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Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0001F 0 N N N N N 1/1/2008 12/31/2078
0005F 0 N N N N N 1/1/2008 12/31/2078
00100 0 N N N N N 1/1/2008 12/31/2078
00102 0 N N N N N 1/1/2008 12/31/2078
00103 0 N N N N N 1/1/2008 12/31/2078
00104 0 N N N N N 1/1/2008 12/31/2078
00120 0 N N N N N 1/1/2008 12/31/2078
00124 0 N N N N N 1/1/2008 12/31/2078
00126 0 N N N N N 1/1/2008 12/31/2078
0012F 0 N N N N N 1/1/2008 12/31/2078
00140 0 N N N N N 1/1/2008 12/31/2078
00142 0 N N N N N 1/1/2008 12/31/2078
00144 0 N N N N N 1/1/2008 12/31/2078
00145 0 N N N N N 1/1/2008 12/31/2078
00147 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 1 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00148 0 N N N N N 1/1/2008 12/31/2078
0014F 0 N N N N N 1/1/2008 12/31/2078
0015F 0 N N N N N 1/1/2008 12/31/2078
00160 0 N N N N N 1/1/2008 12/31/2078
00162 0 N N N N N 1/1/2008 12/31/2078
00164 0 N N N N N 1/1/2008 12/31/2078
0016T 0 Y Y Y N N 1/1/2008 12/31/2010
00170 0 N N N N N 1/1/2008 12/31/2078
00172 0 N N N N N 1/1/2008 12/31/2078
00174 0 N N N N N 1/1/2008 12/31/2078
00176 0 N N N N N 1/1/2008 12/31/2078
0017T 0 Y Y Y N N 1/1/2008 12/31/2010
00190 0 N N N N N 1/1/2008 12/31/2078
00192 0 N N N N N 1/1/2008 12/31/2078
0019T 0 N N Y N N 1/1/2008 12/31/2016
09/08/2020 Global Surgery Rules.xls Page 2 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00210 0 N N N N N 1/1/2008 12/31/2078
00211 0 N N N N N 1/1/2009 12/31/2078
00212 0 N N N N N 1/1/2008 12/31/2078
00214 0 N N N N N 1/1/2008 12/31/2078
00215 0 N N N N N 1/1/2008 12/31/2078
00216 0 N N N N N 1/1/2008 12/31/2078
00218 0 N N N N N 1/1/2008 12/31/2078
00220 0 N N N N N 1/1/2008 12/31/2078
00222 0 N N N N N 1/1/2008 12/31/2078
0026T 0 N N Y N N 1/1/2008 12/31/2008
0027T 0 N N Y N N 1/1/2008 12/31/2008
0028T 0 N N Y N N 1/1/2008 12/31/2008
0029T 0 N N Y N N 1/1/2008 12/31/2008
00300 0 N N N N N 1/1/2008 12/31/2078
0030T 0 N N Y N N 1/1/2008 12/31/2012
09/08/2020 Global Surgery Rules.xls Page 3 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0031T 0 N N Y N N 1/1/2008 12/31/2008
00320 0 N N N N N 1/1/2008 12/31/2078
00322 0 N N N N N 1/1/2008 12/31/2078
00326 0 N N N N N 1/1/2008 12/31/2078
0032T 0 N N Y N N 1/1/2008 12/31/2008
00350 0 N N N N N 1/1/2008 12/31/2078
00352 0 N N N N N 1/1/2008 12/31/2078
00400 0 N N N N N 1/1/2008 12/31/2078
00402 0 N N N N N 1/1/2008 12/31/2078
00404 0 N N N N N 1/1/2008 12/31/2078
00406 0 N N N N N 1/1/2008 12/31/2078
00410 0 N N N N N 1/1/2008 12/31/2078
0041T 0 N N Y N N 1/1/2008 12/31/2008
0042T 0 N N Y N N 1/1/2008 12/31/2078
0043T 0 N N Y N N 1/1/2008 12/31/2008
09/08/2020 Global Surgery Rules.xls Page 4 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00450 0 N N N N N 1/1/2008 12/31/2078
00452 0 N N N N N 1/1/2008 12/31/2014
00452 0 N N N N N 1/1/2016 6/30/2016
00454 0 N N N N N 1/1/2008 12/31/2078
0046T 0 N N Y N N 1/1/2008 12/31/2008
00470 0 N N N N N 1/1/2008 12/31/2078
00472 0 N N N N N 1/1/2008 12/31/2078
00474 0 N N N N N 1/1/2008 12/31/2078
0047T 0 N N Y N N 1/1/2008 12/31/2008
0048T 0 N N Y N N 1/1/2008 12/31/2012
0049T 0 N N Y N N 1/1/2008 12/31/2008
00500 0 N N N N N 1/1/2008 12/31/2078
0050T 0 N N Y N N 1/1/2008 12/31/2012
0051T 0 N N Y N N 1/1/2008 12/31/2017
00520 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 5 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00522 0 N N N N N 1/1/2008 12/31/2078
00524 0 N N N N N 1/1/2008 12/31/2078
00528 0 N N N N N 1/1/2008 12/31/2078
00529 0 N N N N N 1/1/2008 12/31/2078
0052T 0 N N Y N N 1/1/2008 12/31/2017
00530 0 N N N N N 1/1/2008 12/31/2078
00532 0 N N N N N 1/1/2008 12/31/2078
00534 0 N N N N N 1/1/2008 12/31/2078
00537 0 N N N N N 1/1/2008 12/31/2078
00539 0 N N N N N 1/1/2008 12/31/2078
0053T 0 N N Y N N 1/1/2008 12/31/2017
00540 0 N N N N N 1/1/2008 12/31/2078
00541 0 N N N N N 1/1/2008 12/31/2078
00542 0 N N N N N 1/1/2008 12/31/2078
00546 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 6 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00548 0 N N N N N 1/1/2008 12/31/2078
0054T 0 N N Y N N 1/1/2009 12/31/2078
00550 0 N N N N N 1/1/2008 12/31/2078
0055T 0 N N Y N N 1/1/2009 12/31/2078
00560 0 N N N N N 1/1/2008 12/31/2078
00561 0 N N N N N 1/1/2008 12/31/2078
00562 0 N N N N N 1/1/2008 12/31/2078
00563 0 N N N N N 1/1/2008 12/31/2078
00566 0 N N N N N 1/1/2008 12/31/2078
00567 0 N N N N N 1/1/2009 12/31/2078
00580 0 N N N N N 1/1/2008 12/31/2078
0058T 0 N N Y N N 1/1/2008 12/31/2008
0058T 0 N N Y N N 1/1/2011 12/31/2078
0059T 0 N N Y N N 1/1/2008 12/31/2008
0059T 0 N N Y N N 1/1/2011 12/31/2014
09/08/2020 Global Surgery Rules.xls Page 7 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0059T 0 N N Y N N 1/1/2016 6/30/2016
00600 0 N N N N N 1/1/2008 12/31/2078
00604 0 N N N N N 1/1/2008 12/31/2078
0060T 0 N N Y N N 1/1/2008 12/31/2008
0061T 0 N N Y N N 1/1/2008 12/31/2008
00620 0 N N N N N 1/1/2008 12/31/2078
00622 0 N N N N N 1/1/2008 12/31/2014
00622 0 N N N N N 1/1/2016 6/30/2016
00625 0 N N N N N 1/1/2008 12/31/2078
00626 0 N N N N N 1/1/2008 12/31/2078
0062T 0 N N Y N N 1/1/2008 12/31/2009
00630 0 N N N N N 1/1/2008 12/31/2078
00632 0 N N N N N 1/1/2008 12/31/2078
00634 0 N N N N N 1/1/2008 12/31/2014
00634 0 N N N N N 1/1/2016 6/30/2016
09/08/2020 Global Surgery Rules.xls Page 8 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00635 0 N N N N N 1/1/2008 12/31/2078
0063T 0 N N Y N N 1/1/2008 12/31/2009
00640 0 N N N N N 1/1/2008 12/31/2078
0064T 0 N N Y N N 1/1/2008 12/31/2009
0066T 0 N N N N N 1/1/2008 12/31/2009
0066T 26 0 N N N N N 1/1/2008 12/31/2009
0066T TC 0 N N N N N 1/1/2008 12/31/2009
00670 0 N N N N N 1/1/2008 12/31/2078
0067T 0 N Y Y N N 1/1/2008 12/31/2009
0067T 26 0 N N Y N N 1/1/2008 12/31/2009
0067T TC 0 N Y Y N N 1/1/2008 12/31/2009
0068T 0 N N Y N N 1/1/2008 12/31/2009
0069T 0 N N Y N N 1/1/2008 12/31/2009
00700 0 N N N N N 1/1/2008 12/31/2078
00702 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 9 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0070T 0 N N Y N N 1/1/2008 12/31/2009
0071T 0 N N Y N N 1/1/2008 12/31/2078
0072T 0 N N Y N N 1/1/2008 12/31/2078
00730 0 N N N N N 1/1/2008 12/31/2078
00731 0 N N N N N 1/1/2018 12/31/2078
00732 0 N N N N N 1/1/2018 12/31/2078
0073T 0 N N Y N N 1/1/2008 12/31/2014
0073T 0 N N Y N N 1/1/2016 6/30/2016
