MaineCare in Education: Instructions for Providers of Section 28 and Section 96 Services Experiencing Difficulties with Modifier Guidance for Education-related Services 

Jul 22, 2022

On May 17, 2022, MaineCare issued billing guidance, MaineCare in Education: New Modifier Guidance for Sections 28 and 96, that all providers submitting claims for Individuals with Disabilities Education Act (IDEA) services delivered under Section 28 or Section 96 of the MaineCare Benefit Manual should include the TL or TM modifier on the claim line to indicate if the service was provided pursuant to an Individual Family Service Plan (IFSP) or Individualized Education Program (IEP).   

MaineCare has since become aware of technical limitations that make it challenging for some providers to bill in this manner.  We have also received questions about how to handle non-IDEA services that are delivered in schools.  For clarity, providers delivering medically necessary services in schools that are not IDEA related are not required to use the modifiers and may continue to bill without them. 

Providers experiencing technical difficulties including TL/TM modifiers on their claims may reach out to the appropriate MaineCare Provider Relations Specialist to request an extension up to October 1, 2022, to follow this guidance.   

All providers of IDEA services remain responsible for ensuring that the claims they submit are consistent with MaineCare requirements for coverage of IDEA services.  For further detail, please see the Guidance on IEP Documentation issued jointly by MaineCare and the Maine Department of Education in May of 2021.  Additional information may be accessed on the MaineCare in Education website. 

 Please contact the appropriate Provider Relations Specialist with any questions.