Topics Related to Bulletins

NC Medicaid Managed Care Provider Update – Nov. 29, 2022

Upcoming milestones, Provider Playbook updates, organizational Provider affiliation requirement, Beneficiary assignment file and more

Sterilization Procedures for Hospital Providers

This bulletin provides guidance to assist hospital providers’ compliance with federal requirements.

Vaccine Immunization Claims Can Be Submitted on Pharmacy Claims for NC Medicaid Direct Beneficiaries

Effective Dec. 1, 2022, pharmacy providers who administer immunizations at pharmacies may bill NC Medicaid Direct for vaccines on pharmacy claims

Ranibizumab-eqrn Injection, for Intravitreal Use (Cimerli™) HCPCS Code J3590: Billing Guidelines

Effective with date of service Oct. 3, 2022, Medicaid and NC Health Choice cover Ranibizumab-eqrn injection, (Cimerli)

Indigotindisulfonate Sodium Injection, for Intravenous Use (Bludigo™) HCPCS Code: Billing Guidelines

Effective with date of service Sept 30, 2022, Medicaid and NC Health Choice cover Indigotindisulfonate sodium injection (Bludigo)

Bevacizumab-maly Injection, for Intravenous Use (Alymsys®) HCPCS Code J9999: Billing Guidelines

Effective with date of service Oct. 5, 2022, Medicaid and NC Health Choice cover Bevacizumab-maly injection (Alymsys)

Duplicate Billing of Long-Acting Reversible Contraceptive Claims, From Point-of-Sale Pharmacy Claims and Duplicated on Professional Claims

This error occurred when the LARC was filled by a point-of-sale pharmacy and inserted by the provider in the clinic.

NC Medicaid Private Duty Nursing Taxonomy Added to the NC Medicaid Home Health 3-A Fee Schedule

Taxonomy numbers are not included in Clinical Policy but are included in the associated Fee Schedules.

Updated Coverage for Psychiatric Collaborative Care Management Effective Dec. 1, 2022

Includes HCPCS Code G0512 for RHCs and FQHCs

Feedback Requested: NC Medicaid Care Delivery and Value-Based Payment Design

We encourage stakeholders to provide feedback by Dec. 19, 2022.