February 18, 2021 MaineCare Updates

Attention Providers of Section 17 Daily Living Services 

 

Kepro, in collaboration with the Office of MaineCare Services, has updated the utilization review cycle for Daily Living Support Services. Effective immediately, a prior authorization request will change from a maximum of 30 days to a maximum of 90 days allowable. Continued stay reviews will continue to be for a maximum of 90 days. A discharge submission will still be required when a member discharges from the service. 

 

As a reminder, the Kepro Atrezzo Portal defaults to one unit and should be updated at time of submission to ensure the request is linked to the medical necessity of the member.  

 

For questions about this message or training on the Atrezzo Portal, please contact ProviderRelationsME@kepro.com. 

 

Claims Incorrectly Processed Under COVID-19 Testing Eligibility, CR 95330

 

Effective January 1, 2021 we have corrected an issue where some claims incorrectly processed under members’ limited COVID-19 Testing Related Services eligibility instead of their active Primary Care Case Management (PCCM), Office of Child and Family Services (OCFS), or Centers for Disease Control and Prevention (CDC) eligibility.  

 

Affected claims with dates of service between March 18, 2020 and December 30, 2020 will be reprocessed and no provider action is needed.   

 

Please contact Provider Services with questions at: 1-866-690-5585. 

 

Attention Providers of Section 45 and 90 Services: Billing Guidance for Prolonged Services, CR 100255

Effective January 1, 2021, code G2212  must be billed instead of  CPT codes 99354 and 99355 (face-to-face prolonged) and 99358 and 99359 (non-face-to-face prolonged care) when billing for prolonged services with evaluation and management CPT codes 99205 or 99215. No provider action is needed at this time.  

 

Billing Guidance for Code G2212 with CPT Code 99205
CPT Codes 99205	Codes on claims
60-74 Minutes	99205
89-103 Minutes	99205 and G2212(1 unit)
104-118 Minutes	99205  and G2212 (2 units)
119 Minutes or More	99205 and G2212 (3 units or more for each additional 15 minutes)

 

Billing Guidance for Code G2212 with CPT Code 99215
CPT Code 99215	Codes on claims
40-54 Minutes	99215
69-83 Minutes	99215 and G2212 (1 unit)
84-98 Minutes	99215  and G2212 (2units)
99 Minutes or More	99215 and G2212(3 units or more for each additional 15 minutes)

 

G2212 Code Descriptor: Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services) (do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (do not report G2212 for any time unit less than 15 minutes) 

99205 CPT Code Descriptor: Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. 

99215 CPT Code Descriptor: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. 

Please contact your Provider Relations Specialist with questions.