Medicaid Bulletin

Program Year 2019 is Closed, NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series and The Security Risk Analysis (SRA).

NOTE: UPCOMING PROVIDER WEBINAR
NC Medicaid COVID+ Rate Reporting Technical Assistance Session
Wednesday, June 3, 1:00 p.m.
Register

Effective Sunday, May 31, 2020, NC Medicaid is terminating the auto approval for lung imaging requested through EviCore, NC Medicaid’s contracted vendor for imaging services. 

Congress created a $175 billion Provider Relief Fund to support providers as they deal with COVID-19. Recently, the federal Department of Health and Human Services (HHS) began distribution of the first $50 billion of this fund—through the so-called “General Distribution” mechanism—for providers who billed Medicare in 2019. To help providers understand how to access funding, NC Medicaid has developed the Federal Provider Relief Fund: Guidance on How to Access “General Distribution” Funds.

Effective July 1, 2020, coverage of therapeutic Continuous Glucose Monitoring products will transition from the Durable Medical Equipment Program to the Outpatient Pharmacy Point of Sale Program. 

NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and Health Choice beneficiaries. 

Effective with date of service March 16, 2020, the Medicaid and NC Health Choice programs cover trastuzumab-pkrb for injection, for intravenous use (Herzuma®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5113 - Injection, trastuzumab-pkrb, biosimilar, (Herzuma®), 10 mg.

Effective with date of service April 2, 2020, the Medicaid and NC Health Choice programs cover peanut (Arachis hypogaea) allergen powder-dnfp powder for oral administration (Palforzia™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

Effective with date of service March 19, 2020, the Medicaid and NC Health Choice programs cover isatuximab-irfc injection for intravenous use (Sarclisa®) 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 April 6, 2020, the NC Medicaid and NC Health Choice programs cover eptinezumab-jjmr injection, for intravenous use (Vyepti™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.