Blog Entry List

Current Policy: Private Duty Nursing (PDN) Clinical Coverage Policy 3G-1. Private Duty Nursing for Beneficiaries Age 21 and older and Private Duty Nursing (PDN) Clinical Coverage Policy 3G-2 Private Duty Nursing for Beneficiaries Age Under 21 years of age section 5.2.4.1:

Note: SPECIAL BULLETIN COVID-19 #39 replaces SPECIAL BULLETIN COVID-19 #8: Face-to-Face Provider Site Visits and Fingerprinting Requirements Temporarily Suspended Due to COVID-19 Outbreak. Changes to the prior Bulletin are:

Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant), glycopegylated-exei lyophilized powder for solution, for intravenous use (Esperoct®) for use in the Physician Administered Drug Program when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.

Effective with date of service Jan. 6, 2020, the Medicaid and NC Health Choice programs cover imipenem, cilastatin, and relebactam for injection, for intravenous use (Recarbrio™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

SPECIAL BULLETIN COVID-19 #34 replaces the following Medicaid Bulletins in their entirety: SPECIAL BULLETIN COVID-19 #9: Telehealth Provisions – Clinical Policy Modification; SPECIAL BULLETIN COVID-19 #19: Telehealth Provisions – Clinical Policy Modification and SPECIAL BULLETIN COVID-19 #28: [ADDENDUM to Bulletin #9 Effective March 20, 2020] : Telehealth Provisions – Clinical Policy Modification. New telehealth codes, F. Place of Service change and a clarification to "psychologists" are included.

Effective with date of service Jan. 28, 2020, the Medicaid and NC Health Choice programs cover teprotumumab-trbw for injection, for intravenous use (Tepezza™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

Effective with date of service Jan. 13, 2020, the Medicaid and NC Health Choice programs cover bevacizumab-bvzr injection, for intravenous use (Zirabev™) for use in the Physician Administered Drug Program when billed with HCPCS code Q5118 - Injection, bevacizumab-bvzr, biosimilar, (Zirabev™), 10 mg.

SPECIAL BULLETIN COVID-19 #35 replaces in its entirety SPECIAL BULLETIN #20 – Enhanced Behavioral Services.

Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover rituximab-pvvr injection, for intravenous use (Ruxience™) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

NC-MIPS is Open for Program Year 2019 through April 30, 2020, The Security Risk Analysis, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and General Reminders

SPECIAL BULLETIN COVID-19 #36 replaces in its entirety SPECIAL BULLETIN COVID-19 #21: Telehealth Provisions - Outpatient Specialized Therapies and Dental Services. Changes are to F. Place of Service for Outpatient Specialized Therapy and for Dental Services, and includes new teledentistry codes and guidance.

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver. Medicaid is hosting two webinars to further discuss the flexibilities.

*This Bulletin has been updated in SPECIAL BULLETIN COVID-19 #175: Updated Guidance for Non-Emergency Medical Transportation - Aug. 19, 2021

Effective March 10, 2020, the Division of Health Benefits (DHB) implemented a 5% rate increase for certain Medicaid provider groups listed in the Bulletin. DHB will systematically reprocess claims submitted with dates of service beginning March 10, 2020, through the implementation date of the rate increase.

Updated April 22, 2020: Link to downloadable list of enrollmed DMEPOS providers added. Effective March 30, 2020 NC Medicaid and NC HealthChoice coverage was added for HCPCS code A4670 – automatic blood pressure monitor.