CPT Code Update: 2018

The American Medical Association (AMA) publishes an annual Current Procedural Terminology (CPT) manual each fall outlining new, revised, and deleted procedural codes effective January 1 of the following calendar year. (For complete information regarding all code and description changes, refer to the 2018 edition of Current Procedural Terminology.) N.C. Medicaid reviews these codes changes to determine clinical coverage for the Medicaid program.

The state and CSRA are in the process of completing NCTracks system updates to align our policies with CPT code changes (new codes, covered and non-covered, as well as the end-dated codes), to ensure that claims billed with the new codes will process and pay correctly.

Until this process is completed, claims submitted with new codes will pend for “no fee on file.” These pended claims will recycle and pay when the system work is completed. No additional action will be required by providers to ensure that claims process and pay correctly after the system work is completed. This process will also be applicable to the Medicare crossover claims.

To maintain cash flow, providers may wish to split claims and bill new codes on a separate claim. This will ensure that only claims billed with the new procedure codes are pended for processing.

New CPT codes that are covered by N.C. Medicaid are effective with date of service Jan. 1, 2018. Claims submitted with deleted codes will be denied for dates of service on or after Jan. 1, 2018. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code(s).

Providers should note the full descriptions as well as all associated parenthetical information published in this edition when selecting a code for billing services to N.C. Medicaid.

Note: Category II and III Codes are not covered.

A bulletin article will be released listing the new codes that will be separately reimbursable by Ambulatory Surgery Centers (ASC) when that information is released by the Centers for Medicare & Medicaid Services (CMS) in January 2018.