2017 CPT Code Update

Effective with date of service January 1, 2017, the American Medical Association (AMA) has added new CPT codes, deleted others and changed the descriptions of some existing codes.

The state and CSRA are in the process of completing system updates to align its policies with CPT code changes (new codes, covered and non-covered, as well as the end-dated codes), to ensure that claims billed with the new codes will process and pay correctly. An announcement will be posted on the NCTracks provider portal when the system updates are completed.

Until this process is completed, claims submitted with new codes will pend for “NO FEE ON FILE.� These pended claims will recycle and pay when the system work is completed. No additional action will be required by providers. This process also will be applicable to the Medicare crossover claims.

To maintain cash flow, providers may wish to split claims and bill new codes on a separate claim. This will ensure that only claims billed with the new procedure codes are pended for processing.

New CPT codes that are covered by the N.C. Medicaid and N.C. Health Choice (NCHC) programs are effective with date of service January 1, 2017. Claims submitted with deleted codes will be denied for dates of service on or after January 1, 2017. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code(s).