North Carolina
highNC FEE Schedules
Run Date and Time
Oct 15, 2026
2m 45s
Run Metrics
Fee Schedule Impacts
Run summary
This run for North Carolina Medicaid / NC_FEE_SCHEDULES identified 0 changed documents and 22 newly discovered documents. 2 item(s) are high priority. 19 newly discovered item(s) appear current or upcoming.
High Impact (2)
Grouper DRG Weight Table V44.xlsx
The document introduces a new fee schedule for North Carolina's Medicaid program, effective from October 1, 2026, to March 30, 2027. It includes specific DRG weights and costs for procedures like heart transplants.
Highlights
- •New fee schedule effective October 1, 2026.
- •Covers DRG weights and costs for heart transplants.
- •Applies to fee-for-service providers.
- •Managed care providers must contact their health plans for appeal rights.
Reason
The document contains new reimbursement rates effective soon, impacting provider payments.
Watch items
Physician Administered Drug Program.xlsx
The document is a revised fee schedule for the Physician Administered Drug Program in North Carolina, effective from August 1, 2026. It includes specific rates for various botulinum toxin products.
Highlights
- •Revised PADP fee schedule for North Carolina.
- •Effective date: August 1, 2026.
- •Includes rates for botulinum toxin products (e.g., Botox, Dysport).
- •Rates are specified for each product (e.g., J0586, J0587).
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Medium Impact (19)
Hospital Provider Inpatient RCC.xlsx
The document outlines the new inpatient RCC fee schedule for North Carolina, effective from October 1, 2026, to September 30, 2027. It includes specific rates for various hospitals based on DRG Grouper V44.
Highlights
- •Effective date: October 1, 2026
- •End date: September 30, 2027
- •Rates based on DRG Grouper V44
- •Includes specific rates for hospitals
- •Provider appeal rights referenced
Reason
The document is current but changes are not imminent, effective in 2026.
Watch items
Public Ambulance Provider Managed Care.xlsx
The document outlines new Medicaid fee schedule rates for public ambulance providers in North Carolina, effective July 1, 2026. It includes specific rates for various counties and details on billable HCPCS codes for ground and air transport.
Highlights
- •Effective date: July 1, 2026
- •Applies to in-network public ambulance providers
- •Cost-based rates established as a rate floor
- •Billable HCPCS codes: A0426, A0427, A0428, A0429, A0433, T2003, A0430, A0431
- •Specific rates listed for multiple counties
Reason
The changes are not effective until 2026, reducing immediate urgency for review.
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. It includes specific rates for various procedures, such as 'fna bx w/mr gdn ea addl' and 'i&d abscess comp/multiple.'
Highlights
- •New fee schedule for North Carolina Department of Health and Human Services.
- •Effective date: October 1, 2025.
- •Includes rates for procedures like 'fna bx w/mr gdn ea addl' and 'i&d abscess comp/multiple.'
- •Providers should refer to Medicaid billing guide for coverage details.
Reason
The changes are relevant but not effective immediately, allowing time for review.
Watch items
MC FQHC Physician Services.xlsx
The document introduces a new fee schedule for the North Carolina Medicaid program, effective July 1, 2026, for the fiscal year 2027. It includes several CPT codes that are not separately reimbursable as they are included in the PPS APM rate.
Highlights
- •New fee schedule for NC Medicaid effective 7/1/2026.
- •CPT codes included in PPS APM rate, not separately reimbursable.
- •Applies to Federally Qualified Health Center physician services.
Reason
The changes are relevant but not urgent as they are effective in 2026.
Watch items
MC FQHC PPS APM-Well Child.xlsx
The document outlines a new fee schedule for Federally Qualified Health Centers (FQHC) and physician services, effective July 1, 2026, through June 30, 2027. It includes specific rates for Advance Community Health Inc. and details on reimbursement for services in hospital settings.
Highlights
- •New FQHC PPS/APM fee schedule effective 7/1/2026.
- •Applies to Advance Community Health Inc. with specific rates listed.
- •Covers services in hospital inpatient/outpatient settings.
- •Effective date: 7/1/2026 to 6/30/2027.
Reason
The document is current but changes are not immediately effective.
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 providers.
Highlights
- •New outpatient rates effective July 1, 2026.
- •Rates valid through June 30, 2027.
- •Includes specific rates for multiple hospitals.
- •Applies to fee-for-service providers.
Reason
The changes are relevant but not immediately urgent, as they take effect in 2026.
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 July 1, 2026, for the state fiscal year 2027. It includes specific CPT codes that are not separately reimbursable as they are included in the PPS APM rate.
Highlights
- •New fee schedule for rural health clinic non-core services.
- •Effective date: July 1, 2026.
- •CPT codes included in PPS APM rate, not separately reimbursable.
- •Providers should refer to Medicaid billing guide for coverage details.
Reason
The changes are relevant but not urgent as they are effective in 2026.
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 future rate changes and effective dates, but they are not imminent.
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 well-child services and provider-specific PPS APM rates.
Highlights
- •New fee schedule for fiscal year 2027.
- •Effective date: July 1, 2026.
- •Includes well-child service rates.
- •Provider-specific PPS APM rates listed.
- •Applies to managed care and fee-for-service providers.
