Provider Instructions on using Portal for procedure code look-up

1. Procedure Code Lookup screen will look like this . . . .

2. Click on drop down menu as shown:

For example if you were looking up 58340, you would choose the 50000 series as it begins with the number 5. Your screen will look like this example below.

1. Find the code you are looking for on this entire list of codes starting with the number 5. When you have found the code you are looking for, click on the code which should be showing in blue font.

2. By clicking on the code in blue font, it will open up additional details about the code. Information such as whether the code is covered by MaineCare, whether a prior authorization is required, and what MaineCare reimbursement rate is, etc. Please note, there may be multiple lines but the one with the end date of 12/31/2999 is the active line.

You can also see if the code is covered for certain ages, facility types, etc. as the example shown below.

If you have additional prior authorization questions or need help with the procedure code look up portal, please feel free to call MaineCare’s Prior Authorization Unit at 1-866-796-2463 or (207) 624-6902. Hours of operation are 8:00 am to 5:00 pm, Monday through Friday, excluding holidays.

If you have specific billing questions, please contact your MaineCare Provider Relations Specialist at 1-800-321-5557, Option 8.