The NC Medicaid State Plan Amendment for Peer Support Services was approved by the Centers for Medicare & Medicaid Services on Oct. 23, 2019, with an effective date of July 1, 2019. The clinical coverage policy will be posted with an effective date of Nov. 1, 2019.
Topics Related to Bulletins
NC Medicaid has updated its ICD-10 diagnosis code list. Diagnosis code K35.891 (other acute appendicitis without perforation, with gangrene) has been added as an acceptable ICD-10 diagnosis code effective Oct. 1, 2018.
A new or amended clinical coverage policy regarding facility-based crisis management for children and adolescents is available on NC Medicaid’s website.
Unpaid medical bills and current medical expenses count toward NC Medicaid applicants’ deductibles. Private Duty Nursing (PDN) services qualify as a medical expense and may be used toward meeting this deductible.
Per Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies on the NC Medicaid website, HCPCS code A4252 (blood ketone test or reagent strip, each) has a quantity limitation of 100 test strips per month. Considering the national description of A4252 refers to each test strip, DME providers are reminded to submit their claims with the number of test strips supplied to the beneficiary, not the number of boxes of test strips.
As NC Medicaid's managed care launch date approaches, Advanced Medical Home (AMH) providers who believe they are not ready to meet program requirements to perform at the tier level to which they attested may now submit a request to change their AMH Tier status from Tier 3 to Tier 2. The AMH Tier 3 providers may not downgrade lower than AMH Tier 2.
The North Carolina Department of Health and Human Services (DHHS) has expanded the regions awarded to Carolina Complete Health, Inc. (CCH) to serve as a health plan under the state’s transition to Medicaid Managed Care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4.
On Jan. 29, 2013, NC Medicaid issued a memorandum giving guidance on the subject of Guidance for Family Supplementing Payment to the Medicaid Benefit. Several adult care home (ACH) providers have recently referenced this memorandum when inquiring about payment supplements specifically related to the provision of Personal Care Services (PCS) to recipients of special assistance.
On Oct. 1, 2019, an amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies, was posted to the North Carolina Medicaid website. In addition to correcting numbering, grammatical and style errors, several changes have been made.
Effective Oct. 1, 2019, two additional ICD-10 codes will be added to the LARC DRG reimbursement retroactive date of Oct. 1, 2018.
Providers must bill with the following HCPCS code, and the appropriate ICD-10 PCS code on the inpatient hospital claim to receive the LARC DRG reimbursement.