Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Bulletins published prior to January 2019
Articles since January 2018 are available in the blog format below.
Fibrinogen Concentrate (Human) Lyophilized Powder for Reconstitution (Fibryga) HCPCS Code J3590: Billing Guidelines
Effective with date of service April 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs cover fibrinogen concentrate (human) lyophilized powder for reconstitution (Fibryga) for use in the Physician’s Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Reprocessing of Medicare Part B Crossover Claims Due to System Error
North Carolina Medicaid will reprocess Medicare Part B Crossover Professional and Outpatient claims submitted to Medicare from Jan. 2, 2017, to Jan. 5, 2017.
Prior Approval Reminders
As a reminder, providers are to request and obtain proper PA before services are scheduled or rendered. Contractually, CSRA (Medicaid’s fiscal vendor) has five business days (excluding holidays and weekends) to process a PA request once all required information is obtained.
Mometasone Furoate Sinus Implant (Sinuva) HCPCS Code J3490: Billing Guidelines
Effective with date of service March 8, 2018, the North Carolina Medicaid and N.C. Health Choice (NCHC) programs cover mometasone furoate sinus implant (Sinuva) for use in the Physician's Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.
Clinical Coverage Policies
The following new or amended combined North Carolina and NC Health Choice clinical coverage policies are available on Medicaid’s Clinical Coverage Policy web pages.
Clinical Coverage Policy 1-H, Telemedicine and Telepsychiatry
System changes have been completed to allow non-psychiatric Nurse Practitioners and Physician Assistants to receive reimbursement for the following CPT codes.
Nusinersen injection, for intrathecal use (Spinraza) HCPCS code J2326 - Unclassified Drugs: Billing Guidelines and Change in Coverage
Effective July 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs will cover nusinersen injection, for intrathecal use (Spinraza) for use only in the Physician's Drug Program.
Billing Code Update for Nurse Practitioners and Physician Assistants (July 2018)
New codes and taxonomies have been added to the procedure code list for Nurse Practitioners and Physician Assistants.
Coverage for Digital Breast Tomosynthesis Update
Effective May 1, 2018, North Carolina Medicaid began offering coverage of digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography using code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral).
Fosnetupitant and palonosetron for injection, for intravenous use (Akynzeo) HCPCS code J3490: Billing Guidelines
Effective with date of service May 1, 2018, the North Carolina Medicaid and N.C. Health Choice programs covers fosnetupitant and palonosetron for injection, for intravenous use (Akynzeo) for use in the Physician’s Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
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