MaineCare Fee Schedule and Maine Medicaid Reimbursement Rates (2026)

The MaineCare fee schedule pays $65.28 for code 99213, the standard return-patient office visit, in 2026. That places Maine 28th of 46 ranked states and below the $75.27 national median. The headline number hides a split personality: MaineCare pays middle-to-low for office medicine and outpatient therapy, but near the top of the country for hospice, ambulance and several waiver services.

MedicaidRate holds 27,586 current Maine Medicaid reimbursement rates across 129 service categories, compiled from 78 official state publications, with rate history back to 2010. Every rate links to its source document.

MaineCare is almost entirely a fee-for-service program. Of the six programs on file, all six pay from a published fee schedule:

• MaineCare (fee-for-service), with 27,380 current rates, covers nearly everything.
• Section 19 waiver, Home and Community Benefits for the Elderly and Adults with Disabilities, 63 rates.
• Section 21 waiver, home and community services for adults with intellectual disabilities or autism, 56 rates.
• Section 20 waiver, adults with other related conditions, 36 rates.
• Section 29 waiver, support services for adults with intellectual disabilities or autism, 32 rates.
• Section 18 waiver, adults with brain injury, 19 rates.

By volume, physician and practitioner services lead with 10,346 rates, followed by durable medical equipment and supplies (6,671) and hospital outpatient (3,805).

The section numbering matters because it is how MaineCare publishes. Each section of the MaineCare Benefits Manual covers one service type, and many sections carry their own rate schedule.

The core schedule and section schedules

The core document is the MaineCare Fee Schedule (MaineCare UCR, HealthPAS report REF0060). Alongside it sit section-specific schedules, including Section 60, Medical Supplies and Durable Medical Equipment, Section 4, Ambulatory Surgical Center Services, Section 90 Drug Rates, Section 90 Anesthesiology, Section 14 CRNA rates, and the Section 97 PNMI appendices for residential care and mental health. Most of the 2026 schedules run from January 1 through December 31, 2026.

Why it matters for billing

A provider should know which section governs each service before looking up a rate. The same code can appear in more than one section, and a waiver section can pay differently from the general schedule. Section 19 nursing, for example, has its own rate for RN visits. Notices from MaineCare are also organized by section, so tracking the sections you bill under is the simplest way to catch changes that affect you.

Office visits sit consistently in the lower-middle of the pack. MaineCare's evaluation and management rates rank between 28th and 32nd of 46 states, each several dollars under the national median.

A primary care practice billing 99214 receives $93.03 against a Medicare non-facility range of $128.50 to $133.28. Higher-level visits do not close the gap; 99214 ranks lower than 99213. For a practice deciding how much MaineCare volume to accept, that means each additional complex visit adds less relative margin than a routine one.

Behavioral health clinicians see the same gap as physicians on core codes. Hour-long psychotherapy under 90837 pays $118.41, 28th of 48, and the diagnostic evaluation under 90791 pays $122.75, 30th of 44.

The exception is therapeutic behavioral services. Code H2019 pays $112.43 per unit, ranking 2nd of 35, with the HE modifier marking the mental health version of the service. Agencies that deliver structured behavioral programs, rather than office psychotherapy, will find MaineCare among the best-paying Medicaid programs in the country for that work. Office-based clinicians should not assume that strength carries over to their codes. See Maine behavioral health rates.

Two codes stand out for attendant and in-home providers. Personal care under T1019 pays $8.61 per 15 minutes in the Section 19 waiver, or $34.44 an hour, 12th of 39 states and above the $7.07 median. Attendant care under S5125 pays only $3.85 per 15 minutes ($15.40 an hour), 28th of 31 states and well under the $6.47 median.

The difference between those two codes is the practical lesson. Agencies should confirm which code and which section authorize each client's hours, because the hourly revenue for similar hands-on work can differ sharply depending on the code. Registered nurse visits under G0299 in the Section 19 waiver pay $9.06 per 15 minutes, last of 20 ranked states.

Physical therapy is where Maine stands out most, and not in a good way. Using code S8990, MaineCare pays $11.66 per 15 minutes, or $46.64 an hour. That is 49th of 49 ranked states and 51.4% below the $96.04 national median. Exercise therapy under 97110 pays $20.16 per unit, between 70% and 72% of Medicare. Speech therapy under 92507 pays $53.17, 30th of 44.

