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MaineHealth Care at Home Fees - Effective 10/1/2020

Procedure Code  Home Care Fee

G0299

Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, up to 2 hours 

$179

G0299

Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each additional hour after the first 2 hours
$60

G0300

Direct skilled nursing services of a licensed practical nurse (LPN) in the home health or hospice setting, up to 2 hours
$151

G0300

Direct skilled nursing services of a licensed practical nurse (LPN) in the home health or hospice setting, each additional hour after the first 2 hours
$60

S9110

Telemonitoring of patient in their home, including all necessary equipment; computer system, connections, and software; maintenance; patient education and support; per month
$110

G0151

Services performed by a qualified physical therapist in the home health or hospice setting, each visit
$207
G0157 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each visit $128
G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each visit
$197
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each visit
$308
G0155 Services of clinical social worker in home health or hospice settings, each visit
$190
G0156 Services of home health/hospice aide in home health or hospice settings, up to 2 hours
$101
G0156 Services of home health/hospice aide in home health or hospice settings, for each additional hour after the first 2 hours $35
G8780 Counseling for diet and physical activity performed $120
Procedure Code  Community Health Clinics Fee
N/A Blood Pressure No charge
N/A
Foot/Toenail Care $30
N/A
Fingernail Care $10
90686 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
$19.58
90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
$60.58
90471 Immunization administration $17.42
Procedure Code  Hospice Care Fee

Q5001

Hospice or home health care provided in patient's home/residence (1-60 days)

$220

Q5002

Hospice or home health care provided in assisted living facility (1-60 days)
$220

Q5003

Hospice care provided in nursing long term care facility (LTC) or non-skilled nursing facility (1-60 days)
$220

Q5001

Hospice or home health care provided in patient's home/residence (61+ days)
$170

Q5002

Hospice or home health care provided in assisted living facility (61+ days)
$170

Q5003

Hospice care provided in nursing long term care facility (LTC) or non-skilled nursing facility (61+ days)
$170
Q5001 Continuous Hospice or home health care provided in patient's home/residence $54
Q5002 Continuous Hospice or home health care provided in assisted living facility
$54
Q5003 Continuous Hospice care provided in nursing long term care facility (LTC) or non-skilled nursing facility
$54
Q5009 Continuous Hospice or home health care provided in place not otherwise specified
$54
Q5010 Continuous Hospice or home health care provided in hospice residential facility
$54
Q5005 Inpatient Respite Care in inpatient hospital $422.05
Q5006 Inpatient Respite Care in inpatient hospice facility $422.05
Q5005
General Inpatient Care in inpatient hospital
$941
Q5006
General Inpatient Care in inpatient hospice facility
$941
Procedure Code  Community Health Services Fee

n/a

In-service/Consultation Services

$81