NOTE: SPECIAL BULLETIN COVID-19 #42: Telehealth Clinical Policy Modifications – Postpartum Care.has been replaced by SPECIAL BULLETIN COVID-19 #49: Telehealth Clinical Policy Modifications – Interim Perinatal Care Guidance.
Update (April 16, 2020): Clarified that Modifier GT is not appropriate for services performed telephonically or through email or patient portal.
NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid beneficiaries. These temporary changes are retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded. When the temporary modifications end, all face-to-face service requirements will resume.
For additional information, refer to Bulletin #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, General Services and Codes.
Specific guidance related to billing and coding is detailed in the section “Temporary Modifications to Attachment A.”
Postpartum Care Modifications
The following are policy modifications related to postpartum care:
- Eligible Providers and Services
- Physicians, nurse practitioners, physician assistants, certified nurse midwives are eligible to use telehealth to conduct postpartum care visits with established patients during the state of emergency.
- Providers are required to bill the postpartum care code (59430 – postpartum care, separate procedure) separate from delivery when the postpartum care is delivered via telemedicine.
- Intersection with the Pregnancy Medical Home (PMH) Program
- Consistent with Clinical Coverage Policy 1E-6 – Pregnancy Medical Home, enrolled PMH providers should bill the postpartum incentive using HCPCS code S0281 as they normally would after a postpartum visit is completed via telehealth.
- Comprehensive prenatal telehealth guidance is forthcoming. As part of that guidance, NC Medicaid will be approving the PMH Pregnancy Risk Screening Form incentive code (S0280) through telehealth.
- For more guidance on the use of PMH codes, see the clinical coverage policy 1E-6: /documents/files/1e6/download
- See “Temporary Modifications to Attachment A” for additional coding and billing guidance.
Temporary Modifications to Attachment A: Claims-Related Information
Retroactive to March 10, 2020, through the conclusion of the state of emergency related to COVID-19, NC Medicaid is temporarily modifying Attachment A of its Telemedicine and Telepsychiatry Clinical Coverage Policy 1-H to better enable the delivery of remote care to Medicaid beneficiaries. Provider(s) shall comply with the “NCTracks Provider Claims and Billing Assistance Guide,” Medicaid Bulletins, fee schedules, NC Medicaid’s clinical coverage policies and any other relevant documents for specific coverage and reimbursement for Medicaid and NC Health Choice.
A. Claim Type
Professional (CMS-1500/837P transaction)
B. International Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedural Coding System (PCS)
Provider(s) shall report the ICD-10-CM and Procedural Coding System (PCS) to the highest level of specificity that supports medical necessity. Provider(s) shall use the current ICD-10 edition and any subsequent editions in effect at the time of service. Provider(s) shall refer to the applicable edition for code description, as it is no longer documented in the policy.
C. Code(s)
The following postpartum care code, when provided via telemedicine to an established patient, may be billed by physicians, nurse practitioners, physician assistants, certified nurse midwives.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
59430 |
Postpartum care only - separate procedure |
Guidance Regarding the Use of 59430 When Delivered Via Telehealth
- This code must be billed separate from delivery when postpartum care is delivered via telehealth.
- Consistent with Clinical Coverage Policy 1E-6 – Pregnancy Medical Home, enrolled PMH providers should bill the postpartum incentive using HCPCS code S0281 as they normally would after a postpartum visit is completed via telehealth.
D. Modifiers
Provider(s) shall follow applicable modifier guidelines.
- Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal.
- Modifier CR (catastrophe/disaster related) must be appended to all claims for CPT and HCPCS codes listed in this policy to relax frequency limitations defined in code definitions.
E. Billing Unit
Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).
F. Place of Service
Telemedicine claims should be filed with the provider’s usual place of service code per the appropriate clinical coverage policy and not Place of Service (POS) 02 (telehealth).
G. Copayments
- For Medicaid, refer to Medicaid State Plan, Attachment 4.18-A, page 1, located at https://medicaid.ncdhhs.gov/document/state-plan-under-title-xix-social-security-act-medical-assistance-program.
- For NC Health Choice, refer to G.S. 108A-70.21(d), located at http://www.ncleg.net/EnactedLegislation/Statutes/HTML/BySection/Chapter_108A/GS_108A-70.21.html.
H. Reimbursement
Provider(s) shall bill their usual and customary charges. For a schedule of rates, refer to https://medicaid.ncdhhs.gov/providers/fee-schedules. When the GT modifier is appended to a code billed for professional services, the service is paid at 100% of the allowed amount of the fee schedule.
Reimbursement for these services is subject to the same restrictions as face-to-face contacts (such as place of service, allowable providers, multiple service limitations, prior authorization) unless otherwise noted in this policy.
Additional Resources
- NC Medicaid Telehealth Billing Code Summary Chart
- NC Medicaid Telehealth Resources website
- NC Medicaid COVID-19 Resources website
Author: GDIT, (800) 688-6696