Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Bulletins published prior to January 2019
Articles since January 2018 are available in the blog format below.
Levoleucovorin, for intravenous use (Khapzory™) HCPCS code J3490: Billing Guidelines
Effective with date of service Dec. 17, 2018, the North Carolina Medicaid and NC Health Choice programs cover levoleucovorin for injection, for intravenous use (Khapzory) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
Updates to the NC Medicaid Electronic Health Record (EHR) Incentive Program
There are only two months left to submit an attestation for Program Year 2018. The NC Medicaid EHR Incentive Payment System (NC-MIPS) will close for Program Year 2018 at midnight on April 30, 2019. After that, no changes can be made.
Ravulizumab-cwvz injection, for intravenous use (Ultomiris™) HCPCS code J3590: Billing Guidelines
Effective with date of service Dec. 21, 2018, the North Carolina Medicaid and NC Health Choice programs cover ravulizumab-cwvz injection, for intravenous use (Ultomiris) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified Biologics.
NCTracks Provider Training Available in March 2019
Registration is open for the March 2019 instructor-led provider training courses listed below. Slots are limited. WebEx courses can be attended remotely from any location with a telephone, computer and internet connection.
Revised Effective Jan. 31, 2019: Clinical Coverage Policy 3K-1, Specialized Medical Equipment and Supplies for Adaptive Car Seat and Vehicular Transport Vest
Effective Jan. 31, 2019, NC Medicaid’s Community Alternatives Program for Children (CAP/C) approves specialized medical equipment and supplies for an adaptive car seat and a vehicular transport vest for participants in CAP/C when all qualifying conditions are met per the CAP/C Clinical Coverage Policy, 3K-1.
Proposed Clinical Policies for Public Comment
Proposed new or amended North Carolina Medicaid and NC Health Choice clinical coverage policies are posted for comment throughout the month.
Managed Care for Providers: PHP Contracts Awarded
On Feb. 4, 2019, the North Carolina Department of Health and Human Services announced the selection of five Prepaid Health Plans that will participate in Medicaid managed care when the program launches in November 2019.
New American Dental Association Procedure Codes
Effective with date of service Jan. 1, 2019, the following dental procedure codes were added for the NC Medicaid and Health Choice Dental Programs. These additions are a result of the Current Dental Terminology (CDT) 2019 American Dental Association (ADA) code updates. Clinical Coverage Policy 4A, Dental Services will be updated to reflect these changes.
Reminder about Drugs Administered by Injection or Infusion
This is a reminder that not all drugs administered by injection or infusion are covered in the Physicians Drug Program (PDP) as a part of the medical benefit. Some of these drugs are only covered in the outpatient pharmacy benefit when requested by prior authorization (PA) and dispensed by a retail or specialty pharmacy.
Credentialing Updates from the NC Medical Board
NCTracks receives files from the North Carolina Medical Board the first week of every month. Providers do not need to update their license renewals in NCTracks. The expiration date will be updated by NCTracks automatically as long as the license number on the provider's record is correct and matches the license number issued by the Board.
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