Topics Related to Nurses and Physician Assistants (PAs)

Effective with date of service Dec. 11, 2107, the North Carolina Medicaid and NC Health Choice (NCHC) programs cover letermovir injection (Prevymis) for intravenous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.

Prevymis is available as 240 mg/12 mL (20 mg/mL) or 480 mg/24 mL (20 mg/mL) in a single-dose vial. Prevymis is indicated for prophylaxis of cytomegalovirus (CMV) infection and disease in adult CMV-seropositive recipients [R+] of an allogeneic hematopoietic stem cell transplant (HSCT).

Effective with date of service March 1, 2018, North Carolina Medicaid and NC Health Choice (NCHC) programs cover buprenorphine extended-release injection (Sublocade), for subcutaneous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.

Effective Jan. 4, 2018, the North Carolina Medicaid and NC Health Choice (NCHC) programs will cover aprepitant injectable emulsion (Cinvanti), for intravenous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.

Cinvanti is available as 130 mg in a single-dose vial. It is approved by the Food and Drug Administration (FDA) for adults, in combination with other antiemetic agents, for the prevention of:

Effective with date of service, June 1, 2016, the North Carolina Medicaid program covers Axumin for use in the Physician’s Drug Program (PDP) when billed with HCPCS code A4641, radiopharmaceutical, diagnostic, not otherwise classified. Axumin is available in a 30 mL multiple-dose glass vial containing clear, colorless solution of 335-8200 MBq/mL (9-221mCi/mL) fluciclovine F 18 at calibration time and date.

Effective with date of Service Jan. 1, 2018, the North Carolina Medicaid and NC Health Choice programs cover treprostinil injection (Remodulin), for subcutaneous infusion or intravenous infusion in the Physician’s Drug Program when billed with HCPCS code J3285 - Injection, treprostinil, 1 mg.

Effective with date of service Nov. 27, 2017, the North Carolina Medicaid and NC Health Choice (NCHC) Program covers emicizumab-kxwh injection (Hemlibra), for subcutaneous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3590 - Unclassified biologics. Hemlibra is available as a single-dose vial for injection: 30 mg/mL, 60 mg/0.4 mL, 105 mg/0.7 mL, 150 mg/mL.

Medicaid provided instructions to NCTracks to update the claims processing system to address claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

Effective with date of service Nov. 8, 2017, the North Carolina Medicaid program covers zoster vaccine recombinant, adjuvanted, suspension for intramuscular injection (Shingrix) for use in the Physician’s Drug Program (PDP) when billed with CPT code 90750 - Zoster (shingles) vaccine, (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection.

Effective with date of service Nov. 15, 2017, the North Carolina Medicaid and NC Health Choice programs cover rolapitant injectable emulsion, for intravenous use (Varubi) for use in the Physician’s Drug Program when billed with HCPCS code J3490 - Unclassified drugs

Effective with date of service, Nov. 15, 2017, the North Carolina Medicaid and NC Health Choice programs cover delafloxacin for injection, for intravenous use (Baxdela), for use in the Physicians Drug Program when billed with HCPCS code J3490 - Unclassified Drugs.