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NC Medicaid Telehealth Billing Code SummaryUPDATE (June 25, 2020) Updated Telehealth Guidance: Codes that require 2 modifiers (i.e., GT and CR) must be billed with both modifiers or the claim detail will deny.oo Updated Table 2. Telepsychiatry and Telebehavioral Health ServicesUpdated Table 13. Perinatal CareUpdated Table 21. Skilled Nursing Facilities includes new evaluation and management codesSee the Appendix for a complete list of updates.NC Medicaid is temporarily modifying its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care toMedicaid and NC Health Choice members. These temporary changes are effective retroactive to March 10, 2020, and will end the earlier of thecancellation of the North Carolina state of emergency declaration or when this policy is rescinded. The tables below outline revised billing guidance fortelehealth codes. Providers should reference the Medicaid Special COVID-19 Bulletins more specific coding and billing guidance.NC Medicaid Telehealth Billing Code Summary1 of 22June 25, 2020
ContentsTable 1. Prescribers (Medical and Behavioral Health). 3Table 2. Telepsychiatry and Telebehavioral Health Services. 4Table 3. Teletherapy . 6Table 4. Teledentistry . 6Table 5. Local Education Agencies Teletherapy. 7Table 6. Children’s Developmental Services Agencies (CDSAs) – NC Infant Toddler Program (NC ITP) Services. 7Table 7. Diabetes Self-Management Education (DSME) . 9Table 8. Dietary Evaluation and Counseling . 10Table 9. Medical Lactation . 10Table 10. Research-based Behavioral Health (RB-BHT) Treatment for Autism Spectrum Disorder (ASD). 11Table 11. Self-measured Blood Pressure Monitoring (SMBPM) Services. 11Table 12. Optometry. 12Table 13. Perinatal Care . 12Table 14. Remote Physiologic Monitoring. 13Table 15. Well Child Visits . 13Table 16. Postpartum Depression Screening. 14Table 17. Health and Behavior Intervention Visits Provided by Local Health Departments . 14Table 18. Outpatient Respiratory Therapy . 14Table 19. Hybrid Telemedicine with Supporting Home Visit . 15Table 20. End-Stage Renal Disease (ESRD) . 16Table 21. Skilled Nursing Facilities . 16Table 22. Enhanced Behavioral Health Services . 16Table 23. Maternal Support Services Provided by Local Health Departments. 19Table 24. Family Planning Services for MAFDN Beneficiaries . 20Table 25. Smoking and Tobacco Cessation Counseling .20Appendix: List of Updates to the NC Medicaid Telehealth Billing Code Summary .21NC Medicaid Telehealth Billing Code Summary2 of 22June 25, 2020
TABLE 1. PRESCRIBERS (MEDICAL AND BEHAVIORAL HEALTH)ServiceApplicable ProvidersOffice or OtherOutpatient Serviceand Office andInpatientConsultation TelephoneEvaluation andManagement Advance practice midwives FQHCs, FQHC Look-Alikes & RHCs* Nurse practitioners Physicians Physician assistants Advance practice midwives FQHCs, FQHC Look-Alikes & RHCs Nurse practitioners Physicians Physician assistantsConsulting physicians bill for servicesrequested by a physician, physicianassistant, nurse practitioner orcertified nurse midwifeOnline digitalEvaluation andManagementInterprofessionalAssessment andManagementAdvanced practice midwivesClinical pharmacist practitionersFQHCs, FQHC Look-Alikes & RHCs*Nurse practitionersPhysiciansPhysician assistantsPsychiatric nurse practitionersNC Medicaid Telehealth Billing Code SummaryRATE CODE OR PROCEDUREModifiers & POSTELEMEDICINE99201, 99202, 99203, 99204,99205, 99211, 99212 99213,99214, 99215, 99241, 99242,99243, 99244, 99245, 99251,99252, 99253, 99254, 99255 Reported with usual place ofservice (POS) Modifiers GT & CR For additional