Blog Entry List
Effective retroactive to Jan. 1, 2022, CPT code 80050 will no longer be reimbursed.
Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation
Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.
Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions
Billing Requirements for Medicaid Direct Providers
Look for details on training in June related to these changes.
The audit will sample fee-for-service claims collected for a full year – July 1, 2024, through June 30, 2025.
New separately reimbursable CPT codes in the ambulatory surgery setting
Recent State Plan Amendment outlines duties of a responsible third party
The Centers for Medicare & Medicaid Services has approved State Plan Amendments to revise reimbursement methodology.
Providers should work with their Medicaid beneficiary’s health plan and Tailored Care Manager to transition the members to 1915(i) services.
Claims that reuse the same visit key for multiple dates of service, MIDs, NPIs or procedure codes will deny.
Effective with date of service Jan. 16, 2024, NC Medicaid covers benzathine benzylpenicillin (Extencilline)
This rate increase in the latest Physician Administered Drug Program fee schedule supports treating Medicaid members for Congenital Syphilis.