Medicaid Bulletin

Clinical Coverage Policies

Tuesday, April 14, 2020

The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website: 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA) – March 1, 2020   

SPECIAL BULLETIN COVID-19 #44: Pharmacy Claims Flexibility Available to Prevent Spread of Coronavirus Disease (COVID-19)

Tuesday, April 14, 2020

Given the presence of the COVID-19 virus in North Carolina, point of sale pharmacy claims processing flexibility has been instituted to help reduce the administrative burden of providing appropriate medications in a timely fashion to NC Medicaid and NC Health Choice beneficiaries. 

SPECIAL BULLETIN COVID-19 #40: Reduction of In-Person Visits for Specific Optical and Hearing Aid Services

Thursday, April 9, 2020

NC Medicaid has temporarily modified the delivery of specific optical and hearing aid services to reduce in-person visits for Medicaid and NC Health Choice beneficiaries due to the state of emergency related to COVID-19.

SPECIAL BULLETIN COVID-19 #41: Telehealth Clinical Policy Modifications – Optometry Services

Thursday, April 9, 2020

Eligible Providers and Services - Optometrists may now bill for the following services when delivered remotely:

SPECIAL BULLETIN COVID-19 #42: Telehealth Clinical Policy Modifications – Postpartum Care

Thursday, April 9, 2020

SPECIAL BULLETIN COVID-19 #42: Telehealth Clinical Policy Modifications – Postpartum Care.has been replaced by SPECIAL BULLETIN COVID-19 #49: Telehealth Clinical Policy Modifications – Interim Perinatal Care Guidance.

SPECIAL BULLETIN COVID-19 #43: Telehealth Clinical Policy Modifications – Self-Measured Blood Pressure Monitoring

Thursday, April 9, 2020

NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid beneficiaries.

SPECIAL BULLETIN COVID-19 #37: Patient Information and Support Line Available

Wednesday, April 8, 2020

DHHS and Community Care of North Carolina (CCNC) have launched a toll-free Patient Information and Support Line aimed at helping health care providers answer their patients' questions related to COVID-19.

SPECIAL BULLETIN COVID-19 #38; Private Duty Nursing Clinical Policy Modification – Prior Approval Status Due to Refusal of PDN Services

Wednesday, April 8, 2020

Current Policy: Private Duty Nursing (PDN) Clinical Coverage Policy 3G-1. Private Duty Nursing for Beneficiaries Age 21 and older and Private Duty Nursing (PDN) Clinical Coverage Policy 3G-2 Private Duty Nursing for Beneficiaries Age Under 21 years of age section 5.2.4.1:

SPECIAL BULLETIN COVID-19 #39: Face-to-Face Provider Site Visits and Fingerprinting Requirements for NC Medicaid Provider Enrollment Temporarily Suspended

Wednesday, April 8, 2020

Note: SPECIAL BULLETIN COVID-19 #39 replaces SPECIAL BULLETIN COVID-19 #8: Face-to-Face Provider Site Visits and Fingerprinting Requirements Temporarily Suspended Due to COVID-19 Outbreak. Changes to the prior Bulletin are:

Antihemophilic Factor (Recombinant), Glycopegylated-Exei Lyophilized Powder for Solution, for Intravenous Use (Esperoct®) HCPCS Code J7199: Billing Guidelines

Tuesday, April 7, 2020

Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant), glycopegylated-exei lyophilized powder for solution, for intravenous use (Esperoct®) for use in the Physician Administered Drug Program when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.

Subscribe to Medicaid Bulletins Updates

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Associated Files