Medicaid Bulletin

Behavioral Health Policy Update

Wednesday, September 23, 2020

Amended policies will post to the NC Medicaid Clinical Coverage Policies website with an effective date of Oct. 1, 2020. 

Tafasitamab-cxix for Injection, for Intravenous Use (Monjuvi®) HCPCS Code J9999: Billing Guidelines

Tuesday, September 22, 2020

Effective with date of service Aug. 13, 2020, the Medicaid and NC Health Choice programs cover tafasitamab-cxix for injection, for intravenous use (Monjuvi®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

SPECIAL BULLETIN COVID-19 #135: Expectation to Comply with Infection Control and Prevention Measures

Tuesday, September 22, 2020

Strong infection prevention and control practices are critical to reducing the transmission of COVID-19 within long-term care facilities. NC DHHS is reiterating its expectation that providers participate in the infection prevention and control activities. 

SPECIAL BULLETIN COVID-19 #134: Clarification of COVID-19 Temporary Rate Increases and Clinical Policy Changes

Tuesday, September 22, 2020

This bulletin replaces SPECIAL BULLETIN COVID-19 #119 in its entirety.

SPECIAL BULLETIN COVID-19 #133: COVID-19 Exposure Notification App Available

Tuesday, September 22, 2020

The North Carolina Department of Health and Human Services announced the launch of a COVID-19 Exposure Notification app called SlowCOVIDNC. The app will help North Carolinians slow the spread of the virus by alerting them when they may have been exposed to someone who has tested positive for COVID-19.

Public Comment Period for Community Alternatives Program for Children Waiver Renewal

Tuesday, September 22, 2020

To begin the preparation for the renewing of the CAP/C waiver, NC Medicaid is soliciting comments, recommendations, and suggestions in the areas of access, flexibilities of home and community-based services, and operational efficiencies. An open public comment period begins Sept. 22, 2020. 

Inebilizumab-cdon Injection, for Intravenous Use (Uplizna™) HCPCS Code J3590: Billing Guidelines

Tuesday, September 22, 2020

Effective with date of service July 27, 2020, the Medicaid and NC Health Choice programs cover inebilizumab-cdon injection, for intravenous use (Uplizna™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

Community Alternatives Program Internal Independent Assessment

Tuesday, September 22, 2020

To ensure the waiver enrollment administrative processes are executed as approved in each waiver application, until the award of a contract to an external CIAE vendor, NC Medicaid will implement an internal independent assessment review process. This internal independent assessment process will begin in October 2020 with a go-live date of Oct. 19, 2020.   

Billing Code Update for Nurse Practitioners and Physician Assistants

Tuesday, September 22, 2020

North Carolina Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

SPECIAL BULLETIN COVID-19 #132: Laboratory Codes for Coronavirus (COVID-19) Testing

Monday, September 21, 2020

CMS and the American Medical Association have released a CPT code for an antigen test designed to detect proteins from the virus that causes COVID-19 in respiratory specimens. NC Medicaid is adding this CPT code to NCTracks for medically necessary laboratory testing effective Sept. 1, 2020.

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