MaineCare Updates

Corrected Table: Monoclonal Antibody Product and Infusion Codes, CR 99700

Providers of MaineCare Benefits Manual, Section 90 and Section 45 services may submit claims for the delivery of Monoclonal Antibody COVID-19 Infusion treatments when they are delivered on or after the respective effective dates for each product and in accordance with the for each product. 

Please review the Fact Sheets for Health Care Providers of EUA of Bamlanivimab and Casirivimab & Imdevimab for the limitations of authorized use.

OMS Rates for Eli Lily EUA Monoclonal Antibody COVID-19 Infusion Treatment
Code	Description	Effective Date	Rate: Effective Date to 12/31/2020	Rate: Valid Beginning 01/01/2021
Q0239	Injection, bamlanivimab-xxxx, 700 mg	11/10/2020	$0 *	$0 *
M0239	Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring	11/10/2020	$197.37	$195.76

OMS Rates for Regeneron EUA Monoclonal Antibody COVID-19 Infusion Treatment
Code	Description	Effective Date	Rate: Effective Date to 12/31/2020	Rate: Valid Beginning 01/01/2021
Q0243	Injection, casirivimab and imdevimab, 2400 mg	11/21/2020	$0 *	$0 *
M0243	Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring	11/21/2020	$197.37	$195.76
*Monoclonal Antibody COVID-19 product is provided by the Federal Government at no cost to providers. Must be billed with the SL modifier and has a $0 rate.

Please contact your Provider Relations Specialist with questions.   

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Attention Indian Health Service Providers (IHS): Rate Increase, CR 99689  

Effective January 1, 2021, the for IHS providers has increased to $519.00. Claims billed between January 1, 2021 and January 13, 2021 will be adjusted and no provider action is needed.   

Please contact your Provider Relations Specialist with questions.   

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Microdyn Quarterly Update for January 2021 is Delayed, CR 100215

The January 1, 2021 Microdyn file update from the Centers for Medicare and Medicaid Services is delayed and, , some Ambulatory Payment Classifications (APC) claims are paying at zero. MaineCare will PEND claims that are affected by this update.

Once we receive the file from CMS and update our system, the claims will be released from PEND status and we will be process them at the correct rates. We will also reprocess any claims that paid incorrectly at zero. We will notify providers when the update is complete. No provider action is needed.