10-144-101 Me. Code R. § III-65
Crisis Resolution Services:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H2011 | 15 min | Crisis Resolution | *$61.82 | *7/1/22 | N | |
H2011 | HA | 15 min | Crisis Resolution - Children | *$61.82 | *7/1/22 | N |
Crisis Residential Services:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H0018 | Per Diem | Crisis Residential | *By Report | *7/1/22 | Y | |
H0018 | HA | Per Diem | Crisis Residential - Children | *By Report | *7/1/22 | Y |
S9482 | 15 min | Crisis Residential - In Home | *$18.65 | *7/1/22 | N | |
S9482 | HA | 15 min | Crisis Residential - In Home - Children | *$18.65 | *7/1/22 | N |
Outpatient Services - Comprehensive Assessment:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H2000 | 15 min | Independent - Psychologist | *$23.55 | *7/1/22 | Y | |
H2000 | 15 min | Mental Health Agency | *$22.48 | *7/1/22 | Y | |
H2000 | HH | 15 min | Mental Health Agency - Co-occurring | *$22.48 | *7/1/22 | Y |
H2000 | 15 min | Mental Health Agency Deaf & Home-Based Treatment for Adults | *$32.92 | *7/1/22 | Y | |
H2000 | 15 min | Independent - LCSW, LCPC, LMFT | *$14.72 | *7/1/22 | Y | |
H2000 | 15 min | Substance Use Agency | *$22.48 | *7/1/22 | Y | |
H2000 | 15 min | Substance Use Agency - Non-Master's Level LADC | *$21.41 | *7/1/22 | Y | |
H2000 | 15 min | Substance Use Agency - CADC | *$15.52 | *7/1/22 | Y |
Outpatient Services - Individual/Family Therapy:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H0004 | 15 min | Independent - Psychologist | *$23.55 | *7/1/22 | Y | |
H0004 | 15 min | Mental Health Agency | *$22.48 | *7/1/22 | Y | |
H0004 | HH | 15 min | Mental Health Agency-Co-occurring | *$22.48 | *7/1/22 | Y |
H0004 | 15 min | Mental Health Agency-Deaf & Home-Based Treatment for Adults | *$32.92 | *7/1/22 | Y | |
H0004 | 15 min | Independent - LCSW, LCPC, LMFT | *$14.72 | *7/1/22 | Y | |
H0004 | 15 min | Substance Use Agency | *$22.48 | *7/1/22 | Y | |
H0004 | 15 min | Substance Use Agency-Non-Master's Level LADC | *$21.41 | *7/1/22 | Y | |
H0004 | 15 min | Substance Use Agency - CADC | *$15.52 | *7/1/22 | Y | |
*H0004 | ST | 15 min | Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) | *$27.21 | *7/1/22 | Y |
Outpatient Services - Group Therapy:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H0004 | HQ | 15 min | Psychologist-Independent | *$5.89 | *7/1/22 | Y |
H0004 | HQ | 15 min | Mental Health Agency | *$5.62 | *7/1/22 | Y |
H0004 | HQ HH | 15 min | Mental Health Agency-Co-occurring | *$5.62 | *7/1/22 | Y |
H0004 | HQ | 15 min | Substance Use Agency | *$9.63 | *7/1/22 | Y |
H0004 | HQ | 15 min | Substance Use Agency-Non-Master's Level LADC | *$9.10 | *7/1/22 | Y |
H0004 | HQ | 15 min | Substance Use Agency - CADC | *$7.49 | *7/1/22 | Y |
H0004 | HQ | 15 min | Independent - LCSW, LCPC and LMFT | *$3.68 | *7/1/22 | Y |
Family Psychoeducational Treatment:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H0025 | Monthly | Treatment Services- Children | *$79.03 | *7/1/22 | Y | |
H2027 | 15 min | Treatment Services- Adult | *$10.12 | *7/1/22 | Y |
Intensive Outpatient Program (IOP) Services:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H0015 | Per Diem | Substance Use | *$192.83 | *1/1/22 | Y | |
*H0015 | HE | Per Diem | Mental Health | *$231.11 | *11/9/22 | Y |
*H0015 | HI | Per Diem | Dev. Disabilities /Behavioral Health | *$316.53 | *11/9/22 | Y |
*H0015 | HC | Per Diem | Geriatric | *$231.11 | *11/9/22 | Y |
*H0015 | HK | Per Diem | Dialectical Behavior Therapy | *$188.84 | *11/9/22 | Y |
*H0015 | HT | Per Diem | Eating Disorder - Level I | *$247.81 | *11/9/22 | Y |
*H0015 | HT AT | Per Diem | Eating Disorder - Level II | *$407.60 | *11/9/22 | Y |
Medication Management Services:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H2010 | 15 min | Adult Services | $82.64 | 10/1/21 | Y | |
H2010 | HA | 15 min | Children's Services | $94.46 | 10/1/21 | Y |
H2010 | AF | 15 min | Adult Services - Physicians | $82.64 | 10/1/21 | Y |
H2010 | HA AF | 15 min | Children's Services - Physicians | $94.46 | 10/1/21 | Y |
H2010 | HF | 15 min | Medication Services - Suboxone | $82.64 | 10/1/21 | Y |
H2010 | HF AF | 15 min | Medication Services-Suboxone - Physician | $82.64 | 10/1/21 | Y |
