Sections 14, 30, 31, 45, 90 & 103: New Rates Implemented Retroactively for Certain Medicare Covered Family Planning Services and Long-Acting Reversible Contraceptives (LARCs)
As previously noticed, new rates for certain Medicare covered family planning services and LARCs, are implemented for billing retroactively to July 1, 2024. The Section 30, Family Planning fee schedule and usual and customary rates (UCR) are updated and available on the Rate Setting page of the Health PAS Online Portal.
These new rates are the result of a rate determination that concluded in January 2025. You can view all presented materials related to this rate determination on the Rate System Reform webpage.
Billing Guide
A new supplemental billing guide, MaineCare Billing Guidance for Family Planning and Family Planning Related Services, is available on the Billing Instruction page of the Health PAS Online Portal. This billing guide is for providers delivering Medicare covered family planning services and LARCs and describes which services are eligible for the new rates and which modifiers you must use.
Adjustment Billing Guidance for Dates of Service July 1, 2024 – March 18, 2026
Providers are responsible for submitting claims adjustments with the appropriate modifier for all affected claims.
For questions, please contact your Provider Relations Specialist.