NC Medicaid is providing additional information to providers about new federal prohibitions on certain providers.
Topics Related to Medicaid Direct
The Centers for Medicare & Medicaid Services (CMS) released the 2026 ICD-10 code list effective Oct. 1, 2025.
NC Medicaid’s Electronic Visit Verification (EVV) system for Home Health ensures compliance with federal requirements.
Effective Oct. 1, 2025, NC Medicaid coverage for GLP-1s for the treatment of obesity will be discontinued.
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.