North Carolina
highNC FEE Schedules
Run Date and Time
Apr 15, 2026
2m 20s
Run Metrics
Fee Schedule Impacts
Run summary
This run for North Carolina Medicaid / NC_FEE_SCHEDULES identified 0 changed documents and 48 newly discovered documents. 17 item(s) are high priority. 42 newly discovered item(s) appear current or upcoming.
High Impact (17)
Occupational Therapy.xlsx
The document introduces a new fee schedule for occupational therapy services, effective October 1, 2025, with specific rate changes for various procedures.
Highlights
- •New fee schedule for occupational therapy services.
- •Effective date: October 1, 2025.
- •Includes rates for procedures like special eye evaluation and treatment of swallowing dysfunction.
- •Rates for procedures such as strapping of knee and ankle are specified.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
MC FQHC PPS APM-Well Child.xlsx
The document introduces 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 managed care providers.
- •Effective date: 10/1/2025 to 6/30/2026.
Reason
The document outlines new reimbursement rates effective soon, impacting provider payments.
Watch items
Hospitals COVID-19 VAC MAB Admin.xlsx
The document outlines a new fee schedule for COVID-19 vaccine and monoclonal antibody administration in North Carolina, effective October 1, 2023.
Highlights
- •New fee schedule for outpatient facility services.
- •COVID-19 vaccine administration code 90480 set at $65.
- •Effective date: October 1, 2023.
- •End date: September 30, 2024.
- •Includes monoclonal antibody administration details.
Reason
The document includes new reimbursement rates effective imminently, impacting billing and reimbursement.
Watch items
ACA Physicians Services.xlsx
The document introduces a new ACA Physician Services Fee Schedule for NC Medicaid, effective October 1, 2025, with specific rates for audio-only services and defined taxonomies.
Highlights
- •New ACA Physician Services Fee Schedule for NC Medicaid.
- •Effective date: October 1, 2025.
- •Includes rates for audio-only services.
- •Specific taxonomies and procedure codes listed.
Reason
The document contains new reimbursement rates effective soon, impacting billing and policy.
Watch items
Hospital Indian Services.xlsx
The document updates the inpatient per diem fee schedule for the Cherokee Indian Hospital Authority, with new rates effective from January 1, 2024, to December 31, 2024.
Highlights
- •New inpatient per diem rate: 5083
- •Effective date: 2024-01-01
- •End date: 2024-12-31
- •Applies to Cherokee Indian Hospital Authority
Reason
The document includes a new rate effective soon, impacting reimbursement.
Watch items
Orthotics and Prosthetics.xlsx
The document provides a new orthotics and prosthetics fee schedule effective April 1, 2026, with specific rates for various HCPCS codes starting October 1, 2025. It includes details on billing practices and prior approval requirements.
Highlights
- •New orthotics and prosthetics fee schedule effective April 1, 2026.
- •Specific rates for HCPCS codes A6530, A6533, A6534, A6535, A6536 effective October 1, 2025.
- •Billing should reflect usual and customary rates, not maximum rates.
- •Prior approval required for HCPCS code A6530.
Reason
The document includes specific rate changes and effective dates that impact reimbursement.
Watch items
ACA Physician Assistant.xlsx
The document introduces a new fee schedule for physician assistants under the ACA, effective from October 1, 2025. It includes specific rates for various procedure codes, emphasizing that these rates do not guarantee service coverage.
Highlights
- •New ACA physician assistant fee schedule introduced.
- •Effective date: October 1, 2025.
- •Includes specific rates for procedure codes 98012 to 99204.
- •Rates do not guarantee service coverage.
- •Providers should refer to Medicaid billing guide for coverage details.
Reason
The document contains new reimbursement rates effective soon, impacting billing and reimbursement processes.
Watch items
Physician Assistant Fee Schedule.xlsx
The document outlines 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 ACA-defined taxonomy rates and PADP fee schedule.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Grouper DRG Weight Table V43.1.xlsx
The document introduces a new fee schedule for North Carolina's Medicaid program, effective April 1, 2026, with updates to DRG weights and costs.
