Important Information to Review New Medicaid Bulletin Articles Available as of May 16

The NC Division of Health Benefits (DHB) has recently published new Medicaid Bulletin articles. Providers are encouraged to review this important information:

• Update to Age Criteria for CPT Code 81528, Cologuard (Multi-Target Stool DNA-Based Colorectal Screening)- Effective Jan. 1, 2023, the minimum age was adjusted from 50 years to 45 years for Cologuard (multi-target stool DNA-based colorectal screening).
• REMINDER: Preadmission Screening and Resident Review and the Nursing Facility Level of Care Prior Approval Process- A Level I preadmission screening and resident review (PASRR) evaluation must be performed before anyone, regardless of pay source, can be admitted to a Medicaid-certified nursing facility.
• Makena End of Coverage and Removal from NC Medicaid Preferred Drug List- On April 6, 2023, the Food and Drug Administration (FDA) announced that Makena® (hydroxyprogesterone caproate injection) and generics for Makena® are no longer FDA-approved.
• Annual Ambulatory Surgery Center Update- Effective with date of service Jan. 1, 2023, the following new CPT codes as separately reimbursable in the ambulatory surgery setting

All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.