Blog Entry List
Effective July 1, 2018, CPT Code 95012, Fractional Exhaled Nitric Oxide (FENO) measurement, is approved in the assessment of pediatric beneficiaries with suspicion of asthma and for asthma management. Exhaled nitric oxide measurement is considered medically necessary and is covered when used as an adjunct with spirometry.
FENO measurement is considered medical necessary to:
Effective Aug. 1, 2018, North Carolina Medicaid will make a change to the N.C. Medicaid and N.C. Health Choice Preferred Drug List in the Antihyperkinesis/Attention Deficit Hyperactivity Disorder (ADHD) class.
As a reminder, providers are to request and obtain proper PA before services are scheduled or rendered. Contractually, CSRA (Medicaid’s fiscal vendor) has five business days (excluding holidays and weekends) to process a PA request once all required information is obtained.
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for the following CPT codes.
Effective May 1, 2018, North Carolina Medicaid began offering coverage of digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography using code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral).
Effective July 1, 2018, Cologuard (CPT code 81528) has been approved for colorectal cancer screening.
In accordance with the NC State Plan, Section 4.19-B, Section 3, Page 1, North Carolina Division of Medical Assistance (DMA) will revise rates for the following laboratory procedure codes: 81220, 81221, 81222, 81223, 81228, 81229, 81243, 81244, 81331, and 81507.
North Carolina Medicaid will reprocess Medicare Part B Crossover Professional and Outpatient claims submitted to Medicare from Jan. 2, 2017, to Jan. 5, 2017.
Medicare experienced a claims processing issue with claims submitted Jan. 2, 2017 to Jan. 5, 2017, causing incorrect reimbursement. Medicare performed a mass adjustment to correct the reimbursement of the affected claims. However, when the Medicare adjusted claims crossed over to Medicaid, NCTracks denied them in error. The system error that caused the denial of these Medicare adjusted claims has been resolved.
The following new or amended combined North Carolina and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
Note: This article was originally published as a Special Bulletin in January 2018, with updates regarding clinical pharmacist practitioners.
If a provider’s enrollment application or Manage Change Request does not contain errors, it will process more quickly. The NCTracks Enrollment Team identified commons errors that cause delays in processing applications and MCRs.
Registration is open for the July 2018 instructor-led provider training courses listed below. Slots are limited.
Centers for Medicare & Medicaid Services is streamlining the Electronic Health Record Incentive Program. The goal is to move the program beyond requirements for meaningful use to increase focus on interoperability and improving patient access to health information.
Note: This article was originally published in the June 2018 Medicaid Bulletin with a clarification that only high-risk providers must obtain fingerprints.
Effective Aug. 1, 2018, North Carolina Medicaid will make a change to the North Carolina Medicaid and N.C. Health Choice Preferred Drug List (PDL) in the Antihyperkinesis/Attention Deficit Hyperactivity Disorder (ADHD) class.