Blog Entry List
NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid beneficiaries. These changes are retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.
DHHS and Community Care of North Carolina (CCNC) have launched a toll-free Patient Information and Support Line aimed at helping health care providers answer their patients' questions related to COVID-19. Their goal is to relieve some of the tremendous strain the pandemic is putting on health care providers and their staff.
The new helpline is called COVID-19 Triage Plus. Health care providers can recommend their patients call 1-877-490-6642 for assistance from nurse care managers who can help patients with:
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:
(d) If services are terminated as a result of the beneficiary’s loss of Medicaid, or if no PDN services are provided during the 30 consecutive days for any reason such as a hospitalization, then the prior approval process must be initiated once again as outlined in Subsections 5.1 and 5.2.
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.
Teprotumumab-Trbw for Injection, for Intravenous Use (Tepezza™) HCPCS Code J3590: Billing Guidelines
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.
Strength/Package Size(s): For Injection: 500 mg lyophilized powder in a single-dose vial for reconstitution
Indicated for the treatment of Thyroid Eye Disease.
Recommended Dose:
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.
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.
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.
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 #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.
SPECIAL BULLETIN COVID-19 #35 replaces in its entirety SPECIAL BULLETIN #20 – Enhanced Behavioral Services.
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
“NC Medicaid COVID-19 Updated Guidelines for Non-emergency Medical Transportation (NEMT)” provides information to local Departments of Social Services (DSS) and NEMT providers on personal protective equipment (PPE).