New Clinical Policies: Polymerase Chain Reaction Respiratory Viral Panel Testing & Visual Field Testing

WellCare of North Carolina (WellCare) strives to provide high quality, medically necessary, and effective care for our members consistent with the expectations of the NC Medicaid program. Aligned with that mission, effective January 1, 2025, WellCare will be implementing the following two clinical payment policies:

• Polymerase Chain Reaction Respiratory Viral Panel Testing: PCR Respiratory Viral Panel Testing for six (6) or more pathogens will be covered when performed in a setting that cares for critically ill individuals or when the member meets certain diagnostic criteria as outlined in the policy.
• Visual Field Testing: Visual Field Testing will be covered when certain diagnostic criteria are met as outlined in the policy.

Each policy can be located on the WellCare Clinical Guidelines webpage. These policies are now implemented within the claims processing system.

Providers who perform these tests should review the applicable policy to avoid claim denials.

Any questions regarding these policies may be directed to the WellCare Provider Relations Department at NCProviderRelations@wellcare.com.