Medicaid Bulletin

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

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New Covered CPT Codes for Genetic Testing
Effective June 1, 2024, CPT codes are newly eligible for coverage.
Tobacco-Related Policy Requirements Delayed until July 1, 2025
Impacts NC Medicaid Managed Care Standard Plans, Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans and LME/MCOs.
1915(b)(3) Service Transition for TP Eligible Members
Providers should work with the Tailored Plans and Tailored Care Managers to support Medicaid beneficiaries transitioning to 1915(i) services.
NC Managed Care Capitation Rates – Updated Care Management Assumptions for SFY 2025

This bulletin applies to NC Medicaid Managed Care Standard Plans.

Advanced Medical Home Provider Manual May 2024 Released
AMH Provider Manual May 2024 reflects all program modifications and changes that impact provider contracts and operations.
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.