Updates to Clinical Coverage Policy 10D, Respiratory Therapy Services by Independent Practitioner Provider

Tuesday, January 12, 2021

All temporary policy flexibilities outlined in COVID-19 Special Bulletins remain in effect as of this publication date. See COVID-19 Special Bulletins for details.

An updated version of Clinical Coverage Policy 10D, Respiratory Therapy Services by Independent Practitioner Provider (IPP) with an amended date of Jan. 1, 2021, was posted to the NC Medicaid Specialized Therapies Clinical Coverage Policies web page. Following is a summary of updates effective Dec. 1, 2020:

New Subsection 3.1.1, Telehealth Services, was added:
3.1.1 Telehealth Services
As outlined in Attachment A and in Subsection 3.2.1, select services within this clinical coverage policy may be provided via telehealth. Services delivered via telehealth must follow the requirements and guidance set forth in Clinical Coverage Policy 1-H: Telehealth, Virtual Communications, and Remote Patient Monitoring.

In Subsection 3.2.1, Specific criteria covered by both Medicaid and NCHC, guidance for the delivery of select respiratory therapy treatment interventions using telehealth was added:
c. Telehealth
A select set of respiratory therapy treatment interventions may be provided to established patients using a telehealth delivery method as described in Clinical Coverage Policy 1-H. After necessary equipment and supplies have been delivered and assembled, delivery of treatment services via telehealth may be medically necessary when a beneficiary’s medical condition is such that exposure to others should be avoided, or if their location is remote or underserved such that access to appropriately qualified providers is limited.

Note: CPT codes that may be billed when service is furnished via telehealth are indicated in Attachment A, Section C: Codes.

In Subsection 5.3, Limitations or Requirements, the first sentence of the third paragraph was updated to read:
Respiratory Therapy treatment visits by the IPP must occur in the beneficiary’s primary private residence or via telehealth in accordance with Subsection 3.2.1 c., and focus on legal parent(s), legal guardian(s) or foster care provider(s) education.

In Attachment A, Claims-Related Information guidelines for billing telehealth claims were added to Section D, Modifiers and Section F, Place of Service. Additionally, in Section C, Codes, the following CPT codes were identified as telehealth eligible services:
 

CPT code

Description

94664

Demonstration and/or evaluation of patient utilization of an aerosol generator nebulizer, metered dose inhaler or IPPB device

94760

Noninvasive ear or pulse oximetry for oxygen saturation; single determination

99504

Home visit for mechanical ventilation care

 

Contact

NC Medicaid Contact Center, 888-245-0179