North Carolina
highNC FEE Schedules
Run Date and Time
Aug 15, 2026
1m 46s
Run Metrics
Fee Schedule Impacts
Run summary
This run for North Carolina Medicaid / NC_FEE_SCHEDULES identified 0 changed documents and 28 newly discovered documents. 11 item(s) are high priority. 24 newly discovered item(s) appear current or upcoming.
High Impact (11)
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 fee schedule for physician assistant services.
- •Effective date: October 1, 2025.
- •Includes rates for procedures like acne surgery and abscess drainage.
- •References to ACA-defined taxonomy rates and PADP fee schedule.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
CAP_C.xlsx
The document outlines a new fee schedule for the Community Alternatives Program for Children (CAP-C) in North Carolina, effective October 1, 2025, with rate reductions for several services.
Highlights
- •New CAP-C fee schedule effective October 1, 2025.
- •Rate reductions include 3% for non-medical transportation and assistive technology.
- •8% reduction for overlapping personal care services codes.
- •Providers must bill usual and customary charges.
Reason
The document includes imminent rate reductions effective October 1, 2025, impacting reimbursement.
Watch items
CAP_CD.xlsx
The document outlines a new fee schedule for the Community Alternatives Program for Consumer-Directed Services in North Carolina, effective October 1, 2025, with a 3% rate reduction for several services.
Highlights
- •New fee schedule effective October 1, 2025.
- •3% rate reduction for specified services.
- •Applies to non-medical transportation, assistive technology, and more.
- •Providers must bill usual and customary charges.
Reason
The document includes imminent rate reductions effective October 1, 2025, impacting reimbursement.
Watch items
MC FQHC PPS APM-Well Child.xlsx
The document introduces a new fee schedule for the state fiscal year 2027, effective from July 1, 2026, impacting Federally Qualified Health Centers and physician services.
Highlights
- •New fee schedule effective 7/1/2026.
- •Applies to Federally Qualified Health Centers and physician services.
- •Includes specific rates for Advance Community Health Inc.
- •Effective date: 2026-07-01 to 2027-06-30.
Reason
The document contains new reimbursement rates effective soon, impacting provider payments.
Watch items
Pharmacy Diabetic Testing CGM Condoms and Spermicides.xlsx
The document includes updates to the fee schedule for diabetic testing supplies and continuous glucose monitors, effective from July 15, 2026. It also lists specific items with their rates and effective dates, such as the Cequr Simplicity patches and Accu-Chek lancing device.
Highlights
- •Revised fee schedule effective July 15, 2026.
- •Includes diabetic testing supplies and CGMs.
- •Specific rates for Cequr Simplicity patches and Accu-Chek device.
- •Effective dates range from 2022 to 2026.
Reason
The document contains new rates and effective dates for medical supplies impacting reimbursement, effective soon.
Watch items
Physician Administered Drug Program.xlsx
The document is a revised fee schedule for the Physician Administered Drug Program in North Carolina, effective August 1, 2026. It includes updated rates for several biologicals, such as Dysport and Xeomin.
Highlights
- •Revised PADP fee schedule effective August 1, 2026.
- •Updated rates for biologicals like Dysport (J0586) and Xeomin (J0588).
- •Document last uploaded on August 3, 2026.
Reason
The document contains specific rate updates effective imminently, impacting reimbursement.
Watch items
Nurse Midwives Fee Schedule.xlsx
The document includes updates to the nurse midwives fee schedule and mentions a behavioral health rate increase effective January 1, 2024. It also lists specific procedure rates effective October 1, 2025.
Highlights
- •Nurse midwives fee schedule update.
- •Behavioral health rate increase on January 1, 2024.
- •Procedure rates effective October 1, 2025.
- •Includes specific CPT codes and rates.
Reason
The document contains specific rate changes and effective dates that impact reimbursement, requiring urgent review.
Watch items
CAP_DA.xlsx
The document outlines a new fee schedule for the Community Alternatives Program for Disabled Adults (CAP-DA) in North Carolina, effective October 1, 2025. It includes a 3% rate reduction for several services and codes.
Highlights
- •New fee schedule for CAP-DA effective 10/1/2025.
- •3% rate reduction for multiple services.
- •Includes non-medical transportation, medical supplies, and community services.
- •Providers must bill usual and customary charges.
Reason
The document details imminent rate reductions effective October 1, 2025, impacting reimbursement.
Watch items
Hospital DRG Base Rate.xlsx
The document outlines updated DRG base rates for North Carolina Medicaid, effective from July 1, 2026, to June 30, 2027. It includes specific rate changes for various hospitals and mentions a transition to DRG Grouper V44 on October 1, 2026.
Highlights
- •DRG base rates updated for FY 2026-2027.
- •Effective date: July 1, 2026.
- •Transition to DRG Grouper V44 on October 1, 2026.
- •Specific rates listed for multiple hospitals.
Reason
The document contains specific reimbursement-impacting rate changes effective soon.
