Medicaid Bulletin

Attention Advanced Medical Homes, Carolina Access and CCNC Primary Care Practices

The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.

Consistent with the federal Department of Health and Human Services’ extension of the federal COVID-19 Public Health Emergency to January 21, 2021, NC Medicaid is extending COVID-19 temporary provider rate increases and clinical coverage policies to that same date. 

All temporary Durable Medical Equipment (DME) policy flexibilities outlined in COVID-19 Special Bulletins remain in effect. An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of Oct. 1, 2020, was posted to the NC Medicaid Clinical Coverage Policy web page. 

All temporary Durable Medical Equipment (DME) policy flexibilities outlined in COVID-19 Special Bulletins remain in effect. An amended version of Clinical Coverage Policy 5A-2, Respiratory Equipment and Supplies with an effective date of Oct. 1, 2020, was posted to the NC Medicaid Clinical Coverage Policy web page.
 

Effective with date of service Aug. 20, 2020, the Medicaid and NC Health Choice programs cover viltolarsen injection, for intravenous use (Viltepso™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

Effective with date of service Aug. 24, 2020, the NC Medicaid and NC Health Choice programs cover satralizumab-mwge injection, for subcutaneous use (Enspryng™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

Effective with date of service Sept. 11, 2020, the Medicaid and NC Health Choice programs cover infliximab-axxq for injection, for intravenous use (Avsola) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5121 - Injection, infliximab-axxq, biosimilar, (avsola), 10 mg.

Effective with date of service Aug. 6, 2020, the Medicaid and NC Health Choice programs cover belantamab mafodotin-blmf for injection, for intravenous use (Blenrep™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

The US Department of Health and Human Services announced an additional funding opportunity for Medicaid/CHIP providers to apply for federal Provider Relief Funds. The application period runs through Nov. 6, 2020.