MedicaidCoverageHigh impact
Key Updates to NC Medicaid Clinical Coverage Policy 10A, Outpatient Specialized Therapy Services
NC Medicaid - NCDHHS·NC · Occupational Therapy, Physical Therapy·Medical Policy
We identified it
Jul 11, 2026
Summary
NC Medicaid updated Clinical Coverage Policy 10A to expand telehealth delivery options for occupational therapy (OT) and physical therapy (PT) services with updated criteria, removed restrictions on same-day service delivery when services are also provided by local education agencies (LEAs), and requires modifier GT appending for all telehealth claims. All claims must comply with NCCI guidelines.
Action Required
IMMEDIATE ACTIONS REQUIRED: (1) Billing team must review Attachment A, Section C of CCP 10A to identify which specific OT and PT CPT codes are now eligible for telehealth delivery and update billing system rules accordingly. (2) Implement requirement to append modifier GT to ALL telehealth OT/PT claims in billing software; claims submitted without GT modifier will be denied. (3) Update encounter forms and provider templates to prompt therapists to document when telehealth is used versus in-person services. (4) Train billing staff and providers that beneficiaries may request in-person services at any time and must be accommodated or discharged per Subsection 3.2.1.9. (5) Remove legacy billing rules that previously prohibited same-day OST and LEA service billing on the same claim; these restrictions no longer apply. (6) Audit all billing workflows to ensure NCCI compliance for therapy codes. (7) Disseminate policy changes to all NC Medicaid Direct and Managed Care contracted providers. Contact NC Medicaid (888-245-0179) or Provider Ombudsman (866-304-7062) for clarification on specific CPT codes eligible for telehealth if not detailed in Attachment A.