Medicaid Bulletin

Durable Medical Equipment (DME) is covered under NC Medicaid Managed Care for beneficiaries enrolled in a managed care plan and under NC Medicaid Direct for those beneficiaries who remain in NC Medicaid Direct.

NC Medicaid is extending COVID-19 temporary provider rate increases for all providers except hospitals through Sept. 30, 2021.

The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) to permit the emergency use of the unapproved product sotrovimab monoclonal antibody (MAB) for the treatment of certain patients.

All Carolina Access Providers who received health equity payments are asked to take 5-10 minutes to complete a survey by Friday, July 30, 2021. The survey allows DHHS to monitor and evaluate how these payments were used.

CMS has added new HCPCS codes (J Codes), deleted others and changed the description of some existing codes.

Prepaid Health Plans (PHPs) began providing non-emergency medical transportation (NEMT) and non-emergency ambulance transportation (NEAT) services for PHP members on July 1, 2021.

Providers need to submit new prior authorizations (PA) for services subject to 42 Code of Federal Regulations (CFR) Part II

Effective with date of service May 11, 2021, the Medicaid and NC Health Choice programs cover loncastuximab tesirine-lpyl for injection, for intravenous use (Zynlonta) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Effective with date of service May 17, 2021, the Medicaid and NC Health Choice programs cover dostarlimab-gxly injection, for intravenous use (Jemperli) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Update on coverage of medications used in the Physician Administered Drug Program when billed with HCPCS code 90697.