Note: This article was previously published in the September 2017 Medicaid Bulletin. It is republished with updates regarding edit disposition.
Effective Oct. 29, 2017, the NC Department of Health and Human Services (DHHS) validates through NCTracks that the billing provider’s address submitted on the claim corresponds to the location listed on the provider record for the dates of service submitted. The billing provider
The implementation of ICD-10-CM allows specificity for accurate coding, resulting in greater justification of medical necessity. A provider’s documentation must include details to completely depict the nature of a beneficiary’s diagnosis and procedures performed.
Effective May 1, 2018, Clinical Coverage Policy 1C-1, Podiatry Services, is revised to include annual updates to International Classification of Diseases (ICD-10-CM) codes.
Effective May 1, 2017, new pharmacy point of sale clinical edits for behavioral health medications were applied for pediatric and adult beneficiaries. Note: This article was originally published in February 2017 Medicaid Bulletin.
Effective May 1, 2018, North Carolina Medicaid will cover digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography. Providers must submit claims with Healthcare Common Procedure Coding System (HCPCS) code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral) in addition to screening or diagnostic mammography Common Procedural Terminology (CPT) codes 77065-77067.
Clinical coverage policy 1K-1, Breast Imaging, is in the process of being updated to reflect the new coverage.
The Secretary of the N.C. Department of Health and Human Services (DHHS) has approved the disengagement of Columbus County from the Eastpointe Local Management Entity – Managed Care Organization (LME-MCO) and their realignment with Trillium Health Resources LME-MCO.
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.
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).
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.
These policies supersede previously published policies and procedures.
Clinical Policy and Programs
DMA, 919-855-4260