Effective Feb. 1, 2018, Clinical Coverage Policy 1A-42, Balloon Ostial Dilation, was revised to include new coverage of CPT code 31298 (balloon dilation of frontal and sphenoid sinus).
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
On July 21, 2017, the Centers for Medicare & Medicaid Services notified North Carolina Medicaid that its State Plan Amendment (SPA TN17-0003) had been reviewed and was approved effective April 1, 2017.
As previously communicated, Reimbursement Rate Increase, North Carolina Medicaid retroactively increased the rate for Personal Care Services and the Community Alternatives Program for Children.
The Community Alternatives Program for Disabled Adults (CAP/DA) Waiver allows Adult Day Health (ADH) centers licensed to provide overnight respite to be providers of CAP/DA Institutional Respite.
North Carolina Medicaid was recently made aware that several manufacturers of viscous hyaluronic acid products changed the status of their products from “drugs” to “devices” effective Oct. 24, 2017 and are therefore no longer offering rebate agreements with the Centers of Medicare & Medicaid Services.
Effective with date of service December 1, 2017, the North Carolina Medicaid and NC Health Choice (NCHC) programs cover vestronidase alfa-vjbk injection, for intravenous use (Mepsevii) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3590 – Unclassified biologics.
Effective with date of service Jan. 8, 2018, the North Carolina Medicaid and NC Health Choice (NCHC) programs covers hepatitis B vaccine (recombinant), adjuvanted solution for intramuscular injection (Heplisav-B) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code 90739 - Hepatitis B vaccine (HepB), adult dosage, two dose schedule, for intramuscular use.
Effective with date of service Jan. 4, 2018, the North Carolina Medicaid and NC Health Choice (NCHC) programs cover etelcalcetide injection, for intravenous use (Parsabiv) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J0606 - Injection, etelcalcetide, 0.1 mg.
Effective with date of service Jan. 30, 2018, the North Carolina Medicaid and NC Health Choice (NCHC) programs cover Coagulation Factor IX (Recombinant), GlycoPEGylated, lyophilized powder for solution for intravenous injection (Rebinyn) for use in the Physician’s Drug Program (PDP) when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.
The NC Division of Medical Assistance (DMA) has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).