March 5, 2021 MaineCare Updates

In this message:

• Attention Providers of Sections 3, 5, 7, 9, 31, 40, 45, 80, 90, and 103 Services: Johnson and Johnson COVID-19 Vaccine, CR 100700 
• Attention Providers of Section 7: Free-Standing Dialysis Services, CR 100672 
• Attention Providers of Section 25: Dental Services, CR 100495 
• Attention All Billers, Including Electronic Visit Verification (EVV) Providers: Billing Shifts for Multiple Providers on the Same Day for the Same MaineCare Member
• Attention Providers of Section 109 Services: Vestibular Evoked Myogenic Potential (VEMP) Testing, CR 100606 
• Provider Frequently Missed Information Enrollment Document Has Moved, CR 98117

Attention Providers of Sections 3, 5, 7, 9, 31, 40, 45, 80, 90, and 103 Services: Johnson and Johnson COVID-19 Vaccine, CR 100700  

Claims with dates of service beginning on February 27, 2021 for the Johnson & Johnson/ Janssen COVID-19 one-dose vaccine may now be submitted. 

As a reminder, a provider administering a COVID-19 vaccine to a MaineCare member must be enrolled with the Maine CDC to administer the vaccine and must comply with all CDC requirements with respect to record-keeping, vaccine handling, and vaccine administration.   

Please see the codes, dates, and rates in the tables below.  

COVID-19 Vaccine Administration Information and Rates Effective 12/11/20 – 12/31/20
Vaccine Emergency Use Authorization (EUA)	Effective Dates	First Dose Administration Code	Second Dose Administration Code	First Dose Rate	Second Dose Rate
Pfizer-BioNTech	12/11/2020	0001A	0002A	$16.94	$28.39
Moderna	12/18/2020	0011A	0012A	$16.94	$28.39
COVID-19 Vaccine Administration Information and Rates Effective 1/1/2021 – Current
Vaccine Emergency Use Authorization (EUA)	Effective Dates	First Dose Administration Code	Second Dose Administration Code	First Dose Rate	Second Dose Rate
Pfizer-BioNTech	12/11/2020	0001A	0002A	$15.87	$26.21
Moderna	12/18/2020	0011A	0012A	$15.87	$26.21
Johnson and Johnson	2/27/2021	0031A	One dose Vaccine	$26.21	One dose Vaccine

 

COVID-19 Vaccine Product Information
Vaccine Emergency Use Authorization	Effective Dates	COVID-19 Vaccine Product Code	Billing Guidance	Rate
Pfizer-BioNTech	12/11/2020	91300	SL Modifier Required	$0 Government Supplied
Moderna	12/18/2020	91301	SL Modifier Required	$0 Government Supplied
Johnson & Johnson (Janssen)	2/27/2021	91303	SL Modifier Required	$0 Government Supplied

Member Eligibility for Vaccine Coverage   

As a reminder, the COVID-19 vaccine is a covered benefit for all full MaineCare members, for members who are covered through MaineCare’s Special Benefits Waiver, and for members who are in the prison inpatient and the pregnancy presumptive eligibility category (also known as “pregnancy-related coverage”). The vaccine is available to these members at no cost to them. Providers cannot charge individuals for the COVID-19 vaccination, regardless of insurance status.     

Providers who administer a licensed or authorized COVID-19 vaccine to uninsured individuals or those enrolled in MaineCare with certain limited benefits (family planning services, family planning presumptive eligibility, and emergency MaineCare) should request reimbursement through the federal Health Resources & Services Administration (HRSA). For more information on the process and the availability of funds, please visit HRSA’s website. For more guidance about vaccine coverage for uninsured individuals or those with limited benefits, please see CMS’ website.   

Please contact your Provider Relations Specialist with questions.    

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Attention Providers of Section 7: Free-Standing Dialysis Services, CR 100672  

On March 3, 2021, we added COVID-19 vaccination codes to MaineCare Benefits Manual, Chapter II, Section 7: Free-Standing Dialysis Services Contracts.  

As a reminder, a provider administering a COVID-19 vaccine to a MaineCare member must be enrolled with the Maine CDC to administer the vaccine and must comply with all CDC requirements with respect to record-keeping, vaccine handling, and vaccine administration.   

Please see the codes, dates, and rates in the tables below.  

