May 17, 2021 MaineCare Updates

Billing Guidance for HCPCS Telehealth Code G2025 for Providers of MaineCare Benefits Manual (MBM) Sections 31 Federally Qualified Health Centers (FQHCs) and 103 Rural Health Clinics (RHCs), CR102243

MaineCare is issuing guidance regarding FQHCs’ and RHCs’ claims submission for Healthcare Common Procedure Coding System (HCPCs) telehealth code G2025 during the public health emergency (PHE).

This guidance applies to claims with dates of service on or after July 1, 2020, and it is a correction to the December 2020 e-message on this topic. MaineCare will no longer pay for G2025 in addition to payment for a separate encounter service. MaineCare is following Medicare guidance and will return to processing G2025 as an encounter service as described in the billing instructions below. 

Providers should bill as follows:

Medicare primary claims: FQHCs and RHCs must bill HCPCs telehealth code G2025 in accordance with Medicare billing guidelines. On crossover claims, MaineCare will reimburse up to the facility’s encounter rate, based on the member’s eligibility, as detailed within the applicable sections of the MaineCare Benefits Manual.

MaineCare primary claims: FQHCs and RHCs must bill all telehealth and encounter services in accordance with the applicable MaineCare rules, including Chapter I, Section 4: Telehealth Services. When the service delivered is not a covered telehealth or encounter service under current MaineCare rules, but is an allowable service under Medicare G2025 billing guidelines, FQHCs and RHCs must bill MaineCare using code G2025. Code G2025 will be reimbursed up to the facility’s encounter rate. Please note MaineCare will reimburse only one encounter service per claim billed.

Providers will be able to adjust affected claims or submit held claims in accordance with this guidance once our system is ready, which we anticipate for the coming week. We will notify providers at that time.    

 

2021 Laboratory Rate update, CR 100330

Effective April 21, 2021, MaineCare Benefits Manual, Chapter II, Sections 55 and 90 rates have been updated in MIHMS retroactive to January 1, 2021. The updated rates can be found on the Codes and Rates webpage.

For claims processed with dates of service between January 1, 2021 through April 20, 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 a 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. 

Please contact your Provider Relations Specialist with questions.