In response to provider comments and questions regarding the December 2017 Special Bulletin, Billing Guidance:340B Modifiers, North Carolina Medicaid is publishing updated information regarding the use of the JG, TB and UD modifiers which are required to identify 340B drug claims.
Topics Related to All Providers
The NC Division of Medical Assistance (DMA) currently recognizes CPT Code 27216 (Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral).
42 CFR 455.450 requires a state Medicaid agency to screen all initial provider applications based on a categorical risk level of “limited,” “moderate,” or “high.”
The following new or amended combined North Carolina Medicaid and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
1A-4, Cochlear and Auditory Brainstem Implants
1C-1, Podiatry Services
1K-1, Breast Imaging
1T-1, General Ophthalmological Services
These policies supersede previously published policies and procedures.
Clinical Policy and Programs
DMA, 919-855-4260
The NC Medicaid Electronic Health Record (EHR) Incentive Program is no longer accepting Program Year 2017 attestations.
Topics include: list of providers due for re-credentialing, changes to re-credentialing process and changes to ongoing verification process.
In accordance with 10A NCAC 22J .0106, a provider may refuse to accept a patient as a Medicaid patient and bill the patient as a private pay patient only if the provider informs the patient that the provider will not bill Medicaid for any services, but will charge the patient for all services provided.
Effective Feb. 1, 2018, Clinical Coverage Policy 1A-42, Balloon Ostial Dilation, was revised to include new coverage of CPT code 31298 (balloon dilation of frontal and sphenoid sinus). North Carolina Medicaid will cover this procedure or one of the other Balloon Ostial Dilation (BOD) procedures once per sinus during the beneficiary’s lifetime.
Prior approval for this procedure is required.
On April 29, 2018, a new reimbursement methodology will be implemented for medical claims for physician-administered Long Acting Reversible Contraceptives and vaccines, effective for claims with date of service July 1, 2017 and after.
Registration is open for the April 2018 instructor-led provider training course and annual seminar listed below. Slots are limited.