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the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.
NC Medicaid is temporarily enabling eligible providers to deliver smoking and tobacco cessation counseling 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.
For more telehealth policy information, including definitions, see SPECIAL BULLETIN #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes.
- Smoking and tobacco cessation counseling can be delivered by telemedicine to new or established patients during the COVID-19 public health emergency.
- The following providers may deliver smoking and tobacco cessation counseling via telemedicine: physicians, nurse practitioners, physician assistants, and certified nurse midwives.
- Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) core service providers may also deliver smoking and tobacco cessation counseling via telemedicine.
- 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.1 The following Smoking and Tobacco Cessation Counseling Visit codes, when provided via telemedicine to a new or established patient, may be billed by physicians, nurse practitioners, physician assistants, and certified nurse midwives.
Description (See 2020 CPT Code Book for Complete Details)
Smoking and Tobacco Cessation Counseling Visit; Intermediate, greater than 3 minutes, up to 10 minutes
Smoking and Tobacco Cessation Counseling Visit; Intensive, greater than 10 minutes
Billing guidance for FQHCs and RHCs: Smoking and tobacco cessation counseling is a component of a Core Visit provided by Core Service providers and not separately billable as a core service. (See FQHC Clinical Coverage Policy 1D-4)
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).
- For Medicaid, refer to Medicaid State Plan, Attachment 4.18-A, page 1.
- For NC Health Choice, refer to G.S. 108A-70.21(d)
Provider(s) shall bill their usual and customary charges. For a schedule of rates, refer to the Medicaid provider webpage. 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.
- NC Medicaid Telehealth Billing Code Summary Chart
- NC Medicaid Telehealth Resources
- NC Medicaid COVID-19 Resources
NCTracks Contact Center: 800-688-6696