NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
Topics Related to Bulletins
Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover bevacizumab-awwb injection, for intravenous use (Mvasi™) for adult use in the Physician Administered Drug Program when billed with HCPCS code Q5107 - Injection, bevacizumab, (Mvasi™), 10 mg.
Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab-anns for injection, for intravenous use (Kanjinti™) for use in the Physician Administered Drug Program (PADP) when billed with Healthcare Common Procedure Coding System (HCPCS) code J9999 - not otherwise classified, antineoplastic drugs.
The 2020 ICD-10 update will be in place effective Oct. 1, 2019 through Sept. 30, 2020, for provider use. Providers can access the list of ICD-10 codes on the Centers for Medicare and Medicaid Services (CMS) website.
The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations. All eligible professionals (EPs) attesting in Program Year 2019 will be required to attest to Stage 3 MU and use a 2015 Edition of certified EHR technology (CEHRT).
Providers were notified in the August Medicaid bulletin that as of May 1, 2019, the sterilization consent form was updated with an expiration date of April 30, 2022. The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated. Providers should now be using this version when submitting the sterilization consent form to the NC Medicaid fiscal agent.
The Community Alternatives Program for Disabled Adults (CAP/DA) §1915(c) Home and Community-Based Services (HCBS) waiver application has been renewed by the Centers for Medicare and Medicaid Services (CMS), effective Nov. 1, 2019 through Oct. 31, 2024.
Several new or amended clinical coverage policies are available on NC Medicaid’s website.
The clinical criteria used by NC Medicaid for the 2019-2020 Respiratory Syncytial Virus (RSV) season are consistent with guidance published by the American Academy of Pediatrics (AAP): 2018 – 2021 Report of the Committee on Infectious Diseases, 31st Edition. This guidance for Synagis use among infants and children at increased risk of hospitalization for RSV infection is available online by subscription. The coverage season is Nov. 1, 2019, through March 31, 2020. Providers are encouraged to review the AAP guidance prior to the start of the RSV season.
Beginning Oct. 15, 2019, North Carolina Medicaid Bulletin articles will be delivered more often and in an online format. The improvements are in response to feedback from providers looking for a flexible way to receive important Medicaid information to better serve beneficiaries and more effectively operate their businesses.