NC Medicaid reimburses qualified providers for medically necessary circumcision for newborn and non-newborns according to guidelines set forth in NC Medicaid policy 1A-22 Medically Necessary Circumcision.
Following the guidance set forth by policy 1A-22, hospitals are billing using the required ICD-10 diagnosis code Z29.8 (encounter for other specified prophylactic measures), which has been found to change the DRG from 795 normal newborn to 794 sick newborn. This is resulting in claims not being paid and impacting hospital cash flow.
NC Medicaid is not changing the medical necessity criteria in the policy and is currently in the process of removing the notation in policy requiring the use of diagnosis code ICD-10 code Z29.8. Providers will continue to code with the appropriate CPT codes per policy.
Contact
NCTracks Call Center: 800-688-6696