SPECIAL BULLETIN COVID-19 #80: NC Medicaid Temporarily Increasing Flexibility and Reimbursement Rates for Primary and Specialty Care Providers

Friday, May 1, 2020

NC Medicaid is temporarily making the following important changes to clinical policy and reimbursement rates to help primary and specialty care providers continue to serve patients during the COVID-19 emergency:

  • Adding Telemedicine and Telepsychiatry Clinical Coverage Codes for Specialty Providers 
  • Increasing reimbursement rates for telephonic visits and primary care medical home per member per month (PMPM) fees

Added Telemedicine and Telepsychiatry Codes for Specialty Providers

Primary Care Medical Home Fees

To recognize the critical role of specialty providers in maintaining access to critical care for Medicaid beneficiaries during the COVID-19 emergency, effective March 23, 2020, and retroactive to March 10, 2020, codes 99446, 9447, 99448, and 99449 are now activated. These codes allow reimbursement to a specialist who provides telephone or video consultation to other healthcare providers for Medicaid beneficiaries. See SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications (Interprofessional Consultations section) for additional details.

Increased Reimbursement Rates

Primary Care Medical Home Fees

To support continued access to primary care for Medicaid beneficiaries, NC Medicaid is temporarily increasing the per member per month (PMPM) payment for all primary care medical homes. Effective April 1, 2020:

  1. Aged, Blind, Disabled (ABD) rates increase from $5.00 to $10.00
  2. Non-ABD rates increase from $1.00 to $2.00 (Carolina Access I) and from $2.50 to $5.00 (Carolina Access II), respectively 

Telephonic Rates for Primary Care and Specialty Care

To support primary and specialty care providers in conducting telephonic visits when face-to-face or telehealth is not a viable option, NC Medicaid is temporarily increasing the telephonic rate to 80% of Physician E&M comparable rates, retroactive to March 10, 2020.

Note: Providers may resubmit claims previously adjudicated with dates of service within effective date of the respective rate change

Additional Resources

Contact

Medicaid Contact Center: 888-245-0179