CPT Code Update 2021

Tuesday, January 5, 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).
 

New CPT Codes Covered by Medicaid and NC Health Choice (effective Jan. 1, 2021)

30468

32408

33741

33745

33746

33995

33997

57465

71271

76145

80151

80167

80181

80204

82681

90377

92229

92650

92651

92652

92653

93241

93242

93243

93244

93245

93246

93247

93248

94619

99417

                 

 

New HCPCS Codes Covered by Medicaid and NC Health Choice (effective Jan. 1, 2021)

D1355

D7961

D7962

 

New CPT Codes Not Covered by Medicaid and NCHC (effective 1/1/2021)

55880

69705

69706

80143

80161

80179

80189

80193

80210

81168

 

81191

81192

81193

81194

81278

81279

81338

81339

81347

81348

 

81351

81352

81353

81357

81360

81419

81513

81514

81529

81546

 

81554

82077

92517

92518

92519

99439

0139U

0140U

0141U

0142U

 

0143U

0144U

0145U

0146U

0147U

0148U

0149U

0150U

0151U

0152U

 

0153U

0156U

0157U

0158U

0159U

0160U

0161U

0162U

0163U

0164U

 

0166U

0167U

0168U

0169U

0170U

0171U

0172U

0173U

0174U

0175U

 

0176U

0177U

0178U

0179U

0180U

0181U

0182U

0183U

0184U

0185U

 

0186U

0187U

0188U

0189U

0190U

0191U

0192U

0193U

0194U

0195U

 

0196U

0197U

0198U

0199U

0200U

0201U

0202U

0203U

0204U

0205U

 

0206U

0207U

0208U

0209U

0210U

0211U

0212U

0213U

0214U

0215U

 

0216U

0217U

0218U

0219U

0220U

0221U

0222U

     

 

 

End-Dated CPT Codes (effective Dec. 31, 2020)

19324

19366

32405

49220

57112

58293

61870

62163

63180

63182

69605

76970

78135

81545

92585

92586

92992

92993

94250

94400

94750

94770

95071

99201

0006U

0085U

0124U

0125U

0126U

0127U

0128U

                 

 

Covered HCPCS Codes End-Dated (effective Dec. 31, 2020)

D7960

G0297

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