Section 90: Quarter 3, Physician Drug and Seasonal Flu Code Update: CR 142091, 142074

Sep 02, 2026

QTR 3 Physician Drug Codes 

To align with the Centers for Medicare & Medicaid Services’ (CMS) quarterly rate update, we updated the Physician Drug Rates retroactively to July 1, 2026. We implemented these new rates for billing on August 26, 2026.  

You can find the updated rates on the Rate Setting page of the Health PAS Online Portal.   

We will reprocess claims submitted at or above the new rates, for dates of service July 1, 2025, through August 25, 2026. No provider action is needed.    

Seasonal Flu Codes 

Effective August 1, 2026, MaineCare updated the seasonal flu codes. We implemented these new rates for billing on August 26, 2026. 

The new rates are provided in the table below.  

Start Date	Procedure Code	Rate
8/1/2026	90653	$122.52
8/1/2026	90656	$23.89
8/1/2026	90657	$11.14
8/1/2026	90658	$22.28
8/1/2026	90660	$30.58
8/1/2026	90661	$66.57
8/1/2026	90662	$122.52
8/1/2026	90673	$122.52

Adjustment Billing Guidance for Dates of Service July 1, 2026 - August 25, 2026 

• MaineCare will adjust paid claims that were submitted with charges at or above the new rates.   

• Providers are responsible for adjusting claims submitted with charges below the new rates. Per policy, and to avoid timely filing denials, adjustments must be submitted within 120 days of the most recent claim payment date.   

For questions, please contact your Provider Relations Specialist.