Immunizing Pharmacists Enrollment Opening in January 2024

NC Medicaid will allow immunizing pharmacists to enroll as providers using the Ordering, Prescribing, and Referring (OPR) Lite application starting on Jan. 8, 2024. Enrollment will support utilization of the NC Medical Board and Board of Pharmacy statewide protocols which authorize immunizing pharmacists to dispense, deliver or administer the following:

This bulletin applies to both NC Medicaid Direct and NC Medicaid Managed Care. The implementation dates listed in the bulletin are related to NC Medicaid enrollment and NC Medicaid Direct billing. For questions on when the NC Medicaid Managed Care health plans will have their billing implemented, please reach out to the health plan. Contact information for the health plans is on the Health Plan Contacts and Resources webpage.

Immunizing Pharmacist Enrollment Information

Enrolling as a Medicaid provider will allow the individual immunizing pharmacist to be the prescriber on protocol claims submitted for Medicaid beneficiaries. The immunizing pharmacist must have their own NPI number to be the prescriber on the pharmacy point of sale claim. Directions to obtain a NPI are found at CMS.gov. For the most efficient application process use the National Plan & Provider Enumeration System (NPPES). Please note, the name on the NPI, the enrollment application, and the license of the enrolling pharmacist must match. After enrollment, it is important for pharmacists to keep their email address updated to ensure communications from the NCTracks message center are received.

Immunizing pharmacist requirements to enroll in NC Medicaid:

License must indicate immunizing pharmacist.
Immunizing pharmacist must have their own individual NPI.
Individual provider enrollment must be for a level 2 taxonomy, 183500000X.
The OPR Lite enrollment application fee is $100. Any provider applying must pay the application fee when submitting the application.
- The estimated completion time for OPR provider enrollment is approximately two weeks from the application submission (if there are no issues with the submitted application).
- After submitting the application, applying providers should make sure to quickly respond to any notification regarding the application and reach out for assistance as soon as needed to ensure quick resolution of any open items impacting enrollment.
- For more information on OPR provider enrollment, please review the OPR Provider FAQs.

To enroll and for other enrollment guidance, go to the NCTracks Provider Enrollment webpage:

Directions to enroll can be found under the NCTracks Provider Enrollment webpage, click on How to Enroll in North Carolina Medicaid as an Individual Practitioner job aid under Quick Links.
Select Ordering, Prescribing, Referring Providers Enrolled with a Lite Application under Provider Enrollment Application Type.
Requirements for enrollment under the Pharmacy Service Providers level 2 taxonomy 183500000X are found also in the Provider Permission Matrix on the NCTracks Provider Enrollment webpage.

Clinical Pharmacist Practitioners (CPPs) Guidance:

CPPs enroll in North Carolina Medicaid at a level 3 taxonomy. Immunizing pharmacist enrollment is a level 2 taxonomy. To enroll as an immunizing pharmacist, any active NC Medicaid enrolled CPP will need to complete a Manage Change Request (MCR) to add the level 2 taxonomy to their record. After logging into the NCTracks Provider Portal, select the Status and Management button. When the Status and Management screen displays, select Mange Change Request. There is no fee for a CPP to add this additional taxonomy to their record.

Self-Administered Hormonal Contraceptive Protocol Medical Claims Billing and Reimbursement Guidance for Pharmacies

NC Medicaid is committed to supporting increased adoption and utilization of the statewide Self-Administered Hormonal Contraceptive Protocol. Starting Jan. 8, 2024, NC Medicaid will reimburse actively enrolled NC Medicaid pharmacies for clinical services performed by the immunizing pharmacist utilizing the Self-Administered Hormonal Contraceptive Protocol. While the immunizing pharmacist performs the clinical services, the pharmacy will be reimbursed for the services rendered. The Self-Administered Hormonal Contraceptive Protocol is the only protocol eligible for reimbursement at this time.

The following four pharmacy taxonomies may bill for reimbursement of clinical services:

3336C0002X – Clinic Pharmacy
3336C0003X – Community/Retail Pharmacy
3336C0004X – Compounding Pharmacy
3336L0003X – Long Term Care Pharmacy

The following codes should be used for claims submission:

CPT Codes:
- 99202: Office/outpatient new
- 99212: Office/outpatient visit established
Diagnosis Codes:
- Z30.011: Encounter for initial prescription of contraceptive pills
- Z30.016: Encounter for initial prescription of transdermal patch hormonal contraceptive device
- Z30.41: Encounter for surveillance of contraceptive therapy pills
- Z30.45: Encounter for surveillance of transdermal patch hormonal contraceptive therapy
Modifier Code:
- FP: Family Planning
  - Note: The FP modifier is required on the claim.

Please see the below information on reimbursement which applies for both NC Medicaid Direct and NC Medicaid Managed Care Plans:

Reimbursement rates align with the non-facility rate listed for the applicable codes on the Physician Services fee schedule. To review the fee schedule, please refer to the Fee Schedules posted on the NC Medicaid webpage.
Providers will not be reimbursed for providing these clinical services to beneficiaries enrolled in Family Planning Medicaid (MAFDN).
Reimbursement for clinical services will only be paid to pharmacies located within the state of North Carolina.
Border pharmacy providers (providers who render services within 40 miles of the North Carolina border) and out of state providers are not eligible for this clinical services reimbursement.

Contact

NCTracks Call Center: 800-688-6696

For information on NC Medicaid Managed Care Health Plan billing, please contact health plans leveraging the information on the Health Plan Contacts and Resources page.