Medicaid Bulletin

Effective with date of service Oct. 29, 2018, NC Medicaid covers Azedra for use in the Physician’s Administered Drug Program when billed with HCPCS code A9699, Radiopharmaceutical, therapeutic, not otherwise classified (therapeutic use) or A4641, Radiopharmaceutical, diagnostic, not otherwise classified (dosimetric use). 

NC Medicaid has received calls concerning the ICD 10 diagnoses codes for acute appendicitis.

NC Medicaid has provided instructions to NCTracks on updating the diagnoses code list for acute appendicitis.

Effective with date of service 3/8/2019, the North Carolina Medicaid and NC Health Choice programs cover esketamine nasal spray (Spravato™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

In response to provider requests, NC Medicaid has added coverage for central motor evoked potential.

In response to provider requests, NC Medicaid has added coverage for central motor evoked potential.

List of applicable co-payments for adult Medicaid beneficiaries (21 years of age and older)

A new or amended policy on Outpatient Specialized Therapies - Local Education Agencies

To align with children’s health quality measure reporting, NC Medicaid has added diagnosis code Z71.82 (Exercise Counseling) to NCTracks as an acceptable secondary diagnosis effective Oct. 1, 2017.

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

One of the goals of a transformed health care system is for near real-time clinical and demographic data to be made available to all health care providers involved in a patient’s care so that they can securely share health information concerning that patient with each other.

North Carolina’s state-designated health information exchange, NC HealthConnex, was created in 2015 by the North Carolina General Assembly to help bridge the gap between disparate systems and health care networks to support whole patient care.