New or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.
Blog Entry List
NC Medicaid has approved codes for COVID-19-related medically necessary laboratory testing and has completed adding these services in NCTracks. Please note there are other codes currently under review that will be posted at a later date.
Select provider types enrolled in the NC Medicaid Program are required to file annual Medicaid cost reports utilizing cost reporting schedules which are based on approved Medicare cost reporting platforms.
To support continued access to dental care for Medicaid and NC Health Choice beneficiaries in North Carolina at a time when providers are facing challenges posed by the COVID-19 public health emergency, NC Medicaid will be making financial assistance payments to dental providers who serve meaningful numbers of Medicaid and NC Health Choice beneficiaries.
The Provider Directory Listing Report and Provider Affiliation Report is now available to providers as they prepare for Medicaid Managed Care.
Effective with the date of service Jan 1, 2021, the Centers for Medicare & Medicaid Services (CMS) has added new HCPCS codes (J codes), deleted others and changed the description of some existing codes.
Effective Jan. 1, 2021, many D-SNPs will be required to notify the state Medicaid agencies they contract with (or the state's designee) when their enrollees are admitted to a hospital or skilled nursing facility.
An amended version of Clinical Coverage Policy 10C, Outpatient Specialized Therapies, Local Education Agencies (LEAs) with an effective date of Jan. 1, 2021, was posted to the NC Medicaid Specialized Therapies Clinical Coverage Policies web page.
An updated version of Clinical Coverage Policy 10D, Respiratory Therapy Services by Independent Practitioner Provider with an amended date of Jan. 1, 2021, was posted to the NC Medicaid Specialized Therapies Clinical Coverage Policies web page.
Effective with date of service Dec 12, 2020, the Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine for use in the Physician Administered Drug Program.
Effective with date of service Oct. 2, 2020, the Medicaid and NC Health Choice programs cover ferric derisomaltose injection, for intravenous use (Monoferric™) for use in the Physician Administered Drug Program.
Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover pegfilgrastim-apgf injection, for subcutaneous use (Nyvepria™) for use in the Physician Administered Drug Program.
Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover [coagulation factor VIIa (recombinant)-jncw] lyophilized powder for solution, for intravenous use (Sevenfact®) for use in the Physician Administered Drug Program.
NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series, The Security Risk Analysis (SRA) and Program Year 2021 Announcements.
An independent review of referrals for individuals seeking to enroll in the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) waivers is intended to provide an unbiased assessment to ensure the enrollment processes are executed appropriately in each waiver application.