This bulletin applies to NC Medicaid Direct.
It was brought to NC Medicaid’s attention that claims for nerve conduction studies submitted by physical therapists were being denied for no rate on file. This contradicted both a bulletin article, Adding Physical Therapists to Electrodiagnostic Studies, published June 6, 2023, and clinical coverage policy 1A-27, Electrodiagnostic Studies, posted Nov. 1, 2023.
NC Medicaid corrected the reimbursement issue and reprocessed claims for nerve conduction tests performed by physical therapists with dates of service on or after April 1, 2023. Claims initially denied solely due to rate issues were reprocessed and reimbursed in the checkwrite issued on April 23, 2024. Providers are encouraged to consult their readmittance advice to confirm payment and refer to the explanation on benefits (EOB) for any claims that remained denied after the reprocessing.
In addition, the bulletin posted on June 6, 2023, erroneously listed code 95905 (Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report) as a covered service for physical therapists. This code is non-covered for all provider types.
Contact
NCTracks Call Center: 800-688-6696