Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

New Laboratory Coverage for Respiratory Panels
Effective April 1, 2025.
Hospital at Home Extended through March 31, 2025
The Centers for Medicare & Medicaid Services has extended this service through March 31, 2025
Reinstating Coverage of Definitive Drug Testing Codes in Outpatient Settings
Coverage has been restored to definitive drug testing codes that exceed seven drug classes retroactive to Dec. 1, 2024.
Verifying Other Health Insurance for NC Medicaid Managed Care Members
Use Standard Plan and Tailored Plan provider portals or Real-Time Eligibility Electronic Data Interchange Transactions 270/271.
Updates to Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies

An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of March 1, 2025, was posted to the NC Medicaid Clinical Coverage Policy web page.

Updated Reimbursement Guidance for Psychiatric Collaborative Care Management
NC Medicaid added coverage for Healthcare Common Procedure Coding System (HCPCS) Code G0512 for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
Upcoming Multi-Factor Authentication Changes for Pre-Admission Screening and Resident Review Users
Starting April 15, 2025, Pre-Admission Screening and Resident Review (PASRR) users must use Multi-Factor Authentication (MFA) via MyNCID to enhance security.
New Laboratory Codes for Celiac Disease Diagnosis and Management
Effective Date: April 1, 2025.
Point-of-Sale COVID and Flu Vaccine Reimbursement Updates 2025
The PREP Act is extended to Dec. 31, 2029, expanding COVID-19 and flu vaccine access at pharmacy Point-of-Sale for ages 3 and older.
Revisions to Inclusion of Drug Code Rates on Fee Schedules
Effective Feb. 3, 2025, unless communicated otherwise by the Department