Medicaid Bulletin

Effective with date of service Jan. 1, 2020, the American Medical Association (AMA) added new CPT codes, deleted others and changed the descriptions of some existing codes. 

North Carolina Medicaid’s third-party liability (TPL) contractor, Health Management System, Inc. (HMS), will implement the Commercial Insurance (CI) disallowance project to streamline North Carolina’s coordination of benefits direct billing processes. The expected implementation date is Jan.

New or amended clinical coverage policies are available on NC Medicaid's website. 

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.

We are pleased to share for comment the 

The Physicians, Nurse Practitioners and Physician Assistants fee schedules have been revised to include the Evaluation and Management fee schedules. 

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.

The NC Medicaid EHR Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use attestations.

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.

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.