In September 2022, NC Medicaid implemented a new set of billing codes for Food and Housing screening. These screenings are tied to the NC InCK Alternative Payment Model (APM) available in Alamance, Orange, Durham, Granville and Vance counties.
While only providers within these five counties are eligible to participate in the APM and receive financial incentives, all NC Medicaid providers are encouraged to use the billing codes. Since the implementation of these codes, NC Medicaid has some additional clarification on implementation.
HCPCS G Codes
The following non-reimbursable HCPCS codes should be used to document a food- and housing-related screening:
G9920: Screening Performed and Negative
When the provider has screened for both housing and food-related needs, and no needs are identified.
G9919: Screening Performed and Positive and Provision of Recommendations
When the provider has screened for both housing and food-related needs, at least one need is identified, and referrals/resources have been offered. Providers may only code G9919 when referrals were provided to address all identified needs. A provider may use this code even if a patient declines the referrals/resources offered.
G9921: Positive Screening Without Recommendations
When the provider has screened for both housing and food-related needs, and at least one need is identified, but the provider has NOT provided referrals for all identified needs. For providers eligible for the NC InCK APM, use of this code does not count towards the Food Insecurity and Housing Instability Screening Measure.
ICD-10 Z Codes
In addition to the G codes described above, the following ICD-10 codes should be used to describe a positive screen. These Z codes cannot be used as a primary diagnosis code; they must be added to the claim after a primary diagnosis code.
| Questions | Suggested Z code for ‘yes’ response | SDOH Z Code Description |
|---|---|---|
| Food | ||
| Within the past 12 months, did you worry that your food would run out before you got money to buy more? | Z59.41 | Lack of adequate food (food insecurity) |
| Within the past 12 months, did the food you bought just not last and you didn’t have money to get more? | Z59.41 | Lack of adequate food (food insecurity) |
| Housing/ Utilities | ||
| Within the past 12 months, have you ever stayed: outside, in a car, in a tent, in an overnight shelter, or temporarily in someone else’s home (i.e. couch-surfing)? | Z59.00 | Homelessness, unspecified |
| Are you worried about losing your housing? | Z59.10 | Inadequate housing, unspecified |
| Within the past 12 months, have you been unable to get utilities (heat, electricity) when it was really needed? | Z59.89 | Other problems related to housing and economic circumstances |
For more information, please see the NC Medicaid InCK webpage.
Contact
NC Medicaid Contact Center, 888-245-0179