Medicaid Bulletin

Effective with date of service Jan 1, 2021, the Medicaid and NC Health Choice programs cover pegfilgrastim-apgf injection, for subcutaneous use (Nyvepria™) for use in the Physician Administered Drug Program.

NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series, The Security Risk Analysis (SRA) and Program Year 2021 Announcements.

An independent review of referrals for individuals seeking to enroll in the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) waivers is intended to provide an unbiased assessment to ensure the enrollment processes are executed appropriately in each waiver application. 

Effective with date of service Oct. 2, 2020, the Medicaid and NC Health Choice programs cover ferric derisomaltose injection, for intravenous use (Monoferric™) for use in the Physician Administered Drug Program.

Effective with date of service Jan. 1, 2021, the American Medical Association has added new CPT codes, deleted others, and changed the descriptions of some existing codes.  

January marks the go-live date for Electronic Visit Verification (EVV) Phase 1 Implementation. Beginning on January 1, 2021, all providers subject to the Federal EVV mandate should make every effort to capture visits through their chosen EVV solution. 

This bulletin updates and extends NC Medicaid’s reimbursement for allowable COVID-19 testing of nursing facility staff and healthcare personnel. 

This information is only for non-long-term care providers who have the means to handle the specific storage recommendations required of the Moderna COVID-19 vaccine and will be administering it. 

Clinical Coverage Policy 1A-22, Medically Necessary Circumcision, has been revised and will post with an effective date of Jan. 1, 2021 on the NC Medicaid website.

Effective Oct. 1, 2020, NC Medicaid will now cover services for transversus abdominis plane blocks for Medicaid and NC Health Choice beneficiaries 11 years and older.