Maine Regulation Digest / MaineCare Section 55
Hornbeam reads MaineCare's publications every night and records what changed, quoting the source.
Laboratory Services
10-144 C.M.R. ch. 101 · MaineCare Benefits Manual · monitored nightly · Sources last checked 2026-09-02 04:24 EDT
MaineCare Section 55, Laboratory Services, has 24 confirmed changes on record, the most recent effective 1 January 2026. Each row below carries the value it moved from and the value it moved to. The line above each group names the publication that announced those changes and links to it.
| What changed | Was | Now |
|---|---|---|
| 2026 | ||
| Effective 1 January 2026 · 24 rate changesCR 140135 · detected 2026-08-12 | ||
| What changedUpdate the reference rate for CPT code 88106 with modifier 26 to 17.15.# | Was— | Now$17.15 |
| What changedUpdate the reference rate for CPT code 88112 to 61.50.# | Was— | Now$61.50 |
| What changedUpdate the reference rate for CPT code 88112 with modifier 26 to 25.34.# | Was— | Now$25.34 |
| What changedUpdate the reference rate for CPT code 88185 to 21.20.# | Was— | Now$21.20 |
| What changedUpdate the reference rate for CPT code 88187 to 33.89.# | Was— | Now$33.89 |
| What changedUpdate the reference rate for CPT code 88300 with modifier TC to 10.96.# | Was— | Now$10.96 |
| What changedUpdate the reference rate for CPT code 88302 to 29.96.# | Was— | Now$29.96 |
| What changedUpdate the reference rate for CPT code 88302 with modifier TC to 23.56.# | Was— | Now$23.56 |
| What changedUpdate the reference rate for CPT code 88304 to 38.16.# | Was— | Now$38.16 |
| What changedUpdate the reference rate for CPT code 88304 with modifier TC to 28.17.# | Was— | Now$28.17 |
| What changedUpdate the reference rate for CPT code 88305 to 66.25.# | Was— | Now$66.25 |
| What changedUpdate the reference rate for CPT code 88305 with modifier TC to 32.17.# | Was— | Now$32.17 |
| What changedUpdate the reference rate for CPT code 88323 with modifier TC to 27.25.# | Was— | Now$27.25 |
| What changedUpdate the reference rate for CPT code 88355 to 133.57.# | Was— | Now$133.57 |
| What changedUpdate the reference rate for CPT code 88355 with modifier TC to 56.65.# | Was— | Now$56.65 |
| What changedUpdate the reference rate for CPT code 88363 to 21.66.# | Was— | Now$21.66 |
| What changedUpdate the reference rate for CPT code 88367 to 98.19.# | Was— | Now$98.19 |
| What changedUpdate the reference rate for CPT code 88367 with modifier 26 to 30.38.# | Was— | Now$30.38 |
| What changedUpdate the reference rate for CPT code 88367 with modifier TC to 67.81.# | Was— | Now$67.81 |
| What changedUpdate the reference rate for CPT code 88368 with modifier 26 to 39.07.# | Was— | Now$39.07 |
| What changedUpdate the reference rate for CPT code 88380 to 110.73.# | Was— | Now$110.73 |
| What changedUpdate the reference rate for CPT code 88380 with modifier 26 to 47.42.# | Was— | Now$47.42 |
| What changedUpdate the reference rate for CPT code 88380 with modifier TC to 63.31.# | Was— | Now$63.31 |
| What changedUpdate the reference rate for CPT code 88381 with modifier 26 to 21.57.# | Was— | Now$21.57 |
| Back to top | ||
From MaineCare Benefits Manual, 10-144 C.M.R. ch. 101, as published by the Maine Secretary of State and read on an earlier revision. Quoted in part; the section itself is on maine.gov.
An Independent Clinical Laboratory is one which is not under direct jurisdiction of a hospital or the patient's attending physician. For reimbursement under Title XIX, the independent laboratory must be certified as an Independent Clinical Laboratory in accordance with the Medicare conditions of participation and must be licensed under the provisions of 22 M.R.S.A. symbol 167 \f "Kino MT" \s 112011 et seq. and the rules and regulations promulgated thereunder and be in compliance with the rules implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA 88).
-47752016510Effective
11/09/16
00Effective
11/09/16
55.01-7Prior Authorization
Prior Authorization is the process of obtaining prior approval from the Department as to the medical necessity and eligibility for certain MaineCare services before they are delivered, as set forth herein and in Chapter I, Section 1 of the MaineCare Benefits Manual (MBM).
55.02ELIGIBILITY FOR CARE
Individuals must meet the eligibility criteria as set forth in the MaineCare Eligibility Manual. Some members may have restrictions on the type and amount of services they are eligible to receive. It is the responsibility of the provider to verify a member’s eligibility for MaineCare, as described in MaineCare Benefits Manual, Chapter I, Section I, prior to providing services.
Additional specific eligibility criteria are set forth for each service.
55.03DURATION OF CARE
Each Title XIX recipient is eligible for as many covered services as are medically necessary. The Department reserves the right to request additional information to evaluate and determine medical necessity.
[…] The section continues on maine.gov.
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