00740 0 N N N N N 1/1/2008 12/31/2017
00750 0 N N N N N 1/1/2008 12/31/2078
00752 0 N N N N N 1/1/2008 12/31/2078
00754 0 N N N N N 1/1/2008 12/31/2078
00756 0 N N N N N 1/1/2008 12/31/2078
0075T 0 N N Y N N 1/1/2008 12/31/2078
0075T 26 0 N N Y N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 10 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0075T TC 0 N N Y N N 1/1/2008 12/31/2078
0076T 0 N N Y N N 1/1/2008 12/31/2078
0076T 26 0 N N Y N N 1/1/2008 12/31/2078
0076T TC 0 N N Y N N 1/1/2008 12/31/2078
00770 0 N N N N N 1/1/2008 12/31/2078
0077T 0 N N Y N N 1/1/2008 12/31/2009
0078T 0 N N Y N N 1/1/2008 12/31/2013
00790 0 N N N N N 1/1/2008 12/31/2078
00792 0 N N N N N 1/1/2008 12/31/2078
00794 0 N N N N N 1/1/2008 12/31/2078
00796 0 N N N N N 1/1/2008 12/31/2078
00797 0 N N N N N 1/1/2008 12/31/2078
0079T 0 N N Y N N 1/1/2008 12/31/2013
00800 0 N N N N N 1/1/2008 12/31/2078
00802 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 11 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0080T 0 N N Y N N 1/1/2008 12/31/2013
00810 0 N N N N N 1/1/2008 12/31/2017
00811 0 N N N N N 1/1/2018 12/31/2078
00812 0 N N N N N 1/1/2018 12/31/2078
00813 0 N N N N N 1/1/2018 12/31/2078
0081T 0 N N Y N N 1/1/2008 12/31/2013
00820 0 N N N N N 1/1/2008 12/31/2078
00830 0 N N N N N 1/1/2008 12/31/2078
00832 0 N N N N N 1/1/2008 12/31/2078
00834 0 N N N N N 1/1/2008 12/31/2078
00836 0 N N N N N 1/1/2008 12/31/2078
00840 0 N N N N N 1/1/2008 12/31/2078
00842 0 N N N N N 1/1/2008 12/31/2078
00844 0 N N N N N 1/1/2008 12/31/2078
00846 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 12 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00848 0 N N N N N 1/1/2008 12/31/2078
0084T 0 N N Y N N 1/1/2008 12/31/2009
00851 0 N N N N N 1/1/2008 12/31/2078
0085T 0 N N Y N N 1/1/2008 12/31/2009
0085T 0 N N N N N 1/1/2010 12/31/2078
00860 0 N N N N N 1/1/2008 12/31/2078
00862 0 N N N N N 1/1/2008 12/31/2078
00864 0 N N N N N 1/1/2008 12/31/2078
00865 0 N N N N N 1/1/2008 12/31/2078
00866 0 N N N N N 1/1/2008 12/31/2078
00868 0 N N N N N 1/1/2008 12/31/2078
0086T 0 N N Y N N 1/1/2008 12/31/2009
00870 0 N N N N N 1/1/2008 12/31/2078
00872 0 N N N N N 1/1/2008 12/31/2078
00873 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 13 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0087T 0 N N Y N N 1/1/2008 12/31/2009
00880 0 N N N N N 1/1/2008 12/31/2078
00882 0 N N N N N 1/1/2008 12/31/2078
0088T 0 N N Y N N 1/1/2008 12/31/2008
0089T 0 N N Y N N 1/1/2008 12/31/2008
00902 0 N N N N N 1/1/2008 12/31/2078
00904 0 N N N N N 1/1/2008 12/31/2078
00906 0 N N N N N 1/1/2008 12/31/2078
00908 0 N N N N N 1/1/2008 12/31/2078
0090T 0 N N Y N N 1/1/2008 12/31/2008
00910 0 N N N N N 1/1/2008 12/31/2078
00912 0 N N N N N 1/1/2008 12/31/2078
00914 0 N N N N N 1/1/2008 12/31/2078
00916 0 N N N N N 1/1/2008 12/31/2078
00918 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 14 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00920 0 N N N N N 1/1/2008 12/31/2078
00921 0 N N N N N 1/1/2008 12/31/2078
00922 0 N N N N N 1/1/2008 12/31/2078
00924 0 N N N N N 1/1/2008 12/31/2078
00926 0 N N N N N 1/1/2008 12/31/2078
00928 0 N N N N N 1/1/2008 12/31/2078
0092T 0 N N Y N N 1/1/2008 12/31/2014
0092T 0 N N Y N N 1/1/2016 6/30/2016
00930 0 N N N N N 1/1/2008 12/31/2078
00932 0 N N N N N 1/1/2008 12/31/2078
00934 0 N N N N N 1/1/2008 12/31/2078
00936 0 N N N N N 1/1/2008 12/31/2078
00938 0 N N N N N 1/1/2008 12/31/2078
0093T 0 N N Y N N 1/1/2008 12/31/2008
00940 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 15 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
00942 0 N N N N N 1/1/2008 12/31/2078
00944 0 N N N N N 1/1/2008 12/31/2078
00948 0 N N N N N 1/1/2008 12/31/2078
00950 0 N N N N N 1/1/2008 12/31/2078
00952 0 N N N N N 1/1/2008 12/31/2078
0095T 0 N N Y N N 1/1/2008 12/31/2078
0096T 0 N N Y N N 1/1/2008 12/31/2008
0098T 0 N N Y N N 1/1/2008 12/31/2078
0099T 0 N N Y N N 1/1/2008 12/31/2015
0100T 0 N N Y N N 1/1/2008 12/31/2078
0101T 0 N N Y N N 1/1/2008 12/31/2078
0102T 0 N N Y N N 1/1/2008 12/31/2078
0103T 0 N N Y N N 1/1/2008 12/31/2015
0104T 0 N N Y N N 1/1/2008 12/31/2010
0105T 0 N N Y N N 1/1/2008 12/31/2010
09/08/2020 Global Surgery Rules.xls Page 16 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0106T 0 N N Y N N 1/1/2008 12/31/2078
0107T 0 N N Y N N 1/1/2008 12/31/2078
0108T 0 N N Y N N 1/1/2008 12/31/2078
0109T 0 N N Y N N 1/1/2008 12/31/2078
0110T 0 N N Y N N 1/1/2008 12/31/2078
01112 0 N N N N N 1/1/2008 12/31/2078
0111T 0 N N Y N N 1/1/2008 12/31/2015
0111T 0 N N N N N 1/1/2016 12/31/2078
01120 0 N N N N N 1/1/2008 12/31/2078
01130 0 N N N N N 1/1/2008 12/31/2078
01140 0 N N N N N 1/1/2008 12/31/2078
01150 0 N N N N N 1/1/2008 12/31/2078
01160 0 N N N N N 1/1/2008 12/31/2078
01170 0 N N N N N 1/1/2008 12/31/2078
01173 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 17 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01180 0 N N N N N 1/1/2008 12/31/2017
01190 0 N N N N N 1/1/2008 12/31/2017
01200 0 N N N N N 1/1/2008 12/31/2078
01202 0 N N N N N 1/1/2008 12/31/2078
01210 0 N N N N N 1/1/2008 12/31/2078
01212 0 N N N N N 1/1/2008 12/31/2078
01214 0 N N N N N 1/1/2008 12/31/2078
01215 0 N N N N N 1/1/2008 12/31/2078
01220 0 N N N N N 1/1/2008 12/31/2078
01230 0 N N N N N 1/1/2008 12/31/2078
01232 0 N N N N N 1/1/2008 12/31/2078
01234 0 N N N N N 1/1/2008 12/31/2078
0123T 0 N N Y N N 1/1/2008 12/31/2015
0124T 0 N N Y N N 1/1/2008 12/31/2013
01250 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 18 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01260 0 N N N N N 1/1/2008 12/31/2078
0126T 0 N N Y N N 1/1/2008 12/31/2078
01270 0 N N N N N 1/1/2008 12/31/2078
01272 0 N N N N N 1/1/2008 12/31/2078
01274 0 N N N N N 1/1/2008 12/31/2078
0130T 0 N N Y N N 1/1/2008 12/31/2010
01320 0 N N N N N 1/1/2008 12/31/2078
01340 0 N N N N N 1/1/2008 12/31/2078
01360 0 N N N N N 1/1/2008 12/31/2078
0137T 0 N N Y N N 1/1/2008 12/31/2008
01380 0 N N N N N 1/1/2008 12/31/2078
01382 0 N N N N N 1/1/2008 12/31/2078
01390 0 N N N N N 1/1/2008 12/31/2078
01392 0 N N N N N 1/1/2008 12/31/2078
01400 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 19 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01402 0 N N N N N 1/1/2008 12/31/2078
01404 0 N N N N N 1/1/2008 12/31/2078
