Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Bulletins published prior to January 2019
Articles since January 2018 are available in the blog format below.
Influenza Vaccine and Reimbursement Guidelines for 2018-2019 for Medicaid and NC Health Choice
Influenza Vaccine and Reimbursement Guidelines for 2018-2019 for Medicaid and NC Health Choice.
Reminder: Criteria for Polycarbonate Eyeglass Lenses
Providers may request prior approval for polycarbonate lenses without medical justification or additional documentation when eligible beneficiaries meet at least one of the following criteria.
Clinical Policy 1E-7, Family Planning Services - Outpatient Sterilization
Family Planning Medicaid provides limited coverage to beneficiaries with MAFDN eligibility.
Procedures for Prior Authorization of Synagis® (palivizumab) for Respiratory Syncytial Virus Season 2018/2019
The clinical criteria used by NC Medicaid for the 2018/2019 Respiratory Syncytial Virus (RSV) season are consistent with guidance published by the American Academy of Pediatrics (AAP): 2018 – 2021 Report of the Committee on Infectious Diseases, 31th Edition.
Lutetium Lu 177 Dotatate Injection, for Intravenous Use (Lutathera®), HCPCS Code A9699: Billing Guidelines
Effective with date of service, Aug. 1, 2018, the Medicaid and NC Health Choice programs cover Lutathera for use in the Physician’s Drug Program when billed with HCPCS code A9699, Radiopharmaceutical, therapeutic, not otherwise classified.
Coverage for Psychiatric Collaborative Care Management
In response to provider requests and to allow reimbursement for behavioral health integration in primary care settings, North Carolina Medicaid is adding coverage for the following evaluation and management codes effective October 1, 2018.
Balloon Ostial Dilation (BOD) Services Billed with Modifier 50 (Bilateral)
It has come to NC Medicaid’s attention that claims for balloon sinus ostial dilation billed with modifier 50 (bilateral), were resulting in an under payment to providers. The issue has been resolved.
Advanced Medical Home Training
The North Carolina Department of Health and Human Services developed the Advanced Medical Home program as the primary vehicle for delivering local care management as the state transitions to Medicaid managed care.
North Carolina Medicaid EHR Incentive Payment System (NC-MIPS) is Open for Program Year 2018
NC-MIPS is accepting Program Year 2018 Modified Stage 2 and Stage 3 MU attestations.
Clinical Policy 1E-3, Sterilization Procedures
Sterilization claims must be submitted with ICD-10-CM diagnosis Z30.2 (encounter for sterilization) as the primary or secondary diagnosis code on the claim.
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