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SPECIAL BULLETIN: Rate Increase on E&M Procedure Codes

Friday, June 28, 2019

NC Medicaid has received approval from the Centers for Medicare and Medicaid Services (CMS) to increase rates for Evaluation and Management (E&M) procedure codes, as defined in Section 1202 of the Affordable Care Act (ACA) and paid to primary care physicians, nurse practitioners and physician assistants. In addition to the ACA primary care practitioners, obstetricians and gynecologists will also be included as primary care physicians.

Reimbursement rates for E&M procedure codes ranging from 99201-99499 will be increased with an effective date of Jan. 1, 2019. NCTracks implementation of the rate increase is currently projected for the week of July 7, 2019.

Claims previously processed with dates of service from Jan. 1, 2019 through the implementation date of the rate increase will be scheduled for systematic reprocessing. 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 physician services codes, refer to the NC Medicaid website at https://medicaid.ncdhhs.gov/fee-schedule-index

Author: 
GDIT, (800) 688-6696