Medicaid Bulletin

SPECIAL BULLETIN COVID-19 #93: Targeted Rate Increase, Additional Hours and Associated Reporting Requirements for In-Home Personal Care Services (PCS) Providers under State Plan PCS and CAP/C and CAP/DA Programs

Friday, May 29, 2020

NOTE: UPCOMING PROVIDER WEBINAR
NC Medicaid COVID+ Rate Reporting Technical Assistance Session

Wednesday, June 3, 1:00 p.m.
Register

 

SPECIAL BULLETIN COVID-19 #92: Coronavirus (COVID-19) EviCore Chest Computed Tomography (CT) Auto-Approval Ending May 31, 2020

Friday, May 29, 2020

Effective Sunday, May 31, 2020, NC Medicaid is terminating the auto approval for lung imaging requested through EviCore, NC Medicaid’s contracted vendor for imaging services. 

SPECIAL BULLETIN COVID-19 #91: Federal Provider Relief Fund: Guidance on How to Access "General Distribution" Funds

Friday, May 29, 2020

Congress created a $175 billion Provider Relief Fund to support providers as they deal with COVID-19. Recently, the federal Department of Health and Human Services (HHS) began distribution of the first $50 billion of this fund—through the so-called “General Distribution” mechanism—for providers who billed Medicare in 2019. To help providers understand how to access funding, NC Medicaid has developed the Federal Provider Relief Fund: Guidance on How to Access “General Distribution” Funds.

Continuous Glucose Monitoring Systems Coverage Transition

Friday, May 29, 2020

Effective July 1, 2020, coverage of therapeutic Continuous Glucose Monitoring products will transition from the Durable Medical Equipment Program to the Outpatient Pharmacy Point of Sale Program. 

SPECIAL BULLETIN COVID-19 #90: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Smoking and Tobacco Cessation Counseling

Wednesday, May 20, 2020

NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and Health Choice beneficiaries. 

Trastuzumab-pkrb for Injection, for Intravenous Use (Herzuma®) HCPCS Code Q5113: Billing Guidelines

Tuesday, May 19, 2020

Effective with date of service March 16, 2020, the Medicaid and NC Health Choice programs cover trastuzumab-pkrb for injection, for intravenous use (Herzuma®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5113 - Injection, trastuzumab-pkrb, biosimilar, (Herzuma®), 10 mg.

Peanut (Arachis hypogaea) Allergen Powder-dnfp Powder for Oral Administration (Palforzia™) HCPCS Code J3590: Billing Guidelines

Tuesday, May 19, 2020

Effective with date of service April 2, 2020, the Medicaid and NC Health Choice programs cover peanut (Arachis hypogaea) allergen powder-dnfp powder for oral administration (Palforzia™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

Isatuximab-irfc Injection, for Intravenous Use (Sarclisa®) HCPCS Code J9999: Billing Guidelines

Tuesday, May 19, 2020

Effective with date of service March 19, 2020, the Medicaid and NC Health Choice programs cover isatuximab-irfc injection for intravenous use (Sarclisa®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Eptinezumab-jjmr Injection, for Intravenous Use (Vyepti™) HCPCS Code J3590: Billing Guidelines

Tuesday, May 19, 2020

Effective with date of service April 6, 2020, the NC Medicaid and NC Health Choice programs cover eptinezumab-jjmr injection, for intravenous use (Vyepti™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

SPECIAL BULLETIN COVID-19 #89: Prescription Fluoride Available to Beneficiaries

Monday, May 18, 2020

In response to CDC recommendation regarding non-aerosolizing dental treatment during COVID-19, NC Medicaid is reminding dentists of the prescription fluoride products for patients at high-risk for caries.

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