North Carolina reimbursement for telemedicine PDF Print E-mail

11/2018 - Proposed Changes to Medicaid in North Carolina

"Under the new system, the state will pay Managed Care Companies a yet-to-be-determined rate per person instead of its current model, where the state oversaw the care of patients across the state and essentially cut check for every flu shot, operation and emergency room visit for people on Medicaid's rolls."

-From North Carolina Health News - 11/28/2018

What Does this mean for Telehealth? 

More people will be added to Medicaid Services and providers will not be getting reimbursed in the same way.  Telehealth services will be a way to eliminate barriers to access, see more patients more quickly and save money.  


NC Medicaid Telehealth Policy amended 2018

 North Carolina reimburses for telepsychiatry + a separate facility fee (Q3014)

NC Department of Health and Human Services Telepsychiatry Gudelines

Excerpts below...

6.3 Facility Fees

The following providers may bill for a facility fee when their office or facility is the site at which the recipient is located when the service is provided:

a. Physicians

b. Nurse practitioners

c. Nurse midwives

d. Advanced practice psychiatric nurse practitioners

e. Advanced practice psychiatric clinical nurse specialists

f. Licensed psychologists (doctorate level)

g. Licensed clinical social workers (LCSW)

h. Hospitals (inpatient or outpatient)

i. Federally qualified health centers

j. Rural health clinics

k. Local health departments

l. Local Management Entities


The following providers enrolled in the N.C. Medicaid program who provide this service may bill Medicaid:

a. Physicians

b. Advanced practice psychiatric nurse practitioners

c. Advanced practice psychiatric clinical nurse specialists

d. Licensed psychologists (doctorate level)

e. Licensed clinical social workers (LCSW)

f. Community diagnostic assessment agencies


                     • 99251 through 99255

• 90801

• 90804 through 90809

• 90862


The following CPT procedure codes can be billed by the consulting provider for professional services:

• 90801

• 90804 through 90809

• 90862

• 99201 through 99205

• 99211 through 99215

• 99241 through 99245


1. When the GT modifier is appended to a code billed for professional services, the service is paid at 100% of the allowed amount of the fee.



Last Updated on Thursday, 29 November 2018 13:43