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Medicaid Bulletin

Trastuzumab and hyaluronidase-oysk injection, for subcutaneous use (Herceptin Hylecta™) HCPCS code J9999: Billing Guidelines

Monday, July 1, 2019

Effective with date of service April 5, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab and hyaluronidase-oysk injection, for subcutaneous use (Herceptin Hylecta) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Clinical Coverage Policy Update

Monday, July 1, 2019

New or amended clinical coerage policies are available on NC Medicaid's website.

Updates to Clinical Coverage Policy 10B: Independent Practitioners

Monday, July 1, 2019

On June 1, 2019, an amended version of Clinical Coverage Policy 10B, Independent Practitioners, was posted to the North Carolina Medicaid website. The following updates were made in accordance with State Plan Amendment (SPA) NC 18-0005 which allowed an expansion of the universe of documentation that a Local Education Agency (LEA) can use as a basis for providing school-based health services from beyond a student beneficiary’s Individualized Education Program (IEP) to also include the Individual Family Service Plan (IFSP), Individual Health Plan (IHP), Behavior Intervention Plan (BIP) or 504 Plan.

NCTracks Provider Training Available in July

Monday, July 1, 2019

Registration is open for the July 2019 instructor-led provider training courses. Slots are limited.

Reminders on Hospice Policy

Monday, July 1, 2019

Clinical review is not required for North Carolina Medicaid and NC Health Choice hospice services until after the completion of the first and second 90-day benefit period.   

North Carolina Medicaid and NC Health Choice Preferred Drug List (PDL) Changes

Monday, July 1, 2019

Effective July 1, 2019, NC Medicaid will make changes to the North Carolina Medicaid and NC Health Choice Preferred Drug List.

Hospice Payment Reform Update

Monday, July 1, 2019

Due to the implementation of Centers for Medicare and Medicaid Services (CMS) FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Final Rule, NC Medicaid made policy and system changes to allow for the use of two-tier hospice fee schedules effective Jan. 1, 2016.

Coagulation factor Xa (recombinant), inactivated-zhzo lyophilized powder for solution for intravenous injection (Andexxa®) HCPCS code J3590: Billing Guidelines

Monday, July 1, 2019

Effective with date of service April 4, 2019, the North Carolina Medicaid and NC Health Choice programs cover coagulation factor Xa (recombinant), inactivated-zhzo lyophilized powder for solution for intravenous injection (Andexxa) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.

SPECIAL BULLETIN: Rate Increase on E&M Procedure Codes

Friday, June 28, 2019

NC Medicaid has received approval from the Centers for Medicare and Medicaid Services (CMS) to increase rates for Evaluation and Management (E&M) procedure codes, as defined in Section 1202 of the Affordable Care Act (ACA) and paid to primary care physicians, nurse practitioners and physician assistants. In addition to the ACA primary care practitioners, obstetricians and gynecologists will also be included as primary care physicians.

SPECIAL BULLETIN: Approved PHP Provider Contracts as of June 21, 2019

Monday, June 24, 2019

The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.

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