Influenza Vaccine and Reimbursement Guidelines for 2018-2019 for Medicaid and NC Health Choice.
Blog Entry List
The clinical criteria used by NC Medicaid for the 2018/2019 Respiratory Syncytial Virus (RSV) season are consistent with guidance published by the American Academy of Pediatrics (AAP): 2018 – 2021 Report of the Committee on Infectious Diseases, 31th Edition.
It has come to NC Medicaid’s attention that claims for balloon sinus ostial dilation billed with modifier 50 (bilateral), were resulting in an under payment to providers. The issue has been resolved.
Sterilization claims must be submitted with ICD-10-CM diagnosis Z30.2 (encounter for sterilization) as the primary or secondary diagnosis code on the claim.
Facility providers can access Sterilization Consent Form status including denial reasons, on the secure NCTracks Provider Portal, if the sterilization consent form has been properly completed.
The following CPT codes should not be billed with a separate office visit. An office visit component is included in reimbursement for these CPT codes.
Family Planning Medicaid provides limited coverage to beneficiaries with MAFDN eligibility.
In response to provider requests and to allow reimbursement for behavioral health integration in primary care settings, North Carolina Medicaid is adding coverage for the following evaluation and management codes effective October 1, 2018.
NC-MIPS is accepting Program Year 2018 Modified Stage 2 and Stage 3 MU attestations.
Registration is open for the September 2018 instructor-led provider training courses.
Medicaid has provided instructions to NCTracks on updating the claims processing system. The following procedure code list has been updated recently to include additional NP and PA taxonomies.
Providers may request prior approval for polycarbonate lenses without medical justification or additional documentation when eligible beneficiaries meet at least one of the following criteria.
Effective with date of service, Aug. 1, 2018, the Medicaid and NC Health Choice programs cover Lutathera for use in the Physician’s Drug Program when billed with HCPCS code A9699, Radiopharmaceutical, therapeutic, not otherwise classified.
The North Carolina Department of Health and Human Services developed the Advanced Medical Home program as the primary vehicle for delivering local care management as the state transitions to Medicaid managed care.
NC-MIPS is accepting Program Year 2018 Modified Stage 2 and Stage 3 MU attestations.