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the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.
NC Medicaid has temporarily enabled providers to conduct postpartum depression screenings of postpartum women via several remote modalities in light of social distancing measures that may prevent in-person visits.
NC Medicaid will continue to evaluate telehealth policies and will release temporary flexibilities and guidance as needed throughout the state of emergency.
Specific guidance related to billing and coding is detailed in the section “Temporary Modifications to Attachment A.” All claims are subject to audit.
Postpartum Depression Screening Modifications
The following are policy modifications related to postpartum depression screening:
- Eligible Providers and Services
- Eligible providers, including physicians, nurse practitioners, physician assistants and certified nurse midwives may conduct postpartum depression screenings via an in-person visit, telemedicine visit (two-way real-time, interactive audio and video), telephone call, or online patient portal communication using CPT 96127.
- The postpartum depression screening can be provided during an in-person visit, during a telemedicine visit, or via telephone or online patient portal communication on the same day as and in advance of an in-person office or telemedicine visit.
- Maternal depression screens may be billed to the child’s Medicaid as CPT 96161. NC Medicaid will reimburse providers for up to 4 maternal depression risk screens administered to mothers during the infant’s first year postpartum.
- Federally Qualified Health Centers (FQHCs), FQHC Look-alikes, and Rural Health Centers (RHCs) may also deliver postpartum depression screening via telemedicine, telephone call, or online patient portal communication.
- Postpartum screenings delivered as part of an obstetrics care visit are covered under core obstetrics billing (T1015).
- Postpartum depression screenings delivered as part of Well Child Visits are reimbursed on a fee-for-service basis and should be billed using CPT 96161.
Prior Authorization and In-Person Examinations
- Patients are not required to obtain prior authorization or have an initial in-person examination prior to receiving a postpartum depression screening via telemedicine, telephone call, or online patient portal communication.
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.
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)
C.1 The following postpartum depression screening code, when provided via telemedicine, telephone call, or online patient communication to a new or established patient, may be billed by physicians, nurse practitioners, physician assistants and certified nurse midwives.
|
Codes |
Description (See 2020 CPT Code Book for Complete Details) |
|
96127
For Mother’s Provider |
Brief emotional/behavioral assessment [e.g., depression inventory, attention-deficit hyperactivity disorder (ADHD) scale], with scoring and documentation, per standardized instrument Note: Providers should also bill diagnosis code Z13.89 (encounter for screening for other disorder) when billing 96127 for postpartum depression screenings. |
|
96161
For Child’s Provider |
Administration of caregiver-focused health risk assessment instrument (e.g., ‘health hazard appraisal’), for benefit of the patient, with scoring and documentation per standardized instrument. Note: Maternal depression screens may be billed to the child’s Medicaid as CPT 96161. NC Medicaid will reimburse providers for up to 4 maternal depression risk screens administered to mothers during the infant’s first year postpartum. |
Additional Billing Guidance for FQHCs, FQHC-Lookalikes, and RHCs:
- Postpartum screenings delivered as part of an obstetrics care visit are covered under core obstetrics billing (T1015).
- Postpartum depression screenings delivered as part of Well Child Visits are reimbursed on a fee-for-service basis and should be billed using CPT 96161.
D. Modifiers
Provider(s) shall follow applicable modifier guidelines when this service code is delivered via telehealth.
- 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 codes listed in this policy when the postpartum screening is conducted via telemedicine, telephone call or online patient communication.
- Modifier EP must be appended for CPT code 96161 when being billed for services described in this bulletin.
Provider(s) are not required to attached modifiers to this service code when delivered through a face to face evaluation.
E. Billing Unit
Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).
F. Place of Service
Telehealth 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
H. Reimbursement
Provider(s) shall bill their usual and customary charges. For a schedule of rates, refer to https://medicaid.ncdhhs.gov/. 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 at www.medicaid.ncdhhs.gov/coronavirus/covid-19-telehealth
- NC Medicaid Telehealth Resources website at www.medicaid.ncdhhs.gov/coronavirus/covid-19-telehealth
- NC Medicaid COVID-19 Resources website at http://www.medicaid.ncdhhs.gov/coronavirus