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Proposed Health Choice Clinical Coverage Policies

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DHHS > DMA > Health Choice Providers > Health Choice Policies

N.C. Health Choice Policies

CPT codes, descriptors, and other data only are copyright 2010 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

Clinical Coverage Policies for Medicaid Providers

The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), as amended by the Health Care and Education Recovery Act of 2010 (P.L. 111-152), together referred to as the Affordable Care Act (ACA) requires state Medicaid programs to be compliant with the National Correct Coding Initiative (NCCI) in claims processing by March 31, 2011. Each provider shall comply with NCCI methodologies and can access information about NCCI and its impact on claims processing.

The EPSDT Special Provision and the Important Notes on EPDST documented in DMA clinical coverage policies do not apply to NC Health Choice policies.

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Abatacept (Date of termination 9/30/2011)
Acupuncture
Air Fluidized Beds
Alefacept Injection (Date of termination 9/30/2011)
Allergy Immunotherapy (Desensitization)
Allergy Testing
Allogeneic Hematopoietic and Bone Marrow Transplant for Genetic Diseases and Acquired Anemias
Ambulance
Ambulatory Event Monitors
Anesthesia
Ankle Replacement, Total
Anterior Cruciate Ligament Allograft
Arthroscopic Surgery for Femoroacetabular Impingement
Autologous Chondrocyte Implantation

Dental and Oral Surgery Services
Dietary Supplements
Durable Medical Equipment
Electroconvulsive Therapy (ECT)
Electrodiagnostic Studies
Electroencephalograms
Electroencephalography, Stereotactic Approach (Date of termination 9/30/2011)
Electrical Bone Growth Stimulation
Endovascular Stent Graft for Aortic Aneurysm (Date of termination 9/30/2011)
Enhanced External Counterpulsation (EECP) (Date of termination 9/30/2011)
Excision of Gynecomastia
Functional Capacity Assessment and Work Hardening (Date of termination 9/30/2011)

Immunizations
Implantable Bone Conduction Hearing Aids (BAHA)
Infliximab (Date of termination 9/30/2011)
Independent Practitioners
Inpatient Medical Detoxification for Chemical Dependency
Inpatient Psychiatric Care or Inpatient Chemical Dependency Care
Inpatient Rehabilitation Facility Benefits
Intra Articular Hyaluronan Injections for Osteoarthritis of the Knee (Date of termination 9/30/2011)
Intracoronary Brachytherapy (Date of termination 9/30/2011)
Intravascular Ultrasound Imaging (IVUS) (Date of termination 9/30/2011)
Intravenous Antibiotic Therapy for Lyme Disease
Islet Cell Transplantation
Isolated Limb Perfusion (Date of termination 9/30/2011)
Keloids
Kidney (Renal) Transplantation
Liver Transplantation
Lung or Lobar Lung Transplantation
Lung Volume Reduction Surgery (Date of termination 9/30/2011)
Lymphedema Pumps-Sequential Pneumatic Compression Device

Magnetoencephalography/Magnetic Source Imaging (Date of termination 9/30/2011)
Mammoplasties
Medical Photography
Medically Necessary
Medical Supplies and Surgical Dressings
Meniscal Allograft Transplantation
Minimally Invasive Hip and Knee Arthroplasty (Date of termination 9/30/2011)
Mohs Micrographic Surgery (Date of termination 9/30/2011)
Monoclonal Antibody Imaging
Non-Covered Policies
Non-Invasive Measurements of Cardiac Hemodynamics in the Outpatient Setting (Date of termination 9/30/2011)
Noninvasive Respiratory Assist Devices
Nonmyeloablative Allogenic Transplants of Hematopoietic Stem Cells
Off Label Antipsychotic Safety Monitoring in Health Choice Recipients
Orthognathic Surgery
Oscillatory Devices for the Treatment of Respiratory Conditions
Osteochondral Grafting in the Treatment of Articular Cartilage Lesions
Outpatient Diabetes Self Care Program
Outpatient Psychotherapy
Outpatient Specialized Therapies
Outpatient Treatment in an Intensive Outpatient Program (IOP)
Oxygen

Pancreas Transplant
Partial Hip Resurfacing
Partial Hospitalization
Penile Prosthesis (Date of termination 9/30/2011)
Periurethral Bulking Agents for the Treatment of Urinary Incontinence (Date of termination 9/30/2011)
Pharmacy Prior Approval Information
Positron Emission Tomography (PET)
Pre-Admission Certification & Length of Stay
Prescription Drugs
Pressure Reducing Support Surfaces
Private Duty Nursing
Psychiatric Home Care
Psychological Testing
Pulmonary Hypertension, Drug Management (Date of termination 9/30/2011)
Pulsed Irrigation of Fecal Impaction (Date of termination 9/30/2011)
PUVA (Psoralens with Ultraviolet A) Therapy

Sacral Nerve Neuromodulation/Stimulation for Pelvic Floor Dysfunction (Date of termination 9/30/2011)
Salivary Hormone Tests
Selective Internal Radiation Therapy for Tumors of the Liver (Date of termination 9/30/2011)
Sex Transformation Surgery
Sexual Dysfunction Treatment, Female
Skilled Nursing Facility Benefits
Small Bowel, Small Bowel/Liver, or Multivisceral Transplant
Smoking Cessation Services
Speech Therapy and Electronic Speech Aids
Spinal Cord Stimulation
Surgery for Morbid Obesity
Surgical Treatment of Chest Wall Deformities (Congenital or Acquired)

Targeted Phototherapy for Psoriasis
Telemedicine
Tomography (CT) and Computed Tomographic Angiography (CTA)
Topical Negative Pressure Therapy for Wounds
Total Hip Resurfacing
Transcatheter Ablation of Arrhythmogenic Foci in the Pulmonary Vein
Transcatheter Closure of Ventricular Septal Defects
Transplant Coverage under the North Carolina Health Choice Program (Date of termination 1/31/2012)
Treatment for Varicose Veins (Date of termination 9/30/2011)
Treatment of Hyperhidrosis (Date of termination 9/30/2011)
Tumor Markers
T-Wave Alternans
Tympanometry and Acoustic Reflex Testing
Ultrasound Accelerated Fracture Healing Device
Ultrasound Screening for Abdominal Aortic Aneurysm (Date of termination 9/30/2011)
Vagus Nerve Stimulation
Ventricular Assist Devices
Vertebroplasty and Kyphoplasty Percutaneous (Date of termination 9/30/2011)
Vesicoureteral Reflux, Treatment with Periureteral Bulking Agents
Visual Evoked Potential (VEP)

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Updated: February 8, 2012