Effective May 1, 2018, North Carolina Medicaid will cover digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography. Providers must submit claims with Healthcare Common Procedure Coding System (HCPCS) code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral) in addition to screening or diagnostic mammography Common Procedural Terminology (CPT) codes 77065-77067.
Clinical coverage policy 1K-1, Breast Imaging, is in the process of being updated to reflect the new coverage.
Topics Related to Bulletins
Registration is open for several instructor-led training courses for providers that will be held in May 2018. Slots are limited.
In response to provider comments and questions regarding the December 2017 Special Bulletin, Billing Guidance:340B Modifiers, North Carolina Medicaid is publishing updated information regarding the use of the JG, TB and UD modifiers which are required to identify 340B drug claims.
The NC Division of Medical Assistance (DMA) currently recognizes CPT Code 27216 (Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral).
42 CFR 455.450 requires a state Medicaid agency to screen all initial provider applications based on a categorical risk level of “limited,” “moderate,” or “high.”
The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
1A-4, Cochlear and Auditory Brainstem Implants
1C-1, Podiatry Services
1K-1, Breast Imaging
1T-1, General Ophthalmological Services
These policies supersede previously published policies and procedures.
Clinical Policy and Programs
DMA, 919-855-4260
1A-4, Cochlear and Auditory Brainstem Implants
1C-1, Podiatry Services
1K-1, Breast Imaging
1T-1, General Ophthalmological Services
These policies supersede previously published policies and procedures.
Clinical Policy and Programs
DMA, 919-855-4260
The NC Medicaid Electronic Health Record (EHR) Incentive Program is no longer accepting Program Year 2017 attestations.
Topics include: list of providers due for re-credentialing, changes to re-credentialing process and changes to ongoing verification process.
On July 21, 2017, the Centers for Medicare & Medicaid Services notified North Carolina Medicaid that its State Plan Amendment (SPA TN17-0003) had been reviewed and was approved effective April 1, 2017.
North Carolina Medicaid was recently made aware that several manufacturers of viscous hyaluronic acid products changed the status of their products from “drugs” to “devices” effective Oct. 24, 2017 and are therefore no longer offering rebate agreements with the Centers of Medicare & Medicaid Services.