informationabout providing and billingthese services: NC Medicaidclinical coverage policy 1H,telemedicine/telepsychiatry*FQHCs, FQHC Look-Alikes and POS 50 (FQHC) or 72 (RHC)RHCs only: T1015 Modifiers GT & CRVIRTUAL PATIENT COMMUNICATIONS99441, 99442, 99443, G2012 Reported with usual place ofservice (POS) Modifier CR*FQHCs, FQHC Look-Alikes and POS 50 (FQHC), 72 (RHC)RHCs only: G0071 Modifier CR99421, 99422, 99423 Reported with usual place ofservice (POS) Modifier CR99446, 99447, 99448, 994493 of 22Source BulletinSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions,Eligible Providers, Services andCodesSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions,Eligible Providers, Services andCodes Reported with usual place ofservice (POS) Modifier CRJune 25, 2020
TABLE 2. TELEPSYCHIATRY AND TELEBEHAVIORAL HEALTH SERVICESSERVICEAPPLICABLE PROVIDERSPsychiatric DiagnosticEvaluation andPsychotherapy (see toClinical CoveragePolicy 8C. For FQHCs,FQHC Look-Alikes andRHCs, see ClinicalCoverage Policy 1D-4) FQHCs, FQHC Look-Alikes andRHCs* Licensed clinical addictionspecialists Licensed clinical addictionspecialist associates Licensed marriage and familytherapists Licensed marriage and familytherapist associates Licensed clinical mental healthcounselors (formerly licensedprofessional counselors) Licensed clinical mental healthcounselor associates Licensed psychologists Licensed psychological associates Licensed clinical social workers Licensed clinical social workerassociate Physicians Physicians assistantsPsychiatric nurse practitioners (asallowed by Clinical Coverage Policy8C, Section 6.1.m.) Psychiatrists/Physicians Licensed psychologists Licensed psychological Associates Psychiatric nurse practitionersα Physician AssistantsαScreening and TestingCodes (see to ClinicalCoverage Policy 8C)Inpatient Codes Certified psychiatric-mental healthnurse practitioners PsychiatristsNC Medicaid Telehealth Billing Code SummaryRATE CODE OR PROCEDURETELEPSYCHIATRY90785α, 90791Þ, 90792 ,90832Þ, 90833 Þ, 90834Þ,90836 Þ, 90837Þ, 90838 Þ,90839Þ, 90840Þ, 90846Þ,90847Þ, 90849 Þ, 90853Þ Only billable by licensedpsychiatric prescribingprovidersMODIFIERS & POS Reported with usual placeof service (POS) Services that are notCOVID-19 related shouldcontinue to be billed inaccordance with NCMedicaid clinical coveragepolicy 1H,telemedicine/telepsychiatryMay be providedtelephonically when beingused for interpreter services.ÞIf two-way audio-visualoptions are not accessible tothe beneficiary, services maybe offered via telephonicmodality.*FQHCs, FQHC Look-Alikes andRHCs only: T1015-HI When delivered viatelemedicine (real time,two-way audio/visual):Modifiers GT & CR When deliveredtelephonically: CR only96110α, 96112, 96113, 96116,96121, 96130, 96131, 96132,96133, 96136, 96137, 96138,96139, 96146 Reported with usual placeof service (POS) Modifiers GT & CRαPsychiatric NursePractitioners and PhysicianAssistants can only bill 9611099231, 99232, 99233, 99238,99239SOURCE BULLETINSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions, EligibleProviders, Services and CodesSpecial Bulletin COVID-19 #59:Telehealth Clinical PolicyModifications - OutpatientBehavioral Health Services POS 50 (FQHC) or 72 (RHC) Modifiers GT & CRα4 of 22 Reported with usual placeof service (POS) Modifiers GT & CRJune 25, 2020
