Medicaid Bulletin

Providers need to submit new prior authorizations (PA) for services subject to 42 Code of Federal Regulations (CFR) Part II

Effective with date of service May 11, 2021, the Medicaid and NC Health Choice programs cover loncastuximab tesirine-lpyl for injection, for intravenous use (Zynlonta) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Effective with date of service May 17, 2021, the Medicaid and NC Health Choice programs cover dostarlimab-gxly injection, for intravenous use (Jemperli) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Update on coverage of medications used in the Physician Administered Drug Program when billed with HCPCS code 90697.

Effective with date of service June 9, 2021, the Medicaid and NC Health Choice programs cover amivantamab-vmjw injection, for intravenous use (Rybrevant) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 – Not otherwise classified antineoplastic drugs.

Effective July 1, 2021, some Medicaid beneficiaries receiving Personal Care Services (PCS) transitioned from NC Medicaid Direct to receiving services through an NC Medicaid Managed Care health plan.

Health plans have identified a common billing error of providers submitting professional and institutional EDI claims.

Data system guidance and strategy Q&As are now available

Effective July 29, 2021, Session Law 2021-62 (NC Senate Bill 594), repeals portions of the 2020 COVID-19 Recovery Act that permitted the temporary lifting of certain enrollment requirements for providers enrolling in NC Medicaid during the global healthcare emergency.

Effective with date of service May 17, 2021, Medicaid and NC Health Choice cover dostarlimab-gxly injection.