Highlights
- •New fee schedule effective April 1, 2026.
- •Covers DRG weights and costs for Medicaid.
- •Previous rates end-dated as of September 30, 2025.
- •Includes specific DRG descriptions and weights.
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 April 1, 2026. It includes updated rates for specific drugs, such as alglucosidase alfa and vutrisiran, with effective dates starting February 1, 2026.
Highlights
- •Revised PADP fee schedule effective April 1, 2026.
- •Includes rates for alglucosidase alfa and vutrisiran.
- •Effective dates for some rates start February 1, 2026.
- •Rates confirmed as different from previous schedule.
Reason
The document contains new reimbursement rates effective soon, impacting billing and reimbursement.
Watch items
Physicians Services Fee Schedule.xlsx
The document provides updates to the NC Medicaid Physician Services Fee Schedule, including specific rate changes effective October 1, 2025. It includes new rates for various procedures such as biopsies and drainage procedures.
Highlights
- •New rates effective October 1, 2025.
- •Includes procedures like FNA biopsy and acne surgery.
- •Rates for drainage of skin abscess updated.
- •Fee schedule does not guarantee service coverage.
- •Managed care providers should contact contracted health plans for appeal rights.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Ambulatory Infusion Therapy Fee Schedule.xlsx
The document outlines a new ambulatory infusion therapy fee schedule for North Carolina, effective April 1, 2026, with specific rates for various injections starting February 1, 2026.
Highlights
- •New ambulatory infusion therapy fee schedule effective 4/1/26.
- •Rates for injections effective 2/1/26.
- •Includes CPT codes like J0202, J0217, J0219, J0221, J0222, J0223, J0225, J0256.
- •Rates are reimbursed at 100% of the PADP fee schedule rate.
Reason
The document includes specific rate changes effective soon, impacting reimbursement.
Watch items
Hospital Psych Per Diem.xlsx
The document outlines a new psych per diem fee schedule for North Carolina Medicaid, effective from October 1, 2025, to June 30, 2026, with a base rate of $895.63. Providers must be reimbursed at least 100% of this rate unless an alternative arrangement is agreed upon.
Highlights
- •New psych per diem fee schedule effective October 1, 2025.
- •Base rate set at $895.63 per diem.
- •Applies to multiple hospitals in North Carolina.
- •Providers must be reimbursed at least 100% of the base rate.
- •Effective through June 30, 2026.
Reason
The document introduces a new fee schedule with specific rates effective soon, impacting reimbursement.
Watch items
Hospital Indian Svcs Outpatient Per Diem.xlsx
The document updates the outpatient per diem fee schedule for the Cherokee Indian Hospital Authority, with rates effective from January 1, 2024, to December 31, 2024.
Highlights
- •Outpatient per diem rate updated to 719 for 2024.
- •Effective date: January 1, 2024.
- •End date: December 31, 2024.
- •Applies to Cherokee Indian Hospital Authority.
Reason
The update includes a new rate effective soon, impacting reimbursement.
Watch items
Hospital Outpatient Laboratory.xlsx
The document outlines new draft rates for hospital outpatient laboratory services under managed care, effective October 1, 2025. These rates are set at 146.38% of the Medicaid direct fee-for-service rates and are pending CMS approval.
Highlights
- •Rates effective from 10/1/2025.
- •Applies to hospital outpatient lab services under managed care.
- •Rates are 146.38% of FFS lab fee schedule.
- •Draft rates pending CMS approval.
- •Includes specific CPT codes like 80053, 80055, 80061.
Reason
The document contains new draft rates effective soon, impacting reimbursement for hospital outpatient lab services.
Watch items
Hospital Provider Outpatient RCC.xlsx
The document outlines new 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 facilities, impacting reimbursement rates.
Highlights
- •New Medicaid outpatient rates effective October 1, 2025.
- •Rates valid through June 30, 2026.
- •Includes specific rates for multiple hospitals.
- •No rate reductions included in this schedule.
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.
- •New rates for condoms effective October 1, 2024.
- •Rates for condoms listed with specific codes and prices.
