Medicaid Bulletin

Note: Additional Family Planning guidance may be released in the future, which would replace this bulletin.

Effective April 1, 2020, in response to the anticipated spread of coronavirus (COVID-19) in North Carolina, NC Medicaid is adding "U07.1 - 2019-nCoV Acute Respiratory Disease" as a billable diagnosis. Additionally, diagnosis code U07.1 is being added to the list of diagnoses exempt from the annual visit limit also effective April 1.  

Effective retroactive to March 10, 2020, Medicaid and NC Health Choice plans are temporarily covering weight scales and adding a purchase option for portable pulse oximeters.

An update to COVID-19 guidance for North Carolina clinicians and laboratories includes updated laboratory testing guidance; updated criteria for submission of specimens to the North Carolina State Laboratory of Public Health (NCSLPH); and replacement of information that is not North Carolina-specific with links to relevant CDC guidance.

NC Medicaid has implemented flexibilities on how Medicaid providers deliver and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver. 

This SPECIAL BULLETIN COVID-19 #49 replaces SPECIAL BULLETIN #42: Telehealth Clinical Policy Modifications - Postpartum Care. Please note billing guidance change to postpartum care visits, which can be billed separately OR as part of a pregnancy package code.

NC Medicaid has added coverage for providers to help their patients engage in Remote Physiologic Monitoring (RPM), providing the opportunity to improve management of diseases and engage patients in their own care.

PACE organizations should continue to follow the guidance of the local, state and federal officials regarding COVID-19 and thoroughly document reasoning for making decisions which may fall outside of the PACE program model. This guidance supplements the Special Bulletin COVID-19 #27 released on March 30, 2020.  The temporary flexibilities noted in Special Bulletin COVID-19 #27 and this Special Bulletin will end the earlier of the cancellation of the North Carolina state of emergency declaration or December 31, 2020.

Effective April 16, 2020, NC Medicaid, in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services, is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability Clinical Coverage Policies to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic.

Effective March 10, 2020, through the conclusion of the North Carolina declared state of emergency related to the COVID-19 crisis, NC Medicaid is temporarily increasing the number of therapeutic leave days for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs) from 60 days to 90 days and waiving the requirement of approval needed more than 15 consecutive days per Clinical Coverage Policy 8E.