NC Medicaid Private Duty Nursing Taxonomy Added to the NC Medicaid Home Health 3-A Fee Schedule - Updated

This bulletin replaces the previous bulletin published Nov. 21, 2022.

Note: This bulletin replaces the bulletin published Nov. 21, 2022.

Private Duty Nursing (PDN) Clinical Policies 3G-1 Beneficiaries 21 and older and 3G-2 Beneficiaries under 21 years old, Section 5.2.6.5 Medical Supplies, includes the following language:

Medical supplies are covered as per the criteria for coverage of medical supplies and use of the miscellaneous procedure code for medical supplies defined in clinical coverage policies 3A, Home Health Services and 5A, Durable Medical Equipment.

Taxonomy numbers are not included in Clinical Policy but are included in the associated Fee Schedules. Additionally, the effective column in fee schedules is reflective of dates of rate changes only. 

  • Taxonomy 251E00000X (Home Health) was originally the only Taxonomy listed on the Home Health Fee Schedule
  • PDN providers can use their Nursing Taxonomy 251J00000X to bill supplies using the Home Health Fee Schedule. Note: Because this is not new; PDN providers use the PDN policy guidance and use their PDN Taxonomy number when using the Home Health Fee Schedule, there is not an effective date to the PDN Taxonomy addition. 
  • PDN providers using the 5A Durable Medical Equipment (DME) policies must use a DME taxonomy. 

To avoid PDN supply claims denials and bring awareness to PDN providers and Prepaid Health Plans (PHPs), Taxonomy 251J00000X (Nursing Care) has been added to the 3-A Home Health Fee Schedule. 

Contact

Medicaid.homecaresevice@dhhs.nc.gov 

This blog is related to: