Medicaid Bulletin

CMS has added new HCPCS codes (J Codes), deleted others and changed the description of some existing codes.

Prepaid Health Plans (PHPs) began providing non-emergency medical transportation (NEMT) and non-emergency ambulance transportation (NEAT) services for PHP members on July 1, 2021.

Providers need to submit new prior authorizations (PA) for services subject to 42 Code of Federal Regulations (CFR) Part II

Effective with date of service May 11, 2021, the Medicaid and NC Health Choice programs cover loncastuximab tesirine-lpyl for injection, for intravenous use (Zynlonta) 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 May 17, 2021, the Medicaid and NC Health Choice programs cover dostarlimab-gxly injection, for intravenous use (Jemperli) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Update on coverage of medications used in the Physician Administered Drug Program when billed with HCPCS code 90697.

Effective with date of service June 9, 2021, the Medicaid and NC Health Choice programs cover amivantamab-vmjw injection, for intravenous use (Rybrevant) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 – Not otherwise classified antineoplastic drugs.

Effective July 1, 2021, some Medicaid beneficiaries receiving Personal Care Services (PCS) transitioned from NC Medicaid Direct to receiving services through an NC Medicaid Managed Care health plan.

Health plans have identified a common billing error of providers submitting professional and institutional EDI claims.

Data system guidance and strategy Q&As are now available