Topics Related to All Providers
Effective July 1, 2018, Cologuard (CPT code 81528) has been approved for colorectal cancer screening.
Effective May 1, 2018, North Carolina Medicaid began offering coverage of digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography using code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral).
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for the following CPT codes.
As a reminder, providers are to request and obtain proper PA before services are scheduled or rendered. Contractually, CSRA (Medicaid’s fiscal vendor) has five business days (excluding holidays and weekends) to process a PA request once all required information is obtained.
Effective Aug. 1, 2018, North Carolina Medicaid will make a change to the N.C. Medicaid and N.C. Health Choice Preferred Drug List in the Antihyperkinesis/Attention Deficit Hyperactivity Disorder (ADHD) class.
Effective July 1, 2018, CPT Code 95012, Fractional Exhaled Nitric Oxide (FENO) measurement, is approved in the assessment of pediatric beneficiaries with suspicion of asthma and for asthma management. Exhaled nitric oxide measurement is considered medically necessary and is covered when used as an adjunct with spirometry.
FENO measurement is considered medical necessary to:
FENO measurement is considered medical necessary to:
Medicaid’s Third-Party Liability contractor, Health Management Systems, Inc., will implement a Commercial Insurance Disallowance project to streamline North Carolina’s coordination of benefits and direct billing processes. The expected date for implementation is Oct. 1, 2018.
These guidelines assist with claim submissions for dually eligible beneficiaries. This information addresses situations known to affect a significant number of claims. It is not feasible to provide an all-inclusive list due to the variable nature of the programs.
Effective Aug. 1, 2018, North Carolina Medicaid will make a change to the North Carolina Medicaid and N.C. Health Choice Preferred Drug List (PDL) in the Antihyperkinesis/Attention Deficit Hyperactivity Disorder (ADHD) class.
Note: This article was originally published in the June 2018 Medicaid Bulletin with a clarification that only high-risk providers must obtain fingerprints.