Medicaid Bulletin
Clinical Coverage Policies
The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website: 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA) – March 1, 2020
SPECIAL BULLETIN COVID-19 #44: Pharmacy Claims Flexibility Available to Prevent Spread of Coronavirus Disease (COVID-19)
Given the presence of the COVID-19 virus in North Carolina, point of sale pharmacy claims processing flexibility has been instituted to help reduce the administrative burden of providing appropriate medications in a timely fashion to NC Medicaid and NC Health Choice beneficiaries.
SPECIAL BULLETIN COVID-19 #40: Reduction of In-Person Visits for Specific Optical and Hearing Aid Services
NC Medicaid has temporarily modified the delivery of specific optical and hearing aid services to reduce in-person visits for Medicaid and NC Health Choice beneficiaries due to the state of emergency related to COVID-19.
SPECIAL BULLETIN COVID-19 #41: Telehealth Clinical Policy Modifications – Optometry Services
Eligible Providers and Services - Optometrists may now bill for the following services when delivered remotely:
SPECIAL BULLETIN COVID-19 #42: Telehealth Clinical Policy Modifications – Postpartum Care
SPECIAL BULLETIN COVID-19 #42: Telehealth Clinical Policy Modifications – Postpartum Care.has been replaced by SPECIAL BULLETIN COVID-19 #49: Telehealth Clinical Policy Modifications – Interim Perinatal Care Guidance.
SPECIAL BULLETIN COVID-19 #43: Telehealth Clinical Policy Modifications – Self-Measured Blood Pressure Monitoring
NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid beneficiaries.
SPECIAL BULLETIN COVID-19 #37: Patient Information and Support Line Available
DHHS and Community Care of North Carolina (CCNC) have launched a toll-free Patient Information and Support Line aimed at helping health care providers answer their patients' questions related to COVID-19.
SPECIAL BULLETIN COVID-19 #38; Private Duty Nursing Clinical Policy Modification – Prior Approval Status Due to Refusal of PDN Services
Current Policy: Private Duty Nursing (PDN) Clinical Coverage Policy 3G-1. Private Duty Nursing for Beneficiaries Age 21 and older and Private Duty Nursing (PDN) Clinical Coverage Policy 3G-2 Private Duty Nursing for Beneficiaries Age Under 21 years of age section 5.2.4.1:
SPECIAL BULLETIN COVID-19 #39: Face-to-Face Provider Site Visits and Fingerprinting Requirements for NC Medicaid Provider Enrollment Temporarily Suspended
Note: SPECIAL BULLETIN COVID-19 #39 replaces SPECIAL BULLETIN COVID-19 #8: Face-to-Face Provider Site Visits and Fingerprinting Requirements Temporarily Suspended Due to COVID-19 Outbreak. Changes to the prior Bulletin are:
Antihemophilic Factor (Recombinant), Glycopegylated-Exei Lyophilized Powder for Solution, for Intravenous Use (Esperoct®) HCPCS Code J7199: Billing Guidelines
Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant), glycopegylated-exei lyophilized powder for solution, for intravenous use (Esperoct®) for use in the Physician Administered Drug Program when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
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