Section 90, Physician Services: Retroactive Rate Update Effective January 1, 2026, CR#142205, 142218

MaineCare updated certain physician service rates retroactively to January 1, 2026, due to a recent rate update from the Centers for Medicare and Medicaid Services (CMS). The new rates reflect 72.4% of the Maine Medicare rates and were implemented for billing on August 26, 2026. 

CR 142205 

Code 

Old Rate 

New Rate 

15011 

$165.50 

$183.24 

   

15011 

 

$76.90 

Facility 

15012 

$138.19 

$183.24 

 

15012 

 

$76.90 

Facility 

15013 

$102.11 

$57.46 

 

15013 

 

$48.12 

Facility 

15014 

$59.48 

$57.46 

 

15014 

 

$48.12 

Facility 

15015 

$361.26 

$508.57 

 

15015 

 

$411.13 

Facility 

15016 

$96.09 

$83.60 

 

15016 

 

$65.13 

Facility 

15017 

$515.59 

$571.03 

 

15017 

 

$443.56 

Facility 

15018 

$95.77 

$112.42 

 

15018 

  

$89.95 

Facility 

CR 142218 

Code 

Old Rate 

New Rate 

22554 

$801.54 

$801.39 

 

26562 

$879 

$878.86 

 

33269 

532.36 

$532.21 

 

33464 

1522.88 

$1,522.72 

 

33983 

1405.72 

$1,405.57 

 

35221 

894.69 

$894.54 

 

37660 

813.31 

$813.15 

 

44322 

655.32 

$655.17 

 

58290 

687.1 

$686.95 

 

60271 

638.73 

$638.58 

 

61320 

1195.21 

$1,195.06 

 

64804 

781.94 

$781.79 

 

Adjustment Billing Guidance for Dates of Service January 1, 2026 - August 25, 2026 

  • MaineCare will adjust paid claims submitted with charges at or above the new rates.  

  • Providers are responsible for adjusting claims submitted with charges below the new rates, as deemed appropriate by the provider. Per policy, and to avoid timely filing denials, adjustments must be submitted within 120 days of the most recent claim payment date.   

For questions, please contact your Provider Relations Specialist.