Effective Oct. 1, 2025, NC Medicaid coverage for GLP-1s for the treatment of obesity will be discontinued.
Topics Related to Medicaid Direct
NC Medicaid is now routing dual-eligible beneficiary Professional and Institutional Medicare Crossover claims to the designated NC Medicaid Managed Care payor.
Flexibilities effective Aug. 19, 2025, for NC Medicaid beneficiaries due to Hurricane Erin
Effective with date of service Aug. 1, 2025, NC Medicaid covers benzathine benzylpenicillin (Extencilline®) and benzathine benzylpenicillin tetrahydrate (Lentocilin).
Announcing Coverage-67516 Suprachoroidal Space Injection of Pharmacologic Agent (separate procedure)
Current Procedural Terminology code 67516 has replaced category III code 0465T.
Standard Plans will reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.
Providers can continue billing Diagnosis Related Group claims using revenue code 0161 for room and board and occurrence span code 82.
Temporary flexibilities to the Innovations Waiver after Hurricane Helene are ending July 1, 2025.
The Centers for Medicare & Medicaid Services (CMS) requires individuals in the NC Medicaid Innovations waiver program to have a valid and comprehensive assessment.
NC Medicaid’s Electronic Visit Verification (EVV) system for Home Health ensures compliance with federal requirements.