NC Integrated Care for Kids Closeout and Related Billing Code Changes

REQUIREMENTS: By December 31, 2026: Billing team must stop submitting claims with G codes G9919 and G9920 for NC Medicaid (Direct and Standard Plans). Remove these codes from all billing templates, encounter forms, and billing system workflows. Claims containing G9919 or G9920 submitted after December 31, 2026, will be rejected. Immediately (effective now): Billing team must update billing software and provider education materials to properly document CPT 1003F usage for well-child visits (ages birth to 6) using the following modifier combinations: - CPT 1003F (no modifier) = bundle received without Pre-K referral or office-based literacy promotion - CPT 1003F + modifier SE = bundle includes office-based literacy promotion - CPT 1003F + modifier TS = bundle includes Pre-K referral - CPT 1003F + modifier SE and TS = bundle includes both office-based literacy promotion and Pre-K referral Providers must document that at least five of the eleven bundle components were completed (well visit, hearing/vision screening, developmental screening, social-emotional screening, office-based literacy promotion, fluoride varnish, Pre-K referral, Exceptional Children's program referral, parenting support, early childhood mental health referral, or community-based literacy program referral). Note: G9921 has already been end-dated (removed December 31, 2024) and no action is needed. Consequences: Claims with G9919 or G9920 submitted after the deadline will be denied. Incorrect or missing modifiers on CPT 1003F may result in claim denials or delays.