TIP SHEET FOR PERINATAL CARE PROVIDERS | MAY 2023
Prenatal care providers who call NC MATTERS may be able to bill insurance and/or obtain RVUs for using our services. Provision of associated services or administration of related screening tools may also be billable services or garner further RVUs. Please see the table below for billing codes and reimbursement rates in North Carolina. This information is subject to change, and you should check your local contract for coverage/”allowables” by other insurers and rates for reimbursement.
| Billing Codes | Medicaid Reimbursement Rates | State Health Plan | Other Insurers | RVUs | |
| NC MATTERS Interprofessional Consultation (can only be billed once per 14 days per patient) | 99452 (16+ min) | $32.27 | Not covered | Rates vary (covered by Aetna, United & Medicare) | 0.7 |
| If 2nd NC MATTERS consultation is required within 14 days (only applicable if billed outside of global) | Upcode based on time
99213 → 99214 OR 99214 → 99215 |
Upcode based on time
99213 → 99214 OR 99214 → 99215 |
Upcode based on time
99213 → 99214 OR 99214 → 99215 |
Rates vary* | Δ 0.62
Δ 0.88 |
| Behavioral Health Assessment/Screener | 96127
(include ICD10 code, e.g. Z13.39) |
$4.49
(limit 2units/visit, separately reimbursable in PP period and if <4 visits in AP period) |
Covered | Rates vary* (covered by Aetna, Cigna & Medicare) | 0.0 |
| Interpersonal Violence | S08280
(thru Medicaid risk screening form x 1) |
$50 | N/A | N/A | N/A |
| Smoking Cessation Counseling | 99406
(3-10 min; max 4/year) 99407 (11+ min, max 4/year; total 8 visits/year) |
$14.29
$26.75 |
Covered | Rates vary* (covered by Cigna & Medicare) | 0.24
0.50 |
| Screening, Brief Intervention, and Referral to Treatment for SUD (SBIRT) | 96160
(DAST-10, AUDIT) Code for intervention/referral based on E&M |
$2.51
Reimbursement based on E&M |
Check your local contract | Rates vary* (covered by Cigna) | Not yet available |
| Patient-focused Health Risk Assessment using standardized tool (for SDOH) | 96160 | $2.51 | Covered | Rates vary* (covered by United, Cigna & Medicare) | 0.0 |
*check your local contract for coverage/”allowables” by other insurers and rates for reimbursement
Click here to download a PDF version of this table: Coding for Telepsychiatry and Other Behavioral Health Services