In compliance with Session Law 2023-14 (SL 2023-14) and to further improve the maternity coverage for NC Medicaid members, NC Medicaid is making updates to maternity coverage. The information in this bulletin applies to both NC Medicaid Direct and NC Medicaid Managed Care.

In accordance with SL 2023-14, NC Medicaid is making the following coverage and reimbursement updates, effective July 1, 2023:

  • Establishing parity for vaginal and cesarean delivery code rates at the higher rate that is no lower than 71% of the Medicare rate. Please see the Rates Increased for Obstetrical Maternal Services bulletin article for more details (including impacted codes) on this update.
  • Updating Clinical Coverage Policy 1E-5, Obstetrical Services, to reflect that Group Prenatal Care is an optional service that may be provided to pregnant beneficiaries. Medicaid shall pay an incentive for Group Prenatal Care when five or more visits are attended and documented in the health record. Records of this attendance must be available to NC Medicaid Direct or the NC Medicaid Managed Care health plans upon request.

In addition, NC Medicaid is making the following updates to Clinical Coverage Policy 1E-5, Obstetrical Services:

  • Adding coverage for the following new vaginal birth after cesarean (VBAC) codes, effective July 1, 2023:
  • Adding additional codes so that NC Medicaid can have a better understanding of the initial pre-natal and postpartum visits.

Some reminders related to NC Medicaid Maternity Coverage:

  • Providers shall complete the pregnancy risk screening form at the beneficiary’s initial visit and follow-up screening any time there is a maternal or fetal change in condition necessitating a new risk assessment. It is recommended that the Pregnancy Risk Screening Form be completed at the visits closest to 28 weeks gestation and 36 weeks gestation. NC Medicaid now reimburses for completion of the pregnancy risk screening form up to three times in a pregnancy.
  • Home births are not covered by NC Medicaid.
  • The Request for Coverage Form can be used to formally submit a request for coverage of a procedure(s), product(s) and/or service(s) by providers and external stakeholders.

Providers are encouraged to review Clinical Coverage Policy 1E-5, Obstetrical Services for a detailed overview of other language and guidance related to Maternity coverage. Additionally, providers can also see the 1E-5 Obstetrical Services and 1E-6 Pregnancy Management Program Policy Changes Effective Jan. 1, 2023 bulletin for more details on other changes which were made to maternity coverage in January 2023.

Providers can find the applicable rate increases listed on their respective Fee Schedule.

Questions? Contact NCTracks Call Center, 800-688-6696