There is a contrast inside therapy itself. Evaluations rank in the low 30s rather than last, so the gap is widest on the timed treatment units that make up most of a plan of care. Therapy practices weighing a Maine location should model revenue from these figures, not from neighboring states. See the full breakdown on the Maine outpatient therapy rates page.

The industry comparisons show where MaineCare rewards providers and where it does not:

• Hospice: routine home care pays $223.84 a day, third of 21 states and 19.9% above the median. Details on the Maine hospice Medicaid rates page.
• IDD services: in-home and community living supports under T2017 pay $45.04 an hour, 9th of 29 states and 29.0% above the median. See Maine IDD waiver rates.
• Home health: RN visits pay $16.48 per 15 minutes, 13th of 14 states and 31.2% below the median, one of the three lowest in the country.
• Private duty nursing: $36.24 an hour, 34th of 43 states and 33.9% below the median.
• ABA: technician-level ABA is billed under H2021 at $27.87 per 15 minutes rather than 97153, so it is not ranked against other states. See Maine ABA rates.

Taken together, Maine favors providers of long-term and residential supports over clinic-based and nurse-visit providers. Hospice and IDD operators get above-median rates; home health and private duty nursing agencies face some of the lowest nurse rates in the country.

Maine's published rates are not routed through comprehensive managed-care plans. Every program on file is fee-for-service, no managed-care service lines have been classified, and no state directed payment programs are on record.

For a provider, that simplifies contracting. In states with managed care, the published rate is often only a floor or an out-of-network default, and real revenue depends on negotiated plan contracts. In Maine, the published MaineCare rate is the payment. The flip side is that there is no plan to negotiate with: rate increases come from MaineCare rulemaking and rate letters, which is why following the notices below matters. The Maine managed care page tracks this status.

Changes already in effect

• Section 90 Primary Care Physicians, January 1, 2026, Medicare Standardization Rate Updates, published July 20, 2026.
• Section 31 FQHC Fiscal Year 2027 Rate Letters, published September 25, 2026.
• Section 97 PNMI Appendix F Rate Letters for FY 2027, plus a FY 2027 rate correction for Appendix C residential care facilities, effective July 1, 2026.
• Section 25 Dental prior authorization and rate changes effective July 1, 2026, with new deep sedation and anesthesia rates.
• Section 45 Hospitals inpatient cost-of-living adjustments and a DRG weight update.

Proposals to watch

• Section 80 Pharmacy Dispensing Fees, final draft rate and comment summary.
• Section 45 Hospital Services, a reimbursement methodology change.
• Section 20 rulemaking on allowances for adults with other related conditions.
• School Health-Related Services draft rates, open for public comment.
• MaineCare Accountable Communities Program state plan amendment, proposed September 30, 2026.

The primary care standardization update is the one most practices will feel. With history back to 2010, you can trace how each code moved before and after.

Maine pays the least for a 99213 visit among its New England neighbors:

Personal care tells a different story. Maine's $8.61 T1019 rate tops Connecticut, Massachusetts and New Hampshire but trails Rhode Island and Vermont, which pays $12.85. Behavior technician ABA rates in the region run from $13.46 per unit in Connecticut to $17.79 in New Hampshire.

The takeaway for a multi-state operator: Maine is a low-rate state for physicians, clinicians and therapists, and a comparatively strong one for hospice, ambulance and IDD providers.

• Budgeting. Identify the MaineCare section for each service line, then build revenue from that section's rate and unit. Convert per-15-minute rates to hourly before comparing with wages.
• Payer strategy. Because there is no managed-care layer, MaineCare rates cannot be improved through plan contracts. Decisions about MaineCare volume rest on the published rate alone.
• Advocacy and comment. Proposed rules and draft rates, such as the school health and pharmacy dispensing proposals, are open for public comment. Providers with cost data have a direct channel to influence rates.
• Benchmarking. Use the New England comparison for site decisions and the national median for internal margin targets.

The full set of 27,586 MaineCare rates, with section-level detail and history back to 2010, is available with a MedicaidRate plan.

MaineCare rates on MedicaidRate are compiled from official state Medicaid publications, and each rate links to its source document. Named sources include the MaineCare Fee Schedule (MaineCare UCR, HealthPAS report REF0060), the Section 60 Medical Supplies and Durable Medical Equipment and Section 4 Ambulatory Surgical Center schedules for 2026, the Section 90 drug and anesthesiology rates, Section 14 CRNA rates, and the Section 97 PNMI appendices. National medians and ranks compare the same code and unit across states that publish it. See how we compile and verify rates.