Attention Section 90, Physician Service Providers: Seasonal Flu Codes and Rates Updated, CR 126775

Sep 09, 2024

Effective August 1, 2024, or August 6, 2024, MaineCare updated the seasonal flu codes in alignment with the Centers for Medicaid Services (CMS). Please see the table below for the new codes and rates, as well as previous codes that are now end dated. The MaineCare Usual Customary Rates (UCR) Fee Schedule will be updated to reflect this information in the coming weeks.

Adjustment of Claims

To receive the updated rates for paid claims with dates of service, as noted in the table above, on or after August 1, 2024:

• MaineCare will adjust claims billed with the new codes at or above the new rates.
• MaineCare will reprocess claims billed with codes that end dated on July 31, 2024, for the date span noted above.
  • Providers will need to submit a new claim with the replacement code(s) once the Department has reprocessed and denied the original claim line(s). Per policy, providers have one year from the date of service to submit a new claim.
• Providers will be responsible for adjusting claims that were submitted and paid with the new codes with charges below the new rates. Please adjust the oldest dates first to avoid timely filing denials. Per policy, providers have 120 days from the original paid date to adjust claims.  

For questions, please contact your Provider Relations Specialist.