July 20, 2023
North Carolina Medicaid billing update
Claims for inpatient hospital sterilization
According to the NC Medicaid Clinical Coverage Policy 1E-3, when health care professionals submit a claim for sterilization during an inpatient stay where the sterilization is not covered, they should:
- Submit the claim placing non-covered charges (such as sterilization) in the non-covered column
- Not include a sterilization diagnosis or an ICD-10 procedure code for sterilization on the claim
For historical claims where providers included a sterilization diagnosis or an ICD-10 procedure code when billing non-covered sterilization for inpatient hospital claims, they should resubmit the claim without the sterilization diagnosis or ICD-10 procedure code.
How to submit a claim
- Submit claims electronically using the Claims tool or EDI
Questions?
Contact Provider Services at 800-638-3302.
