Author: Clinical Policy and Programs
The NC Division of Medical Assistance (DMA) currently recognizes CPT Code 27216 (Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral). As of June 1, 2018, North Carolina Medicaid will no longer recognize CPT 27216 and will require claims to be submitted with HCPCS Code G0413 (percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral or bilateral) for dates of service on or after June 1, 2018.
Parenthetic notes in the annual Current Procedural Terminology (CPT) manual instruct providers to bill with modifier 50 to report a bilateral procedure. North Carolina Medicaid obtains rates and modifier information from the Centers for Medicare & Medicaid Services (CMS) Relative Value Unit (RVU) file and fee schedule. Since Medicare does not recognize code 27216, North Carolina Medicaid is unable to append modifier 50 to this procedure code. This change will allow North Carolina Medicaid to align with Medicare and allow accurate reporting and reimbursement for services rendered.
Clinical Policy and Programs
DMA, 919-855-4320