0140T 0 N N Y N N 1/1/2008 12/31/2010
0141T 0 N N N N N 1/1/2008 12/31/2011
01420 0 N N N N N 1/1/2008 12/31/2078
0142T 0 N N N N N 1/1/2008 12/31/2011
01430 0 N N N N N 1/1/2008 12/31/2078
01432 0 N N N N N 1/1/2008 12/31/2078
0143T 0 N N N N N 1/1/2008 12/31/2011
01440 0 N N N N N 1/1/2008 12/31/2078
01442 0 N N N N N 1/1/2008 12/31/2078
01444 0 N N N N N 1/1/2008 12/31/2078
0144T 0 N N Y N N 1/1/2008 12/31/2009
0144T 26 0 N N Y N N 1/1/2008 12/31/2009
0144T TC 0 N N Y N N 1/1/2008 12/31/2009
09/08/2020 Global Surgery Rules.xls Page 20 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0145T 0 N N Y N N 1/1/2008 12/31/2009
0145T 26 0 N N Y N N 1/1/2008 12/31/2009
0145T TC 0 N N Y N N 1/1/2008 12/31/2009
01462 0 N N N N N 1/1/2008 12/31/2078
01464 0 N N N N N 1/1/2008 12/31/2078
0146T 0 N N Y N N 1/1/2008 12/31/2009
0146T 26 0 N N Y N N 1/1/2008 12/31/2009
0146T TC 0 N N Y N N 1/1/2008 12/31/2009
01470 0 N N N N N 1/1/2008 12/31/2078
01472 0 N N N N N 1/1/2008 12/31/2078
01474 0 N N N N N 1/1/2008 12/31/2078
0147T 0 N N Y N N 1/1/2008 12/31/2009
0147T 26 0 N N Y N N 1/1/2008 12/31/2009
0147T TC 0 N N Y N N 1/1/2008 12/31/2009
01480 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 21 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01482 0 N N N N N 1/1/2008 12/31/2078
01484 0 N N N N N 1/1/2008 12/31/2078
01486 0 N N N N N 1/1/2008 12/31/2078
0148T 0 N N Y N N 1/1/2008 12/31/2009
0148T 26 0 N N Y N N 1/1/2008 12/31/2009
0148T TC 0 N N Y N N 1/1/2008 12/31/2009
01490 0 N N N N N 1/1/2008 12/31/2078
0149T 0 N N Y N N 1/1/2008 12/31/2009
0149T 26 0 N N Y N N 1/1/2008 12/31/2009
0149T TC 0 N N Y N N 1/1/2008 12/31/2009
01500 0 N N N N N 1/1/2008 12/31/2078
01502 0 N N N N N 1/1/2008 12/31/2078
0150T 0 N N Y N N 1/1/2008 12/31/2009
0150T 26 0 N N Y N N 1/1/2008 12/31/2009
0150T TC 0 N N Y N N 1/1/2008 12/31/2009
09/08/2020 Global Surgery Rules.xls Page 22 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0151T 0 N N Y N N 1/1/2008 12/31/2009
0151T 26 0 N N Y N N 1/1/2008 12/31/2009
0151T TC 0 N N Y N N 1/1/2008 12/31/2009
01520 0 N N N N N 1/1/2008 12/31/2078
01522 0 N N N N N 1/1/2008 12/31/2078
0155T 0 N N Y N N 1/1/2008 12/31/2011
0156T 0 N N Y N N 1/1/2008 12/31/2011
0157T 0 N N Y N N 1/1/2008 12/31/2011
0158T 0 N N Y N N 1/1/2008 12/31/2011
0159T 0 N N Y N N 1/1/2008 12/31/2018
0159T 26 0 N N Y N N 1/1/2008 12/31/2018
0159T TC 0 N N Y N N 1/1/2008 12/31/2018
0160T 0 N N Y N N 1/1/2008 12/31/2010
01610 0 N N N N N 1/1/2008 12/31/2078
0161T 0 N N Y N N 1/1/2008 12/31/2010
09/08/2020 Global Surgery Rules.xls Page 23 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01620 0 N N N N N 1/1/2008 12/31/2078
01622 0 N N N N N 1/1/2008 12/31/2078
0162T 0 N N Y N N 1/1/2008 12/31/2008
01630 0 N N N N N 1/1/2008 12/31/2078
01632 0 N N N N N 1/1/2008 12/31/2009
01634 0 N N N N N 1/1/2008 12/31/2078
01636 0 N N N N N 1/1/2008 12/31/2078
01638 0 N N N N N 1/1/2008 12/31/2078
0163T 0 N N Y N N 1/1/2008 12/31/2078
0164T 0 N N Y N N 1/1/2008 12/31/2078
01650 0 N N N N N 1/1/2008 12/31/2078
01652 0 N N N N N 1/1/2008 12/31/2078
01654 0 N N N N N 1/1/2008 12/31/2078
01656 0 N N N N N 1/1/2008 12/31/2078
0165T 0 N N Y N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 24 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0166T 0 N N Y N N 1/1/2008 12/31/2011
01670 0 N N N N N 1/1/2008 12/31/2078
0167T 0 N N Y N N 1/1/2008 12/31/2011
01680 0 N N N N N 1/1/2008 12/31/2078
01682 0 N N N N N 1/1/2008 12/31/2017
0168T 0 N N Y N N 1/1/2008 12/31/2011
0169T 0 N N Y N N 1/1/2008 12/31/2016
0170T 0 N N Y N N 1/1/2008 12/31/2009
01710 0 N N N N N 1/1/2008 12/31/2078
01712 0 N N N N N 1/1/2008 12/31/2078
01714 0 N N N N N 1/1/2008 12/31/2078
01716 0 N N N N N 1/1/2008 12/31/2078
0171T 0 N N Y N N 1/1/2008 12/31/2016
0172T 0 N N Y N N 1/1/2008 12/31/2016
01730 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 25 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01732 0 N N N N N 1/1/2008 12/31/2078
0173T 0 N N Y N N 1/1/2008 12/31/2012
01740 0 N N N N N 1/1/2008 12/31/2078
01742 0 N N N N N 1/1/2008 12/31/2078
01744 0 N N N N N 1/1/2008 12/31/2078
0174T 0 N N Y N N 1/1/2008 12/31/2078
01756 0 N N N N N 1/1/2008 12/31/2078
01758 0 N N N N N 1/1/2008 12/31/2078
0175T 0 N N Y N N 1/1/2008 12/31/2078
01760 0 N N N N N 1/1/2008 12/31/2078
0176T 0 N N Y N N 1/1/2008 12/31/2010
01770 0 N N N N N 1/1/2008 12/31/2078
01772 0 N N N N N 1/1/2008 12/31/2078
0177T 0 N N Y N N 1/1/2008 12/31/2010
01780 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 26 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01782 0 N N N N N 1/1/2008 12/31/2078
0178T 0 N N Y N N 1/1/2008 12/31/2017
0179T 0 N N Y N N 1/1/2008 12/31/2017
0180T 0 N N Y N N 1/1/2008 12/31/2017
01810 0 N N N N N 1/1/2008 12/31/2078
0181T 0 N N Y N N 1/1/2008 12/31/2014
0181T 0 N N Y N N 1/1/2016 6/30/2016
01820 0 N N N N N 1/1/2008 12/31/2078
01829 0 N N N N N 1/1/2008 12/31/2078
0182T 0 N N Y N N 1/1/2008 12/31/2015
0182T 26 0 N N Y N N 1/1/2010 12/31/2015
0182T TC 0 N N Y N N 1/1/2010 12/31/2015
01830 0 N N N N N 1/1/2008 12/31/2078
01832 0 N N N N N 1/1/2008 12/31/2078
0183T 0 N N Y N N 1/1/2008 12/31/2013
09/08/2020 Global Surgery Rules.xls Page 27 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01840 0 N N N N N 1/1/2008 12/31/2078
01842 0 N N N N N 1/1/2008 12/31/2078
01844 0 N N N N N 1/1/2008 12/31/2078
0184T 0 N N Y N N 1/1/2008 12/31/2078
01850 0 N N N N N 1/1/2008 12/31/2078
01852 0 N N N N N 1/1/2008 12/31/2078
0185T 0 N N Y N N 1/1/2008 12/31/2013
01860 0 N N N N N 1/1/2008 12/31/2078
0186T 0 N N Y N N 1/1/2008 12/31/2013
0187T 0 N N Y N N 1/1/2008 12/31/2010
0188T 0 N N N N N 1/1/2009 12/31/2018
0189T 0 N N N N N 1/1/2009 12/31/2018
0190T 0 N N Y N N 1/1/2009 12/31/2018
01916 0 N N N N N 1/1/2008 12/31/2078
0191T 0 N N Y N N 1/1/2009 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 28 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01920 0 N N N N N 1/1/2008 12/31/2078
01922 0 N N N N N 1/1/2008 12/31/2078
01924 0 N N N N N 1/1/2008 12/31/2078
01925 0 N N N N N 1/1/2008 12/31/2078
01926 0 N N N N N 1/1/2008 12/31/2078
0192T 0 N N Y N N 1/1/2009 12/31/2013
01930 0 N N N N N 1/1/2008 12/31/2078
01931 0 N N N N N 1/1/2008 12/31/2078
01932 0 N N N N N 1/1/2008 12/31/2078
01933 0 N N N N N 1/1/2008 12/31/2078
01935 0 N N N N N 1/1/2008 12/31/2078
