Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Bulletins published prior to January 2019

Articles since January 2018 are available in the blog format below.

Mifepristone tablets, for oral use (Mifeprex®) HCPCS code S0190 and Misoprostol tablets, for oral use (Cytotec®) HCPCS code S0191: Billing Guidelines

Wednesday, May 1, 2019

The Food and Drug Administration (FDA) previously approved a Risk Evaluation and Mitigation Strategies (REMS) for Mifeprex (mifepristone) to mitigate the risk of serious adverse events. After reviewing the supplemental application, the FDA determined that a REMS is necessary to ensure the safe use of Mifeprex.

Clinical Coverage Policy 1K-2, Bone Mass Measurement

Wednesday, May 1, 2019

Bone Mass Measurement policy has been updated to reflect the addition of anorexia nervosa as an approved diagnosis for beneficiaries with other conditions or currently receiving medical therapies known to cause low bone mass.

Billing Code Update for Nurse Practitioners and Physician Assistants

Wednesday, May 1, 2019

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

Clinical Coverage Policy Update

Wednesday, May 1, 2019

New or amended clinical coverage policies are available on Telemedicine and Telepsychiatry, Outpatient Specialized Therapies and Bone Mass Measurement 

Medicare Advantage Plan Pricing Rules

Wednesday, May 1, 2019

This communication serves as an advisory notice for all Providers. The intent is to increase awareness of the Medicare Advantage Plan. The statement below should be used to gain further clarification regarding claims denied for Medicare Part C coverage.           

CPT Transition Code Information

Wednesday, May 1, 2019

NC Medicaid has adopted the American Medical Association's new Current Procedural Terminology® (CPT) Category I codes for Research Based Behavioral Health Treatment, effective for dates of service on or after Jan. 1, 2019.

Updates to the NC Medicaid Electronic Health Record (EHR) Incentive Program

Wednesday, May 1, 2019

The NC Medicaid EHR Incentive Program is no longer accepting Program Year 2018 attestations. Program Year 2018 attestations are being processed in the order they were received. Attestations received in April may take up to eight weeks to be processed from the date the signed attestation was received. 

Recovery Audit Contractor

Wednesday, May 1, 2019

Health Management System is under contract with North Carolina Medicaid as NC Medicaid’s Recovery Audit II Contractor, pursuant to Section 6411 of the Patient Protection and Affordable Care Act of 2010.

Preadmission Screening Resident Review (PASRR) Program Update

Monday, April 1, 2019

Effective Dec. 1, 2018, the North Carolina Medicaid Uniform Screening Tool (NCMUST) application and operation of the Level 1 PASRR screen process transitioned from a NC Medicaid vendor to NC DHHS ITD and NC Medicaid.  The transition enables NC DHHS to achieve a more efficient screening process for PASRRs and provide NCDHHS with direct knowledge of issues and barriers that may impact the timely processing of PASRR Level 1 screens and Level 2 evaluations. 

Pegfilgrastim-cbqv injection, for subcutaneous use (Udenyca™) HCPCS code Q5111: Billing Guidelines

Monday, April 1, 2019

Effective with date of service Jan. 3, 2019, the North Carolina Medicaid and NC Health Choice programs cover pegfilgrastim-cbqv injection, for subcutaneous use (Udenyca) for use in the Physician Administered Drug Program when billed with HCPCS code Q5111 - Injection, pegfilgrastim-cbqv, biosimilar, (Udenyca), 0.5 mg.

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