Medicaid Bulletin

Chimeric Antigen Receptor (CAR) T-Cell Therapy Reimbursement Guidelines
This information replaces the reimbursement guidelines posted in the December 2019 bulletin.
Tailored Care Management Updated Guidance (April 21, 2022)
Capacity building FAQs, guidance on the use of extenders, standard terms and conditions, and Provider Manual updates.
SPECIAL BULLETIN COVID-19 #245: Second Booster for Pfizer-BioNTech and Moderna Vaccines
Billing Reimbursement for second booster
SPECIAL BULLETIN COVID-19 #244: Evusheld Alternative to COVID-19 Vaccination for Some Patients
Billing Guideline for use of Evusheld
Research Based – Behavioral Health Treatment for Autism Spectrum Disorder
Approved for beneficiaries over the age of 21, effective July 1, 2021
Reminder: As the Federal Public Health Emergency Ends, Provider Reverification Requirements are Reinstated

With the end of the federal Public Health Emergency (PHE) expected in the Summer of 2022, NC Medicaid providers will begin receiving reverification notices.

NCCI/MUE Edits for ALL PADP Drug Claims
The Medicaid NCCI edits for the most recent quarter are published on the CMS website.
Additional NC Innovations Funding and Innovations Waiver Clinical Coverage Policy Updated
NC Medicaid received approval to increase NC Innovations Waiver capacity by 1,000 slots.
Tebentafusp-tebn Injection, for Intravenous Use (Kimmtrak®) HCPCS Code J9999: Billing Guidelines
Effective with date of service Feb. 25, 2022, the Medicaid and NC Health Choice programs cover tebentafusp-tebn injection.
Sirolimus Protein-Bound Particles for Injectable Suspension (Albumin-Bound), for Intravenous Use (Fyarro™) HCPCS Code J9999: Billing Guidelines
Effective with date of service Feb. 23, 2022, the Medicaid and NC Health Choice programs cover sirolimus protein-bound particles for injectable suspension (albumin-bound).