01936 0 N N N N N 1/1/2008 12/31/2078
0193T 0 N N Y N N 1/1/2009 12/31/2011
0194T 0 N N Y N N 1/1/2009 12/31/2009
01951 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 29 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
01952 0 N N N N N 1/1/2008 12/31/2078
01953 0 N N N N N 1/1/2008 12/31/2078
01958 0 N N N N N 1/1/2008 12/31/2078
0195T 0 N N Y N N 1/1/2009 12/31/2018
01960 0 N N N N N 1/1/2008 12/31/2078
01961 0 N N N N N 1/1/2008 12/31/2078
01962 0 N N N N N 1/1/2008 12/31/2078
01963 0 N N N N N 1/1/2008 12/31/2078
01965 0 N N N N N 1/1/2008 12/31/2078
01966 0 N N N N N 1/1/2008 12/31/2078
01967 0 N N N N N 1/1/2008 12/31/2078
01968 0 N N N N N 1/1/2008 12/31/2078
01969 0 N N N N N 1/1/2008 12/31/2078
0196T 0 N N Y N N 1/1/2009 12/31/2018
0197T 0 N N Y N N 1/1/2009 12/31/2014
09/08/2020 Global Surgery Rules.xls Page 30 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0197T 0 N N Y N N 1/1/2016 6/30/2016
0198T 0 N N Y N N 1/1/2009 12/31/2078
01990 0 N N N N N 1/1/2008 12/31/2078
01991 0 N N N N N 1/1/2008 12/31/2078
01992 0 N N N N N 1/1/2008 12/31/2078
01996 0 N N N N N 1/1/2008 12/31/2078
01999 0 N N N N N 1/1/2008 12/31/2078
0199T 0 N N Y N N 1/1/2010 12/31/2014
0199T 0 N N Y N N 1/1/2016 6/30/2016
0200T 0 Y N Y N N 1/1/2010 12/31/2078
0201T 0 N N Y N N 1/1/2010 12/31/2078
0202T 0 N N Y N N 1/1/2010 12/31/2078
0203T 0 N N Y N N 1/1/2010 12/31/2010
0203T 26 0 N N Y N N 1/1/2010 12/31/2010
0203T TC 0 N N Y N N 1/1/2010 12/31/2010
09/08/2020 Global Surgery Rules.xls Page 31 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0204T 0 N N Y N N 1/1/2010 12/31/2010
0204T 26 0 N N Y N N 1/1/2010 12/31/2010
0204T TC 0 N N Y N N 1/1/2010 12/31/2010
0205T 0 N N Y N N 1/1/2010 12/31/2019
0206T 0 N N Y N N 1/1/2010 12/31/2019
0207T 0 N N Y N N 1/1/2010 12/31/2078
0208T 0 N N Y N N 1/1/2010 12/31/2078
0209T 0 N N Y N N 1/1/2010 12/31/2078
0210T 0 N N Y N N 1/1/2010 12/31/2078
0211T 0 N N Y N N 1/1/2010 12/31/2078
0212T 0 N N Y N N 1/1/2010 12/31/2078
0213T 0 Y N Y N N 1/1/2010 12/31/2078
0214T 0 Y N Y N N 1/1/2010 12/31/2078
0215T 0 Y N Y N N 1/1/2010 12/31/2078
0216T 0 Y N Y N N 1/1/2010 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 32 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0217T 0 Y N Y N N 1/1/2010 12/31/2078
0218T 0 Y N Y N N 1/1/2010 12/31/2078
0219T 0 N N Y N N 1/1/2010 12/31/2078
0220T 0 N N Y N N 1/1/2010 12/31/2078
0221T 0 N N Y N N 1/1/2010 12/31/2078
0222T 0 N N Y N N 1/1/2010 12/31/2078
0223T 0 N N Y N N 1/1/2011 12/31/2015
0224T 0 N N Y N N 1/1/2011 12/31/2015
0225T 0 N N Y N N 1/1/2011 12/31/2015
0226T 0 N N N N N 1/1/2011 12/31/2014
0226T 0 N N Y N N 1/1/2016 6/30/2016
0227T 0 N N N N N 1/1/2011 12/31/2014
0227T 0 N N Y N N 1/1/2016 6/30/2016
0228T 0 Y N N N N 1/1/2011 12/31/2078
0229T 0 Y N N N N 1/1/2011 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 33 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0230T 0 Y N N N N 1/1/2011 12/31/2078
0231T 0 Y N N N N 1/1/2011 12/31/2078
0232T 0 N N N N N 1/1/2011 12/31/2078
0233T 0 N N Y N N 1/1/2011 12/31/2015
0234T 0 N N Y N N 1/1/2011 12/31/2078
0235T 0 N N Y N N 1/1/2011 12/31/2078
0236T 0 N N Y N N 1/1/2011 12/31/2078
0237T 0 N N Y N N 1/1/2011 12/31/2078
0238T 0 N N Y N N 1/1/2011 12/31/2078
0239T 0 N N Y N N 1/1/2011 12/31/2014
0239T 0 N N Y N N 1/1/2016 6/30/2016
0240T 0 N N Y N N 1/1/2011 12/31/2015
0240T 26 0 N N Y N N 1/1/2011 12/31/2015
0240T TC 0 N N Y N N 1/1/2011 12/31/2015
0241T 0 N N Y N N 1/1/2011 12/31/2015
09/08/2020 Global Surgery Rules.xls Page 34 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0241T 26 0 N N Y N N 1/1/2011 12/31/2015
0241T TC 0 N N Y N N 1/1/2011 12/31/2015
0242T 0 N N Y N N 1/1/2011 12/31/2012
0242T 26 0 N N Y N N 1/1/2011 12/31/2012
0242T TC 0 N N Y N N 1/1/2011 12/31/2012
0243T 0 N N Y N N 1/1/2011 12/31/2015
0243T 26 0 N N Y N N 1/1/2011 12/31/2015
0243T TC 0 N N Y N N 1/1/2011 12/31/2015
0244T 0 N N Y N N 1/1/2011 12/31/2015
0244T 26 0 N N Y N N 1/1/2011 12/31/2015
0244T TC 0 N N Y N N 1/1/2011 12/31/2015
0245T 0 Y N Y N N 1/1/2011 12/31/2014
0245T 0 N N Y N N 1/1/2016 6/30/2016
0246T 0 Y N Y N N 1/1/2011 12/31/2014
0246T 0 N N Y N N 1/1/2016 6/30/2016
09/08/2020 Global Surgery Rules.xls Page 35 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0247T 0 Y N Y N N 1/1/2011 12/31/2014
0247T 0 N N Y N N 1/1/2016 6/30/2016
0248T 0 Y N Y N N 1/1/2011 12/31/2014
0248T 0 N N Y N N 1/1/2016 6/30/2016
0249T 0 N N Y N N 1/1/2011 12/31/2019
0250T 0 N N Y N N 1/1/2011 12/31/2012
0251T 0 N N Y N N 1/1/2011 12/31/2012
0252T 0 N N Y N N 1/1/2011 12/31/2012
0253T 0 N N Y N N 1/1/2011 12/31/2078
0254T 0 N N Y N N 1/1/2011 12/31/2019
0255T 0 N N Y N N 1/1/2011 12/31/2017
0255T 26 0 N N Y N N 1/1/2011 12/31/2017
0255T TC 0 N N Y N N 1/1/2011 12/31/2017
0256T 0 N N Y N N 1/1/2011 12/31/2011
0256T 0 N N Y Y Y 1/1/2012 12/31/2012
09/08/2020 Global Surgery Rules.xls Page 36 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0257T 0 N N Y N N 1/1/2011 12/31/2011
0257T 0 N N Y Y Y 1/1/2012 12/31/2012
0258T 0 N N Y N N 1/1/2011 12/31/2011
0258T 0 N N Y Y Y 1/1/2012 12/31/2012
0259T 0 N N Y N N 1/1/2011 12/31/2011
0259T 0 N N Y Y Y 1/1/2012 12/31/2012
0260T 0 N N Y N N 1/1/2011 12/31/2013
0261T 0 N N Y N N 1/1/2011 12/31/2013
0262T 0 N N Y N N 1/1/2012 12/31/2015
0263T 0 N N Y N N 1/1/2012 12/31/2078
0264T 0 N N Y N N 1/1/2012 12/31/2078
0265T 0 N N Y N N 1/1/2012 12/31/2078
0266T 0 N N Y N N 1/1/2012 12/31/2078
0267T 0 N N Y N N 1/1/2012 12/31/2078
0268T 0 N N Y N N 1/1/2012 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 37 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0269T 0 N N Y N N 1/1/2012 12/31/2078
0270T 0 N N Y N N 1/1/2012 12/31/2078
0271T 0 N N Y N N 1/1/2012 12/31/2078
0272T 0 N N Y N N 1/1/2012 12/31/2078
0273T 0 N N Y N N 1/1/2012 12/31/2078
0274T 0 N N Y N N 1/1/2012 12/31/2078
0275T 0 N N Y N N 1/1/2012 9/30/2014
0275T 0 N N N N N 10/1/2014 12/31/2078
0276T 0 N N Y N N 1/1/2012 12/31/2012
0277T 0 N N Y N N 1/1/2012 12/31/2012
0278T 0 N N Y N N 1/1/2012 12/31/2078
0279T 0 N N Y N N 1/1/2012 12/31/2012
0280T 0 N N Y N N 1/1/2012 12/31/2012
0281T 0 N N Y N N 1/1/2012 12/31/2016
0282T 0 Y N Y N N 1/1/2012 12/31/2016
09/08/2020 Global Surgery Rules.xls Page 38 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0283T 0 Y N Y N N 1/1/2012 12/31/2016
