North Carolina
highNC FEE Schedules
Run Date and Time
May 15, 2026
1m 24s
Run Metrics
Fee Schedule Impacts
Run summary
This run for North Carolina Medicaid / NC_FEE_SCHEDULES identified 0 changed documents and 19 newly discovered documents. 5 item(s) are high priority. 17 newly discovered item(s) appear current or upcoming.
High Impact (5)
FFS RHC PPS-APM.xlsx
The document outlines a new fee schedule for rural health clinics under the North Carolina Department of Health and Human Services, effective October 1, 2025. It includes specific PPS/APM rates for various providers, valid until June 30, 2026.
Highlights
- •New fee schedule for rural health clinics.
- •Effective date: October 1, 2025.
- •Rates valid until June 30, 2026.
- •Includes provider-specific PPS/APM rates.
Reason
The document contains new reimbursement rates effective soon, impacting provider payments.
Watch items
Physicians Services Fee Schedule.xlsx
The document introduces a new fee schedule for NC Medicaid physician services, effective October 1, 2025. It includes specific rates for various procedures, such as 'drainage of skin abscess' and 'acne surgery.'
Highlights
- •New fee schedule for NC Medicaid physician services.
- •Effective date: October 1, 2025.
- •Includes rates for procedures like 'drainage of skin abscess' and 'acne surgery.'
- •References to ACA-defined taxonomy rates and PADP fee schedule.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Physician Administered Drug Program.xlsx
The document outlines updates to the Physician Administered Drug Program (PADP) fee schedule for North Carolina, effective from April 27, 2026. It includes specific rate changes for drugs like alemtuzumab and olipudase alfa-rpcp, with effective dates ranging from November 2025 to May 2026.
Highlights
- •PADP fee schedule revised: April 27, 2026
- •Rate changes for alemtuzumab and olipudase alfa-rpcp
- •Effective dates: November 2025 to May 2026
- •Includes pricing specialties: 001, 061, 210
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Physician Assistant Fee Schedule.xlsx
The document introduces a new fee schedule for physician assistant services under NC Medicaid, effective October 1, 2025. It includes specific rate changes for various procedures, such as acne surgery and drainage of abscesses.
Highlights
- •New physician assistant fee schedule effective October 1, 2025.
- •Includes rates for procedures like acne surgery and abscess drainage.
- •References ACA-defined taxonomy rates and PADP fee schedule.
- •Clarifies provider appeal rights for fee-for-service and managed care.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Pharmacy Diabetic Testing CGM Condoms and Spermicides.xlsx
The document includes updates to the fee schedule for diabetic testing supplies and condoms, with specific rate changes effective from October 1, 2024.
Highlights
- •Revised fee schedule for diabetic testing supplies and condoms.
- •Rate change for condoms effective October 1, 2024.
- •New rates for condoms: $0.33333 each from October 1, 2024.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Medium Impact (14)
Local Health Departments.xlsx
The document provides a new fee schedule for the North Carolina Department of Health and Human Services, including specific drug injection rates. It emphasizes that the inclusion of a rate does not guarantee coverage and advises consulting the Medicaid billing guide for updates.
Highlights
- •New fee schedule for local health departments in NC.
- •Specific rates for drug injections like amikacin sulfate and azithromycin.
- •Advises checking Medicaid billing guide for coverage details.
- •Rates for drugs are subject to change based on NDC.
Reason
The document includes specific rates but lacks an imminent effective date or clear policy changes.
Watch items
FFS FQHC Non-Core Services Well Child.xlsx
The document introduces a new fee schedule for non-core services at Federally Qualified Health Centers in North Carolina, effective October 1, 2025. Specific CPT codes are listed as included in the PPS APM rate and not separately reimbursable.
Highlights
- •New fee schedule for FQHC non-core services.
- •Effective date: October 1, 2025.
- •CPT codes 11005, 11006, 11008, 11042, 11043 included in PPS APM rate.
- •Not separately reimbursable.
Reason
The changes are relevant but not urgent as they are effective in 2025.
Watch items
MC FQHC Physician Services.xlsx
The document introduces a new fee schedule for the North Carolina Medicaid program, effective October 1, 2025, for the fiscal year 2026. It includes specific CPT codes related to debridement and removal procedures, which are not separately reimbursable as they are included in the PPS APM rate.
Highlights
- •New fee schedule for NC Medicaid effective 10/1/2025.
- •CPT codes 11005, 11006, 11008, 11042, 11043 included in PPS APM rate.
- •Procedures not separately reimbursable.
- •Applies to Federally Qualified Health Centers.
Reason
The changes are relevant but not immediately urgent, with an effective date in 2025.
Watch items
Nursing Facility Rates_Short Stay Managed Care.xlsx
The document outlines new Medicaid managed care short stay rates for skilled nursing facilities in North Carolina, effective April 1, 2026, to June 30, 2026. It includes specific per diem rates for various facilities.
Highlights
- •Effective date: April 1, 2026 - June 30, 2026
- •Applies to managed care health plan reimbursement
- •Includes specific per diem rates for facilities
- •Relevant to skilled nursing facilities for short term care
Reason
The changes are not imminent, but they include specific rate updates for future implementation.
Watch items
MC FQHC PPS APM-Well Child.xlsx
The document outlines a new fee schedule for Federally Qualified Health Centers (FQHC) under the North Carolina Department of Health and Human Services, effective October 1, 2025. It includes specific rates for well-child services and provider-specific PPS APM rates.
Highlights
- •New FQHC fee schedule effective 10/1/2025.
