2025 CPT Code Update

This bulletin is related to NC Medicaid Direct.

Effective with date of service Jan. 1, 2025, the American Medical Association (AMA) has added new CPT codes, end-dated others, and changed the descriptions of some existing codes.  For complete information regarding all CPT codes and descriptions, refer to the 2025 edition of Current Procedural Terminology, published by the AMA.  

Providers should note the full descriptions as well as all associated parenthetical information published in this edition when selecting a code for billing services to NC Medicaid.

New CPT codes that are covered by NC Medicaid Direct are effective with date of service Jan. 1, 2025. Claims submitted with end-dated codes will be denied for dates of service on or after Jan. 1, 2025. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on an end-dated code that are continued with the replacement code(s). 

Note: All Category II and III Codes are not covered.

A bulletin article will be released listing the new codes that will be separately reimbursable by Ambulatory Surgery Centers (ASC) when that information is released by the Centers for Medicare & Medicaid Services (CMS) in January 2025.

The pharmacy section will notify providers when new drug codes are added to NCTracks.

The State and GDIT are in the process of completing system updates to align our policies with CPT code changes (new codes, covered and non-covered, as well as the end-dated codes), to ensure that claims billed with the new codes will process and pay correctly.

Until this process is completed, claims submitted with new covered codes will pend for “no fee on file.” These pended claims will recycle and pay when the system work is completed. No additional action will be required by providers to ensure that claims process and pay correctly after the system work is completed. This process will also be applicable to Medicare crossover claims.

To maintain cash flow, when appropriate, providers may wish to split claims and bill new codes on a separate claim. This will ensure that only claims billed with the new procedure codes are pended for processing. 

Contact

NCTracks Call Center: 800-688-6696