10-144-101 Me. Code R. § III-19
PROCEDURE CODE | MODIFIER | REVENUE CODE | DESCRIPTION | UNIT | Rates Effective 4/1/2020* |
H2014 | U7 | Skills Training and Development (Participant Directed Option) | 15 minutes | $14. 03 | |
T2040 | U7 | Financial Management, self-directed, waiver (Participant Directed Option) | Monthly | $85. 09 | |
S5125 | U7 | Attendant Care Services (Personal Care Services, Participant Directed Option) | 15 minutes | $4. 86* | |
S5125 | U7 UN | Attendant Care Services (Personal Care Services, Participant Directed Option)-2 members served | 15 minutes | $2. 67* | |
S5125 | U7 UP | Attendant Care Services (Personal Care Services, Participant Directed Option)-3 members served | 15 minutes | $1. 94* | |
T1019 | U7 | 0589 | Personal Care Services (Agency PSS) | 15 minutes | $6. 55* |
T1019 | U7 UN | 0589 | Personal Care Services (Agency PSS)- 2 members served | 15 minutes | $3. 60* |
T1019 | U7 UP | 0589 | Personal Care Services (Agency PSS)-3 members served | 15 minutes | $2. 62* |
T2022 | U7 | Care Coordination | per month | $136. 00** | |
S5160 | U7 | Personal Emergency Response System, Installation and Testing | 1 unit | Customary Charge, Not to Exceed $45. 00 | |
S5161 | U7 | Personal Emergency Response System, Service Fee | Monthly | Customary Charge, Not to Exceed $35. 00 | |
H0045 | U7 | Respite Care Services, not in the home | Per Diem | $219. 76* | |
T1005 | U7 | Respite Care Services, in the home (PSS) | 15 minutes | $6. 55, Cost Not to Exceed Cap* | |
T1005 | U7 UN | Respite Care Services, in the home (PSS)- 2 members served | 15 minutes | $3. 60 Cost Not to Exceed Cap* | |
T1005 | U7 UP | Respite Care Services, in the home (PSS)-3 members served | 15 minutes | $2. 62 Cost Not to Exceed Cap* | |
T1005 | U7 | Respite Care Services, in the home-Participant Directed Option | 15 minutes | $4. 86 Cost Not to Exceed Cap* | |
T1005 | U7 UN | Respite Care Services, in the home-Participant Directed Option- 2 members served | 15 minutes | $2. 67 Cost Not to Exceed Cap* | |
T1005 | U7 UP | Respite Care Services, in the home-Participant Directed Option-3 members served | 15 minutes | $1. 94 Cost Not to Exceed Cap* | |
S5165 | U7 | Environmental Modifications | Per Service | By report | |
A9279 | U7 | Assistive Technology-(Monitoring feature/device, stand alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified) | 1 unit | Per device | |
A9279 | U7 QC | Assistive Technology-Remote Monitoring-Monthly fee | Monthly | Up to $ 500. 00 | |
T2035 | U7 | Assistive Technology-Transmission (Utility Services) | Monthly | Up to $ 50. 00 | |
T1005 | U7 | 0669 | Respite Care, in the home by CNA/Home Health Aide | 15 minutes | $7. 06* |
T1005 | U7 UN | 0669 | Respite Care, in the home by CNA/Home Health Aide- 2 members served | 15 minutes | $3. 88* |
T1005 | U7 UP | 0669 | Respite Care, in the home by CNA/Home Health Aide-3 members served | 15 minutes | $2. 82* |
0551 | Skilled Nursing Visit (RN) | Per Visit | $53. 60 | ||
0551 | Skilled Nursing Visit (RN)-2 members served | Per Visit | $29. 48 | ||
0551 | Skilled Nursing Visit (RN)-3 members served | Per Visit | $21. 44 | ||
0559 | Other Nursing (LPN) | Per visit | $39. 05 | ||
0559 | Other Nursing (LPN)-2 members served | Per Visit | $21. 48 | ||
0559 | Other Nursing (LPN)-3 members served | Per Visit | $15. 62 | ||
0421 | Physical Therapy Visit | Per visit | $92. 94 | ||
0431 | Occupational Therapy Visit | Per visit | $98. 76 | ||
0441 | Speech Therapy Visit- Home Health Services | Per visit | $97. 34 | ||
G0151 | U7 TF | 0421 | Certified Physical Therapy Assistant- Home Health Services Visit Charge | Per visit | $65. 72 |
G0152 | U7 TF | 0431 | Occupational Therapy Assistant- Home Health Services Visit Charge | Per visit | $69. 83 |
