SPECIAL BULLETIN COVID-19 #11: Outpatient Specialized Therapies Temporary Flexibilities

Effective March 23, 2020, if medically necessary, outpatient Respiratory Therapy (RT) services provided through the Independent Practitioner Provider (IPP) program that typically require prior authorization (PA), may be provided to NC Medicaid and NC Health Choice beneficiaries without PA. All other aspects of Clinical Coverage Policy 10D, Respiratory Therapy Services by Independent Practitioner Provider will remain applicable. 

Providers are encouraged to obtain PA if it is reasonable to do so and won’t delay the provision of medically necessary RT services. Providers must maintain documentation of medical necessity and all records per Clinical Coverage Policy 10D, Respiratory Therapy Services by Independent Practitioner Provider. All claims are subject to audit.
Outpatient Specialized Therapies Clinical Coverage Policies are available at the NC Medicaid Clinical Coverage Policies page. 

CCME, (800) 228-3365
GDIT, (800) 688-6696