SPECIAL BULLETIN COVID-19 #34 replaces the following Medicaid Bulletins in their entirety: SPECIAL BULLETIN COVID-19 #9: Telehealth Provisions – Clinical Policy Modification; SPECIAL BULLETIN COVID-19 #19: Telehealth Provisions – Clinical Policy Modification and SPECIAL BULLETIN COVID-19 #28: [ADDENDUM to Bulletin #9 Effective March 20, 2020] : Telehealth Provisions – Clinical Policy Modification. New telehealth codes, F. Place of Service change and a clarification to "psychologists" are included.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover rituximab-pvvr injection, for intravenous use (Ruxience™) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
NC-MIPS is Open for Program Year 2019 through April 30, 2020, The Security Risk Analysis, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and General Reminders
Effective with date of service Jan. 6, 2020, the Medicaid and NC Health Choice programs cover imipenem, cilastatin, and relebactam for injection, for intravenous use (Recarbrio™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Jan. 13, 2020, the Medicaid and NC Health Choice programs cover bevacizumab-bvzr injection, for intravenous use (Zirabev™) for use in the Physician Administered Drug Program when billed with HCPCS code Q5118 - Injection, bevacizumab-bvzr, biosimilar, (Zirabev™), 10 mg.
Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant), glycopegylated-exei lyophilized powder for solution, for intravenous use (Esperoct®) for use in the Physician Administered Drug Program when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.
NC Medicaid has implemented flexibilities on how Medicaid providers 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. Medicaid is hosting two webinars to further discuss the flexibilities.
Effective March 10, 2020, the Division of Health Benefits (DHB) implemented a 5% rate increase for certain Medicaid provider groups listed in the Bulletin. DHB will systematically reprocess claims submitted with dates of service beginning March 10, 2020, through the implementation date of the rate increase.
*This Bulletin has been updated in SPECIAL BULLETIN COVID-19 #175: Updated Guidance for Non-Emergency Medical Transportation - Aug. 19, 2021
On March 10, 2020, Governor Roy Cooper issued an executive order declaring a State of Emergency for North Carolina to respond to COVID-19. In addition, the Department of Health and Human Services made several recommendations to slow the spread of COVID-19 and reduce the number of people infected.