Effective with date of service Oct 3, 2018, the NC Medicaid and Health Choice programs cover filgrastim-aafi injection, for subcutaneous or intravenous use (Nivestym) for use in the Physician Administered Drug Program when billed with HCPCS code Q5110 - Injection, Filgrastim-aafi, Biosimilar, (Nivestym), 1 microgram. Nivestym is available in a single-dose prefilled syringe containing either 300 mcg/0.5 mL or 480 mcg/0.8 mL.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective with date of service Nov. 28, 2018, the NC Medicaid and Health Choice programs cover elapegademase-lvlr injection, for intramuscular use (Revcovi™) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service Oct. 22, 2018, the NC Medicaid and Health Choice programs cover eravacycline for injection, for intravenous use (Xerava) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified Drugs. Xerava is available as a 50 mg single-dose vial.
Effective with date of service Nov. 2, 2018, the NC Medicaid and Health Choice programs cover crotalidae immune f(ab’)2 (equine), lyophilized powder for solution for injection for intravenous use (Anavip®) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Effective with date of service Jan. 1, 2019, the American Medical Association has added new CPT codes, deleted others and changed descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2019 edition of Current Procedural Terminology, published by the AMA.
The following new or amended clinical coverage policies are available on NC Medicaid’s clinical coverage policies web page:
Clinical Coverage Policy 1N-2, Allergy Immunotherapy has been revised effective Jan. 1, 2019, to reflect changes in unit dosing.
NC Medicaid has been reviewing the Medicaid Durable Medical Equipment rates to comply with the new Centers for Medicare and Medicaid Upper Payment Limit requirements. While further review is needed, NC Medicaid wanted to publish this bulletin to provide a status update.
Effective Jan. 1, 2019, optical services shall be covered for adult Medicaid beneficiaries in accordance with S. L. 2018-97, Part III, Section 11H.13.(c). However, Centers for Medicare and Medicaid Services (CMS) approval of the corresponding State Plan Amendment is pending.
This edit is in place to ensure billing providers are affiliated with the rendering (individual) providers for whom they are billing to prevent inaccurate payment or fraud.