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Medicaid Bulletin

Clinical Policy Update

Monday, June 3, 2019

A new or amended policy on Outpatient Specialized Therapies - Local Education Agencies

Provision of Services for Routine Eye Exams and Visual Aids

Monday, June 3, 2019

Provision of eye examination and visual aids for beneficiaries under 21 years of age as well as beneficiaries over 21 years of age.

Tagraxofusp-erzs injection, for intravenous use (Elzonris™) HCPCS code J9999: Billing Guidelines

Monday, June 3, 2019

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

Monday, June 3, 2019

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"

Monday, May 6, 2019

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

Thursday, May 2, 2019

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

Wednesday, May 1, 2019

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

Wednesday, May 1, 2019

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

Wednesday, May 1, 2019

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

Wednesday, May 1, 2019

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. 

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