Medicaid Bulletin

Clinical Coverage Policies

Tuesday, November 12, 2019

New or amended clinical coverage policies are available on NC Medicaid’s website.

Peer Support Services State Plan Amendment and Policy Update

Tuesday, November 5, 2019

The NC Medicaid State Plan Amendment  for Peer Support Services was approved by the Centers for Medicare & Medicaid Services on Oct. 23, 2019, with an effective date of July 1, 2019.  The clinical coverage policy will be posted with an effective date of Nov. 1, 2019. 

NC Medicaid Electronic Health Record Incentive Program

Tuesday, November 5, 2019

The NC Medicaid Electronic Health Record Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use  attestations.

Lefamulin injection, for intravenous use (Xenleta™) HCPCS code J3490 - Unclassified drugs: Billing Guidelines

Tuesday, November 5, 2019

Effective with date of service Aug. 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover lefamulin injection, for intravenous use (Xenleta) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

Community Support Team Service Update

Tuesday, November 5, 2019

The Medicaid State Plan Amendment was approved by the Centers for Medicare & Medicaid Services with an effective date of Oct. 1, 2019. The clinical coverage policy was posted on Oct. 10, 2019 for an additional 15-day public comment period. Following the 15-day public comment period, the final Community Support Team policy will be posted with an effective date of Nov. 1, 2019.

Billing Update for NC Medicaid Policy 1A-5 Child Medical Evaluation and Addition of CPT 99368

Tuesday, November 5, 2019

NC Medicaid reimburses qualified providers for child medical evaluation and medical team conference services according to guidelines set forth in NC Medicaid policy 1A-5 Child Medical Evaluation and Medical Team Conference for Child Maltreatment.

Updated ICD Diagnosis Code List

Tuesday, October 29, 2019

NC Medicaid has updated its ICD-10 diagnosis code list. Diagnosis code K35.891 (other acute appendicitis without perforation, with gangrene) has been added as an acceptable ICD-10 diagnosis code effective Oct. 1, 2018.

Clinical Coverage Policies

Tuesday, October 29, 2019

A new or amended clinical coverage policy regarding facility-based crisis management for children and adolescents is available on NC Medicaid’s website. 

NC Medicaid Deductibles and Private Duty Nursing

Tuesday, October 22, 2019

Unpaid medical bills and current medical expenses count toward NC Medicaid applicants’ deductibles. Private Duty Nursing (PDN) services qualify as a medical expense and may be used toward meeting this deductible.

Protocol for Changing Advanced Medical Home Tier Status

Tuesday, October 15, 2019

As NC Medicaid’s managed care launch date approaches, Advanced Medical Home (AMH) providers who believe they are not ready to meet program requirements to perform at the tier level to which they attested may now submit a request to change their AMH Tier status from Tier 3 to Tier 2. The AMH Tier 3 providers may not downgrade lower than AMH Tier 2.

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