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Medicaid Bulletin

Clinical Coverage Policy (CCP) 1A-39 Routine Costs in Clinical Trial Services for Life Threatening Conditions

Monday, June 3, 2019

To align with children’s health quality measure reporting, NC Medicaid has added diagnosis code Z71.82 (Exercise Counseling) to NCTracks as an acceptable secondary diagnosis effective Oct. 1, 2017.

Rutherford County Transition Effective July 2019

Monday, June 3, 2019

The Secretary of the N.C. Department of Health and Human Services (DHHS) has approved the disengagement of Rutherford County from the VAYA Health Local Management Entity-Managed Care Organization (LME-MCO) and their alignment with Partners Behavioral Health Management LME-MCO.

Billing Code Update for Physician Assistants and Nurse Practitioners

Monday, June 3, 2019

NC Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

Diagnosis Code Z71.82 (Exercise Counseling) Added to NCTracks

Monday, June 3, 2019

In response to provider requests, NC Medicaid has added coverage for central motor evoked potential.

Updates to Clinical Coverage Policy 10C: Outpatient Specialized Therapies, Local Education Agencies

Monday, June 3, 2019

On May 15, 2019, an amended version of Clinical Coverage Policy 10C, Outpatient Specialized Therapies, Local Education Agencies (LEAs), was posted to the North Carolina Medicaid website. The following updates were made in accordance with State Plan Amendment (SPA) NC 18-0005.

Iobenguane I 131 injection, for intravenous use (Azedra®), HCPCS Code A9699 and A4641: Billing Guidelines

Monday, June 3, 2019

Effective with date of service Oct. 29, 2018, NC Medicaid covers Azedra for use in the Physician’s Administered Drug Program when billed with HCPCS code A9699, Radiopharmaceutical, therapeutic, not otherwise classified (therapeutic use) or A4641, Radiopharmaceutical, diagnostic, not otherwise classified (dosimetric use). 

Coverage for Central Motor Evoked Potential

Monday, June 3, 2019

In response to provider requests, NC Medicaid has added coverage for central motor evoked potential.

Co-payments for Adult Optical Services

Monday, June 3, 2019

List of applicable co-payments for adult Medicaid beneficiaries (21 years of age and older)

Clinical Policy Update

Monday, June 3, 2019

A new or amended policy on Outpatient Specialized Therapies - Local Education Agencies

Provision of Services for Routine Eye Exams and Visual Aids

Monday, June 3, 2019

Provision of eye examination and visual aids for beneficiaries under 21 years of age as well as beneficiaries over 21 years of age.

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