Ambulance Services Reimbursement and Locality Modifiers, CR 108340 

Mar 16, 2022

Effective April 1, 2022, MaineCare will reimburse providers for Medicare-covered services within MaineCare Benefits Manual Chapter III, Section 5, Ambulance Services at 100% of the Maine Medicare area 99 urban, rural, or super rural rate, based on the pick-up location of the member.

For dates of service starting April 1, 2022, providers must bill the following modifiers on ambulance services claims to indicate the applicable locality (as defined by Medicare), based on the pick-up zip code location of the member:

• No modifier – zip codes CMS defines as urban locations
• TN modifier – zip codes CMS defines as rural locations
• UD modifier – zip codes CMS defines as super rural locations

When submitting claims, list the modifier identifying the locality prior to the origin and destination codes (e.g. A0429 TNRH). The Department will conduct claims reviews to ensure proper modifier usage and reimbursement.

See the “National Breakout of the Geographic Area Definitions by Zip Code” file under the Downloads section on Medicare’s Ambulance Fee Schedule website for the list of zip codes for each defined locality.

This change is pursuant to 2021 Resolve, Ch 118, Resolve, To Provide Add-on Payments for Ambulance Services Reimbursed by the MaineCare Program and To Increase Reimbursement Rates for Physical Therapy under the MaineCare Program and was previously announced in a DHHS blog post last fall. The Department is seeking approval from the Centers for Medicare & Medicaid Services for this change.

Please contact your Provider Relations Specialist with questions.