Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Outpatient Specialized Therapies Prior Authorization (PA) Update
A new PA is required for beneficiaries returning to NC Medicaid Direct.
SPECIAL BULLETIN COVID-19 #248: Telehealth Flexibilities for Occupational and Physical Therapies
EPSDT Prior Authorization Available July 1, 2022
New Billing Codes for Social Drivers of Health
New billable codes available Sept.1 to address social drivers of health
Verifying Provider Information (NPI+Location Code) in NCTracks
Prior to submitting an application for Advanced Medical Home/Care Management Agency Certification, please download and utilize the Provider Directory Listing Report.
Updates to Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies
An updated version of the policy with an amendment date of May 15, 2022, is posted.
Shared/Split Evaluation and Management Visits
Beginning Jan. 1, 2023, substantive portion means more than half of the total time spent by the physician and NPP performing the shared/split visit
Billing Requirement Modifications Due to COVID-19 to Expire
Three claims processing edits to end with Public Health Emergency
Lutetium Lu 177 Vipivotide Tetraxetan Injection, for Intravenous Use (Pluvicto™) HCPCS Code A9699: Billing Guidelines
Medicaid and NC Health Choice programs covers lutetium Lu 177 vipivotide tetraxetan injection
Kit for the Preparation of Gallium Ga 68 Gozetotide Injection, for Intravenous Use (Locametz®) HCPCS Code A9597: Billing Guidelines
Medicaid and NC Health Choice cover kit for the preparation of gallium Ga 68 gozetotide injection
Kit for the Preparation of Gallium Ga 68 Dotatate Injection, for Intravenous Use (Netspot®) HCPCS Code A9587: Billing Guidelines
the Medicaid and NC Health Choice cover kit for the preparation of gallium Ga 68 dotatate injection