- •Includes well-child service rates and PPS APM rates.
- •Applies to North Carolina Department of Health and Human Services.
- •Effective date: 2025-10-01 to 2026-06-30.
Reason
The document is current and outlines future rates, but the effective date is not imminent.
Watch items
Nurse Practitioner and CRNA Fee Schedule.xlsx
The document introduces a new nurse practitioner fee schedule for North Carolina Medicaid, effective October 1, 2025, with specific rate changes for various procedures.
Highlights
- •New nurse practitioner fee schedule for NC Medicaid.
- •Effective date: October 1, 2025.
- •Includes specific rate changes for procedures like 'acne surgery' and 'drainage of skin abscess'.
- •References to ACA and PADP fee schedules for additional rates.
Reason
The changes are not effective immediately but include specific future rate updates that require attention.
Watch items
FFS FQHC PPS-APM.xlsx
The document outlines a new fee schedule for Federally Qualified Health Centers (FQHC) with an effective date of October 1, 2025. It specifies a PPS/APM rate of $478.79 for services performed by Advance Community Health Inc. in various settings.
Highlights
- •New FQHC fee schedule effective 10/1/2025.
- •PPS/APM rate set at $478.79.
- •Applies to Advance Community Health Inc.
- •Effective until 6/30/2026.
- •Includes services in hospital settings.
Reason
The changes are relevant but not immediately urgent, with an effective date in the future.
Watch items
Ambulatory Infusion Therapy Fee Schedule.xlsx
The document outlines new ambulatory infusion therapy rates effective May 1, 2026, for North Carolina Medicaid. It includes specific rates for several injection therapies, such as avalglucosidase alfa-ngpt and lumizyme.
Highlights
- •New ambulatory infusion therapy fee schedule effective 5/1/26.
- •Rates for specific injections like j0219 and j0221 included.
- •Reimbursement at 100% of the PADP fee schedule rate.
- •Effective date for changes is 5/1/26.
Reason
The changes are not effective immediately but are relevant for future planning.
Watch items
Nursing Facility Rates (2).xlsx
The document outlines a new Skilled Nursing Facility (SNF) fee schedule effective from April 1, 2026, to June 30, 2026, detailing specific rates for various facilities.
Highlights
- •New SNF fee schedule effective April 1, 2026.
- •Rates include components like CMI, indirect, direct, and add-on.
- •Specific facilities and their rates are listed.
- •Provider appeal rights are referenced in administrative code 10a ncac 22j.0102.
Reason
The changes are not effective immediately, but they provide detailed future rates that may impact planning.
Watch items
Durable Medical Equipment.xlsx
The document outlines a revised fee schedule for Durable Medical Equipment (DME) in North Carolina, effective March 1, 2026. It includes specific rates for various items, effective from October 1, 2025.
Highlights
- •DME fee schedule revision effective March 1, 2026.
- •Rates effective from October 1, 2025, for items like tracheostoma filters and blood pressure monitors.
- •Providers should bill usual and customary rates, not automatically the maximum reimbursement rate.
Reason
The changes are not immediately effective but include specific future rates that may impact billing.
Watch items
Hospital Provider Outpatient RCC.xlsx
The document outlines updated Medicaid outpatient rates for various hospitals in North Carolina, effective from October 1, 2025, to June 30, 2026. It includes specific rate changes for several providers.
Highlights
- •Effective date: October 1, 2025
- •End date: June 30, 2026
- •Provider: Atrium Health Cabarrus, rate 0.125
- •Provider: Novant Health Rowan Medical Center, rate 0.1873
- •Provider: DLP Harris Regional Hospital, rate 0.1096293
Reason
The document contains future rate changes but they are not immediately effective.
Watch items
FFS RHC Non-Core Services Well Child.xlsx
The document outlines a new fee schedule for rural health clinic non-core services effective October 1, 2025, for the state fiscal year 2026. Specific CPT codes related to debridement and removal of prosthetic material are included but not separately reimbursable, as they are part of the PPS APM rate.
Highlights
- •New fee schedule for rural health clinic non-core services.
- •Effective date: October 1, 2025.
- •CPT codes 11005, 11006, 11008, 11042, 11043 included in PPS APM rate.
- •Services not separately reimbursable.
Reason
The changes are relevant but not immediately urgent, with an effective date in the future.
Watch items
MC RHC Physician Services.xlsx
The document introduces a new fee schedule for the North Carolina Medicaid program, effective October 1, 2025, for the fiscal year 2026. It includes specific CPT codes related to debridement procedures, which are not separately reimbursable as they are included in the PPS APM rate.
Highlights
- •New fee schedule for NC Medicaid effective 10/1/2025.
- •Applies to fiscal year 2026.
- •Includes CPT codes for debridement procedures.
- •Procedures not separately reimbursable, included in PPS APM rate.
Reason
The changes are relevant but not urgent as they are effective in 2025.
Watch items
MC RHC PPS APM-Well Child.xlsx
The document outlines a new fee schedule for the North Carolina Department of Health and Human Services, effective October 1, 2025, for the state fiscal year 2026. It includes specific rates for various providers under the Rural Health Clinic PPS-APM/Well Child Fee Schedule.
Highlights
- •Effective date: October 1, 2025
- •State fiscal year 2026
- •Includes provider-specific PPS APM rates
- •Applies to Rural Health Clinic services
- •Updated on April 30, 2026
Reason
The changes are relevant but not immediately urgent, as they take effect in 2025.
Watch items
Low Impact (0)
No documents in this severity group.