This is a reminder that not all drugs administered by injection or infusion are covered in the Physicians Drug Program (PDP) as a part of the medical benefit. Some of these drugs are only covered in the outpatient pharmacy benefit when requested by prior authorization (PA) and dispensed by a retail or specialty pharmacy.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective with date of service Dec. 21, 2018, the North Carolina Medicaid and NC Health Choice programs cover ravulizumab-cwvz injection, for intravenous use (Ultomiris) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified Biologics.
Proposed new or amended North Carolina Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month.
Under the MQB Medicare Eligibility Codes, Medicaid pays only for Medicare Part B premiums or premiums, deductibles, and coinsurance for charges covered by Medicare. Routine eye exams, refraction only and visual aids are not covered by Medicare for MQB beneficiaries. Therefore, MQB beneficiaries are not eligible for Medicaid optical services.
Effective with date of service Jan. 1, 2019, the following dental procedure codes were added for the NC Medicaid and Health Choice Dental Programs. These additions are a result of the Current Dental Terminology (CDT) 2019 American Dental Association (ADA) code updates. Clinical Coverage Policy 4A, Dental Services will be updated to reflect these changes.
Registration is open for the March 2019 instructor-led provider training courses listed below. Slots are limited. WebEx courses can be attended remotely from any location with a telephone, computer and internet connection.
On Feb. 4, 2019, the North Carolina Department of Health and Human Services announced the selection of five Prepaid Health Plans that will participate in Medicaid managed care when the program launches in November 2019.
Effective with date of service Dec. 17, 2018, the North Carolina Medicaid and NC Health Choice programs cover levoleucovorin for injection, for intravenous use (Khapzory) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
NCTracks receives files from the North Carolina Medical Board the first week of every month. Providers do not need to update their license renewals in NCTracks. The expiration date will be updated by NCTracks automatically as long as the license number on the provider's record is correct and matches the license number issued by the Board.
NC Medicaid received approval from CMS for the State Plan Amendment for Adult Optical Services. Effective Feb. 10, 2019, providers may bill for routine eye exams and visual aids for adult Medicaid beneficiaries with dates of service on or after Jan. 1, 2019.