Medicaid Bulletin

Effective with date of service Oct. 3, 2018, North Carolina Medicaid and NC Health Choice programs cover mogamulizumab-kpkc injection, for intravenous use (Poteligeo), for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.

NC Medicaid has instructed Health Management System (HMS) to resume audits of hospital outpatient claims. These reviews are commencing now, as the claims adjustment reason code issue has been resolved.

Enrollment applications submitted with incorrect data including name, social security number and date of birth result in application denials and withdrawals. As a result, providers must submit new applications and pay any applicable fees.

Medicaid has designated specific ICD-10-CM diagnosis codes that do not count toward the annual visit limitation. These codes are reviewed regularly and updated as appropriate.

System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for CPT codes 90791 – Psychiatric Diagnostic Evaluation and 90792 – Psychiatric Diagnostic Evaluation with Medical Servicess when provided via telemedicine/telepsychiatry.

In accordance with the North Carolina’s Medicaid State Plan, Federally Qualified Health Centers and Rural Health Centers may request a rate adjustment due to change in scope of services.

Effective with date of service Oct. 8, 2018, North Carolina Medicaid and NC Health Choice programs cover cemiplimab-rwlc injection, for intravenous use (Libtayo) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.

The NC Medicaid EHR Incentive Program’s Quick Tip Webinar Series has been updated to reflect the rules and regulations for Program Year 2018. This article also covers Promoting Interoperability Reporting Period and NC Medicaid EHR Incentive Payment System is Open for Program Year 2018.

The following new or amended Medicaid and NC Health Choice clinical coverage policies were posted since Oct. 1, 2018. Visit the NC Medicaid website to view the policies.

Effective Oct. 1, 2018, providers can now bill for CPT code 81420 (fetal chromosomal aneuploidy). Procedure is limited to three units per 365 days.