The MaineCare fee schedule is a list of codes and reimbursement rates for MaineCare-covered services. Providers use it to bill correctly. Members can use it to understand how services get priced — but it won’t tell you what you personally owe.
For current schedules, MaineCare points users to the Health PAS Online Portal, where everything is organized by section of the MaineCare Benefits Manual. The listed amount is a provider reimbursement rate — full stop.
What Is the MaineCare Fee Schedule?
Think of the fee schedule as a pricing reference, not a bill. It tells providers how much MaineCare will reimburse for a given service after a claim is submitted.
Rates shift depending on the type of service, the CPT or HCPCS code, the provider type, the Benefits Manual section, and the rate methodology in play. There is no single universal MaineCare reimbursement rate — not even close.
If you’re comparing rates across states, Medicaid fee schedules vary significantly by state, and Maine is no exception.
Does the Fee Schedule Tell Me What I Pay?
No. That’s one of the most common misconceptions.
The fee-schedule amount is what MaineCare reimburses the provider. What you actually owe as a member depends on your coverage, eligibility, any applicable cost-sharing rules, and prior authorization requirements — none of which appear on the fee schedule.
If a procedure lists a reimbursement rate, that number is not your bill.
Where to Find the Current MaineCare Fee Schedule
MaineCare directs users to the Health PAS Online Portal for current codes and rates. The process isn’t complicated once you know the steps:
- Identify the healthcare service
- Find its CPT or HCPCS code
- Identify the relevant MaineCare Benefits Manual section
- Open the current fee schedule
- Locate the code and check the listed rate
- Verify the effective date and any related bulletins
That last step matters. Rates get revised after initial schedules are published.
Portal note for 2026: MaineCare is rolling out an upgraded MIHMS system and a new MaineCare Partner Portal that will eventually replace Health PAS. If you’re searching late in 2026, you may encounter updated portal names.
How to Look Up a MaineCare CPT or HCPCS Rate
Step 1: Identify the Code
CPT codes cover medical procedures and professional services. HCPCS codes handle supplies, products, and additional healthcare services. If you don’t have the code, ask the provider’s billing office directly.
Step 2: Find the Right MaineCare Section
MaineCare reimbursement is organized through the Benefits Manual by service area:
| Section | Service Area |
|---|---|
| Section 14 | APRN Services |
| Section 15 | Chiropractic Services |
| Section 25 | Dental Services |
| Section 30 | Family Planning |
| Section 65 | Behavioral Health |
| Section 68 | Occupational Therapy |
| Section 75 | Vision Services |
| Section 85 | Physical Therapy |
| Section 90 | Physician Services |
| Section 95 | Podiatry |
| Section 101 | Medical Imaging |
| Section 109 | Speech & Hearing |
Step 3: Pull the Current Schedule
Open the applicable fee schedule and find the code. Don’t rely on an old PDF, a screenshot, or a third-party rate table — those go stale fast.
Step 4: Check the Effective Date
A rate’s effective date and its implementation date for billing can be two different things. That distinction is critical and trips up even experienced billers.
MaineCare 2026 Rates and the 72.4% Medicare Rule
Here’s the thing about the 72.4% figure — it doesn’t apply to everything.
For specified Medicare-covered codes and services, MaineCare implemented a 72.4%-of-Medicare methodology for 2026. The affected sections include APRN, chiropractic, family planning, behavioral health, occupational therapy, vision, physical therapy, physician, podiatry, and medical imaging services.
Other services use entirely different methodologies. Do not apply 72.4% to a service yourself without verifying it applies.
| Claim | Correct? |
|---|---|
| MaineCare pays 72.4% of Medicare for everything | No |
| Some 2026 services use 72.4% of Medicare | Yes |
| Every MaineCare provider gets the same rate | No |
| The fee-schedule amount is the patient’s bill | No |
| Rates can be revised after initial publication | Yes |
MaineCare vs. Medicare Fee Schedules
These are separate programs. MaineCare is Maine’s Medicaid program, administered by Maine DHHS. Medicare is federal, run by CMS. The fact that MaineCare benchmarks certain 2026 rates against Medicare does not make them identical.
| Feature | MaineCare | Medicare |
|---|---|---|
| Program | Maine Medicaid | Federal health insurance |
| Administration | Maine DHHS / Office of MaineCare Services | CMS |
| Rates | MaineCare-specific methodologies | Medicare payment methodologies |
| 2026 Medicare benchmark | Used for certain services | Program’s own rates |
| Fee schedule | Varies by section/service | Varies by payment system |
A Medicare rate is not a MaineCare rate. Full stop.
Key 2026 Rate Changes Worth Knowing
Dental Services
MaineCare updated certain dental sedation and general anesthesia rates under Section 25, effective July 1, 2026. The revised methodology uses 67% of the commercial median benchmark for specified services. Codes D9222, D9223, D9224, and D9225 were listed at $205.25 under the change. Temporary reimbursement rates also apply to select additional dental services.
Physician Services
Section 90 physician rates were updated in 2026 — retroactive to January 1, 2026, with implementation for billing coming later in the year. That gap between effective and implementation dates is exactly the kind of detail that leads to billing errors.
