Medicaid Bulletin

Articles published prior to January 2018 are available in the Medicaid Bulletin Archive.

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Adding Coverage of Diagnosis Codes Z31.430 and Z31.440
Effective retroactive to April 1, 2023, Z31.430 and Z31.440 will be covered diagnosis codes in NCTracks.  
Prior Approvals for Private Duty Nursing Will Transition to NCTracks July 28, 2024
Training for Providers begins Friday, June 28. Additional dates are listed in this bulletin.
NC Medicaid Managed Care Provider Update – June 20, 2024
Provider Data Management / Credentialing Verification Organization (PDM/CVO) Solution New Launch Date of 2026. Includes information on the New Launch Date for PDM/CVO, Healthy Opportunities Pilot, Provider Fact Sheets, Reverification Updates and more.
Adding Physical Therapists to Electrodiagnostic Studies Correction
Medicaid corrected the reimbursement issue and reprocessed claims for nerve conduction tests performed by physical therapists.
Adding Coverage for Point of Care Rapid testing for Syphilis and HIV

This bulletin applies to NC Medicaid Managed Care and NC Medicaid Direct.

Terminating Coverage of CPT Code 80050 – General Health Panel
Effective retroactive to Jan. 1, 2022, CPT code 80050 will no longer be reimbursed.
Provider Data Management / Credentialing Verification Organization Solution New Launch Date of 2026
The PDM/CVO solution will consolidate provider data management and coordinate provider enrollment, credentialing, and ongoing data maintenance.
Reminder on Hospital Observation Policy
Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation
Flexibilities to Ease Provider Administrative Burden at Tailored Plan Launch
Includes medical and pharmacy prior authorizations, out of network provider rates and rules, and primary care provider changes
Nicotine Replacement Therapy Protocol Reimbursement Effective Aug. 1, 2024
Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.