Medicaid Bulletin

Personal Care Services Policy 3L, Implementation of Electronic Visit Verification, Public Comment Period Extended

Wednesday, February 24, 2021

The public comment period has been extended through March 15, 2021, for Personal Care Services Policy 3L, Implementation of Electronic Visit Verification.

SPECIAL BULLETIN COVID-19 #158: Correction to COVID-19 Lab Code 87428

Friday, February 19, 2021

CPT Code 87428 (related to COVID-19) was improperly define in a previous Bulletin and is being correctly defined here. 

Community Alternatives Program for Children (CAP/C) Waiver Renewal Stakeholder Engagement

Tuesday, February 16, 2021

The Community Alternatives Program for Children (CAP) §1915(c) Home- and Community-Based Services (HCBS) waiver will expire on Feb. 28, 2022. By October 2021, NC Medicaid will submit a request to the Centers for Medicare and Medicaid Services (CMS) to renew the CAP/C waiver.  

Billing Code Update for Nurse Practitioners and Physician Assistants

Tuesday, February 16, 2021

North Carolina Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

Tailored Care Management Certification Deadline Extended to June 1, 2021

Monday, February 15, 2021

To continue supporting providers interested in obtaining certification as an Advanced Medical Home Plus (AMH+) practice or Care Management Agency (CMA),the Round 1 application deadline is being extended from March 1, 2021 to June 1, 2021. 

SPECIAL BULLETIN COVID-19 #157: Final Reconciliation of Nursing Home Staff Testing Payments Authorized Under Secretarial Orders 2 and 4

Monday, February 15, 2021

NC Medicaid is initiating its final phase of reconciling projected versus actual testing cost submission activity for nursing home staff testing payments authorized under Secretarial Orders 2 and 4 on March 1, 2021. 

SPECIAL BULLETIN COVID-19 #156: Clinical Policy 1E-7, Family Planning Services, COVID-19 Lab Testing for MAFDN Beneficiaries

Monday, February 15, 2021

Effective June 1, 2020, NC Medicaid began reimbursing COVID-19 testing for “Be Smart” Family Planning (MAFDN) beneficiaries through the NC Medicaid Optional COVID-19 Testing (MCV) Program. NC Medicaid is adding codes into NC Tracks for lab testing coverage for MAFDN beneficiaries with retroactive effective dates. 

Rituximab-arrx Injection, for Intravenous Use (Riabni™) HCPCS Code J3590: Billing Guidelines

Tuesday, February 9, 2021

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.

Lumasiran Injection, for Subcutaneous Use (Oxlumo™) HCPCS Code J3490: Billing Guidelines

Tuesday, February 9, 2021

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.

Addition of Licensed Professionals Eligible to Bill Screening, Brief Intervention and Referral to Treatment (SBIRT) CPT Codes

Tuesday, February 9, 2021

This bulletin informs LME-MCOs and providers about the amendments made to providers types eligible to bill the Screening, Brief Intervention and Referral to Treatment (SBIRT) CPT codes effective as of March 1, 2021.

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