CPT Code Update: 2020

Tuesday, December 17, 2019

Effective with date of service Jan. 1, 2020, the American Medical Association (AMA) added new CPT codes, deleted others and changed the descriptions of some existing codes. (For complete information regarding all CPT codes and descriptions, refer to the 2020 edition of Current Procedural Terminology published by the AMA.) 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 NC Medicaid.

New CPT codes covered by the NC Medicaid program are effective with date of service Jan. 1, 2020. Claims submitted with deleted codes will be denied for dates of service on or after Jan. 1, 2020. 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).

*93985 and 93986 will require prior approval (PA) through eviCore. Clinical coverage policy 1K-7, Prior Approval for Imaging Services will be updated to reflect this new information.

*97129 and 97130 will only be available for beneficiaries under the traumatic brain injury (TBI) waiver.

No new HCPCS Codes are being added during the 2020 update process.  Pharmacy will notify providers when new drug codes are added to NCTracks.

Note: All Category II and III Codes are not covered.

A Medicaid 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 2020.

GDIT, (800) 688-6696