On July 1, 2021, an amended version of the policy was posted.
Topics Related to Physicians, Physician Assistants and Nurse Practitioners
Updates to Clinical Coverage Policy 10B, Outpatient Specialized Therapies, Independent Practitioners
Cabotegravir and Rilpivirine Co-Packaged for IM Use (Cabenuva™) HCPCS Code J3490: Billing Guidelines
Effective with date of service Feb. 1, 2021, the Medicaid and NC Health Choice programs cover cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension, co-packaged for intramuscular use (Cabenuva™).
Effective with date of service Jan. 28, 2021, the Medicaid and NC Health Choice programs cover remimazolam for injection, for intravenous use (Byfavo™).
The U.S. Food and Drug Administration has issued an Emergency Use Authorization for the unapproved products, bamlanivimab and etesevimab to be administered together for qualifying patients.
Janssen COVID-19 vaccine is authorized for use under an Emergency Use Authorization (EUA) for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 18 years of age and older.
Effective with date of service Jan 5, 2021, the Medicaid and NC Health Choice programs cover rituximab-arrx injection, for intravenous use (Riabni™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service Dec. 22, 2020, the Medicaid and NC Health Choice programs cover lumasiran injection, for subcutaneous use (Oxlumo™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Dec 12, 2020, the Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine for use in the Physician Administered Drug Program.
Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover [coagulation factor VIIa (recombinant)-jncw] lyophilized powder for solution, for intravenous use (Sevenfact®) for use in the Physician Administered Drug Program.
Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover pegfilgrastim-apgf injection, for subcutaneous use (Nyvepria™) for use in the Physician Administered Drug Program.