0284T 0 N N Y N N 1/1/2012 12/31/2016
0285T 0 N N Y N N 1/1/2012 12/31/2016
0286T 0 N N Y N N 1/1/2012 12/31/2016
0287T 0 N N Y N N 1/1/2012 12/31/2016
0288T 0 N N Y N N 1/1/2012 12/31/2016
0289T 0 N N Y N N 1/1/2012 12/31/2016
0290T 0 N N Y N N 1/1/2012 12/31/2078
0291T 0 N N Y N N 1/1/2012 12/31/2016
0292T 0 N N Y N N 1/1/2012 12/31/2016
0293T 0 N N Y N N 1/1/2012 12/31/2017
0294T 0 N N Y N N 1/1/2012 12/31/2017
0295T 0 N N Y N N 1/1/2012 12/31/2078
0296T 0 N N Y N N 1/1/2012 12/31/2078
0297T 0 N N Y N N 1/1/2012 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 39 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0298T 0 N N Y N N 1/1/2012 12/31/2078
0299T 0 N N Y N N 1/1/2012 12/31/2017
0300T 0 N N Y N N 1/1/2012 12/31/2017
0301T 0 N N Y N N 1/1/2012 12/31/2017
0302T 0 N Y N N Y 7/1/2012 12/31/2017
0303T 0 N Y N N N 7/1/2012 12/31/2017
0304T 0 N Y N N N 7/1/2012 12/31/2017
0305T 0 N N Y N N 7/1/2012 12/31/2017
0306T 0 N N Y N N 7/1/2012 12/31/2017
0307T 0 N Y N N N 7/1/2012 12/31/2017
0308T 0 Y Y N N N 7/1/2012 12/31/2078
0309T 0 N N Y N N 1/1/2013 12/31/2017
0310T 0 N N Y N N 1/1/2013 12/31/2017
0311T 0 N N Y N N 1/1/2013 12/31/2015
0312T 0 N N Y N N 1/1/2013 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 40 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0313T 0 N N Y N N 1/1/2013 12/31/2078
0314T 0 N N Y N N 1/1/2013 12/31/2078
0315T 0 N N Y N N 1/1/2013 12/31/2078
0316T 0 N N Y N N 1/1/2013 12/31/2078
0317T 0 N N Y N N 1/1/2013 12/31/2078
0318T 0 N Y Y Y Y 1/1/2013 12/31/2013
0319T 0 N N Y N N 1/1/2013 12/31/2014
0319T 0 N N Y N N 1/1/2016 6/30/2016
0320T 0 N N Y N N 1/1/2013 12/31/2014
0320T 0 N N Y N N 1/1/2016 6/30/2016
0321T 0 N N Y N N 1/1/2013 12/31/2014
0321T 0 N N Y N N 1/1/2016 6/30/2016
0322T 0 N N Y N N 1/1/2013 12/31/2014
0322T 0 N N Y N N 1/1/2016 6/30/2016
0323T 0 N N Y N N 1/1/2013 12/31/2014
09/08/2020 Global Surgery Rules.xls Page 41 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0323T 0 N N Y N N 1/1/2016 6/30/2016
0324T 0 N N Y N N 1/1/2013 12/31/2014
0324T 0 N N Y N N 1/1/2016 6/30/2016
0325T 0 N N Y N N 1/1/2013 12/31/2014
0325T 0 N N Y N N 1/1/2016 6/30/2016
0326T 0 N N Y N N 1/1/2013 12/31/2014
0326T 0 N N Y N N 1/1/2016 6/30/2016
0327T 0 N N Y N N 1/1/2013 12/31/2014
0327T 0 N N Y N N 1/1/2016 6/30/2016
0328T 0 N N Y N N 1/1/2013 12/31/2014
0328T 0 N N Y N N 1/1/2016 6/30/2016
0329T 0 N N N N N 1/1/2014 12/31/2078
0330T 0 N N N N N 1/1/2014 12/31/2078
0331T 0 N N N N N 1/1/2014 12/31/2078
0332T 0 N N N N N 1/1/2014 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 42 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0333T 0 N N N N N 1/1/2014 12/31/2078
0334T 0 N N N N N 1/1/2014 12/31/2014
0334T 0 N N Y N N 1/1/2016 6/30/2016
0335T 0 N N N N N 1/1/2014 12/31/2078
0336T 0 N N N N N 1/1/2014 12/31/2016
0337T 0 N N N N N 1/1/2014 12/31/2018
0338T 0 N N N N N 1/1/2014 12/31/2078
0339T 0 N N N N N 1/1/2014 12/31/2078
0340T 0 N N N N N 1/1/2014 12/31/2017
0341T 0 N N N N N 1/1/2014 12/31/2019
0342T 0 N N N N N 1/1/2014 12/31/2078
0343T 0 N N N N N 1/1/2014 12/31/2014
0343T 0 N N Y N N 1/1/2016 6/30/2016
0344T 0 N N N N N 1/1/2014 12/31/2014
0344T 0 N N Y N N 1/1/2016 6/30/2016
09/08/2020 Global Surgery Rules.xls Page 43 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0345T 0 N N N N N 1/1/2014 12/31/2078
0346T 0 N N N N N 1/1/2014 12/31/2018
0347T 0 N N N N N 7/1/2014 12/31/2078
0348T 0 N N N N N 7/1/2014 12/31/2078
0349T 0 N N N N N 7/1/2014 12/31/2078
0350T 0 N N N N N 7/1/2014 12/31/2078
0351T 0 N N N N N 7/1/2014 12/31/2078
0352T 0 N N N N N 7/1/2014 12/31/2078
0353T 0 N N N N N 7/1/2014 12/31/2078
0354T 0 N N N N N 7/1/2014 12/31/2078
0355T 0 N N N N N 7/1/2014 12/31/2078
0356T 0 N N N N N 7/1/2014 12/31/2078
0357T 0 N N Y N N 1/1/2015 12/31/2019
0358T 0 N N N N N 7/1/2014 12/31/2078
0359T 0 N N N N N 7/1/2014 12/31/2018
09/08/2020 Global Surgery Rules.xls Page 44 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0360T 0 N N N N N 7/1/2014 12/31/2018
0361T 0 N N N N N 7/1/2014 12/31/2018
0362T 0 N N N N N 7/1/2014 12/31/2078
0363T 0 N N N N N 7/1/2014 12/31/2018
0364T 0 N N N N N 7/1/2014 12/31/2018
0365T 0 N N N N N 7/1/2014 12/31/2018
0366T 0 N N N N N 7/1/2014 12/31/2018
0367T 0 N N N N N 7/1/2014 12/31/2018
0368T 0 N N N N N 7/1/2014 12/31/2018
0369T 0 N N N N N 7/1/2014 12/31/2018
0370T 0 N N N N N 7/1/2014 12/31/2018
0371T 0 N N N N N 7/1/2014 12/31/2018
0372T 0 N N N N N 7/1/2014 12/31/2018
0373T 0 N N N N N 7/1/2014 12/31/2078
0374T 0 N N N N N 7/1/2014 12/31/2018
09/08/2020 Global Surgery Rules.xls Page 45 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0375T 0 N N Y N N 1/1/2015 12/31/2019
0376T 0 N N Y N N 1/1/2015 12/31/2078
0377T 0 N N Y N N 1/1/2015 12/31/2019
0378T 0 N N Y N N 1/1/2015 12/31/2078
0379T 0 N N Y N N 1/1/2015 12/31/2078
0380T 0 N N Y N N 1/1/2015 12/31/2019
0381T 0 N N Y N N 1/1/2015 12/31/2078
0382T 0 N N Y N N 1/1/2015 12/31/2078
0383T 0 N N Y N N 1/1/2015 12/31/2078
0384T 0 N N Y N N 1/1/2015 12/31/2078
0385T 0 N N Y N N 1/1/2015 12/31/2078
0386T 0 N N Y N N 1/1/2015 12/31/2078
0387T 0 N N Y N N 1/1/2015 12/31/2018
0388T 0 N N Y N N 1/1/2015 12/31/2018
0389T 0 N N Y N N 1/1/2015 12/31/2018
09/08/2020 Global Surgery Rules.xls Page 46 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0390T 0 N N Y N N 1/1/2015 12/31/2018
0391T 0 N N Y N N 1/1/2015 12/31/2018
0392T 0 N N Y N N 7/1/2015 12/31/2016
0393T 0 N N Y N N 7/1/2015 12/31/2016
0394T 0 N N Y N N 1/1/2016 12/31/2078
0395T 0 N N Y N N 1/1/2016 12/31/2078
0396T 0 N N Y N N 1/1/2016 12/31/2078
0397T 0 N N Y N N 1/1/2016 12/31/2078
0398T 0 N N Y N N 1/1/2016 12/31/2078
0399T 0 N N Y N N 1/1/2016 12/31/2019
0400T 0 N N Y N N 1/1/2016 12/31/2078
0401T 0 N N Y N N 1/1/2016 12/31/2078
0402T 0 N N Y N N 1/1/2016 12/31/2078
0403T 0 N N Y N N 1/1/2016 12/31/2078
0404T 0 N N Y N N 1/1/2016 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 47 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0405T 0 N N Y N N 1/1/2016 12/31/2078
0406T 0 N N Y N N 1/1/2016 12/31/2018
0407T 0 N N Y N N 1/1/2016 12/31/2018
0408T 0 N N Y N N 1/1/2016 12/31/2078
0409T 0 N N Y N N 1/1/2016 12/31/2078
0410T 0 N N Y N N 1/1/2016 12/31/2078
0411T 0 N N Y N N 1/1/2016 12/31/2078
0412T 0 N N Y N N 1/1/2016 12/31/2078
0413T 0 N N Y N N 1/1/2016 12/31/2078
