This bulletin applies to NC Medicaid Managed Care and NC Medicaid Direct.
NC Medicaid now covers Point of Care rapid testing for Syphilis and HIV with an effective date of Jan. 1, 2024. This new coverage is being added to address the rise of syphilis and congenital syphilis cases that have re-emerged as a public health threat both nationally and in North Carolina.
For rapid (point of care) testing, providers should append the QW (CLIA-waived) modifier for beneficiaries with full Medicaid coverage and the FP and QW modifiers for Family Planning beneficiaries to the following codes:
- 86780: TREPONEMA PALLIDUM for POC Rapid Syphilis test only
- 86780 and 86703: HIV-1/HIV-2 1 SINGLE RESULT for dual Point of Care HIV and Syphilis testing
Contact
NCTracks Call Center: 800-688-6696
For NC Medicaid Managed Care questions, please contact the health plans.