Medicaid Bulletin

Inebilizumab-cdon Injection, for Intravenous Use (Uplizna™) HCPCS Code J3590: Billing Guidelines

Tuesday, September 22, 2020

Effective with date of service July 27, 2020, the Medicaid and NC Health Choice programs cover inebilizumab-cdon injection, for intravenous use (Uplizna™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

Community Alternatives Program Internal Independent Assessment

Tuesday, September 22, 2020

To ensure the waiver enrollment administrative processes are executed as approved in each waiver application, until the award of a contract to an external CIAE vendor, NC Medicaid will implement an internal independent assessment review process. This internal independent assessment process will begin in October 2020 with a go-live date of Oct. 19, 2020.   

Billing Code Update for Nurse Practitioners and Physician Assistants

Tuesday, September 22, 2020

North Carolina Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

SPECIAL BULLETIN COVID-19 #132: Laboratory Codes for Coronavirus (COVID-19) Testing

Monday, September 21, 2020

CMS and the American Medical Association have released a CPT code for an antigen test designed to detect proteins from the virus that causes COVID-19 in respiratory specimens. NC Medicaid is adding this CPT code to NCTracks for medically necessary laboratory testing effective Sept. 1, 2020.

Procedures for Prior Authorization of Synagis® (palivizumab) for Respiratory Syncytial Virus Season 2020/2021

Tuesday, September 15, 2020

Guidelines for Evidenced-Based Synagis® Prophylaxis, Prior Approval Requests, Dose Authorization, Pharmacy Distributor Information, Provider Information, Submitting a Request to Exceed Policy and Technical Support.

Coverage for Genetic Testing for Breast Cancer

Tuesday, September 15, 2020

Effective Sept. 1, 2020, the North Carolina Medicaid and NC Health Choice Programs will cover the following genomic tests used for breast cancer treatment as part of Clinical Coverage policy 1S-7, Gene Expression Profiling for Breast Cancer:

SPECIAL BULLETIN COVID-19 #131: Temporary Rate Increase for Federally Qualified Health Centers and Rural Health Centers

Friday, September 11, 2020

NC Medicaid is temporarily increasing financial assistance to Federally Quality Health Centers (FQHCs) and Rural Health Centers (RHCs) to maintain critical access to care for Medicaid beneficiaries during the COVID-19 public health emergency. For each FQHC and RHC, the temporary increase already in place for provider-specific Core Service (T1015) billing rate will increase by 7 percentage points and the Prospective Payment System (PPS) rate will increase by 18 percentage points.

SPECIAL BULLETIN COVID-19 #130: Reminder – Provider Relief Fund Application Deadline Sunday, Sept. 13

Friday, September 11, 2020

Medicaid/CHIP providers who have not yet submitted their applications for federal Provider Relief Fund are encouraged to apply. The deadline is Sunday, Sept. 13, 2020.

SPECIAL BULLETIN COVID-19 #129: Reporting Requirements and Financial Support to Nursing Homes under Secretarial Order No.2

Tuesday, September 8, 2020

This bulletin outlines the process by which nursing homes may access interim payments of State-administered federal funding to support compliance with Secretarial Order No.2.

NC Medicaid Electronic Health Record Incentive Program Announcements

Tuesday, September 8, 2020

NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series and The Security Risk Analysis (SRA)

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