Immunizing Pharmacists Enrollment in NC Medicaid and Contraceptives and NRT Protocol for Reimbursement to Pharmacies

Immunizing Pharmacists Enrollment in NC Medicaid

NC Medicaid allows immunizing pharmacists to enroll as providers using the Ordering, Prescribing and Referring (OPR) Lite application process. Enrolling pharmacists as providers will allow the immunizing pharmacist’s National Provider Identifier (NPI) to be the prescriber on Point of Sale (POS) pharmacy claims for products dispensed in accordance with the NC Board of Pharmacy statewide protocols.

To reimburse for any medication, including those dispensed, per the state protocols, the prescriber must be an enrolled NC Medicaid provider. The pharmacist’s NPI will be the ordering provider on the medical claim submitted for the clinical services reimbursement to the pharmacy.

The protocols authorize immunizing pharmacists practicing in the state of North Carolina to dispense, deliver or administer five categories of medications, including:

  • Self-Administered Hormonal Contraceptives Protocol.
  • Nicotine Replacement Therapy Protocol.
  • Prenatal Vitamins Protocol.
  • Post-Exposure Prophylaxis (PEP) for HIV Protocol.
  • Glucagon Protocol.

The immunizing pharmacist must meet requirements to enroll as a NC Medicaid provider. NCTracks manages the application process for provider enrollment.

Enrollment Requirements

Enrollment requirements include:

  • NC Pharmacy License must indicate immunizing pharmacist.
  • Immunizing pharmacists must have their own individual NPI.
    • The most efficient application process to obtain an NPI is the National Plan & Provider Enumeration System (NPPES).
    • The name on the NPI, the enrollment application, and the license of the enrolling pharmacist must match.
  • Enrollment is for the Pharmacy Service Provider taxonomy level 2 code 183500000X.
  • Enrollment is as an individual in state provider.
  • The OPR Lite enrollment application includes a $100 fee, paid when application is submitted.

The estimated completion time for OPR provider enrollment is approximately two weeks from the application submission, if there are no issues with the submitted application.

After submitting the application, providers should make sure to quickly respond to any notification regarding the application and reach out for assistance as soon as needed to ensure quick resolution of any open items impacting enrollment.

For more information on OPR provider enrollment, please review the NCTracks Ordering, Prescribing, Rendering or Referring Provider (OPR) FAQs.

Enrollment Guidance

For enrollment guidance, go to the NCTracks Provider Enrollment webpage:

  • Click on How to Enroll in North Carolina Medicaid as an Individual Practitioner job aid under Quick Links.
  • Select Ordering, Prescribing, Referring Providers Enrolled with a Lite Application under Provider Enrollment Application Type.

The Provider Permission Matrix on the NCTracks Provider Enrollment webpage provides the requirements for the taxonomy level 2 code 183500000X.

Clinical Pharmacy Practitioners (CPPs) already enrolled in NC Medicaid will use the NCTracks manage change request (MCR) function to add the taxonomy level II code 18350000X to their record.

CPPs enroll in NC Medicaid at a taxonomy level 3 code. Immunizing pharmacist enrollment is a taxonomy level 2 code.

The CPP must meet the taxonomy Level 2 code requirements for immunizing pharmacists. No fee applies when using the MCR.

Contraceptives and NRT Protocol Reimbursement to Pharmacies

NC Medicaid is committed to supporting increased adoption and utilization of the statewide protocols and reimbursement to actively-enrolled pharmacies. While the immunizing pharmacist performs the clinical services, the pharmacy will be reimbursed for the services rendered.

The clinical services reimbursement request is submitted as a medical claim. An individual provider cannot be reimbursed for the clinical services provided for the protocols. Reimbursement is made to the Pharmacy provider only.

Pharmacy providers with the below taxonomies are allowed the reimbursement. The following four pharmacy taxonomies may bill for the clinical services reimbursement:

  • 3336C0002X – Clinic Pharmacy
  • 3336C0003X – Community/Retail Pharmacy
  • 3336C0004X – Compounding Pharmacy
  • 3336L0003X – Long Term Care Pharmacy

Protocols eligible for clinical services reimbursement include self-administered hormonal contraceptives and nicotine replacement therapy. Below are details for claim submission.

Self-Administered Hormonal Contraceptive Protocol

The following CPT codes are allowed for claims submission:

  • 99202: Office/outpatient new
  • 99212: Office/outpatient visit established

Diagnosis Codes:

  • Z30.011: Encounter for initial prescription of contraceptive pills
  • Z30.016: Encounter for initial prescription of transdermal patch hormonal

Contraceptive Devices:

  • Z30.41: Encounter for surveillance of contraceptive therapy pills
  • Z30.45: Encounter for surveillance of transdermal patch hormonal

Contraceptive Therapy: 

  • Z30.09: Encounter for other general counseling and advice on

Contraception:

  • Z30:09 is allowed when the beneficiary completes the questionnaire, the immunizing pharmacist performs the assessment, but no dispensing of a contraception product ultimately occurs.

Modifier Code:

  • FP: Family Planning
  • Note: The FP modifier is required on the claim.

Place of Service:

  • 01: Pharmacy

Nicotine Replacement Therapy Protocol

The following CPT codes are allowed for claims submission:

  • 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: 

  • N/A

Place of Service:

  • 01: Pharmacy

Additional Information

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This page was last modified on 07/10/2026