0414T 0 N N Y N N 1/1/2016 12/31/2078
0415T 0 N N Y N N 1/1/2016 12/31/2078
0416T 0 N N Y N N 1/1/2016 12/31/2078
0417T 0 N N Y N N 1/1/2016 12/31/2078
0418T 0 N N Y N N 1/1/2016 12/31/2078
0419T 0 N N Y N N 1/1/2016 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 48 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0420T 0 N N Y N N 1/1/2016 12/31/2078
0421T 0 N N Y N N 1/1/2016 12/31/2078
0422T 0 N N Y N N 1/1/2016 12/31/2078
0423T 0 N N N N N 1/1/2016 12/31/2078
0424T 0 N N Y N N 1/1/2016 12/31/2078
0425T 0 N N Y N N 1/1/2016 12/31/2078
0426T 0 N N Y N N 1/1/2016 12/31/2078
0427T 0 N N Y N N 1/1/2016 12/31/2078
0428T 0 N N Y N N 1/1/2016 12/31/2078
0429T 0 N N Y N N 1/1/2016 12/31/2078
0430T 0 N N Y N N 1/1/2016 12/31/2078
0431T 0 N N Y N N 1/1/2016 12/31/2078
0432T 0 N N Y N N 1/1/2016 12/31/2078
0433T 0 N N Y N N 1/1/2016 12/31/2078
0434T 0 N N Y N N 1/1/2016 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 49 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0435T 0 N N Y N N 1/1/2016 12/31/2078
0436T 0 N N Y N N 1/1/2016 12/31/2078
0437T 0 N N Y N N 7/1/2016 12/31/2078
0438T 0 N N Y N N 7/1/2016 12/31/2017
0439T 0 N N Y N N 7/1/2016 12/31/2078
0440T 0 N N Y N N 7/1/2016 12/31/2078
0441T 0 N N Y N N 7/1/2016 12/31/2078
0442T 0 N N Y N N 7/1/2016 12/31/2078
0443T 0 N N Y N N 7/1/2016 12/31/2078
0444T 0 N N Y N N 7/1/2016 12/31/2078
0445T 0 N N Y N N 7/1/2016 12/31/2078
0446T 0 N N N N N 1/1/2017 12/31/2078
0447T 0 N N N N N 1/1/2017 12/31/2078
0448T 0 N N N N N 1/1/2017 12/31/2078
0449T 0 N N N N N 1/1/2017 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 50 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0450T 0 N N N N N 1/1/2017 12/31/2078
0451T 0 N N N N N 1/1/2017 12/31/2078
0452T 0 N N N N N 1/1/2017 12/31/2078
0453T 0 N N N N N 1/1/2017 12/31/2078
0454T 0 N N N N N 1/1/2017 12/31/2078
0455T 0 N N N N N 1/1/2017 12/31/2078
0456T 0 N N N N N 1/1/2017 12/31/2078
0457T 0 N N N N N 1/1/2017 12/31/2078
0458T 0 N N N N N 1/1/2017 12/31/2078
0459T 0 N N N N N 1/1/2017 12/31/2078
0460T 0 N N N N N 1/1/2017 12/31/2078
0461T 0 N N N N N 1/1/2017 12/31/2078
0462T 0 N N N N N 1/1/2017 12/31/2078
0463T 0 N N N N N 1/1/2017 12/31/2078
0464T 0 N N N N N 1/1/2017 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 51 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0465T 0 N N N N N 1/1/2017 12/31/2078
0466T 0 N N N N N 1/1/2017 12/31/2078
0467T 0 N N N N N 1/1/2017 12/31/2078
0468T 0 N N N N N 1/1/2017 12/31/2078
0469T 0 N N N N N 7/1/2017 12/31/2078
0470T 0 N N N N N 7/1/2017 12/31/2078
0470T 26 0 N N N N N 7/1/2017 12/31/2078
0470T TC 0 N N N N N 7/1/2017 12/31/2078
0471T 0 N N N N N 7/1/2017 12/31/2078
0471T 26 0 N N N N N 7/1/2017 12/31/2078
0471T TC 0 N N N N N 7/1/2017 12/31/2078
0472T 0 N N N N N 7/1/2017 12/31/2078
0473T 0 N N N N N 7/1/2017 12/31/2078
0474T 0 N N N N N 7/1/2017 12/31/2078
0475T 0 N N N N N 7/1/2017 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 52 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0476T 0 N N N N N 7/1/2017 12/31/2078
0477T 0 N N N N N 7/1/2017 12/31/2078
0478T 0 N N N N N 7/1/2017 12/31/2078
0479T 0 N Y N N N 1/1/2018 12/31/2078
0480T 0 N N N N N 1/1/2018 12/31/2078
0481T 0 N N N N N 1/1/2018 12/31/2078
0482T 0 N N N N N 1/1/2018 12/31/2019
0482T 26 0 N N N N N 1/1/2018 12/31/2019
0482T TC 0 N N N N N 1/1/2018 12/31/2019
0483T 0 N Y Y Y Y 1/1/2018 12/31/2078
0484T 0 N Y Y Y Y 1/1/2018 12/31/2078
0485T 0 Y N N N N 1/1/2018 12/31/2078
0485T 26 0 Y N N N N 1/1/2018 12/31/2078
0485T TC 0 Y N N N N 1/1/2018 12/31/2078
0486T 0 N N N N N 1/1/2018 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 53 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0486T 26 0 N N N N N 1/1/2018 12/31/2078
0486T TC 0 N N N N N 1/1/2018 12/31/2078
0487T 0 N N N N N 1/1/2018 12/31/2078
0488T 0 N N N N N 1/1/2018 12/31/2078
0489T 0 N N N N N 1/1/2018 12/31/2078
0490T 0 N N N N N 1/1/2018 12/31/2078
0491T 0 N N N N N 1/1/2018 12/31/2078
0492T 0 N N N N N 1/1/2018 12/31/2078
0493T 0 N N N N N 1/1/2018 12/31/2078
0494T 0 N Y Y N Y 1/1/2018 12/31/2078
0495T 0 N N N N N 1/1/2018 12/31/2078
0496T 0 N N N N N 1/1/2018 12/31/2078
0497T 0 N N N N N 1/1/2018 12/31/2078
0498T 0 N N N N N 1/1/2018 12/31/2078
0499T 0 N Y N N N 1/1/2018 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 54 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0500F 0 N N N N N 1/1/2008 12/31/2078
0500T 0 N N N N N 1/1/2018 12/31/2078
0501F 0 N N N N N 1/1/2008 12/31/2078
0501T 0 N N N N N 1/1/2018 12/31/2078
0502F 0 N N N N N 1/1/2008 12/31/2078
0502T 0 N N N N N 1/1/2018 12/31/2078
0503F 0 N N N N N 1/1/2008 12/31/2078
0503T 0 N N N N N 1/1/2018 12/31/2078
0504T 0 N N N N N 1/1/2018 12/31/2078
0505F 0 N N N N N 1/1/2008 12/31/2078
0505T 0 N N Y N N 7/1/2018 12/31/2078
0506T 0 N N Y N N 7/1/2018 12/31/2078
0506T 26 0 N N Y N N 7/1/2018 12/31/2078
0506T TC 0 N N Y N N 7/1/2018 12/31/2078
0507F 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 55 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0507T 0 N N Y N N 7/1/2018 12/31/2078
0507T 26 0 N N Y N N 7/1/2018 12/31/2078
0507T TC 0 N N Y N N 7/1/2018 12/31/2078
0508T 0 N N Y N N 7/1/2018 12/31/2078
0508T 26 0 N N Y N N 7/1/2018 12/31/2078
0508T TC 0 N N Y N N 7/1/2018 12/31/2078
0509F 0 N N N N N 1/1/2008 12/31/2078
0509T 0 N N Y N N 1/1/2019 12/31/2078
0509T 26 0 N N Y N N 1/1/2019 12/31/2078
0509T TC 0 N N Y N N 1/1/2019 12/31/2078
0510T 0 Y Y N N N 1/1/2019 12/31/2078
0511T 0 Y Y N N N 1/1/2019 12/31/2078
0512T 0 N N Y N N 1/1/2019 12/31/2078
0513F 0 N N N N N 1/1/2008 12/31/2078
0513T 0 N N Y N N 1/1/2019 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 56 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0514F 0 N N N N N 1/1/2008 12/31/2078
0514T 0 N N N N N 1/1/2019 12/31/2078
0515T 0 N Y N N N 1/1/2019 12/31/2078
0516F 0 N N N N N 1/1/2008 12/31/2078
0516T 0 N Y N N N 1/1/2019 12/31/2078
0517F 0 N N N N N 1/1/2008 12/31/2078
0517T 0 N Y N N N 1/1/2019 12/31/2078
0518F 0 N N N N N 1/1/2008 12/31/2078
0518T 0 N Y N N N 1/1/2019 12/31/2078
0519F 0 N N N N N 1/1/2008 12/31/2078
0519T 0 N Y N N N 1/1/2019 12/31/2078
0520F 0 N N N N N 1/1/2008 12/31/2078
0520T 0 N Y N N N 1/1/2019 12/31/2078
0521F 0 N N N N N 1/1/2008 12/31/2078
0521T 0 N N N N N 1/1/2019 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 57 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0521T 26 0 N N N N N 1/1/2019 12/31/2078
0521T TC 0 N N N N N 1/1/2019 12/31/2078
0522T 0 N N N N N 1/1/2019 12/31/2078
0522T 26 0 N N N N N 1/1/2019 12/31/2078
0522T TC 0 N N N N N 1/1/2019 12/31/2078
0523T 0 N N Y N N 1/1/2019 12/31/2078
0524T 0 Y Y N N N 1/1/2019 12/31/2078
0525F 0 N N N N N 1/1/2009 12/31/2078
0525T 0 N Y N N N 1/1/2019 12/31/2078
0526F 0 N N N N N 1/1/2009 12/31/2078
0526T 0 N Y N N N 1/1/2019 12/31/2078
0527T 0 N Y N N N 1/1/2019 12/31/2078
0528F 0 N N N N N 1/1/2009 12/31/2078
0528T 0 N N N N N 1/1/2019 12/31/2078
0528T 26 0 N N N N N 1/1/2019 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 58 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0528T TC 0 N N N N N 1/1/2019 12/31/2078
0529F 0 N N N N N 1/1/2009 12/31/2078
0529T 0 N N N N N 1/1/2019 12/31/2078
0529T 26 0 N N N N N 1/1/2019 12/31/2078
0529T TC 0 N N N N N 1/1/2019 12/31/2078
0530T 0 N Y N N N 1/1/2019 12/31/2078
0531T 0 N Y N N N 1/1/2019 12/31/2078
0532T 0 N Y N N N 1/1/2019 12/31/2078
0533T 0 N N N N N 1/1/2019 12/31/2078
0533T 26 0 N N N N N 1/1/2019 12/31/2078
0533T TC 0 N N N N N 1/1/2019 12/31/2078
0534T 0 N N N N N 1/1/2019 12/31/2078
0534T 26 0 N N N N N 1/1/2019 12/31/2078
0534T TC 0 N N N N N 1/1/2019 12/31/2078
0535F 0 N N N N N 1/1/2009 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 59 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0535T 0 N N N N N 1/1/2019 12/31/2078
0535T 26 0 N N N N N 1/1/2019 12/31/2078
0535T TC 0 N N N N N 1/1/2019 12/31/2078
0536T 0 N N N N N 1/1/2019 12/31/2078
0536T 26 0 N N N N N 1/1/2019 12/31/2078
0536T TC 0 N N N N N 1/1/2019 12/31/2078
0537T 0 N N N N N 1/1/2019 12/31/2078
0538T 0 N N N N N 1/1/2019 12/31/2078
0539T 0 N N N N N 1/1/2019 12/31/2078
0540F 0 N N N N N 1/1/2009 12/31/2078
0540T 0 N N N N N 1/1/2019 12/31/2078
0541T 0 N N N N N 1/1/2019 12/31/2078
0542T 0 N N N N N 1/1/2019 12/31/2078
0543T 0 N N Y N N 1/1/2020 12/31/2078
0544T 0 N N Y N N 1/1/2020 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 60 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0545F 0 N N N N N 1/1/2010 12/31/2078
0545T 0 N N Y N N 1/1/2020 12/31/2078
0546T 0 N N Y N N 1/1/2020 12/31/2078
0547T 0 N N Y N N 1/1/2020 12/31/2078
0548T 0 N N Y N N 1/1/2020 12/31/2078
0549T 0 N N Y N N 1/1/2020 12/31/2078
0550F 0 N N N N N 1/1/2012 12/31/2078
0550T 0 N N Y N N 1/1/2020 12/31/2078
0551F 0 N N N N N 1/1/2012 12/31/2078
0551T 0 N N Y N N 1/1/2020 12/31/2078
0552T 0 N N Y N N 1/1/2020 12/31/2078
0553T 0 N N Y N N 1/1/2020 12/31/2078
0554T 0 N N Y N N 1/1/2020 12/31/2078
0555F 0 N N N N N 1/1/2012 12/31/2078
0555T 0 N N Y N N 1/1/2020 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 61 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0556F 0 N N N N N 1/1/2012 12/31/2078
0556T 0 N N Y N N 1/1/2020 12/31/2078
0557F 0 N N N N N 1/1/2012 12/31/2078
0557T 0 N N Y N N 1/1/2020 12/31/2078
0558T 0 N N Y N N 1/1/2020 12/31/2078
0559T 0 N N Y N N 1/1/2020 12/31/2078
0560T 0 N N Y N N 1/1/2020 12/31/2078
0561T 0 N N Y N N 1/1/2020 12/31/2078
0562T 0 N N Y N N 1/1/2020 12/31/2078
0563T 0 N N Y N N 1/1/2020 12/31/2078
0564T 0 N N Y N N 1/1/2020 12/31/2078
0565T 0 N N Y N N 1/1/2020 12/31/2078
0566T 0 N N Y N N 1/1/2020 12/31/2078
0567T 0 N N Y N N 1/1/2020 12/31/2078
0568T 0 N N Y N N 1/1/2020 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 62 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0569T 0 N N Y N N 1/1/2020 12/31/2078
0570T 0 N N Y N N 1/1/2020 12/31/2078
0571T 0 N N Y N N 1/1/2020 12/31/2078
0572T 0 N N Y N N 1/1/2020 12/31/2078
0573T 0 N N Y N N 1/1/2020 12/31/2078
0574T 0 N N Y N N 1/1/2020 12/31/2078
0575F 0 N N N N N 1/1/2009 12/31/2078
0575T 0 N N Y N N 1/1/2020 12/31/2078
0576T 0 N N Y N N 1/1/2020 12/31/2078
0577T 0 N N Y N N 1/1/2020 12/31/2078
0578T 0 N N Y N N 1/1/2020 12/31/2078
0579T 0 N N Y N N 1/1/2020 12/31/2078
0580F 0 N N N N N 1/1/2013 12/31/2078
0580T 0 N N Y N N 1/1/2020 12/31/2078
0581F 0 N N N N N 1/1/2013 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 63 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0581T 0 N N Y N N 1/1/2020 12/31/2078
0582F 0 N N N N N 1/1/2013 12/31/2078
0582T 0 N N Y N N 1/1/2020 12/31/2078
0583F 0 N N N N N 1/1/2013 12/31/2078
0583T 0 N N Y N N 1/1/2020 12/31/2078
0584F 0 N N N N N 1/1/2013 12/31/2078
0584T 0 N N Y N N 1/1/2020 12/31/2078
0585T 0 N N Y N N 1/1/2020 12/31/2078
0586T 0 N N Y N N 1/1/2020 12/31/2078
0587T 0 N N Y N N 1/1/2020 12/31/2078
0588T 0 N N Y N N 1/1/2020 12/31/2078
0589T 0 N N Y N N 1/1/2020 12/31/2078
0590T 0 N N Y N N 1/1/2020 12/31/2078
0591T 0 N N Y N N 1/1/2020 12/31/2078
0592T 0 N N Y N N 1/1/2020 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 64 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
0593T 0 N N Y N N 1/1/2020 12/31/2078
10004 0 N N Y N N 1/1/2019 12/31/2078
10005 0 N Y Y N N 1/1/2019 12/31/2078
10006 0 N N Y N N 1/1/2019 12/31/2078
10007 0 N Y Y N N 1/1/2019 12/31/2078
10008 0 N N Y N N 1/1/2019 12/31/2078
10009 0 N Y Y N N 1/1/2019 12/31/2078
1000F 0 N N N N N 1/1/2008 12/31/2078
10010 0 N N Y N N 1/1/2019 12/31/2078
10011 0 N Y Y N N 1/1/2019 12/31/2078
10012 0 N N Y N N 1/1/2019 12/31/2078
10021 0 N N Y N N 1/1/2008 12/31/2018
10021 0 N Y Y N N 1/1/2019 12/31/2078
10022 0 N N Y N N 1/1/2008 12/31/2018
1002F 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 65 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
10030 0 N Y Y N N 1/1/2014 12/31/2078
10035 0 Y Y Y N N 1/1/2016 12/31/2078
10036 0 N Y Y N N 1/1/2016 6/30/2016
10036 0 N N Y N N 7/1/2016 12/31/2078
1003F 0 N N N N N 1/1/2008 12/31/2078
10040 10 N Y N N N 1/1/2008 12/31/2078
1004F 0 N N N N N 1/1/2008 12/31/2078
1005F 0 N N N N N 1/1/2008 12/31/2078
10060 10 N Y N N N 1/1/2008 12/31/2078
10061 10 N Y N N N 1/1/2008 12/31/2078
1006F 0 N N N N N 1/1/2008 12/31/2078
1007F 0 N N N N N 1/1/2008 12/31/2078
10080 10 N Y N N N 1/1/2008 12/31/2078
10081 10 N Y N N N 1/1/2008 12/31/2078
1008F 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 66 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
1010F 0 N N N N N 1/1/2012 12/31/2078
1011F 0 N N N N N 1/1/2012 12/31/2078
10120 10 N Y N N N 1/1/2008 12/31/2078
10121 10 N Y N N N 1/1/2008 12/31/2078
1012F 0 N N N N N 1/1/2012 12/31/2078
10140 10 N Y N N N 1/1/2008 12/31/2078
