Revisions to previous scope of authorization
Blog Entry List
Effective with date of service Dec. 1, 2021, Medicaid and NC Health Choice cover ranibizumab injection for intravitreal use via ocular implant.
Oral tablets covered for those in a home setting
Certain immunocompromised children will qualify for third dose of Pfizer-BioN Tech Vaccine
FDA has expanded the use of single booster dose to include ages 12-15.
Emergency use of Evusheld approved by FDA
Effective with date of service Oct. 22, 2021, Medicaid and NC Health Choice programs cover afamelanotide implant, for subcutaneous use (Scenesse®).
Effective with date of service Nov 1, 2021, Medicaid and NC Health Choice programs cover pneumococcal 15-valent conjugate vaccine suspension for intramuscular injection (Vaxneuvance™).
COVID-19 vaccination has been approved for all pediatric patients who meet specific criteria regarding COVID-19.
Beginning Dec. 9, 2021, Medicaid and NC Health Choice will cover the Pfizer-BioNTech COVID-19 vaccine booster dose for administration to individuals age 16 and older.
Billing guidelines for PADP when billed with HCPCS code J3490.
Effective with date of service Sept. 22, 2021, the Medicaid and NC Health Choice programs cover tisotumab vedotin-tftv for use in the PADP when billed with HCPCS code J9999.
Effective with date of service Aug. 23, 2021, the Medicaid and NC Health Choice programs cover pneumococcal 20-valent conjugate vaccine for use in the PADP when billed with HCPCS code 90677.
Effective with date of service Jan. 1, 2022 (updated from Sept. 29, 2021), the Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine (12 years of age and older).
Update on COVID-19 booster shot recommendations for Pfizer, Moderna and Janssen