The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page.
Blog Entry List
Section 6401(a) of the Affordable Care Act requires the Secretary to impose a fee on each "institutional provider of medical or other items or services and suppliers." Based upon provisions of the ACA, this fee will vary from year to year based on adjustments made pursuant to the Consumer Price Index for Urban Areas.
The Foundation for Health Leadership and Innovation's Center of Excellence for Integrated Care, in partnership with UNC-Chapel Hill School of Nursing, is conducting a short survey.
NC-MIPS is Open for Program Year 2019, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and general reminders.
The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page.
New or amended clinical coverage policies are available on NC Medicaid's website.
Effective with date of service Jan. 1, 2020, the American Medical Association (AMA) added new CPT codes, deleted others and changed the descriptions of some existing codes.
North Carolina Medicaid’s third-party liability (TPL) contractor, Health Management System, Inc. (HMS), will implement the Commercial Insurance (CI) disallowance project to streamline North Carolina’s coordination of benefits direct billing processes. The expected implementation date is Jan.
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.
A Clinical Coverage Policy has been developed to add coverage for Chimeric Antigen Receptor (CAR) T-Cell Therapies KYMRIAH and YESCARTA. This policy will become effective Dec. 1, 2019.
The NC Medicaid EHR Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use attestations.