COVID-19 Vaccine Administration Information and Rates Effective 12/11/20 – 12/31/20
Vaccine Emergency Use Authorization (EUA)	Effective Dates	First Dose Administration Code	Second Dose Administration Code	First Dose Rate	Second Dose Rate
Pfizer-BioNTech	12/11/2020	0001A	0002A	$16.94	$28.39
Moderna	12/18/2020	0011A	0012A	$16.94	$28.39
COVID-19 Vaccine Administration Information and Rates Effective 1/1/2021 – Current
Vaccine Emergency Use Authorization (EUA)	Effective Dates	First Dose Administration Code	Second Dose Administration Code	First Dose Rate	Second Dose Rate
Pfizer-BioNTech	12/11/2020	0001A	0002A	$15.87	$26.21
Moderna	12/18/2020	0011A	0012A	$15.87	$26.21
Johnson and Johnson	2/27/2021	0031A	One dose Vaccine	$26.21	One dose Vaccine

 

COVID-19 Vaccine Product Information
Vaccine Emergency Use Authorization	Effective Dates	COVID-19 Vaccine Product Code	Billing Guidance	Rate
Pfizer-BioNTech	12/11/2020	91300	SL Modifier Required	$0 Government Supplied
Moderna	12/18/2020	91301	SL Modifier Required	$0 Government Supplied
Johnson & Johnson (Janssen)	2/27/2021	91303	SL Modifier Required	$0 Government Supplied

 Member Eligibility for Vaccine Coverage   

As a reminder, the COVID-19 vaccine is a covered benefit for all full MaineCare members, for members who are covered through MaineCare’s Special Benefits Waiver, and for members who are in the prison inpatient and the pregnancy presumptive eligibility category (also known as “pregnancy-related coverage”). The vaccine is available to these members at no cost to them. Providers cannot charge individuals for the COVID-19 vaccination, regardless of insurance status.    

Providers who administer a licensed or authorized COVID-19 vaccine to uninsured individuals or those enrolled in MaineCare with certain limited benefits (family planning services, family planning presumptive eligibility, and emergency MaineCare) should request reimbursement through the federal Health Resources & Services Administration (HRSA). For more information on the process and the availability of funds, please visit HRSA’s website. For more guidance about vaccine coverage for uninsured individuals or those with limited benefits, please see CMS’ website.   

Please contact your Provider Relations Specialist with questions.    

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Attention Providers of Section 25: Dental Services, CR 100495  

Effective January 1, 2021, code D7960: Frenulectomy was removed and replaced with the following codes:   

• D7961: Buccal/labial frenectomy (frenulectomy) 
• D7962: Lingual frenectomy (frenulectomy)  

Denied claims for deleted code D7960 may be resubmitted with the correct replacement code.  

Please contact your Provider Relations Specialist with questions.    

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Attention All Billers, Including Electronic Visit Verification (EVV) Providers: Billing Shifts for Multiple Providers on the Same Day for the Same MaineCare Member

If different agencies provide the same service(s) to the same MaineCare member on the same day, the service(s) will not deny as duplicates.

If different staff from the same agency provide the same service(s) to the same member on the same day, the service(s) will not deny as duplicates if claims are submitted with the appropriate modifier(s).

• If the service code requires one modifier, list it in the first modifier position.
• List any additional modifier or a combination of modifiers in subsequent modifier positions. 
• If all modifiers (or combinations of modifiers) submitted with the code are unique on separate claim lines within the claim, or on multiple claims for the same member for the same date of service, then the service will not deny as a duplicate. 

As an example, the following service would not deny as duplicate if submitted for the same member on the same date of service, either as multiple claims lines on the same claim or on different claims:

• S5125 U7
• S5125 U7UF
• S5125 U7UFXP 

The following is a list of possible modifiers and descriptions that could be used in this situation:

• UF - Services provided in the morning
• UG - Services provided in the afternoon
• UH - Services provided in the evening
• UJ - Services provided at night
• UN - Two patients served
• UP - Three patients served
• XE - Separate encounter, a service that is distinct because it occurred during a separate encounter
• XP - Separate practitioner, a service that is distinct because it was performed by a different practitioner
• XS - Separate structure, a service that is distinct because it was performed on a separate organ/structure
• XU - Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

The complete list of Alpha-Numeric Healthcare Common Procedure Coding System (HCPCS) modifiers (by year) can be found on the Centers for Medicare and Medicaid Services (CMS) Alpha-Numeric HCPCS webpage.

For more information contact Provider Services at 1-866-690-5585.

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Attention Providers of Section 109 Services: Vestibular Evoked Myogenic Potential (VEMP) Testing, CR 100606  

Effective April 1, 2021, MaineCare will add the following codes for VEMP services:  

• 92517: Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP) 
• 92518: Vestibular evoked myogenic potential testing, with interpretation and report; ocular (oVEMP) 
• 92519: Vestibular evoked myogenic potential testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP)  

We will send a reminder with rates closer to the effective date. Please wait to submit VEMP claims on or after April 1, 2021.  

Please contact your Provider Relations Specialist with questions.   

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Provider Frequently Missed Information Enrollment Document Has Moved, CR 98117

The Enrollment Frequently Missed Information document has moved to the Health PAS Online Portal. You can access the document by going to Provider Enrollment and Revalidation. 

The purpose of the document is to help ensure that all the information is complete and accurate if you are enrolling as a new MaineCare provider, or if you submit a maintenance case to update existing enrollment information. 

By reviewing this document, you can help prevent delays in completing your enrollment or maintenance case. If there is incomplete or missing information in your case, MaineCare will return the enrollment or maintenance case for Needing More Information (NMI). 

Please email Provider Enrollment with questions or call 1-866-690-5585, Option 7. TTY users dial 711.