C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-31, subsec. 144-101-II-31.09
Providers billing for FQHC services must bill using standard CPT and HCPC procedure codes as detailed in Chapter III, Section 31, Table 1. For Core and Ambulatory Services, as described under Covered Services-Section 31. 04, providers must bill T1015 and include the appropriate revenue codes. When billing, providers must use a UB 04 claim form. Effective October 1, 2010, in addition to billing the code T1015 for Core and Ambulatory Services, providers must also report all services provided including all procedures with the standard CPT and HCPC5 codes on the UB 04 claims form for reporting purposes.
In accordance with Chapter I of the MaineCare Benefits Manual, it is the responsibility of the provider to seek payment from other third party payers prior to billing MaineCare for a rendered service. If a member has capitated third party coverage other than MaineCare, and if that third party carrier requires a member co-pay but makes no fee-for-service payment to cover FQHC services, MaineCare reimbursement will be limited to the amount of the co-pay alone.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-31, subsec. 144-101-II-31.09