Medicaid Bulletin

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)

A new or amended policy on Outpatient Specialized Therapies - Local Education Agencies

To align with children’s health quality measure reporting, NC Medicaid has added diagnosis code Z71.82 (Exercise Counseling) to NCTracks as an acceptable secondary diagnosis effective Oct. 1, 2017.