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SPECIAL BULLETIN: NEMT Reimbursement Rate Increase

Thursday, June 20, 2019

The Division of Health Benefits (NC Medicaid) has received approval from the Centers for Medicare & Medicaid Services (CMS) to increase the rate for code T2003 Non-Emergency Transportation, Encounter/Trip for Ambulance Non-Emergency Medical Transportation (NEMT) Services.

The NEMT reimbursement rate for Ambulance NEMT Services was increased from $78.25 to $474.00 with an effective date of Jan. 1, 2019.

Upon implementation of the rate increase, claims processed with dates of service from Jan. 1, 2019 through the implementation date will be systematically reprocessed. Providers are reminded to bill their usual and customary charges rather than the Medicaid rate.

Providers will be notified through future Medicaid Bulletins and/or NCTracks Provider Communications regarding the claims reprocessing schedule.

For current pricing on all ambulance codes, refer to the NC Medicaid website at https://medicaid.ncdhhs.gov/providers/fee-schedule/ambulance-services-fee-schedule

Author: 
GDIT, (800) 688-6696