- •Document revised on March 19, 2026.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Medium Impact (30)
Hospital DRG Base Rate.xlsx
The document outlines updated DRG base rates for North Carolina Medicaid, effective from October 1, 2025, to June 30, 2026. It includes specific rates for various hospitals and mentions the transition to DRG Grouper V44 on October 1, 2026.
Highlights
- •DRG base rates effective October 1, 2025, to June 30, 2026.
- •Transition to DRG Grouper V44 on October 1, 2026.
- •Specific rates listed for multiple hospitals.
- •No rate reductions included in the schedule.
Reason
The changes are not immediately effective but are relevant for future planning.
Watch items
Optometry Services.xlsx
The document outlines a revised fee schedule for optometry services under NC Medicaid, effective April 1, 2026. It includes specific rates for various procedures, effective from October 1, 2025.
Highlights
- •Optometry services fee schedule revision date: April 1, 2026
- •Rates effective from October 1, 2025
- •Includes procedures like vitrectomy and eyelid treatments
- •Providers should refer to Medicaid billing guide for coverage details
Reason
The document contains future rate changes effective in 2025 and 2026, which are not immediately urgent but relevant for planning.
Watch items
Hospital Provider Inpatient RCC.xlsx
The document outlines the new inpatient RCC fee schedule for North Carolina, effective from October 1, 2025, to September 30, 2026. It includes specific rates for various hospitals and notes the transition to DRG Grouper V44 on October 1, 2026.
Highlights
- •Effective date: October 1, 2025
- •End date: September 30, 2026
- •Transition to DRG Grouper V44 on October 1, 2026
- •Specific rates for hospitals like Rowan Regional Medical Center and DLP Harris Regional Hospital
Reason
The document is current but changes are not immediately effective, and it primarily updates future rates.
Watch items
Ambulatory Surgical Center Dental.xlsx
The document outlines new billing instructions for dental services in ambulatory surgical centers, effective April 1, 2026. It specifies the use of HCPCS code G0330 and modifier SG for claims.
Highlights
- •Revision date: April 1, 2026
- •Ambulatory surgical center dental code: G0330
- •Use modifier "SG" with procedure code
- •Claims must be electronic (CMS-1500)
- •Place of service code: 24
Reason
The changes are relevant but not immediately urgent, with an effective date in 2026.
Watch items
Physical Therapy.xlsx
The document provides a new physical therapy fee schedule for North Carolina Medicaid, effective October 1, 2025. It includes specific rates for various procedures such as application of casts and splints, and treatment of swallowing dysfunction.
Highlights
- •New physical therapy fee schedule for North Carolina.
- •Effective date: October 1, 2025.
- •Includes rates for procedures like short leg cast and swallowing treatment.
- •Providers should refer to Medicaid billing guide for coverage details.
Reason
The changes are relevant but not immediately urgent as they are effective in 2025.
Watch items
Hearing Aid Program.xlsx
The document introduces a new fee schedule for the North Carolina Hearing Aid Program, effective April 1, 2026, with specific rates for various hearing aid services effective October 1, 2025.
Highlights
- •New fee schedule for Hearing Aid Program effective April 1, 2026.
- •Specific rates for hearing aid services effective October 1, 2025.
- •Includes rates for monaural and binaural hearing aids and dispensing fees.
Reason
The document outlines future rate changes effective in 2025 and 2026, which are not immediately urgent but relevant for future planning.
Watch items
Hospital Rehab Per Diem.xlsx
The document outlines the rehab per diem fee schedule for North Carolina Medicaid, effective from October 1, 2025, to June 30, 2026. It includes specific rates for various hospitals and notes that these rates do not include reductions.
Highlights
- •Rehab per diem fee schedule for NC Medicaid.
- •Effective from October 1, 2025, to June 30, 2026.
- •Rates do not include reductions.
- •Specific rates listed for multiple hospitals.
Reason
The document is current and outlines future rates, but the effective date is not imminent.
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 October 1, 2025, and includes specific rates for Advance Community Health Inc. The schedule is applicable for the state fiscal year 2026.
