An amended version of clinical coverage policy 1A-5, Child Medical Evaluation and Medical Team Conference for Child Maltreatment with an effective date of Sept. 1, 2022, was posted to the NC Medicaid Clinical Coverage Policy webpage.
Following is a summary of updates:
- Added criteria for when a Child Medical Evaluation (CME) is not covered. CME is not covered when the provider is not rostered with the North Carolina Child Medical Evaluation Program to conduct the type of diagnostic medical evaluation that was performed.
- Added ICD-10 code Z04.72 Encounter for examination and observation following alleged child physical abuse.
- Added note: Physicians, nurse practitioners and physician assistants may bill CPT code 99367.
- Added note: CPT code 99170-Anogenital exam, magnified, in childhood for suspected trauma, including image recording when performed, is included in the reimbursement for CPT code 99499 unless a colposcope is used.
Contact
NC Medicaid Contact Center: 888-245-0179