Medicaid Bulletin

Clinical Coverage Policies

Tuesday, November 12, 2019

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

Updated ICD Diagnosis Code List

Tuesday, November 12, 2019

NC Medicaid has updated its ICD-10 diagnosis code list.

Enrollment for CAP/DA Direct Service Informational Webinar

Tuesday, November 12, 2019

The Community Alternatives Program for Disabled Adults (CAP/DA) unit within NC Medicaid will host an informational webinar on how to become a CAP/DA-qualified direct service provider. Becoming qualified will enable providers to render one or more of the CAP/DA services listed below* or other approved Medicaid services for a CAP/DA beneficiary.

Billing Update for NC Medicaid Policy 1A-5 Child Medical Evaluation and Addition of CPT 99368

Tuesday, November 5, 2019

NC Medicaid reimburses qualified providers for child medical evaluation and medical team conference services according to guidelines set forth in NC Medicaid policy 1A-5 Child Medical Evaluation and Medical Team Conference for Child Maltreatment.

Lefamulin injection, for intravenous use (Xenleta™) HCPCS code J3490 - Unclassified drugs: Billing Guidelines

Tuesday, November 5, 2019

Effective with date of service Aug. 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover lefamulin injection, for intravenous use (Xenleta) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

NC Medicaid Electronic Health Record Incentive Program

Tuesday, November 5, 2019

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

Community Support Team Service Update

Tuesday, November 5, 2019

The Medicaid State Plan Amendment was approved by the Centers for Medicare & Medicaid Services with an effective date of Oct. 1, 2019. The clinical coverage policy was posted on Oct. 10, 2019 for an additional 15-day public comment period. Following the 15-day public comment period, the final Community Support Team policy will be posted with an effective date of Nov. 1, 2019.

Peer Support Services State Plan Amendment and Policy Update

Tuesday, November 5, 2019

The NC Medicaid State Plan Amendment  for Peer Support Services was approved by the Centers for Medicare & Medicaid Services on Oct. 23, 2019, with an effective date of July 1, 2019.  The clinical coverage policy will be posted with an effective date of Nov. 1, 2019. 

Clinical Coverage Policies

Tuesday, October 29, 2019

A new or amended clinical coverage policy regarding facility-based crisis management for children and adolescents is available on NC Medicaid’s website. 

Updated ICD Diagnosis Code List

Tuesday, October 29, 2019

NC Medicaid has updated its ICD-10 diagnosis code list. Diagnosis code K35.891 (other acute appendicitis without perforation, with gangrene) has been added as an acceptable ICD-10 diagnosis code effective Oct. 1, 2018.

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