Highlights
- •New FQHC fee schedule effective 10/1/2025.
- •Applies to state fiscal year 2026.
- •Specific rate for Advance Community Health Inc: $478.79.
- •Separate reimbursement for services under taxonomy 193200000x.
Reason
The changes are relevant but not immediately urgent, as the effective date is in the future.
Watch items
Home Health Services.xlsx
The document provides a new fee schedule for NC Medicaid Home Health Services, effective October 1, 2025. It includes specific rates for physical therapy visits and various medical supplies.
Highlights
- •New fee schedule for NC Medicaid Home Health Services.
- •Effective date: October 1, 2025.
- •Includes rates for physical therapy visits and medical supplies.
- •Rates do not include reductions.
Reason
The changes are relevant but not immediately urgent, with an effective date in the future.
Watch items
Rural Health Center Dental.xlsx
The document outlines new Medicaid dental reimbursement rates for rural health centers, effective April 1, 2026. It includes specific rates for various dental procedures, effective from October 1, 2025.
Highlights
- •New Medicaid dental reimbursement rates for rural health centers.
- •Effective date for new rates: April 1, 2026.
- •Specific procedure rates effective from October 1, 2025.
- •Includes rates for procedures like bitewing and panoramic radiographic images.
Reason
The changes are relevant but not immediately urgent, with effective dates in 2025 and 2026.
Watch items
State Laboratory.xlsx
The document outlines a new fee schedule for the N.C. State Lab, effective October 1, 2025, with specific rates for various procedures, including newborn and non-newborn genotyping tests.
Highlights
- •New fee schedule for N.C. State Lab effective October 1, 2025.
- •Includes rates for newborn and non-newborn genotyping tests.
- •Specific CPT codes and rates are provided, such as 81109 and 81162.
- •Rates are effective until December 31, 9999.
Reason
The changes are relevant but not immediately urgent, as they take effect in 2025.
Watch items
Hospital Swing Bed Per Diem.xlsx
The document outlines a new swing bed per diem fee schedule effective from October 1, 2025, to June 30, 2026, with updated rates for several hospitals.
Highlights
- •New swing bed per diem fee schedule effective October 1, 2025.
- •Rates updated for UNC Hospitals, MH Mission Hospital, and others.
- •Fee schedule valid through June 30, 2026.
- •No rate reductions included in the schedule.
Reason
The changes are relevant but not immediately effective, with the start date in the future.
Watch items
Nurse Midwives Fee Schedule.xlsx
The document outlines a new fee schedule for nurse midwives in North Carolina, effective October 1, 2025, with specific rates for various procedures. It also mentions a behavioral health rate increase effective January 1, 2024.
Highlights
- •New nurse midwives fee schedule effective October 1, 2025.
- •Behavioral health rate increase effective January 1, 2024.
- •Specific rates listed for procedures like 'drainage of skin abscess' and 'tangential biopsy skin single lesion'.
- •References to ACA physician services and PADP fee schedules.
Reason
The document includes future rate changes and effective dates, but they are not imminent.
Watch items
Nursing Facility Rates.xlsx
The document outlines a new Skilled Nursing Facility (SNF) fee schedule effective from April 1, 2026, to June 30, 2026, detailing 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 document is current but the effective date is not imminent, requiring review but not urgently.
Watch items
Private Duty Nursing.xlsx
The document is a new fee schedule for private duty nursing in North Carolina, effective from October 1, 2025. It includes specific procedure codes and rates for services provided by registered nurses.
Highlights
- •New fee schedule for private duty nursing.
- •Effective date: October 1, 2025.
- •Includes procedure code T1000 TD for RN services.
- •Rates do not contain reductions.
Reason
The changes are relevant but not immediately urgent as the effective date is in the future.
Watch items
General Dental.xlsx
The document outlines updated Medicaid dental reimbursement rates for various dental procedures, effective October 1, 2025. It includes specific rates for radiographic images and other dental services.
Highlights
- •New reimbursement rates for dental procedures effective October 1, 2025.
- •Includes rates for intraoral and extraoral radiographic images.