G0156 | U7 TF | 0571 | Home Health Aide Visit - Home Health Services | Per visit | $28. 43* |
G0156 | U7 TF UN | 0571 | Home Health Aide Visit- Home Health Services-2 members served | Per visit | $15. 64* |
G0156 | U7 TFUP | 0571 | Home Health Aide Visit- Home Health Services-3 members served | Per visit | $11. 37* |
G0155 | U7 TF | 0561 | Medical Social Services Visit- Home Health Services | Per visit | $84. 10 |
G0299 | U7 | 0551 | Skilled Nursing Visit (R. N.) (Non-Medicare Certified Home Health Agency) - Home Health Services | 15 minutes | $13. 74 |
G0299 | U7 UN | 0551 | Skilled Nursing Visit (RN) (Non-Medicare Certified Home Health Agency) - Home Health Services- 2 members served | 15 minutes | $7. 56 |
S5170 | U7 | Home Delivered Meals | Per Meal | $7. 64 | |
98960 | U7 59 | Living Well (Chronic Disease Management) | 30 Minutes | $17. 09 | |
98960 | U7 33 | Matter of Balance (Falls Prevention) | 30 Minutes | $14. 83 | |
G0299 | U7 UP | 0551 | Skilled Nursing Visit (RN) (Non-Medicare Certified Home Health Agency) - Home Health Services-3 members served | 15 minutes | $5. 50 |
G0300 | U7 | 0559 | Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency) - Home Health Services | 15 minutes | $9. 75 |
G0300 | U7 UN | 0559 | Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency) - Home Health Services-2 members served | 15 minutes | $5. 37 |
G0300 | U7 UP | 0559 | Nursing Visit (LPN) (Non-Medicare Certified Home Health Agency) - Home Health Services-3 members served | 15 minutes | $3. 90 |
G0151 | U7 | 0421 | Physical Therapy Visit- Home Health Services | 15 minutes | $12. 36 |
G0152 | U7 | 0431 | Occupational Therapy Visit- Home Health Services | 15 minutes | $12. 87 |
G0153 | U7 | 0441 | Speech Therapy Visit- Home Health Services | 15 minutes | $12. 87 |
T1004 | U7 | 0581 | Certified Nurse's Aide- Home Health Services | 15 minutes | $7. 06* |
T1004 | U7 UN | 0581 | Certified Nurse's Aide- Home Health Services- 2 members served | 15 minutes | $3. 88* |
T1004 | U7 UP | 0581 | Certified Nurse's Aide- Home Health Services-3 members served | 15 minutes | $2. 82* |
G0156 | U7 | 0571 | Home Health Aide- Home Health Services | 15 minutes | $7. 06* |
G0156 | U7 UN | 0571 | Home Health Aide- Home Health Services- 2 members served | 15 minutes | $3. 88* |
G0156 | U7 UP | 0571 | Home Health Aide- Home Health Services- 3 members served | 15 minutes | $2. 82* |
G0155 | U7 | 0561 | Medical Social Services Visit- Home Health Services | 15 minutes | $11. 48 |
INDEPENDENT PRACTITIONERS ONLY | |||||
PROCEDURE CODE | MODIFIER | REVENUE CODE | DESCRIPTION | UNIT | Rates Effective 4/1/2020* |
INDEPENDENT PRACTITIONERS ONLY | |||||
G0299 | U7 | Skilled Nursing Visit (R. N.) - Home Health Services | 15 minutes | $13. 74 | |
G0299 | U7 UN | Skilled Nursing Visit (RN) - Home Health Services-2 members served | 15 minutes | $7. 56 | |
G0299 | U7 UP | Skilled Nursing Visit (RN) - Home Health Services-3 members served | 15 minutes | $5. 50 | |
G0151 | U7 | Physical Therapy Visit- Home Health Services | 15 minutes | $10. 80 | |
G0152 | U7 | Occupational Therapy Visit- Home Health Services | 15 minutes | $10. 60 | |
G0153 | U7 | Speech Therapy Visit- Home Health Services | 15 minutes | $11. 75 | |
| Modifiers | Description |
QC | Monthly Fee |
U7 | Indicates Section 19 Services |
TF | Intermediate Level of Care |
U1 | Other Qualified Staff |
59 | Living Well |
33 | Matter of Balance |
UN | 2 members served |
UP | 3 members served |
** The PMPM reimbursement for care coordination shall be effective prospectively (not 4/1/2020).
10-144 C.M.R. ch. 101, § III-19
November 1, 2017 - filing 2017-169
October 9, 2018 - filing 2018-226
January 7, 2019 - filing 2018-002
5/2/2021 filing 2021- 090