Watch items
Hospital Provider Outpatient RCC.xlsx
The document outlines new Medicaid outpatient rates for various hospitals in North Carolina, effective from July 1, 2026, to June 30, 2027. It includes specific rate changes for several facilities, indicating reimbursement-impacting updates.
Highlights
- •New Medicaid outpatient rates effective July 1, 2026.
- •Rates valid through June 30, 2027.
- •Includes specific rate changes for multiple hospitals.
- •Reimbursement-impacting updates noted.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Nurse Practitioner and CRNA Fee Schedule.xlsx
The document introduces a new nurse practitioner fee schedule for North Carolina Medicaid, effective January 1, 2024, with specific rate increases for behavioral health. Additionally, new rates for various procedures are set to take effect on October 1, 2025.
Highlights
- •New nurse practitioner fee schedule for NC Medicaid.
- •Behavioral health rate increase effective January 1, 2024.
- •New procedure rates effective October 1, 2025.
- •Includes specific CPT codes and rates.
Reason
The document contains new reimbursement rates and effective dates impacting Medicaid billing.
Watch items
Medium Impact (15)
Hospital Rehab Per Diem.xlsx
The document outlines the rehab per diem fee schedule for North Carolina Medicaid, effective from July 1, 2026, to June 30, 2027. It includes specific rates for various hospitals.
Highlights
- •Rehab per diem fee schedule for North Carolina.
- •Effective dates: July 1, 2026 - June 30, 2027.
- •Includes specific rates for hospitals like Atrium Health Cabarrus and Mission Hospital.
- •Rates range around $600.63 to $600.64.
Reason
The document is current but effective in the future, with specific rate details provided.
Watch items
Personal Care Services.xlsx
The document outlines updated Medicaid reimbursement rates for personal care services in North Carolina, effective from October 1, 2025, to July 31, 2026. It specifies per diem rates for different care settings and mentions that rates are based on a $5.96 rate from October 1, 2025.
Highlights
- •Updated Medicaid rates for personal care services.
- •Effective from October 1, 2025, to July 31, 2026.
- •Per diem rates for adult care homes and in-home settings.
- •Rates based on $5.96 from October 1, 2025.
Reason
The changes are relevant but not immediately urgent, with effective dates starting in 2025.
Watch items
Laboratory.xlsx
The document provides updates to the laboratory fee schedule for the NC Department of Health and Human Services, effective October 1, 2025. It includes specific rates for various laboratory tests but does not guarantee coverage for these services.
Highlights
- •Laboratory fee schedule updated as of 7/17/2026.
- •Rates effective from 10/01/2025 for various tests.
- •Includes CPT codes like 80074, 80076, 80150, etc.
- •Providers should bill usual and customary charges.
- •Coverage not guaranteed by rate inclusion.
Reason
The changes are relevant but not immediately effective, with rates starting in 2025.
Watch items
Physicians Services Fee Schedule.xlsx
The document provides updates to the NC Medicaid Physician Services Fee Schedule, including specific rate changes for various procedures effective October 1, 2025.
Highlights
- •New rates for CPT codes 10021, 10030, 10035, 10036, 10040, 10060, 10061, 10080, and 10081.
- •Effective date for changes is October 1, 2025.
- •Rates are listed for procedures like 'drainage of skin abscess' and 'acne surgery'.
- •Document includes references to ACA-defined taxonomy rates and PADP fee schedule.
Reason
The changes are relevant but not immediately urgent, with an effective date in 2025.
Watch items
State Laboratory.xlsx
The document outlines updates to the North Carolina state lab fee schedule, effective October 1, 2025, with new rates for various CPT codes related to newborn and non-newborn testing.
Highlights
- •New rates effective October 1, 2025.
- •Includes CPT codes for newborn and non-newborn testing.
- •Rates for procedures like genotyping and amino acids listed.
- •Document pertains to NC Department of Health and Human Services.
Reason
The changes are relevant but not immediately urgent, with an effective date in the future.
Watch items
FFS FQHC PPS-APM.xlsx
The document introduces a new fee schedule for Federally Qualified Health Centers (FQHC) effective July 1, 2026, with a specific rate of $438.99 for services performed in hospital settings.
Highlights
- •New FQHC fee schedule effective 7/1/2026.
- •Rate set at $438.99 for specific services.
- •Applies to services in hospital inpatient/outpatient settings.
- •Effective for state fiscal year 2027.
Reason
The changes are relevant but not immediately urgent, with an effective date in the future.
Watch items
Speech Therapy and Audiology.xlsx
The document provides updates to the North Carolina Medicaid fee schedule for speech therapy and audiology, effective October 1, 2025. It includes specific rate changes for various audiology procedures.
Highlights
- •New fee schedule for speech therapy and audiology.
- •Effective date: October 1, 2025.
- •Rate changes for procedures like 92557, 92567, and 92570.
- •Providers should refer to Medicaid billing guide for coverage details.
Reason
The changes are relevant but not immediately urgent, as they take effect in 2025.