TABLE 2. TELEPSYCHIATRY AND TELEBEHAVIORAL HEALTH SERVICESSERVICEAPPLICABLE PROVIDERSRATE CODE OR PROCEDUREEnhanced and OtherBehavioral HealthServices Assertive Community Treatment(ACT) providers Community Support Team (CST)providers Intensive in-home Servicesproviders Mobile crisis managementproviders Multisystemic therapy providers Peer Supports Services (PSS)providersH2022, H2033, H2011, H0040,H2015HT, H0038TelephoneAssessment andManagement Licensed clinical addictionspecialists Licensed clinical addictionspecialist associates Licensed clinical social workers Licensed clinical social workerassociates Licensed marriage and familytherapists Licensed marriage and familytherapist associates Licensed clinical mental healthcounselors (formerly licensedprofessional counselors) Licensed clinical mental healthcounselor associates Licensed psychologists Licensed psychological associates FQHC, FQHC lookalikes and RHCs*98966, 98967, 98968NC Medicaid Telehealth Billing Code SummaryMODIFIERS & POS Reported with usual placeof service (POS) Modifiers GT & CRSOURCE BULLETIN8A, 8A-1, 8A-6, and 8GSpecial Bulletin COVID-19 #35:Telehealth Clinical PolicyModifications – EnhancedBehavioral ServicesVIRTUAL PATIENT COMMUNICATION*Federally Qualified HealthCenters (FQHCs) and RuralHealth Centers (RHCs) may billfor services provided bylicensed clinical addictionspecialists, licensed clinicalmental health counselors,licensed psychologists,licensed psychologicalassociates, licensed clinicalsocial workers and licensedmarriage and family therapists5 of 22 Reported with usual placeof service (POS) Modifier CRSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions, EligibleProviders, Services and CodesJune 25, 2020
TABLE 3. TELETHERAPYSERVICEOutpatientSpecialized Therapies(Clinical CoveragePolicies 10A and 10B)APPLICABLE PROVIDERSRATE CODE OR PROCEDUREAudiologists92630, 92633Physical therapists97161, 97162, 97163, 97164,97750, 97110, 97112, 97116,97530, 97533, 97535, 97542,97763, 9599292065, 92526 (oral functionand feeding only), 97110,97112, 97116, 97165, 97166,97167, 97168, 97530, 97533,97535, 97542, 97763, 9775092521, 92522, 92523, 92524,92607, 92608, 96125, 92507,92526 (oral function andfeeding only), 92609, 92630,92633Occupational therapistsSpeech language therapistsMODIFIERS & POS Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CRSOURCE BULLETINSpecial Bulletin COVID-19 #36:Telehealth Clinical PolicyModifications – OutpatientSpecialized Therapies and DentalServices Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CR*Teletherapy requires the use of real-time, two-way audio video capability*TABLE 4. TELEDENTISTRYSERVICETeledentistryAPPLICABLE PROVIDERSDentistsNC Medicaid Telehealth Billing Code SummaryRATE CODE OR PROCEDUREMODIFIERS & POSD0140, D0170, D0999, D9995,D9996 POS 02 Dental codes will not useCR or GT modifiers D9995 and D9996 requirevideo and/or photos andmust be reported with oralevaluation codes D0140 orD0170 D0999 must be reportedfor patient telephonicencounters with realtime/live audiointeractions only and arenot allowed to be reportedwith any other service6 of 22SOURCE BULLETINSpecial Bulletin COVID-19 #36:Telehealth Clinical PolicyModifications – OutpatientSpecialized Therapies and DentalServicesJune 25, 2020
TABLE 5. LOCAL EDUCATION AGENCIES TELETHERAPYSERVICEOutpatientSpecialized Therapies,Local EducationAgencies (LEAs)(Clinical CoveragePolicy 10C)APPLICABLE PROVIDERSRATE CODE OR PROCEDUREAudiologists92630, 92633Physical therapists97161, 97162, 97163, 97164,97750, 97110, 97112, 97116,97530, 97533, 97535, 97542,97763, 9599297165, 97166, 97167, 97168,97750, 92065, 92526 (oralfunction and feeding only),97110, 97112, 97116, 97530,97533, 97535, 97542, 9776392521, 92522, 92523, 92524,92526 (oral function andfeeding only), 92607, 92608,96125, 92507, 92609, 92630,9263390832, 90834, 90837, 90847,96110, 96112, 96113, 96130,96131Occupational therapistsSpeech language therapistsAppropriate psychology