Medicaid Bulletin

Effective with date of service Jan. 28, 2020, the Medicaid and NC Health Choice programs cover teprotumumab-trbw for injection, for intravenous use (Tepezza™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

SPECIAL BULLETIN COVID-19 #34 replaces the following Medicaid Bulletins in their entirety: SPECIAL BULLETIN COVID-19 #9: Telehealth Provisions – Clinical Policy Modification; SPECIAL BULLETIN COVID-19 #19: Telehealth Provisions – Clinical Policy Modification and SPECIAL BULLETIN COVID-19 #28: [ADDENDUM to Bulletin #9 Effective March 20, 2020] : Telehealth Provisions – Clinical Policy Modification. New telehealth codes, F. Place of Service change and a clarification to "psychologists" are included.

Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover rituximab-pvvr injection, for intravenous use (Ruxience™) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

NC-MIPS is Open for Program Year 2019 through April 30, 2020, The Security Risk Analysis, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and General Reminders

Effective with date of service Jan. 6, 2020, the Medicaid and NC Health Choice programs cover imipenem, cilastatin, and relebactam for injection, for intravenous use (Recarbrio™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

Effective with date of service Jan. 13, 2020, the Medicaid and NC Health Choice programs cover bevacizumab-bvzr injection, for intravenous use (Zirabev™) for use in the Physician Administered Drug Program when billed with HCPCS code Q5118 - Injection, bevacizumab-bvzr, biosimilar, (Zirabev™), 10 mg.

Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant), glycopegylated-exei lyophilized powder for solution, for intravenous use (Esperoct®) for use in the Physician Administered Drug Program when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver. Medicaid is hosting two webinars to further discuss the flexibilities.