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.
On July 1, 2021, an amended version of Clinical Coverage Policy 10B, Outpatient Specialized Therapies, Independent Practitioners was posted to the NC Medicaid Clinical Coverage Policy web page. Following is a summary of updates:
New Subsection 3.1.1, Telehealth Services, was added:
3.1.1 Telehealth Services
As outlined in Attachment A and in Subsection 3.2.1.3.e, 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, on NC Medicaid’s website at https://medicaid.ncdhhs.gov.
In Subsection 3.2.1.3, Speech-Language Therapy, the following medical necessity guidance was added:
e. Telehealth
- A select set of speech and language evaluation and treatment interventions may be provided to a beneficiary using a telehealth delivery method as described in Clinical Coverage Policy 1-H. Telehealth delivery may be medically necessary when a beneficiary’s medical condition is such that exposure to others should be avoided, access to transportation is inconsistent, or if their location is remote or underserved such that access to appropriately qualified providers is limited.
- To ensure a beneficiary receives high quality care aligned with best practices, the following criteria must be considered when making decisions about providing care using a telehealth delivery method:
A. Unless in-person care is contraindicated or unavailable, telehealth must be used as an adjunct to in-person care and not as a replacement.
B. Telehealth must be used in the best interest of the beneficiary and not as a convenience for the therapist.
C. Telehealth must never be used solely to increase therapist productivity.
Note: CPT codes that may be billed when service is furnished via telehealth are indicated in Attachment A, Section C: Codes.
In Attachment A, Claims-Related Information, Section C: Codes, the following CPT codes were identified as telehealth eligible services:
CPT code |
Short Description |
92521 |
Evaluation of speech fluency (e.g., stuttering, cluttering) |
92522 |
Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) |
92523 |
Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language) |
92524 |
Behavioral and qualitative analysis of voice and resonance |
92607 |
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour |
92608 |
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes |
92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual |
92526 (oral motor only) |
Treatment of swallowing dysfunction and/or oral function for feeding |
92609 |
Therapeutic services for the use of speech-generating device, including programming and modification |
Attachment A, Section D, Modifiers, was updated to read:
Non-Telehealth Claims: Provider(s) shall follow applicable modifier guidelines.
Telehealth Claims: Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for virtual communications or remote patient monitoring.
Attachment A, Section F, Place of Service, was updated to add:
Telehealth claims should be filed with the provider’s usual place of service code(s).
Additional Resources
The full text of Clinical Coverage Policy 10B, Outpatient Specialized Therapies, Independent Practitioners is available at NC Medicaid’s Outpatient Specialized Therapy Services web page. All COVID-19 Special Bulletins are available here.
Contact
NC Medicaid Contact Center, 888-245-0179