and/orcounseling professional per policy 10CMODIFIERS & POS Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CRSOURCE BULLETINSpecial Bulletin COVID-19 #36:Telehealth Clinical PolicyModifications – OutpatientSpecialized Therapies and DentalServices Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CRSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions, EligibleProviders, Services and CodesTABLE 6. CHILDREN’S DEVELOPMENTAL SERVICES AGENCIES (CDSAS) – NC INFANT TODDLER PROGRAM (NC ITP) atryAPPLICABLE PROVIDERSRATE CODE OR PROCEDUREAudiologists92630, 92633, T1023Educational diagnosticians96110, 96112, 96113, T1023Infant/Family/Toddler specialists96110, 96112, 96113, H0036,H0036-HI, H0036-HM, H0036HQ, H0036-TL, H0036-UI,T1017, T102390832, 90834, 90837, 90846,90847, 96110, 96112, 96113,H0031, T1023Licensed clinical social workersNC Medicaid Telehealth Billing Code Summary7 of 22MODIFIERS & POS Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CRSOURCE BULLETINSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions, EligibleProviders, Services and Codes Reported with usual placeof service (POS) Modifiers GT & CRJune 25, 2020
TABLE 6. CHILDREN’S DEVELOPMENTAL SERVICES AGENCIES (CDSAS) – NC INFANT TODDLER PROGRAM (NC ITP) SERVICESSERVICEAPPLICABLE PROVIDERS Licensed clinical mental healthcounselors (formerly licensedprofessional counselors) Licensed marriage and familytherapists Licensed psychological associatesNurse practitioners (medical andpsychiatric)NutritionistsOccupational therapistsPhysiciansPhysician assistantsPhysical therapistsPsychologistsNC Medicaid Telehealth Billing Code SummaryRATE CODE OR PROCEDUREMODIFIERS & POS90832, 90834, 90837, 90846,90847, H0031 Reported with usual placeof service (POS) Modifiers GT & CR90832, 90834, 90837, 96112,96113, 99211, 99212, 99213,9214, 99215, T102396112, 96113, 97802, 97803,T1023 Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CR92526 (oral function andfeeding only), 96110, 96112,96113, 97110, 97112, 97116,97165, 97166, 97167, 97168,97533, 97535, 97542, 97750,97763, T102390832, 90834, 90837, 96110,96112, 96113, 96116, 96121,96132, 96133, 99201, 99202,99203, 99204, 99205, 99211,99212, 99213, 99214, 99215,99241, 99242, 99243, 99244,99245, T102396112, 96113, 99211, 99212,99213, 99214, 9921592526 (oral function andfeeding only), 96110, 96112,96113, 97110, 97112, 97116,97162, 97163, 97164, 97533,97535, 97542, 97750, 97763,T102390832, 90834, 90837, 90846,90847, 96110, 96112, 96113,96116, 96121, 96130, 96131,96132, 96133, H0031, T10238 of 22SOURCE BULLETIN Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CRJune 25, 2020
TABLE 6. CHILDREN’S DEVELOPMENTAL SERVICES AGENCIES (CDSAS) – NC INFANT TODDLER PROGRAM (NC ITP) SERVICESSERVICESERVICEDiabetes SelfManagementEducationAPPLICABLE PROVIDERSRATE CODE OR PROCEDUREMODIFIERS & POSRegistered dieticians96110, 96112, 96113, 97802,97803Registered nurses who are QualifiedProfessionals96112, 96113, T1023Speech language therapists92507, 92521, 92522, 92523,92524, 92526 (oral functionand feeding only), 92630,92633, 96110, 96112, 96113,T1023 Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifiers GT & CRTABLE 7. DIABETES SELF-MANAGEMENT EDUCATION (DSME)APPLICABLE PROVIDERSNon-physician practitioners: Behaviorists who are Ed.D.prepared Certified diabetes educators(CDE) Registered dieticians who areemployed by physicians orentities Registered nursesPhysician practitioners/sites: Certified nurse midwives Clinical pharmacist practitioners(CPP) Federally qualified healthcenters/rural health clinics Hospital outpatient departments Local health departments Nurse practitioners Physicians Physician assistantsNC Medicaid Telehealth Billing Code SummaryRATE CODE OR PROCEDUREG0108MODIFIERS & POS Reported with usual placeof service (POS) Modifiers GT & CRSOURCE BULLETINSOURCE BULLETIN1A-24.pdf1A-24, Diabetes Outpatient SelfManagement EducationSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions, EligibleProviders, Services and Codes9 of 22June 25, 2020
