Medicaid Bulletin

Trastuzumab-pkrb for Injection, for Intravenous Use (Herzuma®) HCPCS Code Q5113: Billing Guidelines

Tuesday, May 19, 2020

Effective with date of service March 16, 2020, the Medicaid and NC Health Choice programs cover trastuzumab-pkrb for injection, for intravenous use (Herzuma®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5113 - Injection, trastuzumab-pkrb, biosimilar, (Herzuma®), 10 mg.

Peanut (Arachis hypogaea) Allergen Powder-dnfp Powder for Oral Administration (Palforzia™) HCPCS Code J3590: Billing Guidelines

Tuesday, May 19, 2020

Effective with date of service April 2, 2020, the Medicaid and NC Health Choice programs cover peanut (Arachis hypogaea) allergen powder-dnfp powder for oral administration (Palforzia™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

Isatuximab-irfc Injection, for Intravenous Use (Sarclisa®) HCPCS Code J9999: Billing Guidelines

Tuesday, May 19, 2020

Effective with date of service March 19, 2020, the Medicaid and NC Health Choice programs cover isatuximab-irfc injection for intravenous use (Sarclisa®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Eptinezumab-jjmr Injection, for Intravenous Use (Vyepti™) HCPCS Code J3590: Billing Guidelines

Tuesday, May 19, 2020

Effective with date of service April 6, 2020, the NC Medicaid and NC Health Choice programs cover eptinezumab-jjmr injection, for intravenous use (Vyepti™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

SPECIAL BULLETIN COVID-19 #89: Prescription Fluoride Available to Beneficiaries

Monday, May 18, 2020

In response to CDC recommendation regarding non-aerosolizing dental treatment during COVID-19, NC Medicaid is reminding dentists of the prescription fluoride products for patients at high-risk for caries.

Immune Globulin Subcutaneous, Human – klhw 20% Solution (Xembify®) HCPCS code J3590: Billing Guidelines

Tuesday, May 12, 2020

Effective with date of service Oct. 4, 2019, the Medicaid and NC Health Choice programs cover immune globulin subcutaneous, human – klhw 20% solution (Xembify®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.
 

Community Alternatives Program for Children Amended Waiver Application Approved

Tuesday, May 12, 2020

The Community Alternatives Program for Children (CAP) §1915( c) Home and Community-Based Services (HCBS) waiver application has been amended and approved by the Centers for Medicare and Medicaid Service (CMS), effective May 1, 2020. 

SPECIAL BULLETIN COVID-19 #88: Additional Temporary Rate Increases for Skilled Nursing Facilities, LTSS Personal Care Service Providers and Home Health Providers to support Strengthening Infection Prevention Activities

Monday, May 11, 2020

NC Medicaid continues provide support to Skilled Nursing Facilities (SNF) and Personal Care Services (PCS) and Home Health (HH) providers to strengthen their infection prevention and management activities as they serve beneficiaries at high risk of contracting COVID-19. 

SPECIAL BULLETIN COVID-19 #87: Additional Dental Clinical Coverage Policy Provisions

Monday, May 11, 2020

NC Medicaid is implementing temporary clinical policy revisions that will allow dentists to provide additional services to Medicaid and NC Health Choice beneficiaries. These temporary policy changes were applied in the NCTracks system with a retroactive effective date of March 10, 2020. 

SPECIAL BULLETIN COVID-19 #86: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Family Planning Services for MAFDN Beneficiaries

Monday, May 11, 2020

NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to enable eligible providers to deliver family planning services to NC Medicaid Be Smart Family Planning Medicaid program (MAFDN) eligible beneficiaries via telemedicine or virtual patient communication (telephone call, only) in light of social distancing measures that may prevent in-person visits. 

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