Background and General Guidance
NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and Health Choice 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the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.
This Bulletin temporarily enables eligible providers to deliver end stage renal disease services via telemedicine in light of social distancing measures that may prevent in-person visits.
NC Medicaid will continue to evaluate telemedicine 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.
Definitions
- Telemedicine is the use of two-way real-time interactive audio and video to provide care and services when participants are in different physical locations.
End Stage Renal Disease Services Modifications
The following are policy modifications:
- End stage rental disease (ESRD) services, including monthly/daily capitation services and training, may now be conducted via telemedicine (two-way real-time, interactive audio and video) with both new and established patients, as appropriate.
- While it is understood that providers should have at least one “hands on visit” per month to complete the required clinical examination of the vascular access site, this service can be provided via telemedicine.
- Eligible providers include physicians, nurse practitioners, and physician assistants.
- Patients are not required to obtain prior authorization prior to receiving services via telemedicine.
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)
C.1 The following ESRD service codes, when provided via telemedicine to a new or established patient, may be billed by physicians, nurse practitioners and physician assistants.
| Code | Modifiers (NC Medicaid) | Modifiers (NC Health Choice) | Description (See 2020 CPT Code Book for Complete Details) |
|
Monthly Capitation Services |
|||
|
90951 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents with 4 or more face-to-face visits by a physician or other qualified health care professional per month. |
|
90952 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents with 2-3 face-to-face visits by a physician or other qualified health care professional per month. |
|
90953 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents with 1 face-to-face visit by a physician or other qualified health care professional per month. |
|
90954 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents, with 4 or more face-to-face visits by a physician or other qualified health care professional per month. |
|
90955 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents with 2-3 face-to-face visits by a physician or other qualified health care professional per month. |
|
90956 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents, with 1 face-to-face visit by a physician or other qualified health care professional per month. |
|
90957 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents with 4 or more face-to-face visits by a physician or other qualified health care professional per month. |
|
90958 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents with 2-3 face-to-face visits by a physician or other qualified health care professional per month. |
|
90959 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents with 1 face-to-face visit by a physician or other qualified health care professional per month. |
|
90960 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month. |
|
90961 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month. |
|
90962 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 1 face-to-face visit by a physician or other qualified health care professional per month. |
|
90963 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents. |
|
90964 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents. |
|
90965 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents. |
|
90966 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services for home dialysis per full month, for patients 20 years of age and older. |
|
Daily Capitation Services |
|||
|
90967 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services for dialysis less than a full month of service, per day, for patients younger than 2 years old. |
|
90968 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services for dialysis less than a full month of service, per day, for patients 2-11 years of age. |
|
90969 |
GT-CR |
GT-CR |
End-Stage renal disease (ESRD) related services for dialysis less than a full month of service, per day, for patients 12-19 years of age. |
|
90970 |
GT-CR |
Not eligible |
End-Stage renal disease (ESRD) related services for dialysis less than a full month of service, per day, for patients 20 years of age and older. |
|
Training Services |
|||
|
90989 |
GT-CR |
GT-CR |
Dialysis training, patient, including helper where applicable, any mode, completed course. |
|
90993 |
GT-CR |
GT-CR |
Dialysis training, patient, including helper where applicable, any mode, course not completed, per training session. |
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.
- Modifier CR (catastrophe/disaster related) must be appended to all claims for CPT codes listed in this policy.
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/.
- 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/. 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
- NC Medicaid COVID-19 Resources
Contact
NCTracks Contact Center: 800-688-6696