Watch items
Nursing Facility Rates.xlsx
The document outlines a new Skilled Nursing Facility (SNF) fee schedule effective from July 1, 2026, to September 30, 2026, detailing rates for various facilities.
Highlights
- •New SNF fee schedule effective July 1, 2026.
- •Rates include components like CMI, indirect, direct, and add-on.
- •Specific rates provided for facilities such as Abbotts Creek and Abernethy Laurels.
- •Document includes provider appeal rights information.
Reason
The changes are not effective immediately, but they provide detailed future rates that may impact planning.
Watch items
Hospital Psych Per Diem.xlsx
The document outlines the updated psych per diem fee schedule for North Carolina Medicaid, effective from July 1, 2026, to June 30, 2027. The base rate is set at $895.63, with specific provider appeal rights and reimbursement requirements detailed.
Highlights
- •Effective date: July 1, 2026 - June 30, 2027
- •Psych per diem base rate: $895.63
- •Applies to fee-for-service and managed care providers
- •Provider appeal rights referenced in administrative code 10a ncac 22j.0102
- •Reimbursement must be at least 100% of base rate unless otherwise agreed
Reason
The document is current but effective date is not imminent, indicating a medium urgency for review.
Watch items
FFS RHC PPS-APM.xlsx
The document outlines a new fee schedule for rural health clinics in North Carolina, effective July 1, 2026, through June 30, 2027. It includes specific PPS/APM rates for various providers.
Highlights
- •New fee schedule for rural health clinics.
- •Effective date: July 1, 2026.
- •Rates provided for specific providers.
- •Applies to state fiscal year 2027.
Reason
The changes are not effective immediately, but they provide future reimbursement rates that need review.
Watch items
Hospital Provider Inpatient RCC.xlsx
The document outlines the inpatient RCC fee schedule for North Carolina, effective from October 1, 2025, to September 30, 2026, with specific rates for various hospitals.
Highlights
- •Effective date: October 1, 2025
- •End date: September 30, 2026
- •Rates based on DRG Grouper v43.1
- •New Grouper v44 effective October 1, 2026
- •Specific rates for hospitals like Atrium Health Cabarrus and Novant Health Rowan
Reason
The document provides future rate changes effective in 2025, which are not immediately urgent but relevant for planning.
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 July 1, 2026, for the state fiscal year 2027. It includes specific rates for various providers under the Rural Health Clinic PPS-APM/Well Child Fee Schedule.
Highlights
- •Effective date: July 1, 2026
- •State fiscal year 2027
- •Includes provider-specific PPS APM rates
- •Applies to Rural Health Clinic PPS-APM/Well Child Fee Schedule
- •Updated on July 22, 2026
Reason
The document is current and outlines future rates, but the effective date is not imminent.
Watch items
Local Health Departments.xlsx
The document provides a new fee schedule for the North Carolina Department of Health and Human Services, effective October 1, 2025, with specific rates for various procedures.
Highlights
- •New fee schedule for local health departments in North Carolina.
- •Effective date: October 1, 2025.
- •Includes rates for procedures like 'fna bx w/mr gdn ea addl' and 'i&d abscess simple/single'.
- •Rates are subject to change and may require NDC codes.
Reason
The changes are relevant but not immediately effective, with an effective date in 2025.
Watch items
Local Education Agencies.xlsx
The document provides updates to the North Carolina Medicaid fee schedule, including new rates for specific procedure codes effective from 2026-07-01.
Highlights
- •New rates for procedure codes 90785, 90792, and 90833 effective 2026-07-01.
- •Rates for codes 29505, 29515, 29530, and 29540 effective from 2022-04-01.
- •Procedure code 90791 and 90832 rates effective from 2024-01-01.
Reason
The document includes future rate changes but they are not immediately effective.
Watch items
Ambulatory Infusion Therapy Fee Schedule.xlsx
The document introduces new rates for ambulatory infusion therapy services effective August 1, 2026, including specific rates for several injection codes.
Highlights
- •New rates effective 8/1/26 for ambulatory infusion therapy.
- •Includes rates for J0219, J0221, J0222, J0223, J0225, J0256, J0257.
- •Rates are reimbursed at 100% of the PADP fee schedule.
- •Effective date is 2026-08-01.
Reason
The changes are relevant but not urgent as they are effective in 2026.
Watch items
Low Impact (2)
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 from July 1, 2026, to September 30, 2026. It includes specific per diem rates for various facilities.
Highlights
- •Effective date: July 1, 2026 - September 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 effective date is far in the future, reducing urgency for immediate review.
Watch items
Indian Tribal (I_T_U) Home Health.xlsx
The document is a fee schedule for Indian Tribal Home Health services in North Carolina, last updated on 9/1/26. It includes rates for various services and supplies, effective from 2022-04-01 with no end date specified.
Highlights
- •Fee schedule for Indian Tribal Home Health services.
- •Last updated on 9/1/26.
- •Rates effective from 2022-04-01 with no specified end date.
- •Includes physical therapy and medical supplies rates.
Reason
The document appears to be archival with rates effective from 2022, and no immediate changes or updates are indicated.