Effective July 3, 2025, claims submitted without the ordering or referring physician National Provider Identifier will be adjudicated with a pay status for the Community Alternatives Program for Children and Disabled Adults.
Topics Related to Durable Medical Equipment Providers
An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of March 1, 2025, was posted to the NC Medicaid Clinical Coverage Policy web page.Summary of UpdatesIn the table Related Clinical Coverage Policies, added reference to clinical coverage policy 3D, Hospice Services.The terms ‘approval,’ ‘authorization’ and ‘prior authorization’ were changed to ‘prior approval’ for consistency throughout.
This bulletin contains information on updated flexibilities being implemented by NC Medicaid due to the Hurricane Helene Public Health Emergency.
An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies promulgated on March 1, 2024, with an effective date of Jan. 1, 2024.
An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of Dec. 1, 2023, is posted.
Updates on NC Medicaid programs that received legislative increases to service rates in the Current Operations Appropriations Act of 2023
DME Fee schedule updated effective Feb. 28, 2023
The waiver has received approval for another five years through Feb. 29, 2028.
A new prior authorization is required for beneficiaries returning to NC Medicaid Direct
Flexibilities ending at or after the end of the Federal Public Health Emergency