CPT Code Update 2021

Effective with date of service Jan. 1, 2021, the American Medical Association (AMA) has added new CPT codes, deleted others, and changed the descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2021 edition of Current Procedural Terminology, published by the AMA. Providers should note the full descriptions as well as all associated parenthetical information published in this edition when selecting a code for billing services to NC Medicaid.

The State and GDIT are in the process of completing system updates to align our policies with CPT code changes (new codes, covered and non-covered, as well as the end-dated codes) to ensure that claims billed with the new codes will process and pay correctly.

Until this process is completed, claims submitted with new codes will pend for “no rate on file.” These pended claims will recycle and pay when the system work is completed. No additional action will be required by providers to ensure that claims process and pay correctly after the system work is completed. This process will also be applicable to the Medicare crossover claims.

To maintain cash flow, providers may wish to split claims and bill new codes on a separate claim. This will ensure that only claims billed with the new procedure codes are pended for processing.

New CPT codes that are covered by the NC Medicaid program are effective with date of service Jan. 1, 2021. Claims submitted with deleted codes will be denied for dates of service on or after Jan. 1, 2021. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code(s).
 

Note: All Category II and III Codes are not covered.

Code Set for Office and Other Outpatient Services Revised

To ease time and administrative burdens, the AMA revised the Evaluation and Management (E/M) code set for Office or Other Outpatient Services (99201-99215). 

• CPT 99201 has been end-dated effective Dec. 31, 2020. 
• Documentation of history and physical examination needs to be medically appropriate, however, the amount of history or number of elements examined and documented will no longer factor into the determination of the overall E/M level of service. 
• Code selection will be based on the level of Medical Decision Making (MDM) performed or the total time spent on the day of the encounter. 
• Providers are to follow all parenthetical information and code definitions found in the most recent version of AMA’s CPT manual when determining the most appropriate E/M code for billing.

A bulletin article will be released listing the new codes that will be separately reimbursable for Ambulatory Surgery Centers (ASC) when information is released by the Centers for Medicare & Medicaid Services (CMS) in January 2021.

Pharmacy will notify providers when new drug codes are added to NCTracks.

Contact

NCTracks Contact Center
1-800-688-6696