In SPECIAL BULLETIN COVID-19 #208: Amended Outpatient Billing Guidance for Vaccine and Monoclonal Antibody Administration - Jan. 6, 2022, providers who originally submitted outpatient COVID-19 administration code claims with revenue code 0261 were given an option to wait for a systematic reprocessing that would adjust their claims reimbursement.
This bulletin advises providers that after internal review of the NC Medicaid Reimbursement Policy, NC Medicaid does not revise provider submitted claims data. Therefore, NC Medicaid will not be able to reprocess provider submitted outpatient COVID-19 administration code claims originally submitted with Revenue Code 0261.
In order for providers to receive the maximum reimbursement at 100% of the fee schedule rate, providers are encouraged to resubmit their claims and replace Revenue Code 0261 with Revenue Code 0771. Providers who have billed claims with Revenue 0261 and received 100% of the fee schedule rate are not required to take any action.
Providers who bill these claims with Revenue Code 0771 at the usual and customary charges that are less than the fee schedule maximum rate will be subject to the lesser of logic pricing methodology, which could result in reimbursement at a rate less than the fee schedule maximum rate.
Please refer to the COVID-19 administration table below for the current appropriate codes and rates.
Notes:
- Maximum outpatient COVID-19 administration code rates are the same as maximum Physician COVID-19 Administration Code rates.
- Outpatient Dialysis facilities are included in this new outpatient billing guidance.
- For future COVID-19 administration code updates, refer to NC Medicaid’s Physician Services Fee Schedules.
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