1015F 0 N N N N N 1/1/2008 12/31/2078
10160 10 N Y N N N 1/1/2008 12/31/2078
10180 10 N Y N N N 1/1/2008 12/31/2078
1018F 0 N N N N N 1/1/2008 12/31/2078
1019F 0 N N N N N 1/1/2008 12/31/2078
1022F 0 N N N N N 1/1/2008 12/31/2078
1026F 0 N N N N N 1/1/2008 12/31/2078
1030F 0 N N N N N 1/1/2008 12/31/2078
1031F 0 N N N N N 1/1/2012 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 67 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
1032F 0 N N N N N 1/1/2012 12/31/2078
1033F 0 N N N N N 1/1/2012 12/31/2078
1034F 0 N N N N N 1/1/2008 12/31/2078
1035F 0 N N N N N 1/1/2008 12/31/2078
1036F 0 N N N N N 1/1/2008 12/31/2078
1038F 0 N N N N N 1/1/2008 12/31/2078
1039F 0 N N N N N 1/1/2008 12/31/2078
1040F 0 N N N N N 1/1/2008 12/31/2078
1050F 0 N N N N N 1/1/2008 12/31/2078
1052F 0 N N N N N 1/1/2012 12/31/2078
1055F 0 N N N N N 1/1/2008 12/31/2078
1060F 0 N N N N N 1/1/2008 12/31/2078
1061F 0 N N N N N 1/1/2008 12/31/2078
1065F 0 N N N N N 1/1/2008 12/31/2078
1066F 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 68 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
1070F 0 N N N N N 1/1/2008 12/31/2078
1071F 0 N N N N N 1/1/2008 12/31/2078
1090F 0 N N N N N 1/1/2008 12/31/2078
1091F 0 N N N N N 1/1/2008 12/31/2078
11000 0 N Y N N N 1/1/2008 12/31/2078
11001 0 N N N N N 1/1/2008 12/31/2078
11004 0 N Y N N N 1/1/2008 12/31/2078
11005 0 N N Y N N 1/1/2008 12/31/2078
11006 0 N Y N N N 1/1/2008 12/31/2078
11008 0 N N Y N N 1/1/2008 12/31/2078
1100F 0 N N N N N 1/1/2008 12/31/2078
11010 10 N Y N N N 1/1/2008 12/31/2078
11011 0 N Y N N N 1/1/2008 12/31/2078
11012 0 N Y N N N 1/1/2008 12/31/2078
1101F 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 69 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
11040 0 N Y N N N 1/1/2008 12/31/2010
11041 0 N Y N N N 1/1/2008 12/31/2010
11042 0 N Y N N N 1/1/2008 12/31/2078
11043 10 N Y N N N 1/1/2008 12/31/2010
11043 0 N Y N N N 1/1/2011 12/31/2078
11044 10 N Y N N N 1/1/2008 12/31/2010
11044 0 N Y N N N 1/1/2011 12/31/2078
11045 0 N N Y N N 1/1/2011 12/31/2078
11046 0 N N Y N N 1/1/2011 12/31/2078
11047 0 N N Y N N 1/1/2011 12/31/2078
11055 0 N Y N N N 1/1/2008 12/31/2078
11056 0 N Y N N N 1/1/2008 12/31/2078
11057 0 N Y N N N 1/1/2008 12/31/2078
11100 0 N Y N N N 1/1/2008 12/31/2018
11101 0 N N N N N 1/1/2008 12/31/2018
09/08/2020 Global Surgery Rules.xls Page 70 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
11102 0 N Y N N N 1/1/2019 12/31/2078
11103 0 N N N N N 1/1/2019 12/31/2078
11104 0 N Y N N N 1/1/2019 12/31/2078
11105 0 N N N N N 1/1/2019 12/31/2078
11106 0 N Y N N N 1/1/2019 12/31/2078
11107 0 N N N N N 1/1/2019 12/31/2078
1110F 0 N N N N N 1/1/2008 12/31/2078
1111F 0 N N N N N 1/1/2008 12/31/2078
1116F 0 N N N N N 1/1/2008 12/31/2078
1118F 0 N N N N N 1/1/2008 12/31/2078
1119F 0 N N N N N 1/1/2008 12/31/2078
11200 10 N Y N N N 1/1/2008 12/31/2078
11201 0 N N N N N 1/1/2008 12/31/2078
1121F 0 N N N N N 1/1/2008 12/31/2078
1123F 0 N N N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 71 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
1124F 0 N N N N N 1/1/2008 12/31/2078
1125F 0 N N N N N 1/1/2008 12/31/2078
1126F 0 N N N N N 1/1/2008 12/31/2078
1127F 0 N N N N N 1/1/2008 12/31/2009
1127F 0 N N N N N 1/1/2012 12/31/2078
1128F 0 N N N N N 1/1/2008 12/31/2009
1128F 0 N N N N N 1/1/2012 12/31/2078
11300 0 N Y Y N N 1/1/2008 12/31/2078
11301 0 N Y Y N N 1/1/2008 12/31/2078
11302 0 N Y Y N N 1/1/2008 12/31/2078
11303 0 N Y Y N N 1/1/2008 12/31/2078
11305 0 N Y Y N N 1/1/2008 12/31/2078
11306 0 N Y Y N N 1/1/2008 12/31/2078
11307 0 N Y Y N N 1/1/2008 12/31/2078
11308 0 N Y Y N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 72 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
1130F 0 N N N N N 1/1/2009 12/31/2078
11310 0 N Y Y N N 1/1/2008 12/31/2078
11311 0 N Y Y N N 1/1/2008 12/31/2078
11312 0 N Y Y N N 1/1/2008 12/31/2078
11313 0 N Y Y N N 1/1/2008 12/31/2078
1134F 0 N N N N N 1/1/2009 12/31/2078
1135F 0 N N N N N 1/1/2009 12/31/2078
1136F 0 N N N N N 1/1/2009 12/31/2078
1137F 0 N N N N N 1/1/2009 12/31/2078
11400 10 N Y N N N 1/1/2008 12/31/2078
11401 10 N Y N N N 1/1/2008 12/31/2078
11402 10 N Y N N N 1/1/2008 12/31/2078
11403 10 N Y N N N 1/1/2008 12/31/2078
11404 10 N Y N N N 1/1/2008 12/31/2078
11406 10 N Y N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 73 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
11420 10 N Y N N N 1/1/2008 12/31/2078
11421 10 N Y N N N 1/1/2008 12/31/2078
11422 10 N Y N N N 1/1/2008 12/31/2078
11423 10 N Y N N N 1/1/2008 12/31/2078
11424 10 N Y N N N 1/1/2008 12/31/2078
11426 10 N Y N N N 1/1/2008 12/31/2078
11440 10 N Y N N N 1/1/2008 12/31/2078
11441 10 N Y N N N 1/1/2008 12/31/2078
11442 10 N Y N N N 1/1/2008 12/31/2078
11443 10 N Y N N N 1/1/2008 12/31/2078
11444 10 N Y N N N 1/1/2008 12/31/2078
11446 10 N Y N N N 1/1/2008 12/31/2078
11450 90 N Y N N N 1/1/2008 12/31/2012
11450 90 Y Y N N N 1/1/2013 12/31/2078
11451 90 N Y Y N N 1/1/2008 12/31/2012
09/08/2020 Global Surgery Rules.xls Page 74 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
11451 90 Y Y Y N N 1/1/2013 12/31/2078
11462 90 N Y Y N N 1/1/2008 12/31/2012
11462 90 Y Y Y N N 1/1/2013 12/31/2078
11463 90 N Y Y N N 1/1/2008 12/31/2012
11463 90 Y Y Y N N 1/1/2013 12/31/2078
11470 90 N Y N N N 1/1/2008 12/31/2078
11471 90 N Y Y N N 1/1/2008 12/31/2078
1150F 0 N N N N N 1/1/2009 12/31/2078
1151F 0 N N N N N 1/1/2009 12/31/2078
1152F 0 N N N N N 1/1/2009 12/31/2078
1153F 0 N N N N N 1/1/2009 12/31/2078
1157F 0 N N N N N 1/1/2009 12/31/2078
1158F 0 N N N N N 1/1/2009 12/31/2078
1159F 0 N N N N N 1/1/2009 12/31/2078
11600 10 N Y N N N 1/1/2008 12/31/2078
09/08/2020 Global Surgery Rules.xls Page 75 of 1403
MaineCare Fee Schedule
Service Code Modifier Global Days
Bilateral Multiple Assistant Team Co-surgeon Professional Fee
Rule ID Effective Date Termination Date
11601 10 N Y N N N 1/1/2008 12/31/2078
11602 10 N Y N N N 1/1/2008 12/31/2078
11603 10 N Y N N N 1/1/2008 12/31/2078
11604 10 N Y N N N 1/1/2008 12/31/2078
11606 10 N Y N N N 1/1/2008 12/31/2078
1160F 0 N N N N N 1/1/2009 12/31/2078
11620 10 N Y N N N 1/1/2008 12/31/2078
11621 10 N Y N N N 1/1/2008 12/31/2078
11622 10 N Y N N N 1/1/2008 12/31/2078
11623 10 N Y N N N 1/1/2008 12/31/2078
11624 10 N Y N N N 1/1/2008 12/31/2078
11626 10 N Y N N N