Subsection 144-101-II-15.08 - REIMBURSEMENTIf CMS approves, the payment amount for services rendered shall be the lowest of the following:
A. The amount listed in the "Allowances for Chiropractic Services," Chapter III, Section 15, MBM; orB. The lowest amount allowed by the Medicare Part B carrier; or C. The provider's usual and customary charge; or D. The amount, if any, by which the MaineCare rate of reimbursement for services billed exceeds the amount of the third-party payment as set in Chapter I of the MBM. MaineCare considers a claim paid in full if the third-party payment amount received exceeds the MaineCare rate of reimbursement.E. Payment for x-ray services rendered medically necessary for diagnosis and treatment of a spinal condition shall be: the lowest of the amounts set forth in 15.08 (A)-(C); OR, the fee-for-service rate is set at seventy (70%) of the lowest level in the 2009 Medicaid fee schedule for Maine area "99" for services under this policy, including adjustments for place of service and modifiers. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-15, subsec. 144-101-II-15.08