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.
Topics Related to Nurses and Physician Assistants (PAs)
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.
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.
Effective with date of service, June 1, 2016, the North Carolina Medicaid and N.C. Health Choice programs cover NETSPOT for use in the Physician’s Drug Program when billed with HCPCS code A4641, radiopharmaceutical, diagnostic, not otherwise classified.
Effective with date of service June 1, 2016, the North Carolina Medicaid and NC Health Choice programs cover methacholine chloride (Provocholine) administered as inhalation solution, for use in the Physician’s Drug Program when billed with HCPCS code J7674 (Methacholine chloride, neb, per 1 mg).
Effective with the date of service of April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-2, Rituximab (Rituxan), within the Physician Drug Program.