MaineCare Payments

MaineCare Fee Schedule Payments

MaineCare is the State of Maine’s Medicaid program, providing free or low-cost health coverage to eligible residents based on income and other qualifying criteria. The MaineCare Fee Schedule establishes the standard reimbursement amounts MaineCare pays to healthcare providers for covered services.

The rates from the MaineCare Fee Schedule are displayed for select procedures, including Chiropractic Services.

  • CPT Code 51798 – Ultrasound to measure bladder capacity after urinating
  • CPT Code 93000 – Electrocardiogram (ECG or EKG), with interpretation and report
  • CPT Code 93010 – Routine electrocardiogram (ECG or EKG) using at least 12 leads, interpretation and report only
  • CPT Code 93270 – Electrocardiogram (ECG or EKG) monitoring
  • CPT Code 93296 – Remote evaluations of pacemaker systems or implantable defibrillator systems for up to 90 days, with technician review, support, and distribution of results
  • CPT Code 96110 – Developmental screening
  • CPT Code 97012 – Application of mechanical traction to 1 or more areas
  • CPT Code 97014 – Application of electrical stimulation to 1 or more areas, when physical therapist is not there
  • CPT Code 97016 – Application of blood vessel compression or decompression device to 1 or more areas
  • CPT Code 97032 – Application of electrical stimulation to 1 or more areas
  • CPT Code 97033 – Application of medication through skin using electrical current
  • CPT Code 97035 – Application of ultrasound to 1 or more areas
  • CPT Code 97110 – Therapeutic exercise to develop strength, endurance, range of motion, and flexibility
  • CPT Code 97112 – Therapeutic procedure to re-educate brain-to-nerve-to-muscle function
  • CPT Code 97113 – Water pool therapy for 1 or more areas
  • CPT Code 97116 – Walking training to 1 or more areas
  • CPT Code 97124 – Therapeutic massage to 1 or more areas
  • CPT Code 97140 – Manual (physical) therapy techniques to 1 or more regions
  • CPT Code 97150 – Therapeutic procedures in a group setting
  • CPT Code 97161 – Physical therapy evaluation, low complexity
  • CPT Code 97162 – Physical therapy evaluation, moderate complexity
  • CPT Code 97163 – Physical therapy evaluation, high complexity
  • CPT Code 97164 – Physical therapy re-evaluation
  • CPT Code 97165 – Occupational therapy evaluation, low complexity
  • CPT Code 97166 – Occupational therapy evaluation, moderate complexity
  • CPT Code 97168 – Occupational therapy re-evaluation
  • CPT Code 97530 – Therapeutic activities to improve function, with one-on-one contact between patient and provider
  • CPT Code 97535 – Self-care or home management training
  • CPT Code 97750 – Physical performance test or measurement with report
  • CPT Code 97760 – Orthotic management of arm or leg and/or trunk
  • CPT Code 97763 – Evaluation of orthotic or prosthetic use, each 15 minutes
  • CPT Code 98940 – Chiropractic treatment, 1-2 spinal regions
  • CPT Code 98941 – Chiropractic treatment, 3-4 spinal regions
  • CPT Code 98942 – Chiropractic treatment, 5 spinal regions
  • CPT Code 98943 – Chiropractic treatment, 1+ non-spinal regions

MaineCare Median Payments

MaineCare statewide median payments are calculated for select procedures using the CompareMaine methodology:

  • CPT Code 76801 – Abdominal ultrasound of pregnant uterus, less than 14 weeks, single or first fetus
  • CPT Code 76805 – Abdominal ultrasound of pregnant uterus, greater than or equal to 14 weeks, single or first fetus
  • CPT Code 76815 – Ultrasound of pregnant uterus, 1 or more fetus
  • CPT Code 76816 – Ultrasound re-evaluation of pregnant uterus, per fetus
  • CPT Code 76817 – Vaginal ultrasound of pregnant uterus
  • CPT Code 76819 – Ultrasound of fetus
  • CPT Code 76820 – Doppler velocimetry, fetal; umbilical artery
  • CPT Code 76821 – Doppler velocimetry, fetal; middle cerebral artery
  • CPT Code 76830 – Transvaginal ultrasound
  • CPT Code 76856 – Ultrasound of pelvis

MaineCare was also added a payor in the Ambulance Services dashboard.