Medicaid Bulletin

Viltolarsen Injection, for Intravenous Use (Viltepso™) HCPCS Code J3490: Billing Guidelines

Tuesday, October 13, 2020

Effective with date of service Aug. 20, 2020, the Medicaid and NC Health Choice programs cover viltolarsen injection, for intravenous use (Viltepso™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

Satralizumab-mwge Injection, for Subcutaneous Use (Enspryng™) HCPCS Code J3590: Billing Guidelines

Tuesday, October 13, 2020

Effective with date of service Aug. 24, 2020, the NC Medicaid and NC Health Choice programs cover satralizumab-mwge injection, for subcutaneous use (Enspryng™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

Infliximab-axxq for Injection, for Intravenous use (Avsola™) HCPCS code Q5121: Billing Guidelines

Tuesday, October 13, 2020

Effective with date of service Sept. 11, 2020, the Medicaid and NC Health Choice programs cover infliximab-axxq for injection, for intravenous use (Avsola) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5121 - Injection, infliximab-axxq, biosimilar, (avsola), 10 mg.

Belantamab Mafodotin-blmf for injection, for Intravenous use (Blenrep™) HCPCS Code J9999: Billing Guidelines

Tuesday, October 13, 2020

Effective with date of service Aug. 6, 2020, the Medicaid and NC Health Choice programs cover belantamab mafodotin-blmf for injection, for intravenous use (Blenrep™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

SPECIAL BULLETIN COVID-19 #138: New Opportunity for Providers Applying for Federal Relief Funds and Additional Guidance

Thursday, October 8, 2020

The US Department of Health and Human Services announced an additional funding opportunity for Medicaid/CHIP providers to apply for federal Provider Relief Funds. The application period runs through Nov. 6, 2020.

NC Medicaid Electronic Health Record Incentive Program Announcements

Tuesday, October 6, 2020

NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series, The Security Risk Analysis (SRA) and Program Year 2021 Announcements.

Clinical Coverage Policies

Tuesday, October 6, 2020

The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.

SPECIAL BULLETIN COVID-19 #137: Reimbursement for COVID-19 Related Primary Care Services for Uninsured NC Residents – Steps to Prepare

Friday, October 2, 2020

North Carolina Department of Health and Human Services (DHHS) developed a program to reimburse primary care providers (PCP) with federal funds for providing medical care for COVID-19 related services to uninsured North Carolina residents. 

DHHS Awards Contract for Electronic Visit Verification

Friday, October 2, 2020

NC DHHS awarded a contract to Sandata Technologies, LLC on Sept. 24, 2020, and will implement services for Electronic Visit Verification (EVV) statewide on Jan. 1, 2021. EVV is a method used to verify visit activity for services delivered as part of home- and community-based service programs. EVV offers a measure of accountability to help ensure that individuals who are authorized to receive services in fact receive them.

Updated Breast and Cervical Cancer Control Program Criteria

Tuesday, September 29, 2020

North Carolina’s Breast and Cervical Cancer Control Program has changed the criteria to allow additional providers who screen and diagnose women for breast and cervical cancer to refer to Breast and Cervical Cancer Medicaid.

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