Personal Care Services (PCS) Providers: Billing Telemedicine UB04 Claim Form - Individuals Excluded by Maine or Federal Government Reminder 

Personal Care Services (PCS) Providers: Billing Telemedicine UB04 Claim Form, CR 96215

Recently, we advised you that Telehealth PCS claims are excluded from Electronic Visit Verification (EVV) record requirements.

Please note that UB04 claim lines submitted with telemedicine revenue code 078x are now also exempt from EVV editing. 

Please see the message we sent on October 23, 2020 regarding the CMS 1500 Claim Form:

Personal Care Services (PCS) Providers: Billing Telehealth on CMS 1500 Claim Form, CR 96215

Telehealth PCS claims are excluded from Electronic Visit Verification (EVV) record requirements. When billing telehealth claims on the CMS 1500 Claim Form, you must use the Place of Service code 02 and include the GT modifier as this indicates you are providing services via telehealth and not in-person.

See the table below for affected codes. Please note that coming soon, UB04 claim lines submitted with telemedicine revenue code 078x will be also be exempt from EVV editing. We will advise you when that change is in the system. 

Code	Description	Code	Description
G0151	PT services, home health or hospice, each 15 min	S5150	Unskilled respite care not hospice per 15 min
G0152	OT services, home health or hospice, each 15 min	T1000	Private duty/independent nursing up to 15 min
G0153	Speech\lang, home health or hospice, each 15 min	T1004	Services of a qualified nursing aide to 15min
G0155	Social work service, HH or hospice, each 15 min	T1005	Respite care services, up to 15 minutes
G0156	Home health aide, HH or hospice, each 15 min	T1019	Personal care serv, per 15 min, not for inpat
G0299	HHS/hospice of rn each 15 minutes	T1502	Administration of oral/IM/subcut med, /visit
G0300	HHS/hospice of lpn each 15 minutes	T2017	Habilitation, residential waiver, per 15 min
H2021	Community based wrap-around servs, per 15 min	T2042	Hospice routine home care, per diem
S5125	Attendant care services, per 15 min	T2043	Hospice continuous home care, per hour

 

Please contact your Provider Relations Specialist with questions.

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Individuals Excluded by Maine or Federal Government Reminder  

MaineCare providers are prohibited from employing or contracting with people who have been excluded by the state or federal government.

Providers must screen all employees and contractors for exclusions and require their contractors to screen their staff for excluded individuals. Providers must screen all new potential employees prior to hire and should routinely screen all staff at set time intervals, e.g. annually, quarterly, etc.

Providers must check both the state and federal websites. Maine may have excluded someone who is not excluded by the federal government, and the federal government may have excluded someone who is not listed on Maine’s website.

Search for People Excluded by the State

The Maine Excluded Providers Database, found on the Health PAS Online Portal, is a tool used to search for people who have been excluded by the state. You can search potential employees by last name. You can then verify the Social Security or Employer Identification Number using this tool.

To find the Maine Excluded Provider Database, you can also follow this pathway on the Health PAS Online Portal and following this pathway: Provider Tab > Useful Links > Provider Exclusion Check - Individual Search. If you want to check the Monthly Exclusion Report, select Provider Exclusion Check – Monthly Exclusion Report instead of the Individual Search Option.

Search for People Excluded by the Federal Government

To check whether a person is excluded by the federal government, providers can use the Office of Inspector General Excluded Providers Database. Another federal exclusion website to check is the System for Award Management.

Please contact the Program Integrity Unit at 207-287-4660 with questions.