NC Medicaid is committed to supporting increased adoption and utilization of the Board of Pharmacy statewide protocols authorized by HB 96, SL 2021-110. As part of this commitment, immunizing pharmacists will receive reimbursement for clinical services provided when utilizing the statewide Nicotine Replacement Therapy (NRT) Protocol effective Aug. 1, 2024. This bulletin applies to NC Medicaid Managed Care and NC Medicaid Direct.
The claim should be submitted using a medical claim and payment will be issued to the pharmacy. As with the Self-Administered Hormonal Contraceptive Protocol, an individual provider will not be reimbursed directly for the clinical services provided for the NRT protocol.
Effective Jan. 8, 2024, NC Medicaid allowed immunizing pharmacists to enroll as Medicaid providers and implemented reimbursement to pharmacies for the clinical services performed by pharmacists per the Self-Administered Hormonal Contraceptive Protocol. Pharmacies are reimbursed for the services rendered when immunizing pharmacists perform the clinical services per the protocol. Immunizing Pharmacist enrollment and medical claims billing is provided in the Dec. 20, 2023, bulletin regarding Immunizing Pharmacists Enrollment.
Nicotine Replacement Therapy Protocol Medical Claims Billing and Reimbursement Guidance for Pharmacies
The following four pharmacy taxonomies may bill for clinical services reimbursement:
- 3336C0002X – Clinic Pharmacy
- 3336C0003X – Community/Retail Pharmacy
- 3336C0004X – Compounding Pharmacy
- 3336L0003X – Long Term Care Pharmacy
The following codes are allowed for claims submission:
- CPT Codes:
- 99202: Office/outpatient new
- 99212: Office/outpatient visit established
- Diagnosis Codes:
- Z72.0 Tobacco Use
- 099.330 Smoking (tobacco) complicating pregnancy, unspecified trimester
- Modifier Code:
- No modifier is required
The following applies for both NC Medicaid Direct and NC Medicaid Managed Care health 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. Select Physician Services for the Program and Fee Schedule, then click apply filters to download the fee schedule.
- 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 40miles 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