Medicaid Bulletin

SPECIAL BULLETIN COVID-19 #2: General Guidance and Policy Modifications

Friday, March 13, 2020

NC Medicaid is committed to ensuring our beneficiaries continue to receive Medicaid and NC Health Choice services with no interruptions or delays due to the novel coronavirus (COVID-19) outbreak. This includes making it easier for health care providers to deliver Medicaid services by temporarily modifying certain policy conditions and expanding coverage to include additional forms of clinical service.

Timely Submission of PDN Prior Authorization Request for Additional Information

Tuesday, March 10, 2020

Effective March 1, 2020, Medicaid will begin issuing letters to PDN agencies addressing non-compliance with the timely submission of required documentation as indicated in the Request for Additional Information notice. 

SPECIAL BULLETIN COVID-19 #1: NC Medicaid Provider Webcast: Medicaid Policies and Codes Related to COVID-19

Tuesday, March 10, 2020

NC Medicaid is committed to ensuring our beneficiaries continue to receive Medicaid and NC Health Choice services with no interruptions or delays due to the novel coronavirus (COVID-19) outbreak. A webcast has been scheduled to discuss temporary modifications to certain policies and provide related billing codes. 

Fam-trastuzumab deruxtecan-nxki for Injection, for Intravenous Use (Enhertu®) HCPCS Code J9999: Billing Guidelines

Tuesday, March 10, 2020

Effective with date of service Jan. 6, 2020, Medicaid and NC Health Choice programs cover fam-trastuzumab deruxtecan-nxki for injection, for intravenous use (Enhertu) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Enfortumab vedotin-ejfv for Injection, for Intravenous Use (Padcev™) HCPCS Code J9999: Billing Guidelines

Tuesday, March 10, 2020

Effective with date of service Dec. 31, 2019, the Medicaid and NC Health Choice programs cover enfortumab vedotin-ejfv for injection, for intravenous use (Padcev) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Behavioral Health Crisis System Memo for Standard Plans

Friday, March 6, 2020

The department is releasing a Behavioral Health Crisis System Memo for Standard Plans

NC Medicaid Electronic Health Record Incentive Program Announcements

Tuesday, March 3, 2020

NC-MIPS is Open for Program Year 2019; The Security Risk Analysis (SRA); Reminder from CMS Regarding Objective 6 and Objective 7; Clarification from CMS Regarding Objective 5 Measure 1: Patient Electronic Access and General Reminders.

CPT Code Update: 2020

Tuesday, February 25, 2020

Effective with date of service Jan. 1, 2020, the Centers for Medicare & Medicaid Services (CMS) has identified some new CPT and HCPCS codes for reimbursement in ambulatory surgery.

Reminder Regarding the Naloxone Standing Order

Tuesday, February 18, 2020

The North Carolina State Health Director’s Standing Order for Naloxone authorizes any pharmacist practicing in the state of North Carolina and licensed by the North Carolina Board of Pharmacy to dispense naloxone to any person who meets the set criteria. 

Billing Code Update for Nurse Practitioners and Physician Assistants

Tuesday, February 18, 2020

NC Medicaid has provided instructions to NCTracks on updating the claims processing system. The following procedure code list has been updated recently to include additional NP and PA taxonomies. 
 

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