Blog Entry List
Effective with date of service Nov. 20, 2019, the NC Medicaid and NC Health Choice programs cover crizanlizumab-tmca injection, for intravenous use (Adakveo) for use in the Physician Administered Drug Program (when billed with HCPCS code J3590 - Unclassified biologics.
Immune Globulin Intravenous, Human – Slra 10% Liquid (Asceniv™) HCPCS Code J1599: Billing Guidelines
Effective with date of service Nov. 18, 2019, the NC Medicaid and NC Health Choice programs cover immune globulin intravenous, human – slra 10% liquid (Asceniv) for use in the Physician Administered Drug Program when billed with HCPCS code J1599 - Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg.
Effective with date of service Nov. 26, 2019, the NC Medicaid and NC Health Choice programs cover givosiran injection, for subcutaneous use (Givlaari) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Nov. 11, 2019, the NC Medicaid and NC Health Choice programs cover luspatercept-aamt for injection, for subcutaneous use (Reblozyl) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Pegfilgrastim-bmez Injection, for Subcutaneous Use (Ziextenzo™) HCPCS Code J3590: Billing Guidelines
Effective with date of service Nov. 8, 2019, the NC Medicaid and NC Health Choice programs cover pegfilgrastim-bmez injection, for subcutaneous use (Ziextenzo) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
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.
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 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.
The Physicians, Nurse Practitioners and Physician Assistants fee schedules have been revised to include the Evaluation and Management fee schedules.
Effective with date of service Aug. 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover lefamulin injection, for intravenous use (Xenleta) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab-anns for injection, for intravenous use (Kanjinti™) for use in the Physician Administered Drug Program (PADP) when billed with Healthcare Common Procedure Coding System (HCPCS) code J9999 - not otherwise classified, antineoplastic drugs.
Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover bevacizumab-awwb injection, for intravenous use (Mvasi™) for adult use in the Physician Administered Drug Program when billed with HCPCS code Q5107 - Injection, bevacizumab, (Mvasi™), 10 mg.
NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
Effective with date of service June 20, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone ophthalmic insert 0.4 mg, for intracanalicular use (Dextenza) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service June 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover polatuzumab vedotin-piiq for injection, for intravenous use (Polivy) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.