Topics Related to Bulletins

Effective Jan. 4, 2018, the North Carolina Medicaid and NC Health Choice (NCHC) programs will cover aprepitant injectable emulsion (Cinvanti), for intravenous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.

Effective with date of service, June 1, 2016, the North Carolina Medicaid program covers Axumin for use in the Physician’s Drug Program (PDP) when billed with HCPCS code A4641, radiopharmaceutical, diagnostic, not otherwise classified.

Effective with date of Service Jan. 1, 2018, the North Carolina Medicaid and NC Health Choice programs cover treprostinil injection (Remodulin), for subcutaneous infusion or intravenous infusion in the Physician’s Drug Program when billed with HCPCS code J3285 - Injection, treprostinil, 1 mg.

Effective with date of service Nov. 27, 2017, the North Carolina Medicaid and NC Health Choice (NCHC) Program covers emicizumab-kxwh injection (Hemlibra), for subcutaneous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3590 - Unclassified biologics.

Medicaid provided instructions to NCTracks to update the claims processing system to address claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

Effective April 1, 2018, the following CPT codes for diabetic testing supplies will be removed from the Home Health fee schedule.

Effective April 1, 2018, North Carolina Medicaid will make several changes to the Medicaid and NC Health Choice Preferred Drug List (PDL):

In response to provider feedback, the use of the NPI Exemption List for residents and interns enrolled in graduate dental and medical programs, and area health education centers will be extended from Jan. 31, 2018 to April 30, 2018. Note: This article was originally published as a Special Bulletin in January 2018.

This article assists providers to identify and report potential report fraud, waste, or abuse.