Attention MaineCare Benefits Manual Section 5 Ambulance Services Providers - MaineCare Benefits Manual Chapter III, Section 109, Speech and Hearing Services: Rate Correction for 92508 TF HQ GN - Updated Guidance: Alternative Settings During COVID-19

Attention MaineCare Benefits Manual Section 5 Ambulance Services Providers, CRs 99688 and 99429

This message is to inform ambulance providers of two changes: (1) The annual update to MaineCare rates, which are based on Medicare’s annual updates, and (2) A retroactive, upward adjustment to HCPC code A0225: Ambulance service; specialized neonatal transport, base rate emergency one way [ground][birth to 2 years of age].

1. Annual Update to Rates 

Effective January 1, 2021, reimbursement amounts for the services in the table below have been updated in accordance with Medicare’s annual rate update.

Procedure Code	Rate Effective 1/1/21
A0225	$719.03
A0425	$7.67
A0426	$265.49
A0427	$420.36
A0428	$221.24
A0429	$353.99
A0430	$3,741.69
A0431	$4,350.27
A0433	$608.41
A0434	$719.03
A0435	$11.19
A0436	$29.85

 If you have billed higher than the 2021 MaineCare rate, MaineCare will automatically reprocess the claim with no provider action required. If you have billed lower than the 2021 rate since January 1, 2021, you may now adjust your claims. 

2. Retroactive Upwards Adjustment to HCPC Code A0225

We have recently learned that A0225 was incorrectly cross-walked with A0433 and should have been cross-walked with A0434. On January 1, 2020, the rate increased from $612.70 to $724.10. If you billed at the lower rate for services provided from January 1, 2020 through December 31, 2020, you may now adjust affected claims.

Please refer to the MaineCare Benefits Manual for a description of the methodology used to establish rates. Please go to the Health PAS Online Portal to view provider fee schedules. Please contact your Provider Relations Specialist with questions. 

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MaineCare Benefits Manual Chapter III, Section 109, Speech and Hearing Services: Rate Correction for 92508 TF HQ GN, CR 99938

The rate for 92508 TF HQ GN: Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals (Assistant) was set at $14.82 in error, and should have been $17.82 as our June 28, 2019 notice stated. The rate has now been corrected in MIHMS.     

For claims processed with dates of service between January 12, 2019 and January 28, 2021:  

• If you have been billing at a higher rate, we will reprocess your claims and no provider action is needed.  
• If you have been billing at the lower rate, please adjust the affected claims.  Providers will have 90 days from the date of this notice to submit corrected adjustments, with the focus on the older dates of service first.

 If you have any questions, please contact your Provider Relations Specialist.    

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Updated Guidance: Alternative Settings During COVID-19

MaineCare’s Alternative Settings During COVID-19 provider guidance has been updated to include contact information for hospitals that wish to utilize temporary service locations (alternative settings) to deliver care during the pandemic. Please note that this guidance only applies to providers who are already enrolled with MaineCare.