NC Medicaid will not pay for the second twin if delivered by c-section as they say it basically did not require any additional work. They will however, pay the 59409 vaginal birth was attempted but c-section was elected.
You may want to try to file an adjustment request on the required form w/all documentation appending modifer 22 and explain the additional work, but I have tried this several times and they say the claim processed correctly and required no additional work, therefore they will not pay.