Medicaid Bulletin

Federal Enrollment Application Fee Increase for Year 2020

Monday, January 13, 2020

Section 6401(a) of the Affordable Care Act requires the Secretary to impose a fee on each "institutional provider of medical or other items or services and suppliers." Based upon provisions of the ACA, this fee will vary from year to year based on adjustments made pursuant to the Consumer Price Index for Urban Areas.

Clinical Coverage Policy Update

Monday, January 13, 2020

The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page.

Clinical Coverage Policies

Monday, January 13, 2020

The following new or amended clinical coverage policies are available on the NC Medicaid Clinical Coverage Policies web page. 

Updated ICD Diagnosis Code List

Tuesday, December 17, 2019

NC Medicaid has updated its ICD-10 diagnosis code list.

Trastuzumab-dkst for injection, for intravenous use (Ogivri™) HCPCS code Q5114: Billing Guidelines

Tuesday, December 17, 2019

Effective with date of service Nov. 7, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab-dkst for injection, for intravenous use (Ogivri) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5114 - Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg.

Rituximab-abbs injection, for intravenous use (Truxima®) HCPCS code Q5115: Billing Guidelines

Tuesday, December 17, 2019

Effective with date of service Nov. 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover rituximab-abbs injection, for intravenous use (Truxima) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5115 - Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg.

CPT Code Update: 2020

Tuesday, December 17, 2019

Effective with date of service Jan. 1, 2020, the American Medical Association (AMA) added new CPT codes, deleted others and changed the descriptions of some existing codes. 

Commercial Insurance Disallowance

Tuesday, December 17, 2019

North Carolina Medicaid’s third-party liability (TPL) contractor, Health Management System, Inc. (HMS), will implement the Commercial Insurance (CI) disallowance project to streamline North Carolina’s coordination of benefits direct billing processes. The expected implementation date is Jan.

Clinical Coverage Policies

Tuesday, December 17, 2019

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

Brolucizumab-dbll injection, for intravitreal injection (Beovu®) HCPCS code J3590: Billing Guidelines

Tuesday, December 17, 2019

Effective with date of service Oct. 10, 2019, the North Carolina Medicaid and NC Health Choice programs cover brolucizumab-dbll injection, for intravitreal injection (Beovu) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

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