Neurobehavioral Status Exam, Neuropsychological Testing, Psychological Testing, and Adaptive Assessments:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
96116 | HE | 1-hour | Neurobehavioral Status Exam, Psychologist or Physician (includes face-to-face time with the member, time interpreting test results, and preparing the report) - First Hour | *$84.77 | *7/1/22 | N |
96121 | HE | 1-hour | Neurobehavioral Status Exam, Psychologist or Physician (includes face-to-face time with the member, time interpreting test results, and preparing the report) . Each Additional Hour | *$84.77 | *7/1/22 | N |
96130 | HE | 1-hour | Psychological testing, Psychologist or Physician (includes face-to-face time administering tests to the member and time interpreting these results and preparing the report) - First Hour | *$84.77 | *7/1/22 | N |
96131 | HE | 1-hour | Psychological testing, Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these results, and preparing the report) - Each Additional Hour | *$84.77 | *7/1/22 | N |
96132 | HE | 1-hour | Neuropsychological testing (e.g., Halstead Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) - First Hour | *$84.77 | *7/1/22 | N |
96133 | HE | 1-hour | Neuropsychological testing (e.g., Halstead Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) . Each Additional Hour | *$84.77 | *7/1/22 | N |
96136 | HE | 30 min | Psychological or Neuropsychological test administration - two or more tests - Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these test results, and preparing the report) - First 30 Minutes | *$42.39 | *7/1/22 | N |
96137 | HE | 30 min | Psychological or Neuropsychological test administration - two or more tests - Psychologist or Physician (includes face-to-face time administering tests to the member, time interpreting these results, and preparing the report) - Each Additional 30 Minutes | *$42.39 | *7/1/22 | N |
96138 | HE | 30 min | Neuropsychological and Psychological testing- Psychological Examiner (interpretation and report, administered by a technician, face-to-face) - First 30 Minutes | *$26.88 | *7/1/22 | N |
96139 | HE | 30 min | Neuropsychological and Psychological testing- Psychological Examiner (interpretation and report, administered by a technician, face-to-face) - Each Additional 30 Minutes | *$26.88 | *7/1/22 | N |
When using any of the above Neurobehavioral Status Exam, Neuropsychological Testing, and Psychological Testing codes (96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139), the following modifiers may also be required in order to access the child's educational related services under IDEA, if indicated: | ||||||
TL | Early intervention/individualized family service plan (IFSP). | |||||
TM | Individualized education plan (IEP) | |||||
*96112 | HE | 1-hour | Adaptive Assessment - First Hour | *$88.87 | *7/1/22 | N |
*96113 | HE | 30 min | Adaptive Assessment - Each Add. 30 min | *$44.44 | *7/1/22 | N |
Children's Assertive Community Treatment (ACT):
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
*H0040 | HA | Per Diem | Children's ACT | *111.46 | *7/1/22 | Y |
Children's Comprehensive Community Support Services - Home and Community Based Treatment (HCT)
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H2021 | HO | 15 min | HCT-Master's level | *$24.92 | *7/1/22 | Y |
H2021 | HU | 15 min | HCT -Master's level (OCFS) | *$24.92 | *7/1/22 | Y |
*H2021 | ST | 15 min | HCT-Master's level (TF-CBT) | *$24.92 | *11/9/22 | Y |
*G9007 | HO | 15 min | HCT Collateral Services - Master's level | *$24.92 | *7/1/22 | Y |
*G9007 | HU | 15 min | HCT Collateral Services - OCFS | *$24.92 | *7/1/22 | Y |
H2021 | HN | 15 min | HCT-BHP level | *$17.40 | *7/1/22 | Y |
H2021 | HU U1 | 15 min | HCT-BHP level (OCFS) | *$17.40 | *7/1/22 | Y |
G9007 | HN | 15 min | HCT Collateral Services - BHP | *$17.40 | *7/1/22 | Y |
Children's Comprehensive Community Support Services - Functional Family Therapy (FFT), Multi-Systemic Therapy (MST) and MST for Problem Sexualized Behaviors (MST-PSB):
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H2021 | HE | Weekly | FFT | *$302.26 | *7/1/22 | Y |
H2033 | Weekly | MST | *$601.05 | *7/1/22 | Y | |
H2033 | HK | Weekly | MST-PSB | *$776.61 | *7/1/22 | Y |
Opioid Treatment Program Services:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H0020 | Weekly | Opioid Treatment Program Services | *$115.43 | *7/1/22 | N |