- •Applies to general dentists, oral surgeons, pediatric dentists, periodontists, and orthodontists.
- •Rates do not guarantee service coverage; refer to clinical coverage policies.
Reason
The changes are relevant but not immediately urgent, with an effective date in the future (October 2025).
Watch items
Speech Therapy and Audiology.xlsx
The document provides a new fee schedule for speech therapy and audiology services in North Carolina, 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.
- •Includes specific rates for procedures like audiometry and tympanometry.
- •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
Auditory Implant.xlsx
The document outlines a revised fee schedule for auditory implant parts under NC Medicaid, effective October 1, 2025. It includes specific rates for various cochlear implant components.
Highlights
- •Fee schedule revision date: April 1, 2026
- •Effective date for rates: October 1, 2025
- •Includes rates for cochlear implant components like headsets and batteries
- •Rates are listed for replacement parts
Reason
The changes are relevant but not immediately urgent, as the effective date is in the future.
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 April 1, 2026, to June 30, 2026. It includes specific per diem rates for various facilities.
Highlights
- •New short stay rates for skilled nursing facilities.
- •Effective date: April 1, 2026 - June 30, 2026.
- •Rates applicable to managed care health plan reimbursement.
- •Specific per diem rates listed for multiple facilities.
Reason
The changes are relevant but not urgent as they are effective in 2026.
Watch items
Podiatry Services.xlsx
The document outlines a new fee schedule for podiatry services in North Carolina, effective April 1, 2026, with specific rates for various procedures starting October 1, 2025.
Highlights
- •New podiatry services fee schedule for North Carolina.
- •Effective date for new rates: October 1, 2025.
- •Latest revision date: April 1, 2026.
- •Includes specific rates for procedures like debridement and surgical cleansing.
Reason
The document contains upcoming rate changes effective in 2025, but the revision date is in 2026, indicating a future implementation.
Watch items
ACA Nurse Practitioner.xlsx
The document introduces a new ACA Nurse Practitioner fee schedule for North Carolina Medicaid, specifying taxonomy-defined rates and procedure codes. It also lists new rates for various services effective from October 1, 2025.
Highlights
- •New ACA Nurse Practitioner fee schedule for NC Medicaid.
- •Taxonomy-defined rates for specific procedure codes.
- •New rates effective October 1, 2025.
- •Includes synch audio-only and new patient office visit rates.
Reason
The changes are relevant but not immediately urgent, with an effective date in 2025.
Watch items
FQHC Dental.xlsx
The document outlines new Medicaid reimbursement rates for FQHC dental services effective April 1, 2026. It includes specific rates for various dental procedures, such as bitewing radiographic images and sialography, effective from October 1, 2025.
Highlights
- •Effective date for FQHC dental rates: April 1, 2026
- •Rates for procedures like D0270, D0272, D0273, D0274, D0310, D0320, D0330, D0340
- •Rates effective from October 1, 2025
- •Providers should bill usual and customary charges
- •Refer to NC Medicaid bulletins for updates
Reason
The document contains future rate changes, but they are not immediately effective.
Watch items
Nurse Practitioner and CRNA Fee Schedule.xlsx
The document includes updates to the North Carolina Medicaid nurse practitioner fee schedule and mentions a behavioral health rate increase effective January 1, 2024. It also lists specific CPT codes with rates effective from October 1, 2025.
Highlights
- •Nurse practitioner fee schedule update for NC Medicaid.
- •Behavioral health rate increase effective January 1, 2024.
- •CPT codes with rates effective October 1, 2025.
- •Includes taxonomies for nurse practitioners.
Reason
The document contains future rate changes and a behavioral health rate increase, but the effective dates are not imminent.
Watch items
Independent Diagnostic Testing Facility.xlsx
The document provides a new fee schedule for Independent Diagnostic Testing Facility Services, effective October 1, 2025, with specific rates for various procedures.
Highlights
- •New fee schedule for IDTF services.
- •Effective date: October 1, 2025.
- •Includes rates for procedures like punch biopsy and breast lesion drainage.
- •Facility and non-facility rates provided.
- •Last update noted as March 10, 2026.
