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Billing Update for NC Medicaid Policy 1A-5 Child Medical Evaluation and Addition of CPT 99368

Tuesday, November 5, 2019

NC Medicaid reimburses qualified providers for child medical evaluation (CME) and medical team conference services according to guidelines set forth in NC Medicaid policy 1A-5 Child Medical Evaluation and Medical Team Conference for Child Maltreatment.

Recently, claims have been denying when nurse practitioners (NPs) and physician assistants (PAs) bill for medical team conference services with procedure code 99367 (Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician).

NPs and PAs can now use procedure code 99368 (Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present; 30 minutes or more; participation by nonphysician qualified health care professional) for billing of medical team conferences associated with CMEs and clinical coverage policy 1A-5.

NPs and PAs may only bill for medical team conference (procedure 99368) when they were the provider that performed and billed for the child medical evaluation (procedure 99499) prior to the medical team conference. Claims submitted for reimbursement of this service for any other indication will be denied/recouped. 

Coverage for this code has been added to NCTracks with a retroactive date of Jan. 1, 2019. Providers may resubmit denied claims for reprocessing.

Author: 
GDIT, (800) 688-6696