Medicaid Bulletin
Clinical Coverage Policies
New or amended clinical coverage policies are available on NC Medicaid's website.
Brolucizumab-dbll injection, for intravitreal injection (Beovu®) HCPCS code J3590: Billing Guidelines
Effective with date of service Oct. 10, 2019, the North Carolina Medicaid and NC Health Choice programs cover brolucizumab-dbll injection, for intravitreal injection (Beovu) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
Updated ICD Diagnosis Code List
NC Medicaid has updated its ICD-10 diagnosis code list.
New Coverage, Prior Approval and Billing Requirement for CAR-T Cell Therapy (KYMRIAH & YESCARTA)
A Clinical Coverage Policy has been developed to add coverage for Chimeric Antigen Receptor (CAR) T-Cell Therapies KYMRIAH and YESCARTA. This policy will become effective Dec. 1, 2019.
NC Medicaid Electronic Health Record (EHR) Incentive Program Announcements
The NC Medicaid EHR Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use attestations.
Relocation of Evaluation and Management (E&M) Fee Schedules Effective Nov. 8, 2019
The Physicians, Nurse Practitioners and Physician Assistants fee schedules have been revised to include the Evaluation and Management fee schedules.
Clarification from CMS Regarding Objective 5, Measure 1: Patient Electronic Access
The Centers for Medicare and Medicaid Services (CMS) has recently provided clarification outside of the specification sheet for their intent of Stage 3 Meaningful Use’s Objective 5, Measure 1.
SPECIAL BULLETIN: DHHS Suspends Implementation of Managed Care
While this year’s legislative session was one of the longest in recent memory, it ended without needed action required for managed care to move forward. The General Assembly adjourned last week without providing required new spending and program authority for the transition to managed care. Therefore, the Department of Health and Human Services will be suspending managed care implementation and open enrollment. Managed care will not go live on February 1, 2020.
Medicaid Application Revisions Necessary to Comply with New CMS Rule on Affiliations
To comply with a final rule issued by the Centers for Medicare and Medicaid Services (CMS), which requires additional disclosures by enrolling providers, revisions to the NC Medicaid Provider Enrollment Application are underway. This final rule, effective Nov. 4, 2019, implements statutory provisions that require providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers.
SPECIAL BULLETIN: Medicaid Bulletin Holiday Posting Schedule
In preparation for the upcoming holidays, please be aware of the change to the schedule for posting of Medicaid Bulletin articles.
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
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