SPECIAL BULLETIN COVID-19 #206: Coverage for COVID-19 Treatment for NC Medicaid Optional Eligibility Group

This group includes MAFDN Family Planning Medicaid and uninsured MCV beneficiaries.

The American Rescue Plan Act extended coverage (without cost-sharing) for COVID-19 treatment to the NC Medicaid Optional Eligibility Group effective March 11, 2021. This group includes MAFDN Family Planning Medicaid and uninsured MCV beneficiaries. COVID-19 treatment includes treatment of a condition that may seriously complicate the treatment of COVID-19 in beneficiaries who are presumed positive for the virus or have been diagnosed with COVID-19, if otherwise covered under the State Plan. 

For eligible MAFDN Family Planning Medicaid beneficiaries, COVID-19 treatment services are covered effective March 11, 2021, when diagnosis code U07.1 (2019-nCoV Acute Respiratory Disease) is submitted as the primary/principal diagnosis code on the claim.

For eligible MCV beneficiaries, COVID-19 treatment services are covered effective March 11, 2021, when the following diagnosis coding is on the claim.  

1. Diagnosis code U07.1 (2019-nCoV Acute Respiratory Disease) is submitted as the primary/principal diagnosis code on the claim; or 
2. For a beneficiary in the prenatal or postpartum period: 
   • One of the following pregnancy diagnosis codes is submitted as primary/principal diagnosis code:
     • O98.511- Other viral diseases complicating pregnancy, first trimester;
     • O98.512- Other viral diseases complicating pregnancy, second trimester;
     • O98.513- Other viral diseases complicating pregnancy, third trimester;
     • O98.519- Other viral diseases complicating pregnancy, unspecified trimester;
     • O98.52- Other viral diseases complicating childbirth; or
     • O98.53- Other viral diseases complicating the puerperium; and
   • Diagnosis code U07.1 (2019-nCoV Acute Respiratory Disease) is submitted as a secondary diagnosis on the claim.   

Note: For hospital claims, the principal diagnosis code field is used to identify the primary diagnosis code for services rendered. For professional claims, the diagnosis pointer method is used to identify the primary diagnosis code for services rendered.

Claims for COVID-19 treatment services that were billed to and denied by the Health Resources and Services Administration (HRSA) program for Medicaid processing with dates of service on or after March 11, 2021, may be billed to Medicaid at this time. Treatment claims that have denied by Medicaid may also be refiled for processing at this time. 

Contact

NCTracks Call Center: 800-688-6696