TABLE 8. DIETARY EVALUATION AND COUNSELINGSERVICEDietary Evaluationand CounselingAPPLICABLE PROVIDERS Licensed dieticians or nutritionists(currently licensed by the N.C.Board of Dietetics Nutrition) Registered dieticiansRATE CODE OR PROCEDURE97802, 97803MODIFIERS & POS Reported with usual placeof service (POS) Modifiers GT & CRSOURCE BULLETIN1-I-.pdf1-I, Dietary Evaluation andCounseling and Medical LactationServicesSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions, EligibleProviders, Services and CodesTABLE 9. MEDICAL LACTATIONSERVICEMedical LactationSupportAPPLICABLE PROVIDERS Certified nurse midwives International board-certifiedlactation consultants (IBCLC) Nurse practitioners Physicians Physician assistantsNC Medicaid Telehealth Billing Code SummaryRATE CODE OR PROCEDURE96156, 96158, 96159MODIFIERS & POS Reported with usual placeof service (POS) Modifiers GT & CRSOURCE BULLETIN1-I-.pdf1-I, Dietary Evaluation andCounseling and Medical LactationServicesSpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions, EligibleProviders, Services and Codes10 of 22June 25, 2020
TABLE 10. RESEARCH-BASED BEHAVIORAL HEALTH (RB-BHT) TREATMENT FOR AUTISM SPECTRUM DISORDER (ASD)SERVICERB-BHT for ASDAPPLICABLE PROVIDERSRATE CODE OR PROCEDUREMODIFIERS & POSSOURCE BULLETINLicensed Qualified Autism ServiceProviders (LQASP): Developmental or behavioralpediatricians Licensed clinical social workers Licensed clinical mental healthcounselors (formerly licensedprofessional counselors) Licensed marriage and familytherapists Licensed psychologists Licensed psychological assistants Occupational therapists Physicians Speech and language pathologistsProviders of Research Based Behavioral Health Treatment whenthose services are delivered by: Certified – qualified professionalor Technician under the supervisionof a LQASP97151, 97152, 97153, 97154,97155*, 97156Þ, 97157Þ Reported with usual placeof service (POS)*In administering 97155, thephysician or other qualifiedhealth care professionalresolves one or moreproblems with the protocoland may simultaneouslydirect a technician inadministering the modifiedprotocol while the patient ispresent. Physician or otherqualified health careprofessional direction to thetechnician without the patientpresent is not reportedseparately. Modifiers GT & CRÞModifier CR onlySpecial Bulletin COVID-19 #34:Telehealth Clinical PolicyModifications – Definitions, EligibleProviders, Services and CodesSpecial Bulletin COVID-19 #59:Telehealth Clinical PolicyModifications - OutpatientBehavioral Health ServicesIf two-way audio-visualoptions are not accessible tothe beneficiary, services maybe offered via telephonicmodality.ÞTABLE 11. SELF-MEASURED BLOOD PRESSURE MONITORING (SMBPM) SERVICESSERVICESelf-Measured BloodPressure MonitoringAPPLICABLE PROVIDERS PhysiciansNurse practitionersPhysician assistantsCertified nurse midwivesFQHCs, FQHC Lookalikes and RHCsNC Medicaid Telehealth Billing Code SummaryRATE CODE OR PROCEDURE99473, 9947411 of 22MODIFIERS & POSSOURCE BULLETIN Reported with usual placeof service (POS) Modifier CR (all claims)SPECIAL BULLETIN COVID-19 #43:Telehealth Clinical PolicyModifications – Self-Measured BloodPressure MonitoringJune 25, 2020
