Addition of Rehabilitation/Substance Use Taxonomy 261QR0405X

On July 31, 2022, behavioral health providers will be able to enroll with taxonomy 261QR0405X (Rehabilitation/Substance Use) for North Carolina Medicaid and NC Health Choice participation in addition to providers enrolling through Division of Mental Health (DMH) programs. This taxonomy is being enacted retroactively for Medicaid and NC Health Choice providers; providers may back-date their applications for this taxonomy to as early as July 31, 2021, for coverage of services previously rendered under this taxonomy.

The taxonomy is valid for participation by in-state, out-of-state and border area providers. To qualify for participation, a provider must be actively enrolled in Medicare as confirmed through Provider Enrollment, Chain and Ownership System (PECOS) using the current Medicare verification process. If a provider is not actively participating with Medicare, verification of active Substance Abuse and Mental Health Services Administration (SAMHSA) certification from Oct. 23, 2018, and later must be provided.

This taxonomy will be covered only for Health Care Procedure Coding System (HCPCS) code H0020 through the following Benefit Service Groups (BSGs):

• NCXIX – North Carolina Title XIX
• SCHIP – State's Children's Health Insurance Program
• MCSTD – Medicaid Standard
• HCSTD – Health Choice Standard

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M22181-R-2504