Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries.
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Registration is open for the February 2018 instructor-led provider training courses listed below. Slots are limited.
Facility providers can now access Sterilization Consent Form status, including denial reasons, on the secure NCTracks Provider Portal.
Effective April 1, 2018, when performing a wet mount screening, providers serving Family Planning Medicaid (MAFDN) beneficiaries shall bill procedure code 87210 (smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]).
At various times of the year, Medicaid providers may receive notification of participation letters from the DMA Office of Compliance and Program Integrity which facilitates audits from various auditing agencies, e.g. Office of the Inspector General, Office of Internal Auditor, and Office of State Auditor.
Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies, is updated to add policy guidelines for home ventilators with a non-invasive interface and to add HCPCS codes E0466 to the Durable Medical Equipment and Supplies fee schedule as a continuous rental.
North Carolina Medicaid received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).
Effective with the date of service of April 31, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.
Effective with the date of service of April 31, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.
Botulinum Toxin Type A (Botox) HCPCS code J0585 Botulinum Toxin Type A, per unit: Billing Guidelines
Effective with the date of service April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-1, Botulinum Toxin Treatment, within the Physician Drug Program.
Effective with the date of service of April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-2, Rituximab (Rituxan), within the Physician Drug Program.
Effective with date of service June 1, 2016, the North Carolina Medicaid and NC Health Choice programs cover methacholine chloride (Provocholine) administered as inhalation solution, for use in the Physician’s Drug Program when billed with HCPCS code J7674 (Methacholine chloride, neb, per 1 mg).
Effective with date of service, June 1, 2016, the North Carolina Medicaid and N.C. Health Choice programs cover NETSPOT for use in the Physician’s Drug Program when billed with HCPCS code A4641, radiopharmaceutical, diagnostic, not otherwise classified.
Effective with date of service, Nov. 15, 2017, the North Carolina Medicaid and NC Health Choice programs cover delafloxacin for injection, for intravenous use (Baxdela), for use in the Physicians Drug Program when billed with HCPCS code J3490 - Unclassified Drugs.
Effective with date of service Nov. 15, 2017, the North Carolina Medicaid and NC Health Choice programs cover rolapitant injectable emulsion, for intravenous use (Varubi) for use in the Physician’s Drug Program when billed with HCPCS code J3490 - Unclassified drugs