Topics Related to Medicaid Direct

This is an update to the September 2016 Medicaid Ordering, Prescribing or Referring Special Bulletin.

This bulletin has updated end dates & additional flexibilities for Behavioral Health, Care Management, Innovations, and Long-Term Services & Supports.

This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care. NC Medicaid is committed to ensuring continued access to care for NC Medicaid beneficiaries. As a service to both NC Medicaid beneficiaries and providers, NCTracks has created a webpage listing of all enrolled out-of-state (OOS) pharmacies, categorized by state.  

This bulletin applies to NC Medicaid Direct.Please note the corrected effective dates for the following codes that were reported in bulletin article: CPT Code Update Effective Jan. 1, 2024. 87593 Detection of Orthopoxvirus- effective date 7/26/202290589 Chikungunya Virus Vaccine- effective date 2/28/2024Also note the following CPT codes are covered, effective 1/1/2024:

NC Medicaid will continue the current Tailored Care Management temporary payment rate of $343.97 statewide through June 30, 2025.

Effective Jan. 1, 2025, the unit of reimbursement will change from a 15-minute increment to a daily per diem.

Two policies will be effective on Jan. 1, 2025, and posted to the NC Medicaid website.

Includes information on vaccine reimbursement, billing, counseling coverage and Immunization Program/Vaccines for Children

Health plans are required to pay interest to providers if they fail to accurately pay or inappropriately deny a claim.

For providers unable to provide services under an active, approved service plan due to the impacts of Hurricane Helene.