Physical and Occupational Therapy
Sections 85 and 68 received 2026 updates using the 72.4%-of-Medicare methodology. Importantly, MaineCare initially posted an incorrect fee schedule for these sections and later replaced it with corrected versions. Always verify you’re looking at the latest.
Hospital Services
A 3.7% cost-of-living adjustment (COLA) applied to specified Section 45 inpatient reimbursement rates, effective July 1, 2026. Hospital reimbursement also involves diagnosis-related group considerations, so a flat percentage doesn’t cover every situation.
Effective Date vs. Implementation Date
This one deserves its own section because it causes real problems.
Effective date is when the new rate or policy officially applies. Implementation date is when the updated rate is actually loaded into the billing system. These can be months apart.
A rate effective January 1 might not be available for billing until later in the year, with MaineCare issuing adjustment instructions for affected claims in between. If a provider billed before the rate was loaded, they may need to reprocess claims. Check the official bulletin every time a rate changes.
Who Uses the MaineCare Fee Schedule?
Members — to understand how reimbursement works, not to determine personal costs. For MaineCare eligibility and income-related questions, go directly to MaineCare resources rather than the fee schedule.
Providers — for billing, claims, and rate verification.
Medical billers and coders — for CPT/HCPCS codes, modifiers, units, provider types, effective dates, and section-specific rules.
Families and caregivers — often when arranging dental, therapy, behavioral health, or other MaineCare-covered services for a dependent.
Common Mistakes to Avoid
- Assuming one MaineCare rate covers all services
- Applying 72.4% to every service
- Treating reimbursement as the patient’s bill
- Using an outdated fee schedule
- Ignoring the effective date
- Confusing effective and implementation dates
- Relying only on the Codes & Rates spreadsheet
- Skipping later MaineCare provider bulletins
- Looking up the wrong CPT/HCPCS code
- Assuming Medicare and MaineCare rates are identical
MaineCare specifically notes that Codes & Rates spreadsheets don’t capture every rate and code change — which is exactly why the applicable fee schedule and related bulletins are the authoritative sources.
Quick Decision Guide
Looking for a rate? Find the CPT/HCPCS code → identify the MaineCare section → check the current fee schedule.
Trying to understand your personal cost? Don’t use the fee schedule alone. Check your MaineCare coverage and member cost-sharing rules.
Seeing a 72.4% Medicare reference? Confirm the specific service and section are covered by that methodology before using it.
Finding two different rates? Compare effective dates, implementation dates, revisions, and provider bulletins.
Found an old PDF? Verify it against the current MaineCare schedule before acting on it.
Frequently Asked Questions
What is the MaineCare fee schedule?
A list of reimbursement rates for MaineCare-covered services tied to specific billing codes. Primarily a provider and billing resource — not a patient price list.
Where can I find the MaineCare fee schedule?
The Health PAS Online Portal, which MaineCare directs users to for current codes and rates organized by Benefits Manual section.
Does MaineCare pay 72.4% of Medicare?
Not for every service. The 72.4% methodology applies to specified Medicare-covered codes under identified MaineCare sections in 2026. Other services use different rate-setting methods.
Does the fee schedule determine what patients pay?
No. The fee-schedule amount is provider reimbursement. A member’s actual cost depends on coverage, eligibility, and applicable cost-sharing rules.
How do I find a MaineCare CPT rate?
Identify the CPT code, find the applicable Benefits Manual section, open the current fee schedule, and verify the rate’s effective date and any related updates.
Are MaineCare dental rates included?
Yes. Dental services fall under Section 25, with service-specific codes and reimbursement rates.
Can MaineCare rates change retroactively?
Yes. MaineCare can issue updates effective for earlier dates of service but implemented later for billing, with bulletins providing claim-adjustment instructions.
How often does MaineCare update rates?
There’s no single schedule. Changes come throughout the year — Medicare-related updates, COLAs, rate determinations, corrections, and service-specific changes all happen on their own timelines.
Are MaineCare and Medicare rates the same?
No. Separate programs, separate payment systems. MaineCare benchmarks certain services against Medicare but that doesn’t make the rates identical.
Can I rely on an old MaineCare fee schedule PDF?
Verify it first. MaineCare has issued corrected 2026 schedules for certain sections, and relying on an outdated version is one of the most common billing mistakes.
Conclusion
The Maine Medicaid fee schedule is a provider tool, not a patient bill. If you need to look up a rate, start with the correct CPT or HCPCS code, find the right MaineCare section, and always confirm the effective date.
For 2026 specifically, watch the 72.4% methodology, COLA adjustments, retroactive effective dates, and corrected schedules — those are the details that actually affect how claims get processed and paid.
If you’re a member trying to figure out what you owe, the fee schedule isn’t your answer. Call MaineCare directly.
I need to find the exact official URLs for MaineCare and related government resources before creating the links.
Official Resources
- Check Current Fee Schedules — MaineCare Health PAS Portal
- Verify Codes & Rate Updates — Maine DHHS
- Apply for MaineCare Coverage — MyMaineConnection
- Get Provider Resources & Enrollment Info — Office of MaineCare Services
Disclaimer: This guide is for general informational purposes only and is not official MaineCare billing or legal advice. Rates, codes, policies, and portal rules change. Always confirm latest rates and applicable policies with official Maine DHHS/MaineCare resources before making billing or healthcare decisions.