Providers

Changes to the North Carolina Medicare Behavioral Health Services Fee Schedule

Dear Provider,
We are writing to inform you about some upcoming changes regarding the rates of certain services covered under Medicare. These adjustments have been carefully considered to ensure the continued provision of quality care to our beneficiaries.

Effective immediately, there will be changes to the rates for specific services as outlined below:

1. 90791 and 90792, and Psychological/Developmental Testing Codes: These services will now be billed at 120% of the Medicare rates. They will no longer be pegged to Medicare and will remain at this level until further notice. There are a few rates where the State is above Medicare. These rates will not decrease.
2. Enhanced Services: These services will increase based on inflation with a rate floor being set. No service is getting less than a 10% increase from the rate floor. Some services will be getting upwards of a 30% increase in the rate floor. 
3. Assertive Community Treatment (tailored plan only service):
   1. Crisis Services (Mobile Crisis): The rate was changed not too long ago; rates will be increasing by 10%.
   2. Child FBC: The rate will increase by 10%.
   3. Adult FBC: Technical change being made by 1/1, currently capped at 16 units a day. The per unit rate increase is not that high, but the policy will allow for 24 units a day. Providers can separately bill for E/M services (currently silent in the adult policy).
4. Substance Use Services:
   1. Rates for these services are part of the 1115 waiver and will be addressed separately with a likely overall increase in the future.
   2. There are specific adjustments related to SAIOP/SACOT rates. However, those cannot go into effect until the new service definition goes into effect, likely on 2/1/23. The new rates are intended to reflect new staffing requirements and service requirements that match the ASAM 2.5 LOC. 
5. BH ILOS: A flat 10% increase is recommended by the State for Behavioral Health ILOS.

We believe that these changes will better align reimbursement rates with the evolving needs of our beneficiaries and providers. We appreciate your cooperation and understanding during this transition period.

Should you have any questions or require further clarification, please do not hesitate to reach out to Wellcare at 1-855-538-0454.

Thank you for your continued commitment to providing exceptional care to Medicare beneficiaries.

Sincerely,
Wellcare