Correct Anesthesia Base Units for Code 01968 - New Billing Requirement for Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Indian Health Services (IHS), and School Health Centers
Maine Department of Health & Human Services sent this bulletin at 03/20/2020 09:19 AM EDT
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Correct Anesthesia Base Units for Code 01968, CR 92817
Effective July 1, 2017, MaineCare has updated the base units for anesthesia code 01968 from 0 units to 2 units to match Medicare’s base units. Affected claims will be reprocessed. For questions, please contact your Provider Relations Specialist, Tia Bolduc, by email at tia.l.bolduc@maine.gov or phone at (207) 624-6938.
New Billing Requirement for Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Indian Health Services (IHS), and School Health Centers
Effective immediately, when billing claims that are secondary to Medicare, please use the same codes that were billed to Medicare. The codes should match the Medicare claim and EOB. For example, if you did not bill T1015 on the primary Medicare claim, do not include it on the secondary MaineCare claim. Once system updates are done, claims billed to MaineCare after Medicare using T1015 will be denied.
Please see the reminder sent on February 28, 2020:
This is a reminder that Rural Health Centers (RHC), Federally Qualified Health Centers (FQHC), Indian Health Services (IHS), and School Health Center providers who bill T1015 are required to provide all encounter services related to the claim. Claims submitted with T1015 and no encounter services will be denied. The claim will also deny if all encounter services on the claim are not covered by MaineCare.
Claims that cross over automatically from Medicare will continue processing as usual.
If you have questions, please contact your Provider Relations Specialist, Rebecca Maranda, by phone (207) 624-6963 or email at Rebecca.A.Maranda@Maine.gov.