Medicaid Bulletin

Pegfilgrastim-apgf Injection, for Subcutaneous Use (Nyvepria™) HCPCS Code Q5122: Billing Guidelines

Tuesday, January 5, 2021

Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover pegfilgrastim-apgf injection, for subcutaneous use (Nyvepria™) for use in the Physician Administered Drug Program.

NC Medicaid Electronic Health Record Incentive Program Announcements

Tuesday, January 5, 2021

NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series, The Security Risk Analysis (SRA) and Program Year 2021 Announcements.

Interim CIAE Referral Process to Participate in Community Alternatives Programs

Tuesday, January 5, 2021

An independent review of referrals for individuals seeking to enroll in the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) waivers is intended to provide an unbiased assessment to ensure the enrollment processes are executed appropriately in each waiver application. 

Ferric Derisomaltose Injection, for Intravenous Use (Monoferric™) HCPCS Code J1437: Billing Guidelines

Tuesday, January 5, 2021

Effective with date of service Oct. 2, 2020, the Medicaid and NC Health Choice programs cover ferric derisomaltose injection, for intravenous use (Monoferric™) for use in the Physician Administered Drug Program.

CPT Code Update 2021

Tuesday, January 5, 2021

Effective with date of service Jan. 1, 2021, the American Medical Association has added new CPT codes, deleted others, and changed the descriptions of some existing codes.  

Electronic Visit Verification – Implementation Update

Thursday, December 31, 2020

January marks the go-live date for Electronic Visit Verification (EVV) Phase 1 Implementation. Beginning on January 1, 2021, all providers subject to the Federal EVV mandate should make every effort to capture visits through their chosen EVV solution. 

SPECIAL BULLETIN COVID-19 #146: Update on CARES Act-Funded Payments to Nursing Facility Providers and Availability of Extension Funding

Wednesday, December 30, 2020

This bulletin updates and extends NC Medicaid’s reimbursement for allowable COVID-19 testing of nursing facility staff and healthcare personnel. 

SPECIAL BULLETIN COVID-19 #147: Moderna COVID-19 Vaccine (N/A) HCPCS code 91301: Billing Guidelines

Tuesday, December 29, 2020

This information is only for non-long-term care providers who have the means to handle the specific storage recommendations required of the Moderna COVID-19 vaccine and will be administering it. 

Clinical Policy 1A-22, Medically Necessary Circumcision Revised

Tuesday, December 29, 2020

Clinical Coverage Policy 1A-22, Medically Necessary Circumcision, has been revised and will post with an effective date of Jan. 1, 2021 on the NC Medicaid website.

Coverage Added for Transversus Abdominis Plane Blocks

Tuesday, December 22, 2020

Effective Oct. 1, 2020, NC Medicaid will now cover services for transversus abdominis plane blocks for Medicaid and NC Health Choice beneficiaries 11 years and older.

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