Medicaid Bulletin

Effective with date of service Feb. 19, 2020, the Medicaid and NC Health Choice programs cover cetirizine hydrochloride injection, for intravenous use (Quzyttir™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

Effective with date of service Feb. 24, 2020, the Medicaid and NC Health Choice programs cover cefiderocol for injection, for intravenous use (Fetroja®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

This Bulletin clarifies which specific Prior Authorizations were lifted on the March 1, 2020, effective date stated in SPECIAL BULLETIN COVID-19 #15: Medicaid and NC Health Choice Temporary Flexibilities - 1135 Waiver Provisions (posted March 24, 2020), including references all relevant Prior Authorization information included in other Bulletins; replaces the effective dates originally stated in the following Bulletins: SPECIAL BULLETIN COVID-19 #2: General Guidance and Policy Modifications (posted March 13, 2020); SPECIAL BULLETIN COVID-19 #10: Durable Medical Equipment: Temporary Flexibilities Effective March 23, 2020 (posted March 24, 2020); and SPECIAL BULLETIN COVID-19 #11: Outpatient Specialized Therapies Temporary Flexibilities (posted March 24, 2020).

NOTE: This bulletin has been replace in its entirety by SPECIAL BULLETIN COVID-19 #82.

NC Medicaid has eliminated the restriction that teletherapy services cannot be conducted via “video cell phone interactions.” These services can now be delivered via any HIPAA-compliant, secure technology with audio and video capabilities, including (but not limited to) smart phones, tablets and computers. 

NC Medicaid is temporarily adding telemedicine coverage for providers to conduct Well Child Visits with patients to ensure the provision of comprehensive and preventive health care services for children under age 21. Providers are encouraged to continue providing well child visits, immunizations and or preventive care during the pandemic. 

NC Medicaid has temporarily enabled providers to conduct postpartum depression screenings of postpartum women via several remote modalities in light of social distancing measures that may prevent in-person visits.

NC Medicaid has temporarily enabled licensed clinical social workers at Local Health Departments to conduct Health and Behavior Intervention visits for pregnant and postpartum women who have serious psychosocial needs via telemedicine. Local health departments can bill for a variety of other medical and behavioral services provided by an MD, NP, PA, CNM, or appropriate Behavioral Health personnel when delivered via telehealth or virtual patient communications, as outlined in various NC Medicaid Special Bulletins (#34, 35, 36, 43, 48 and 49) regarding Telehealth Clinical Policy Modifications that have been instituted in light of COVID-19.

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries may access and receive Medicaid services in the wake of COVID-19. Retainer payments may be made for direct care providers of services that include habilitation or personal care that are currently authorized in the Individual Support Plan (ISP). 

NCDHHS is directing providers to stop collecting copayments from Medicaid and NC Health Choice beneficiaries on all COVID-19 related testing, services and treatments. This change is effective retroactive to Jan.