Medicaid Bulletin
Clinical Coverage Policies
New or amended clinical coverage policies are available on NC Medicaid’s website.
Peer Support Services State Plan Amendment and Policy Update
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
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
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
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
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
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
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
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
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.
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Share this page: