On May 15, 2019, an amended version of Clinical Coverage Policy 10C, Outpatient Specialized Therapies, Local Education Agencies (LEAs), was posted to the North Carolina Medicaid website. The following updates were made in accordance with State Plan Amendment (SPA) NC 18-0005.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective with date of service March 7, 2019, the North Carolina Medicaid and NC Health Choice programs cover tagraxofusp-erzs injection, for intravenous use (Elzonris) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
The Secretary of the N.C. Department of Health and Human Services (DHHS) has approved the disengagement of Rutherford County from the VAYA Health Local Management Entity-Managed Care Organization (LME-MCO) and their alignment with Partners Behavioral Health Management LME-MCO.
Provision of eye examination and visual aids for beneficiaries under 21 years of age as well as beneficiaries over 21 years of age.
Effective with date of service Oct. 29, 2018, NC Medicaid covers Azedra for use in the Physician’s Administered Drug Program when billed with HCPCS code A9699, Radiopharmaceutical, therapeutic, not otherwise classified (therapeutic use) or A4641, Radiopharmaceutical, diagnostic, not otherwise classified (dosimetric use).
NC Medicaid has received calls concerning the ICD 10 diagnoses codes for acute appendicitis.
NC Medicaid has provided instructions to NCTracks on updating the diagnoses code list for acute appendicitis.
Effective with date of service 3/8/2019, the North Carolina Medicaid and NC Health Choice programs cover esketamine nasal spray (Spravato™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
In response to provider requests, NC Medicaid has added coverage for central motor evoked potential.
In response to provider requests, NC Medicaid has added coverage for central motor evoked potential.
List of applicable co-payments for adult Medicaid beneficiaries (21 years of age and older)