All temporary Obstetrical Services policy flexibilities outlined in COVID-19 Special Bulletins remain in effect as of this publication date. See COVID-19 Special Bulletins for details.
An amended version of Clinical Coverage Policy 1E-5, Obstetrical Services with an effective date of April 1, 2022, will post to the NC Medicaid Clinical Coverage Policy webpage and contains the following revisions:
- Updated Medicaid for Pregnant Women (MPW) coverage for the legislated 12-month postpartum period.
- Removed Prior Approval (PA) requirements for non-obstetrical services under the MPW program to align with the 12-month postpartum coverage expansion.
- Added clarification on services allowed for telehealth coverage and added billing guidelines for telehealth services with the use of the GT modifier.
- Added guidelines for Tobacco Cessation Counseling, vaccinations with reference to Centers for Disease Control (CDC) guidelines for pregnancy and postpartum periods and guidelines for RhoGAM administration.
- Updated guidelines for billing individual antepartum visits and global or package billing.
- Added coverage and billing guidelines for hybrid telehealth visit with supporting home visit.
- Added United States Preventive Services Task Force (USPSTF) recommendations that align with the Obstetrical Services clinical coverage policy.
- Added a subsection “Non-Emergency Services for Undocumented Aliens” with a list of non-covered services.
- Clarified that NC Health Choice beneficiaries are not eligible for obstetrical services. Pregnant NC Health Choice beneficiaries must contact their local Department of Social Services (DSS) office for reassessment of eligibility.
Providers are encouraged to review Clinical Coverage Policy 1E-5, Obstetrical Services for a detailed overview of other general language and formatting updates to the policy.
Contact
NCTracks Contact Center: 800-688-6696