Topics Related to Bulletins
Effective with date of service Oct. 10, 2019, the North Carolina Medicaid and NC Health Choice programs cover brolucizumab-dbll injection, for intravitreal injection (Beovu) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service Nov. 7, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab-dkst for injection, for intravenous use (Ogivri) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5114 - Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg.
Effective with date of service Nov. 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover rituximab-abbs injection, for intravenous use (Truxima) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5115 - Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg.
North Carolina Medicaid’s third-party liability (TPL) contractor, Health Management System, Inc. (HMS), will implement the Commercial Insurance (CI) disallowance project to streamline North Carolina’s coordination of benefits direct billing processes. The expected implementation date is Jan. 1, 2020. This will result in higher recoveries for the state and higher pay rates for providers. HMS will assist Medicaid providers by identifying and validating other (non-Medicaid) health coverage so that providers can maximize payment rates by billing commercial rates rather than Medicaid rates.
Effective with date of service Jan. 1, 2020, the American Medical Association (AMA) added new CPT codes, deleted others and changed the descriptions of some existing codes.
New or amended clinical coverage policies are available on NC Medicaid's website.
The Physicians, Nurse Practitioners and Physician Assistants fee schedules have been revised to include the Evaluation and Management fee schedules.
The NC Medicaid EHR Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use attestations.
A Clinical Coverage Policy has been developed to add coverage for Chimeric Antigen Receptor (CAR) T-Cell Therapies KYMRIAH and YESCARTA. This policy will become effective Dec. 1, 2019.