Medicaid Bulletin

NC-MIPS is Open for Program Year 2019 through April 30, 2020, The Security Risk Analysis, Reminder from CMS Regarding Objective 6 and Objective 7, Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and General Reminders

Effective with date of service Jan. 6, 2020, the Medicaid and NC Health Choice programs cover imipenem, cilastatin, and relebactam for injection, for intravenous use (Recarbrio™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

Effective with date of service Jan. 13, 2020, the Medicaid and NC Health Choice programs cover bevacizumab-bvzr injection, for intravenous use (Zirabev™) for use in the Physician Administered Drug Program when billed with HCPCS code Q5118 - Injection, bevacizumab-bvzr, biosimilar, (Zirabev™), 10 mg.

Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant), glycopegylated-exei lyophilized powder for solution, for intravenous use (Esperoct®) for use in the Physician Administered Drug Program when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver. Medicaid is hosting two webinars to further discuss the flexibilities.

Effective March 10, 2020, the Division of Health Benefits (DHB) implemented a 5% rate increase for certain Medicaid provider groups listed in the Bulletin. DHB will systematically reprocess claims submitted with dates of service beginning March 10, 2020, through the implementation date of the rate increase.

*This Bulletin has been updated in SPECIAL BULLETIN COVID-19 #175: Updated Guidance for Non-Emergency Medical Transportation - Aug. 19, 2021

On March 10, 2020, Governor Roy Cooper issued an executive order declaring a State of Emergency for North Carolina to respond to COVID-19. In addition, the Department of Health and Human Services made several recommendations to slow the spread of COVID-19 and reduce the number of people infected.

Updated April 22, 2020: Link to downloadable list of enrollmed DMEPOS providers added. Effective March 30, 2020 NC Medicaid and NC HealthChoice coverage was added for HCPCS code A4670 – automatic blood pressure monitor.

NOTE: SPECIAL BULLETIN COVID-19 #28 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications - Definitions, Eligible Providers, Services and Codes.