In This Issue...................................

All Providers:

Checkwrite Schedule

Rates for 2006 CPT Codes

Clinical Coverage Policies

Changes to the Prior Approval Process and Requests For Non-covered Services

CPT Code Update 2006

Medical Review of North Carolina (MRNC) Unveils New Name

Mental Health Non-Licensed Fee Schedule Effective September 1, 2005

Rate Change for Mirena IUD, J7302

Updated EOB Code Crosswalk to HIPAA Standard Codes

 

Adult Care Home Providers: 

Medicaid Payment for Recipients Residing in  Adult Care Home Special Unit for Persons with Alzheimer’s and Related Disorders

 

CDSA’s (Children’s Developmental Services Agencies):

CPT Code Changes for CDSA’s

 

Community Alternatives Program Case Managers:

HCPCS Code Changes for Medical Supplies

 

Dialysis Centers:

Doxercalciferol, 1mcg (Hectorol, J1270 – Billing Guidelines

 

Durable Medical Equipment Providers:

HCPCS Code Changes for Durable Medical  Equipment

 

Family Planning Waiver Providers:

Code Update for Family Planning Services

 

Home Health Agencies:

HCPCS Code Changes for Medical Supplies

 

Home Infusion Therapists:

HCPCS Code Changes for Parenteral Nutrition Supplies

 

Hospitals:

HCPCS Code Changes for Radiopharmaceutical Agents

 

Independent Practitioners:

Code Changes

 

Local Education Agencies:

Code Changes

 

Mental Health Practitioners:

CPT Code Update

 

Orthotic and Prosthetic Providers:

HCPCS Code Changes for Orthotics and  Prosthetics

 

Physicians:

Anticipated 2006 CPT Code Rate Changes

HCPCS Code Changes for Radiopharmaceutical Agents

HCPCS Code Changes for the Physician’s Drug Program

 

Private Duty Nursing Providers:

HCPCS Code Changes for Medical Supplies

 

UB-92 Billers:

Payer Code H9999

 

Attention: All Providers

Rates for 2006 CPT Codes

 

Effective January 1, DMA will publish the new rates for the 2006 CPT codes.  The codes were revised based on information from the Center for Medicare and Medicaid Services (CMS). 

 

The fee schedules may be accessed through the DHHS website at http://www.dhhs.state.nc.us/dma/  or http://www.dhhs.state.nc.us/dma/fee/fee.htm.  Providers may also receive a current fee schedule by completing and submitting a copy of the Fee Schedule Request form http://www.dhhs.state.nc.us/dma/Forms.html.

 

Providers must bill their usual and customary charges.

 

For assistance, please call EDS @ 1-800-688-6696, local providers can call 919-851-8888.

 

EDS, 1-800-688-6696 or 919-851-8888

 

 

 

---

 

Attention: All Providers

Clinical Coverage Policies

 

The following new or amended clinical coverage policies are now available on the Division of Medical Assistance’s website at http://www.dhhs.state.nc.us/dma/mp/mpindex.htm:

 

5A – Durable Medical Equipment

5B – Orthotics and Prosthetics

8A – Mental Health/Developmental Disabilities/Substance Abuse Services

8C - Outpatient Behavioral Health Service Provided by Direct-Enrolled Providers

8D1 – Psychiatric Residential Treatment Facilities for Children under the Age of 21

8J – Children’s Developmental Service Agencies

10A – Outpatient Specialized Therapies

10B – Independent Practitioners

10C – Local Education Agencies

A1 – Special Services:  After Hours

 

These policies supersede previously published policies and procedures.  Providers may contact EDS at 1-800-688-6696 or 919-851-8888 with billing questions.

 

Clinical Policy and Programs

DMA, 919-855-4260

 

 

 

 

 

 

Attention: All Providers

Changes to the Prior Approval Process and Requests for Non-covered Services

 

Information regarding changes to the prior approval process and requests for non-covered services is available in the January 2006 Special Bulletin on the Division of Medical Assistance’s website at http://www.dhhs.state.nc.us/dma/bulletin.htm.

 

Clinical Policy and Programs

DMA, 919-855-4260

 

---

Attention:  All Providers

CPT Code Update 2006

 

The Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have added new and deleted current CPT codes effective with date of service January 1, 2006.  New CPT codes are covered by the N.C. Medicaid program effective with date of service January 1, 2006.  Claims submitted with deleted codes will deny for dates of service on or after January 1, 2006. 

 

The following table lists the new CPT codes that are covered by N.C. Medicaid beginning with date of service January 1, 2006:

 

 

The following table lists CPT codes that were end-dated effective with date of service December 31, 2005:

 

 

The following table lists the new 2006 CPT codes that are not covered pending further review:

 

 

The following table lists the new 2006 CPT codes that are not covered:

 

 

The following CPT code was non-covered by N.C. Medicaid during the 2005 CPT Update.  This code is now covered by N.C. Medicaid beginning with date of service January 1:

 

 

Ambulatory Surgery Center (ASC)

 

The following table lists the new CPT codes that are covered by N.C. Medicaid for an Ambulatory Surgery Center (ASC) beginning with date of service January 1: