Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Electronic Visit Verification Payer Program and Service Codes
Effective July 1, 2023, the visit record must match the claim submitted to NCTracks. This bulletin provides additional information and resources.
Update to Age Criteria for CPT Code 81528, Cologuard (Multi-Target Stool DNA-Based Colorectal Screening)
Effective Jan. 1, 2023, the minimum age was adjusted from 50 years to 45 years.
REMINDER: Preadmission Screening and Resident Review and the Nursing Facility Level of Care Prior Approval Process
The review must be performed before anyone can be admitted to a Medicaid-Certified nursing facility.
Makena End of Coverage and Removal from NC Medicaid Preferred Drug List
FDA approvals of these drugs were withdrawn.
Annual Ambulatory Surgery Center Update
Effective with date of service Jan. 1, 2023, the following new CPT codes as separately reimbursable in the ambulatory surgery setting
Provider Reverification and Billing Modifications Reminder
The federal COVID-19 Public Health Emergency (PHE) ends today, May 11, 2023. This bulletin contains information on the reverification process.
Provider Reverification and Billing Modifications Reminder
The federal COVID-19 Public Health Emergency (PHE) will end May 11, 2023. This bulletin contains important information on the reverification process.
Patient Driven Payment Model and the Implementation of the Optional State Assessment
Federal support ending for Resource Utilization Groups III and IV on federally required assessments for patients effective Oct. 1, 2023.
Lenacapavir Injection, for Subcutaneous Use (Sunlenca®) HCPCS Code J3490 - Unclassified Drugs: Billing Guidelines
Effective with date of service Jan. 27, 2023, Medicaid and NC Health Choice cover lenacapavir injection
Ublituximab-Xiiy Injection, for Intravenous Use (Briumvi™) HCPCS Code J3590 - Unclassified Biologics: Billing Guidelines
Effective with date of service Jan. 27, 2023, the Medicaid and NC Health Choice programs covers ublituximab-xiiy injection, for intravenous use (Briumvi)