Medicaid Bulletin
Tagraxofusp-erzs injection, for intravenous use (Elzonris™) HCPCS code J9999: Billing Guidelines
Effective with date of service March 7, 2019, the North Carolina Medicaid and NC Health Choice programs cover tagraxofusp-erzs injection, for intravenous use (Elzonris) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Updates to NC Medicaid Electronic Health Record (EHR) Incentive Program
The NC Medicaid EHR Incentive Payment System (NC-MIPS) is currently accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations.
SPECIAL BULLETIN: Posting "Notice of Your Rights Under Hawkins v. Cohen"
Please post an English and Spanish version of the “Notice Of Your Rights Under Hawkins v. Cohen” in a prominent location for at least 180 calendar days. This notice contains important information regarding beneficiary rights as they pertain to improper termination of Medicaid benefits, resulting from a federal lawsuit filed in 2017 on behalf of Medicaid beneficiaries in North Carolina.
SPECIAL BULLETIN: Dental Reimbursement Rate Increase
The Division of Health Benefits (NC Medicaid) has received approval from the Centers for Medicare & Medicaid Services (CMS) to increase rates for dental services.
Caplacizumab-yhdp for injection, for intravenous or subcutaneous use (Cablivi®) HCPCS code J3590: Billing Guidelines
Effective Feb. 25, 2019, the North Carolina Medicaid and NC Health Choice programs cover caplacizumab-yhdp for injection, for intravenous or subcutaneous use (Cablivi) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
Credit Balance Audits
North Carolina’s Department of Health and Human Services, Division of Health Benefits (DHB) has contracted with Health Management Systems (HMS) to conduct Overpayment Recovery Reviews for Medicaid/Health Choice recipients.
Dexamethasone intraocular suspension 9%, for intraocular administration (Dexycu™) HCPCS code J1095 - injection, dexamethasone 9%, intraocular, 1 microgram: Billing Guidelines
Effective March 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover dexamethasone intraocular suspension 9%, for intraocular administration (Dexycu) for use in the Physician Administered Drug Program when billed with HCPCS code J1095 - Injection, dexamethasone 9%, intraocular, 1 microgram.
Coverage for Psychiatric Collaborative Care Management Reminder
Psychiatric collaborative care management services must be rendered under the direction of a treating physician or non-physician practitioner, typically in a primary care setting. These services are rendered when a beneficiary has a diagnosed psychiatric disorder and requires assessment, care planning and provision of brief interventions.
SPECIAL BULLETIN: Procedures Billable by Independent Diagnostic Testing Facilities (IDTF)
In response to provider requests and to align more closely with Medicare coverage for Independent Diagnostic Testing Facilities (IDTF), effective June 1, 2019, NC Medicaid will add coverage for additional procedure codes outlined in the attached document.
Mifepristone tablets, for oral use (Mifeprex®) HCPCS code S0190 and Misoprostol tablets, for oral use (Cytotec®) HCPCS code S0191: Billing Guidelines
The Food and Drug Administration (FDA) previously approved a Risk Evaluation and Mitigation Strategies (REMS) for Mifeprex (mifepristone) to mitigate the risk of serious adverse events. After reviewing the supplemental application, the FDA determined that a REMS is necessary to ensure the safe use of Mifeprex.
Medicaid Bulletin Monthly Digest
Medicaid Bulletin Archive (Prior to January 2018)
Articles beginning January 2018 are available in the blog format below.
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