<p> 10-144 CH. 101 MAINECARE BENEFITS MANUAL CHAPTER III SECTION 7 FREE-STANDING DIALYSIS SERVICES Effective 7/26/10</p><p>HCPCS *** MAXIMUM CODE CODE DESCRIPTION ALLOWANCE</p><p>0821 90999 HEMODIALYSIS/COMPOSITE BY REPORT</p><p>0825 90993, 90989 SUPPORT SERVICES (HEMODIALYSIS BY REPORT</p><p>0831 90999 PERITONEAL DIALYSIS/COMPOSITE BY REPORT</p><p>0835 90993, 90989 SUPPORT SERVICES (IP) BY REPORT</p><p>0841 90999 CAPD/COMPOSITE BY REPORT</p><p>0845 90993, 90989 SUPPORT SERVICES/CAPD BY REPORT</p><p>0849 90945 OTHER CAPD DIALYSIS BY REPORT</p><p>0851 90999 CONTINUOUS CYCLING PERITONEAL DIALYSIS (CCPD) BY REPORT</p><p>0855 90993, 90989 SUPPORT SERVICES (CCPD) BY REPORT</p><p>0634 * EPO- INJECTION, EPOETIN ALFA, UNDER 10,000 UNITS BY REPORT</p><p>0635 * EPO- INJECTION, EPOETIN ALFA, ABOVE 10,000 UNITS</p><p>0636** ARANESP- INJECTION, DARBEPOETIN ALFA, 1 MCG BY REPORT</p><p>* Providers must also put HCPCS Q4081 on claim form. * * Providers must also put HCPCS JO882 on claim form.</p><p>*** These HCPCS codes will become effective upon implementation of MIHMS. (APA Office Note: This occurred on September°1, 2010.)</p><p>1</p>