Effective July 1, 2020, coverage of therapeutic Continuous Glucose Monitoring products will transition from the Durable Medical Equipment Program to the Outpatient Pharmacy Point of Sale Program.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and Health Choice beneficiaries.
Effective with date of service March 16, 2020, the Medicaid and NC Health Choice programs cover trastuzumab-pkrb for injection, for intravenous use (Herzuma®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5113 - Injection, trastuzumab-pkrb, biosimilar, (Herzuma®), 10 mg.
Effective with date of service April 2, 2020, the Medicaid and NC Health Choice programs cover peanut (Arachis hypogaea) allergen powder-dnfp powder for oral administration (Palforzia™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service March 19, 2020, the Medicaid and NC Health Choice programs cover isatuximab-irfc injection for intravenous use (Sarclisa®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Effective with date of service April 6, 2020, the NC Medicaid and NC Health Choice programs cover eptinezumab-jjmr injection, for intravenous use (Vyepti™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
In response to CDC recommendation regarding non-aerosolizing dental treatment during COVID-19, NC Medicaid is reminding dentists of the prescription fluoride products for patients at high-risk for caries.
Effective with date of service Oct. 4, 2019, the Medicaid and NC Health Choice programs cover immune globulin subcutaneous, human – klhw 20% solution (Xembify®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
The Community Alternatives Program for Children (CAP) §1915( c) Home and Community-Based Services (HCBS) waiver application has been amended and approved by the Centers for Medicare and Medicaid Service (CMS), effective May 1, 2020.
NC Medicaid continues provide support to Skilled Nursing Facilities (SNF) and Personal Care Services (PCS) and Home Health (HH) providers to strengthen their infection prevention and management activities as they serve beneficiaries at high risk of contracting COVID-19.