From NC Medicaid:

Some private and commercial insurers already require these codes, so providers should check with their billing team to review relevant protocol. These F codes are required by NC Medicaid’s clinical policy and apply to all delivery claims (not just those that are globally billed).

NC Medicaid urges providers to begin using the new codes as soon as possible. After July 1, 2025, Medicaid claims for delivery will deny if 0500F is not in the patient's history. This change will apply to both NC Medicaid Managed Care and NC Medicaid Direct claims.

Details and Source: New F Codes: Capturing Prenatal and Postpartum Care Services

Syphilis cases are on the rise in North Carolina. Syphilis can affect anyone but is currently rising in women, and in men who have sex with women. This has led to an alarming increase in cases of congenital syphilis.

The NC Medicaid 2024 Quality Symposium (save the date: October 2, 2024 [registration information to come]) will highlight three topics that coincide with NC Medicaid quality improvement priorities. The presenters will share the quality improvement initiatives they have implemented to improve outcomes for Medicaid members. Below are the details for each presentation, including presentation title, presentation date, presenter and registration link. Click on each registration link to learn more and register.

With only a single case in our state about a decade ago, congenital syphilis has been on the rise ever since.

In 2023, (according to preliminary data), North Carolina lost nine people from this completely preventable cause; with another 63 babies suffering from  congenital syphilis infection.  

According to Victoria Mobley, HIV/STI medical director for the North Carolina Department of Health and Human Services' Division of Public Health, more than half of the mothers of the babies born with syphilis had no documented prenatal care at the time they delivered. Equally of concern, of the women who did have prenatal care, only 41% received appropriate screening tests, despite state law requirements for syphilis testing for anyone who is pregnant (at first pre-natal visit, again between 28-30 weeks gestation and at time of delivery). 

Sadly, this is a national epidemic, and more action must be taken to begin to address it.

Based on the North Carolina State of Emergency established through Executive Order (EO) 116, NC Medicaid implemented temporary changes to clinical policy to support providers and beneficiaries during the COVID-19 State of Emergency.