Children's Behavioral Health Day Treatment:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H2012 | HN | Hourly | BHP Level | *$62.72 | *7/1/22 | Y |
H2012 | HN UN | Hourly | BHP Level-Two patients served | *$31.37 | *7/1/22 | Y |
H2012 | HN UP | Hourly | BHP Level-Three patients served | *$20.90 | *7/1/22 | Y |
H2012 | HN UQ | Hourly | BHP Level-Four patients served | *$15.68 | *7/1/22 | Y |
H2012 | HO | Hourly | Master's Level | *$101.69 | *7/1/22 | Y |
H2012 | HO UN | Hourly | Master's Level-Two patients served | *$50.84 | *7/1/22 | Y |
H2012 | HO UP | Hourly | Master's Level-Three patients served (School-Children) | *$33.83 | *7/1/22 | Y |
H2012 | HO UQ | Hourly | Master's Level-Four patients served (School-Children) | *$25.43 | *7/1/22 | Y |
When using any of the above Children's Behavioral Health Day Treatment codes (H2012 HN, H2012 HN UN, H2012 HN UP, H2012 HN UQ, H2012 HO, H2012 HO UN, H2012 HO UP, or H2012 HO UQ), the following modifiers may also be required in order to access the child's educational related services under IDEA, if indicated: | ||||||
TL | Early intervention/individualized family service plan (IFSP). | |||||
TM | Individualized education plan (IEP) | |||||
Tobacco Cessation Treatment Services:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
99406 | 3-10 min | Smoking and Tobacco Cessation Counseling; individual, intermediate | *$9.28 | *7/1/22 | N | |
99407 | 10 min | Smoking and Tobacco Cessation Counseling; individual, intensive | *$18.00 | *7/1/22 | N | |
99411 | 30 min | Preventive Medicine, Tobacco Cessation Group Counseling | *$12.35 | *7/1/22 | N | |
99412 | 60 min | Preventive Medicine, Tobacco Cessation Group Counseling | *$16.10 | *7/1/22 | N |
Mental Health Psychosocial Clubhouse Services:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
*H2030 | 15 min | Mental Health Clubhouse Services | *$6.33 | *7/1/22 | Y |
Specialized Group Services:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
H2019 | 15 min | Wellness Recovery Action Planning | *$11.21 | *7/1/22 | Y | |
H2019 | 15 min | Recovery Workbook | *$11.21 | *7/1/22 | Y | |
H2019 | 15 min | Trauma Recovery and Empowerment | *$11.21 | *7/1/22 | Y | |
H2019 | 15 min | Dialectical Behavior Therapy | *$11.21 | *7/1/22 | Y |
Behavioral Therapies for Children with Disruptive Behavior Disorders:
Procedure Code | Modifier(s) | Unit | Service Description | Maximum Allowance Per Unit | Rate Effective Date | PA/UR |
T1027 | HA | 15 min | Triple P 1:1 | *$22.48 | *7/1/22 | Y |
T1027 | HA HQ UN | 15 min | Triple P - Group 2-4 members | *$11.53 | *7/1/22 | Y |
T1027 | HA HQ UR | 15 min | Triple P - Group 5-7 members | *$4.84 | *7/1/22 | Y |
T1027 | HA HQ US | 15 min | Triple P - Group 8+ members | *$3.12 | *7/1/22 | Y |
T1027 | TJ HQ UN | 15 min | Incredible Years - Group 2-4 members | *$13.13 | *7/1/22 | Y |
T1027 | TJ HQ UR | 15 min | Incredible Years - Group 5-7 members | *$5.48 | *7/1/22 | Y |
T1027 | TJ HQ US | 15 min | Incredible Years - Group 8+ members | *$3.55 | *7/1/22 | Y |
T1027 | HO | 15 min | Parent-Child Interaction Therapy (PCIT) | *$25.12 | *7/1/22 | Y |
*The Department shall submit to CMS and anticipates? approval for a State Plan Amendment related to these provisions.
Modifiers
AF-Specialty physician
AT-Acute treatment
HA-Child/adolescent program
HC-Adult program, geriatric
HE-Mental health program
HF-Substance abuse program
HH-Integrated mental health/substance abuse program
HI-Integrated mental health and intellectual disability/developmental disabilities program
HK-Specialized mental health program for high-risk populations
HN-Bachelor's degree level
HO-Master's degree level
HQ-Group Setting
HT-Multi-disciplinary team
HU-Funded by child welfare
ST-Related to trauma or injury
TJ-Program group, child and/or adolescent
TL-Early intervention/individualized family service plan (IFSP)
TM-Individualized education program (IEP)
U1-Level of care 1
UN-Two patients served
UP-Three patients served
UQ-Four patients served
UR-Five patients served
US-Six or more patients served
10-144 C.M.R. ch. 101, § III-65
February 11, 2019 - filing 2019-031
May 21, 2020 - filing 2020-121
8/19/2020 - filing 2020-178
11/9/2022 - filing 2022- 220