NC Medicaid has identified an error in the Fee Schedule rates published for CAP/C, CAP/DA and CAP/CD (formerly CAP Choice) reimbursement of Personal Care Services (PCS). This bulletin only applies to NC Medicaid Direct.
The rates for all PCS codes should have reflected a required minimum of $5.96 per 15-minute increment, but a calculation error led to the rate for the HCPCS codes listed below being posted on Dec. 5, 2023, as $6.41.
On Feb. 5, 2024, NC Medicaid corrected the fee schedule rate to be $5.96 for the affected codes to align with the SFY 2024 budget appropriations for PCS services:
- S5125
- S5135
- S5150
- T2027
As stated in the Oct. 19, 2023, Medicaid bulletin Legislated Medicaid Provider Rate Increases: Skilled Nursing Facilities (SNF), Personal Care Services (PCS), and Private-Duty Nursing (PDN), effective July 1, 2023, PCS service codes, as defined by NC Medicaid in the current CAP service array, receive the same permanent increase of $1.07 added to either the previously established Direct Care Worker (DCW) rate or to the rate in effect prior to the Public Health Emergency (PHE). Electronic Visit Verification (EVV) rate adjustments to applicable PCS codes also remained in effect.
To reduce potential disruption of operations for providers who were paid a rate greater than $5.96, based on the incorrect higher posted rate of $6.41, NC Medicaid will not recoup overpayments related to the erroneous fee schedule.
Providers with questions regarding the rate adjustment may contact Medicaid’s Provider Reimbursement Section.
Contact
Provider Reimbursement 919-527-7699
Medicaid.ProviderReimbursement@dhhs.nc.gov