This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.
Telehealth Updates
One key update is the availability of occupational therapy (OT) and physical therapy (PT) telehealth service delivery for select service codes, with updated Outpatient Specialized Therapy (OST) telehealth and discharge criteria. The updated telehealth language was developed in consideration of Session Law 2025-64 (House Bill 546), research and stakeholder feedback.
OST telehealth criteria are in Subsection 3.1.1 of Clinical Coverage Policy (CCP) 10A. Current Procedural Terminology (CPT) codes that may be provided via telehealth service delivery are indicated in Attachment A., Section C. Codes.
Standard of Care Requirements
NC Medicaid beneficiaries shall receive high-quality care aligned with best practices for telehealth service delivery and may request in-person services at any time.
If a provider cannot meet the same standard of care as in-person services with telehealth service delivery, or if in-person services cannot be accommodated upon beneficiary request, the beneficiary must be discharged. At discharge, the therapist shall identify indicators for potential follow-up care or referral (Subsection 3.2.1.9).
Removal of Same-Day Local Education Agency and OST Service Restrictions
The other key change is the removal of language that precluded same day service delivery when OST services are also provided by a local education agency (LEA). This update complies with federal regulations 34 Code of Federal Regulations (CFR) 300.154 and IDEA: PL 108-446.
Non-Substantive Policy Updates
All sections and attachments are updated with non-substantive changes such as:
- Grammatical corrections
- Template language
- Style guide alignment
- Clarity enhancements
Billing and Compliance Reminders
- All claims must comply with the Medicaid National Correct Coding Initiative (NCCI).
- Modifier GT must be appended to the CPT code to indicate that a service has been provided via interactive audio-visual communication (telehealth).
Contact
NC Medicaid Contact Center: 888-245-0179
Provider Ombudsman: 866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov