Effective with date of service Oct. 16, 2018, the NC Medicaid and Health Choice programs cover immune globulin intravenous, human - ifas (Panzyga®) for use in the Physician Administered Drug Program when billed with HCPCS code J1599 - Injection, Immune Globulin, Intravenous, Non-lyophilized (e.g. liquid), Not Otherwise Specified, 500 mg.
Blog Entry List
Effective with date of service Nov. 19, 2018, the NC Medicaid and Health Choice programs cover risperidone for extended-release injectable suspension, for subcutaneous use (Perseris™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Nov. 28, 2018, the NC Medicaid and Health Choice programs cover elapegademase-lvlr injection, for intramuscular use (Revcovi™) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service Oct. 22, 2018, the NC Medicaid and Health Choice programs cover eravacycline for injection, for intravenous use (Xerava) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified Drugs. Xerava is available as a 50 mg single-dose vial.
Clinical Policy 1E-7, Family Planning Services, has been revised effective Jan. 1, 2019.
NC Medicaid has been reviewing the Medicaid Durable Medical Equipment rates to comply with the new Centers for Medicare and Medicaid Upper Payment Limit requirements. While further review is needed, NC Medicaid wanted to publish this bulletin to provide a status update.
Effective Jan. 1, 2019, optical services shall be covered for adult Medicaid beneficiaries in accordance with S. L. 2018-97, Part III, Section 11H.13.(c). However, Centers for Medicare and Medicaid Services (CMS) approval of the corresponding State Plan Amendment is pending.
As of Dec. 1, 2018, there are no NC Medicaid policies posted for public comment.
The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Nov. 1, 2018.
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for CPT codes 90791 – Psychiatric Diagnostic Evaluation and 90792 – Psychiatric Diagnostic Evaluation with Medical Servicess when provided via telemedicine/telepsychiatry.
Medicaid has designated specific ICD-10-CM diagnosis codes that do not count toward the annual visit limitation. These codes are reviewed regularly and updated as appropriate.
This edit is in place to ensure billing providers are affiliated with the rendering (individual) providers for whom they are billing to prevent inaccurate payment or fraud.
Enrollment applications submitted with incorrect data including name, social security number and date of birth result in application denials and withdrawals. As a result, providers must submit new applications and pay any applicable fees.
The Money Follows the Person Demonstration Project (MFP) team is preparing for the 2019-2023 Medicaid Transition Period and has updated its application for the coming year.
In response to the anticipated higher than normal number of influenza cases this coming season, effective December 1, 2018, North Carolina Medicaid is offering telephonic evaluation and management services to beneficiaries who are actively experiencing flu-like symptoms.