TABLE 12. OPTOMETRYSERVICEOffice or OtherOutpatient ServiceAPPLICABLE PROVIDERSOptometristsRATE CODE OR PROCEDUREMODIFIERS & POSSOURCE BULLETIN99211, 99212, 99213, 99214,99215 Reported with usual placeof service (POS) Modifiers GT & CR Reported with usual placeof service (POS) Modifier CR Reported with usual placeof service (POS) Modifier CRSPECIAL BULLETIN COVID-19 #41:Telehealth Clinical PolicyModifications – Optometry ServicesVirtual patientcommunication99421, 99422, 99423, 99441,99442, 99443, G2012InterprofessionalConsultation99446, 99447, 99448, 99449TABLE 13. PERINATAL CARESERVICEPerinatal CareAPPLICABLE PROVIDERS PhysiciansNurse practitionersPhysician assistantsCertified nurse midwivesFQHCs, FQHC Lookalikes and RHCs*RATE CODE OR PROCEDUREMODIFIERS & POS59400, 59510, 59410, 59515,59425, 59426, 59430 Reported with usual placeof service (POS) If at least one visit wasconducted viatelemedicine: Modifiers GTand CR Modifiers GT & CR are notrequiredHCPCS codes: S0280, S0281*FQHCs, FQHC Look-Alikesand RHCs only: T1015 forperinatal services rendered bycore service providersNC Medicaid Telehealth Billing Code Summary12 of 22SOURCE BULLETINSPECIAL BULLETIN COVID-19 #49:Telehealth Clinical PolicyModifications – Interim PerinatalCare Guidance Reported with usual placeof service (POS) Modifiers GT & CRJune 25, 2020
TABLE 14. REMOTE PHYSIOLOGIC MONITORINGSERVICERemote PatientMonitoringRemote PhysiologicMonitoring (RPM)TreatmentManagement ServicesAPPLICABLE PROVIDERS PhysiciansNurse practitionersPhysician assistantsCertified nurse midwivesFQHCs, FQHC Lookalikes and RHCsRATE CODE OR PROCEDURE99453, 9945499457, 99458MODIFIERS & POS Reported with usual placeof service (POS) Modifier CRSOURCE BULLETINSPECIAL BULLETIN COVID-19 #48:Telehealth Clinical PolicyModifications – Remote PhysiologicMonitoring ServicesTABLE 15. WELL CHILD VISITSSERVICEWell Child Visits forchildren under 24months APPLICABLE PROVIDERSRATE CODE OR PROCEDUREMODIFIERS & POSPhysiciansNurse practitionersPhysician assistantsFQHCs, FQHC Lookalikes and RHCs90460 , 96110, 96127, 96160,All codes should be reportedwith usual place of service(POS)Well Child Visits forpatients 24 monthsand older96161, 99211 , 99212 ,99213 , 99214 , 99215 ,99381, 99382, 99391, 9939290460 ,96110, 96127, 96160,99211 , 99212 , 99213 ,99214 , 99215 , 99382,99383, 99384, 99385, 99392,99393, 99394, 99395TelemedicineFor Medicaid: Modifiers EP, GT & CRFor NC Health Choice: Modifiers TJ, GT & CRSOURCE BULLETINSPECIAL BULLETIN COVID-19 #66:Telehealth and Virtual PatientCommunications Clinical PolicyModifications - Well Child Visits99211-99215 follow-up inperson visits Modifier CR 90460For Medicaid Modifiers EP & CRFor NC Health Choice Modifiers TJ & CRNC Medicaid Telehealth Billing Code Summary13 of 22June 25, 2020
TABLE 16. POSTPARTUM DEPRESSION SCREENINGSERVICEAPPLICABLE PROVIDERSPostpartumDepression Screening PhysiciansNurse practitionersPhysician assistantsCertified nurse midwivesFQHCs, FQHC Lookalikes and RHCs*RATE CODE OR PROCEDURE96127, 96161 *Postpartum screeningsdelivered as part of anobstetrics care visit arecovered under core obstetricsbilling (T1015). Postpartumdepression screeningsdelivered as part of Well ChildVisits are reimbursed on afee-for-service basis.MODIFIERS & POS Reported with usual placeof service (POS) Delivered viatelemedicine:o Modifiers GT & CR Delivered via telephone oronline patientcommunication:o Modifier CRSOURCE BULLETINSPECIAL BULLETIN COVID-19 #65:Telehealth and Virtual PatientCommunications Clinical PolicyModifications - PostpartumDepression Screening For 96161, append EPmodifier.TABLE 17. HEALTH AND BEHAVIOR INTERVENTION VISITS PROVIDED BY LOCAL HEALTH DEPARTMENTSSERVICEHealth