Medicaid Bulletin

In accordance with the NC State Plan, Section 4.19-B, Section 3, Page 1, North Carolina Division of Medical Assistance (DMA) will revise rates for the following laboratory procedure codes: 81220, 81221, 81222, 81223, 81228, 81229, 81243, 81244, 81331, and 81507.

Effective with date of service May 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs covers fosnetupitant and palonosetron for injection, for intravenous use (Akynzeo) for use in the Physician’s Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

Effective with date of service April 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs cover fibrinogen concentrate (human) lyophilized powder for reconstitution (Fibryga) for use in the Physician’s Drug Program when billed with HCPCS code J3590 - Unclassified biologics.

Effective May 1, 2018, North Carolina Medicaid began offering coverage of digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography using code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral).

Effective July 1, 2018, CPT Code 95012, Fractional Exhaled Nitric Oxide (FENO) measurement, is approved in the assessment of pediatric beneficiaries with suspicion of asthma and for asthma management.

System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for the following CPT codes.

The following new or amended combined North Carolina and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.

New codes and taxonomies have been added to the procedure code list for Nurse Practitioners and Physician Assistants.

Effective July 1, 2018, Cologuard (CPT code 81528) has been approved for colorectal cancer screening.

Note: This article was originally published in the June 2018 Medicaid Bulletin with a clarification that only high-risk providers must obtain fingerprints.