Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Bulletins published prior to January 2019
Articles since January 2018 are available in the blog format below.
Allergy Immunotherapy 1N-2
Clinical Coverage Policy 1N-2, Allergy Immunotherapy has been revised effective Jan. 1, 2019, to reflect changes in unit dosing.
Risperidone for extended-release injectable suspension, for subcutaneous use (Perseris™) HCPCS code J3490: Billing Guidelines
Effective with date of service Nov. 19, 2018, the NC Medicaid and Health Choice programs cover risperidone for extended-release injectable suspension, for subcutaneous use (Perseris™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
CPT Code Update 2019
Effective with date of service Jan. 1, 2019, the American Medical Association has added new CPT codes, deleted others and changed descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2019 edition of Current Procedural Terminology, published by the AMA.
Clinical Coverage Policies
The following new or amended clinical coverage policies are available on NC Medicaid’s clinical coverage policies web page:
Elapegademase-lvlr injection, for intramuscular use (Revcovi™) HCPCS code J3590: Billing Guidelines
Effective with date of service Nov. 28, 2018, the NC Medicaid and Health Choice programs cover elapegademase-lvlr injection, for intramuscular use (Revcovi™) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Crotalidae Immune f(ab’)2 (equine), lyophilized powder for solution for injection for intravenous use (Anavip®) HCPCS code J3590: Billing Guidelines
Effective with date of service Nov. 2, 2018, the NC Medicaid and Health Choice programs cover crotalidae immune f(ab’)2 (equine), lyophilized powder for solution for injection for intravenous use (Anavip®) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Prior Approval Reminders
As a reminder, providers are to request and obtain proper prior authorization before services are scheduled or rendered. Contractually, GDIT has five business days (excluding holidays and weekends) to process a medical PA request once all required information is obtained. Pharmacy PAs are processed within 24 hours. Medical necessity cannot be determined with a partial or incomplete clinical picture.
Elapegademase-lvlr injection, for intramuscular use (Revcovi™) HCPCS code J3590: Billing Guidelines
Effective with date of service Oct. 22, 2018, the NC Medicaid and Health Choice programs cover eravacycline for injection, for intravenous use (Xerava) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified Drugs. Xerava is available as a 50 mg single-dose vial.
Moxetumomab Pasudotox-tdfk for Injection, for intravenous use (Lumoxiti™) HCPCS code J9999: Billing Guidelines
Effective with date of service Oct. 22, 2018, the NC Medicaid and Health Choice programs cover moxetumomab pasudotox-tdfk for injection, for intravenous use (Lumoxiti™) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, antineoplastic drugs.
Updates to the NC Medicaid Electronic Health Record (EHR) Incentive Program
There are only four months left to submit an attestation for Program Year 2018. Attestations submitted after Feb. 28, 2019 are not guaranteed to be reviewed by program staff prior to close of Program Year 2018. Providers have until April 30, 2019 to submit a complete and accurate attestation for Program Year 2018. After that no changes can be made.
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