and BehaviorInterventionAPPLICABLE PROVIDERSLicensed Clinical Social Workersrendering care within Local HealthDepartmentsRATE CODE OR PROCEDURE96158, 96159MODIFIERS & POSSOURCE BULLETIN Reported with usual placeof service (POS) Modifiers GT & CRSPECIAL BULLETIN COVID-19 #64:Telehealth and Virtual PatientCommunications Clinical PolicyModifications - Health and BehaviorIntervention Visits Provided by LocalHealth DepartmentsTABLE 18. OUTPATIENT RESPIRATORY THERAPYSERVICEOutpatientRespiratory TherapyAPPLICABLE PROVIDERSRespiratory therapistsNC Medicaid Telehealth Billing Code SummaryRATE CODE OR PROCEDUREMODIFIERS & POS94010, 94060, 94150, 94375,94664, 94760, 99503, 99504 Reported with usual placeof service (POS) Modifiers GT & CR14 of 22SOURCE BULLETINSPECIAL BULLETIN COVID-19 #67Telehealth and Virtual PatientCommunications Clinical PolicyModifications - OutpatientRespiratory TherapyJune 25, 2020
TABLE 19. HYBRID TELEMEDICINE WITH SUPPORTING HOME VISITSERVICEHybrid Telemedicinewith SupportingHome VisitAPPLICABLE PROVIDERSRATE CODE OR PROCEDURE Non-FQHCs (including Local HealthDepartments) Eligible providers to perform thetelemedicine visit include:o Physicianso Nurse practitionerso Physician assistantso Certified nurse midwives The assisting care team memberperforming the home visit shouldbe an appropriately traineddelegated staff person.99347, 99348, 99349, 99350FQHCs, FQHC Look-Alikes & RHCs Eligible providers to perform thetelemedicine visit include:o Physicianso Nurse practitionerso Physician assistantso Certified nurse midwives The assisting care team memberperforming the home visit shouldbe an appropriately traineddelegated staff person. For Well Child hybridtelemedicine withsupporting home visits,only: 99347, 99348, 99349,99350 For Non-Well Child hybridtelemedicine withsupporting home visits:T1015 Q3014NC Medicaid Telehealth Billing Code Summary15 of 22MODIFIERS & POS Reported with POS 12(home) For Well Child servicesonly:o Medicaid: EP,GT & CRo NC HealthChoice: TJ, GT& CR For Perinatal Servicesonly: See SPECIALBULLETIN COVID-19 #49for special billing andcoding guidance forperinatal telemedicinevisits with a supportinghome visit. For all other services:Modifiers GT & CR Reported with POS 12(home) For Well Child hybridtelemedicine withsupporting home visits,only:o Medicaid: EP,GT & CRo NC HealthChoice: TJ, GT& CR For Non-Well Child hybridtelemedicine withsupporting home visits:GT & CRSOURCE BULLETINSPECIAL BULLETIN COVID-19 #78:Telehealth and Virtual PatientCommunications Clinical PolicyModifications – Telemedicine withSupporting Home VisitJune 25, 2020
TABLE 20. END-STAGE RENAL DISEASE (ESRD)SERVICEESRD Monthly andDaily CapitationServicesAPPLICABLE PROVIDERS Physicians Nurse practitioners Physician assistantsDialysis TrainingRATE CODE OR PROCEDUREMODIFIERS & POSNC Medicaid: 90951, 90952,90953, 90954, 90955, 90956,90957, 90958, 90959, 90960,90961, 90962, 90963, 90964,90965, 90966, 90967, 90968,90969, 90970NC Health Choice: 90954,90955, 90956, 90957, 90958,90959, 90964, 90965, 90968,90969NC Medicaid and NC HealthChoice: 90989, 90993 Reported with usual placeof service (POS) Modifiers GT & CRSOURCE BULLETINSPECIAL BULLETIN COVID-19 #77:Telehealth and Virtual PatientCommunications Clinical PolicyModifications – End Stage RenalDisease Services Reported with usual placeof service (POS)
NC Medicaid Telehealth Billing Code Summary 1 of 22 June 25, 2020 NC Medicaid Telehealth Billing Code Summary UPDATE (June 25, 2020) Updated Telehealth Guidance: Codes that require 2 modifiers (i.e., GT and CR) must be billed with both modifiers or the claim detail will deny. o Updated Table 2.