Reason
The changes are relevant but not immediately urgent, as they take effect in 2026.
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 January 1, 2026. It also lists specific rates for items like the Cequr Simplicity patch and Accu-Chek lancing device.
Highlights
- •Revised fee schedule effective January 1, 2026.
- •Includes diabetic testing supplies and CGMs.
- •Specific rates for Cequr Simplicity patches and Accu-Chek lancing device.
- •Effective dates range from 2025 to 2026.
Reason
The document outlines future rate changes effective in 2026, which are not immediately urgent but relevant for planning.
Watch items
FFS FQHC Non-Core Services Well Child.xlsx
The document outlines a new fee schedule for non-core services at Federally Qualified Health Centers in North Carolina, effective July 1, 2026. Several services are included in the PPS APM rate and are not separately reimbursable.
Highlights
- •New fee schedule for FQHC non-core services.
- •Effective date: July 1, 2026.
- •Services included in PPS APM rate, not separately reimbursable.
- •Applies to state fiscal year 2027.
Reason
The changes are relevant but not urgent as they are effective in 2026.
Watch items
Hospice FFY27_10.5.26.xlsx
The document outlines revised Medicaid reimbursement rates for hospice services effective from October 1, 2026, to September 30, 2027. It includes specific rates for various types of care across different regions in North Carolina.
Highlights
- •Revised Medicaid rates for hospice services.
- •Effective date: October 1, 2026 - September 30, 2027.
- •Includes rates for routine home care, continuous home care, inpatient respite care, and general inpatient care.
- •Specific rates provided for regions like Asheville, Burlington, and Raleigh/Cary.
Reason
The changes are relevant but not urgent as they are effective in 2026.
Watch items
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 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 relevant but not immediately urgent, as they take effect in 2026.
Watch items
Out of State Hospital Inpatient and Outpatient Rates.xlsx
The document is an update to the Medicaid fee schedule for out-of-state hospitals in North Carolina, effective October 1, 2026, with no rate changes from the previous schedule.
Highlights
- •Document type: Fee schedule update
- •Region: North Carolina, out-of-state hospitals
- •Effective date: October 1, 2026
- •No rate changes from previous schedule
Reason
The update is current but indicates no rate changes, reducing urgency.
Watch items
FFS FQHC PPS-APM.xlsx
The document introduces a new fee schedule for Federally Qualified Health Centers (FQHC) with an effective date of July 1, 2026, and a specific rate of $438.99 for Advance Community Health Inc. services.
Highlights
- •New FQHC fee schedule effective 7/1/2026.
- •Rate of $438.99 for Advance Community Health Inc.
- •Applies to services in hospital inpatient/outpatient settings.
- •Separate reimbursement under physician services fee schedule.
Reason
The changes are relevant but not urgent as they are effective in 2026.
Watch items
Dialysis Provider Specific.xlsx
The document provides a revised fee schedule for dialysis services, effective October 1, 2025, with specific rates for various providers. It includes details on hemodialysis and peritoneal dialysis rates.
Highlights
- •Revised fee schedule for dialysis services.
- •Effective date: October 1, 2025.
- •Includes rates for hemodialysis and peritoneal dialysis.
- •Specific provider rates listed (e.g., Bio Medical Applications of NC Inc).
Reason
The changes are relevant but not immediately urgent, as the effective date is in the future.
Watch items
Vent Bed Facilities_Fee Schedule eff 10 1 2026.xlsx
The document updates the vent facility rates for North Carolina, effective October 1, 2026, with a 3.54% inflationary increase for specified facilities.
Highlights
- •Vent facility rates updated for North Carolina.
- •Effective date: October 1, 2026.
- •3.54% inflationary increase applied.
- •Facilities include Kindred Hospital East Greensboro, Oak Forest Health and Rehabilitation, and Valley Nursing Center.
Reason
The changes are relevant but not urgent as they are effective in 2026.
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 from October 1, 2026, to December 31, 2026. It includes specific per diem rates for various facilities.
Highlights
- •Effective date: October 1, 2026 - December 31, 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 RHC Physician Services.xlsx
The document outlines a new fee schedule for the North Carolina Medicaid program, effective July 1, 2026, for rural health clinic physician services. Several CPT codes are included but not separately reimbursable, as they are part of the PPS APM rate.
Highlights
- •New fee schedule for NC Medicaid effective 7/1/2026.
- •CPT codes included but not separately reimbursable.
- •Applies to rural health clinic physician services.
- •Effective date: 7/1/2026 to 6/30/2027.
Reason
The document is current but changes are not effective immediately, impacting future reimbursement policies.
Watch items
Low Impact (1)
Oct 1 2026 Fee Schedule_v2.xlsx
The document outlines a revised fee schedule for Skilled Nursing Facilities (SNF) under Medicaid, effective from October 1, 2026, to December 31, 2026. It includes updated case-mix values and rates for various facilities as part of the transition to the Patient-Driven Payment Model (PDPM).
Highlights
- •Effective date: October 1, 2026 - December 31, 2026
- •Includes revised case-mix values for SNF rates
- •Transition to PDPM continues
- •Specific rates listed for multiple facilities
Reason
The changes are effective in 2026, which is not imminent, reducing urgency for immediate review.
Watch items