Reason
The changes are relevant but not immediately urgent, as the effective date is in the future.
Watch items
Durable Medical Equipment.xlsx
The document is a revised fee schedule for Durable Medical Equipment (DME) in North Carolina, effective April 1, 2026. It includes specific rates for various items, effective from October 1, 2025.
Highlights
- •DME fee schedule revision effective April 1, 2026.
- •Rates effective from October 1, 2025, for items like A4437, A4481, A4604.
- •Providers should bill usual and customary rates, not maximum rates.
- •Reference to Medicaid billing guide and clinical coverage policies.
Reason
The document outlines future rate changes effective in 2025 and 2026, which are not immediately urgent but relevant for planning.
Watch items
Respiratory Therapy.xlsx
The document provides a new respiratory therapy fee schedule for North Carolina, effective October 1, 2025. It includes specific rates for various procedures, such as tracheotomy tube changes and spirometry.
Highlights
- •New respiratory therapy fee schedule for North Carolina.
- •Effective date: October 1, 2025.
- •Includes rates for procedures like tracheotomy tube change and spirometry.
- •Rates are specified for both facility and non-facility settings.
Reason
The changes are relevant but not urgent as they are effective in 2025.
Watch items
Home Infusion Therapy.xlsx
The document outlines updates to the NC Medicaid home infusion therapy fee schedule, effective April 1, 2026, with specific rates for enteral nutrition products effective October 1, 2025.
Highlights
- •New fee schedule for NC Medicaid home infusion therapy effective April 1, 2026.
- •Enteral nutrition product rates effective October 1, 2025.
- •Includes rates for pediatric enteral formulas (B4161, B4162).
- •Providers should bill usual and customary rates.
Reason
The document includes future effective dates for rate changes, but they are not imminent.
Watch items
Chiropractic Services.xlsx
The document outlines a new chiropractic services fee schedule for North Carolina, effective April 1, 2026. It includes specific rates for various radiologic exams of the spine, effective from October 1, 2025.
Highlights
- •New chiropractic services fee schedule effective April 1, 2026.
- •Includes rates for spine radiologic exams effective October 1, 2025.
- •Rates listed do not include reductions.
- •Providers should refer to Medicaid billing guides for coverage details.
Reason
The document is current but changes are not immediately effective, and it lacks immediate reimbursement impact.
Watch items
Optical Program.xlsx
The document outlines a new optical program fee schedule for NC Medicaid, effective April 1, 2026, with specific rates for various optical services starting October 1, 2025.
Highlights
- •New optical program fee schedule effective April 1, 2026.
- •Rates for services like contact lens dispensing effective October 1, 2025.
- •Includes taxonomies: 156fc0800x, 156fc0801x, 156fx1800x, 207w00000x, 152w00000x.
- •Providers should refer to Medicaid billing guide for coverage details.
Reason
The document is current but changes are not effective immediately, impacting future reimbursement.
Watch items
Laboratory.xlsx
The document provides a new laboratory fee schedule from the NC Department of Health and Human Services, effective October 1, 2025. It includes specific rates for various laboratory tests, such as the acute hepatitis panel and hepatic function panel.
Highlights
- •New laboratory fee schedule effective October 1, 2025.
- •Includes rates for tests like acute hepatitis panel ($58.07) and hepatic function panel ($9.99).
- •Providers should bill usual and customary charges.
- •Rates do not guarantee service coverage.
Reason
The changes are relevant but not urgent as they are effective in 2025.
Watch items
Low Impact (1)
Hospital Lower Level of Care.xlsx
The document outlines a fee schedule for lower level of care rates in North Carolina, with updates last made on March 12, 2026. It includes specific per diem rates for swing bed and vent levels of care, with effective dates ranging from 2020 to 2022.
Highlights
- •Lower level of care fee schedule updated on 03/12/2026.
- •Swing bed per diem rate: $129.15 effective from 2022-03-01.
- •Vent level of care per diem rate: $423.61 ended on 2022-02-28.
Reason
The document appears to be archival with effective dates in the past, and no new rates are effective imminently.