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NC Medicaid State Plan Amendment NC-23-0006 includes reimbursement methodology revisions to align with updates to Opioid Treatment Program (OTP) Service Clinical Coverage Policy 8A-9. These changes create a treatment model that integrates medication, medication administration, counseling, laboratory tests, psychoeducation, and case management services and add a bundled reimbursement rate.
Providers of integrated OTP services will receive reimbursement through the bundled payment rate specific to NC Medicaid service code H0020 and cannot individually bill for each service. The weekly bundled rate is $221.88. At least one of the bundled services must be provided within the one-week increment to bill the bundled rate.
Providers delivering Medicaid OTP services outside of the bundle may bill for services in accordance with NC Medicaid billing procedures.
This amendment is retroactive to April 1, 2023. Please note:
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Providers should immediately use the H0020 code. The weekly rate will be billed on a daily reimbursement rate of $31.70.
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Vaya will re-adjudicate all approved claims with dates of service on or after April 1, 2023, at the new rate.
- Providers should not rebill previously approved claims.
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Modifiers, including telehealth, are no longer required for service code H0020 and will lapse effective Aug. 25, 2023.
- An OTP approved for the Medicaid take-home waiver may bill up to 29 days/units (one medication dosing unit for the visit and 28 days of take-home doses).
For more information, contact Regional Opioid Response Coordinator James Collins at james.collins@vayahealth.com or 1-800-893-6246, ext. 1285.
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