Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Bulletins published prior to January 2019
Articles since January 2018 are available in the blog format below.
Update to Clinical Policy 1E-7, Family Planning Services
Clinical Policy 1E-7, Family Planning Services, has been revised effective Jan. 1, 2019.
Filgrastim-aafi injection, for subcutaneous or intravenous use (Nivestym™) HCPCS code Q5110: Billing Guidelines
Effective with date of service Oct 3, 2018, the NC Medicaid and Health Choice programs cover filgrastim-aafi injection, for subcutaneous or intravenous use (Nivestym) for use in the Physician Administered Drug Program when billed with HCPCS code Q5110 - Injection, Filgrastim-aafi, Biosimilar, (Nivestym), 1 microgram. Nivestym is available in a single-dose prefilled syringe containing either 300 mcg/0.5 mL or 480 mcg/0.8 mL.
NCTracks Provider Training Available in January 2019
Registration is open for the January 2019 instructor-led provider training courses listed below. Slots are limited. WebEx courses can be attended remotely from any location with a telephone, computer and internet connection. Please note that the WebEx information has changed.
Immune globulin intravenous, human - ifas (Panzyga®) HCPCS code J1599: Billing Guidelines
Effective with date of service Oct. 16, 2018, the NC Medicaid and Health Choice programs cover immune globulin intravenous, human - ifas (Panzyga®) for use in the Physician Administered Drug Program when billed with HCPCS code J1599 - Injection, Immune Globulin, Intravenous, Non-lyophilized (e.g. liquid), Not Otherwise Specified, 500 mg.
Special Bulletin: Review of Durable Medical Equipment Rates
NC Medicaid has been reviewing the Medicaid Durable Medical Equipment rates to comply with the new Centers for Medicare and Medicaid Upper Payment Limit requirements. While further review is needed, NC Medicaid wanted to publish this bulletin to provide a status update.
Special Bulletin: Optical Services Covered for Adult Medicaid Beneficiaries Effective Jan. 1, 2019
Effective Jan. 1, 2019, optical services shall be covered for adult Medicaid beneficiaries in accordance with S. L. 2018-97, Part III, Section 11H.13.(c). However, Centers for Medicare and Medicaid Services (CMS) approval of the corresponding State Plan Amendment is pending.
The Affiliation Edit: What It Is and How to Prevent It
This edit is in place to ensure billing providers are affiliated with the rendering (individual) providers for whom they are billing to prevent inaccurate payment or fraud.
Cemiplimab-rwlc Injection, for Intravenous Use (Libtayo®) HCPCS Code J9999: Billing Guidelines
Effective with date of service Oct. 8, 2018, North Carolina Medicaid and NC Health Choice programs cover cemiplimab-rwlc injection, for intravenous use (Libtayo) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs.
Errors on Provider Records in NCTracks
Enrollment applications submitted with incorrect data including name, social security number and date of birth result in application denials and withdrawals. As a result, providers must submit new applications and pay any applicable fees.
Proposed Clinical Coverage Policies for Public Comment
As of Dec. 1, 2018, there are no NC Medicaid policies posted for public comment.
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