OCCUPATIONAL THERAPY SERVICES

Effective January 1, 2017, the Current Procedural Terminology coding manual codes 97003 and 97004 were replaced with codes 97165, 97166, 97167, and 97168. 

The new Occupational Therapy codes and rates are: 

CODE	SERVICE	UNIT	MAXIMUM ALLOWANCE
97165	Occupational therapy evaluation: low complexity	Per evaluation	$52.83
97166	Occupational therapy evaluation: moderate complexity	Per evaluation	$52.83
97167	Occupational therapy evaluation: high complexity	Per evaluation	$52.83
97168	Re-evaluation of occupational therapy established plan of care	Per session	$34.85

SECTION 85, PHYSICAL THERAPY SERVICES

Effective January 1, 2017, the Current Procedural Terminology coding manual codes 97001 and 97002 were replaced with codes 97161, 97162, 97163, and 97164. 

The new Physical Therapy codes and rates are: 

CODE	SERVICE	UNIT	MAXIMUM ALLOWANCE
97161	Physical therapy evaluation: low complexity	per evaluation	$54.45
97162	Physical therapy evaluation: moderate complexity	per evaluation	$54.45
97163	Physical therapy evaluation: high complexity	per evaluation	$54.45
97164	Re-evaluation of physical therapy established plan of care	per session	$36.87

Please contact Shannon Beggs with questions at (207) 624-6926.

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Code and Rate Additions, Deletions, and Corrections 

The “Code and Rate Additions, Deletions, and Corrections” spreadsheets have recently been updated. The spreadsheets are used to notify you of code and rate changes or corrections. You can view these spreadsheets on the Claims and Billing webpage.