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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

Monday, September 3, 2018

Influenza Vaccine and Reimbursement Guidelines for 2018-2019 for Medicaid and NC Health Choice.

Reminder: Criteria for Polycarbonate Eyeglass Lenses

Monday, September 3, 2018

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

Monday, September 3, 2018

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

Monday, September 3, 2018

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

Monday, September 3, 2018

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

Monday, September 3, 2018

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)

Monday, September 3, 2018

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

Monday, September 3, 2018

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

Monday, September 3, 2018

NC-MIPS is accepting Program Year 2018 Modified Stage 2 and Stage 3 MU attestations.

Clinical Policy 1E-3, Sterilization Procedures

Monday, September 3, 2018

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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