North Carolina
highNC FEE Schedules
Run Date and Time
Jun 15, 2026
1m 30s
Run Metrics
Fee Schedule Impacts
Run summary
This run for North Carolina Medicaid / NC_FEE_SCHEDULES identified 0 changed documents and 14 newly discovered documents. 2 item(s) are high priority. 13 newly discovered item(s) appear current or upcoming.
High Impact (2)
Anesthesiology Base Units.xlsx
The document introduces a new anesthesia fee schedule for North Carolina Medicaid, effective October 1, 2025. It specifies fixed rates for various anesthesia services related to vaginal delivery.
Highlights
- •New anesthesia fee schedule for North Carolina Medicaid.
- •Effective date: October 1, 2025.
- •Fixed rate of $209.63 for anesthesia services related to vaginal delivery.
- •Applies to services by anesthesiologists, CRNAs, and under medical direction.
Reason
The document specifies new reimbursement rates effective soon, impacting billing and 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. The revised schedule was last uploaded on June 1, 2026.
Highlights
- •Revised fee schedule for diabetic testing supplies and condoms.
- •Rate change for condoms effective October 1, 2024.
- •Document last uploaded on June 1, 2026.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Medium Impact (12)
Orthotics and Prosthetics.xlsx
The document provides a new orthotics and prosthetics fee schedule effective June 1, 2026, with specific rates for various HCPCS codes starting October 1, 2025.
Highlights
- •New orthotics and prosthetics fee schedule effective June 1, 2026.
- •Rates for HCPCS codes A6530, A6533, A6534, A6535, A6536 effective October 1, 2025.
- •Prior approval required for HCPCS code A6530.
- •Providers should bill usual and customary rates, not maximum rates.
Reason
The document includes future rate changes and effective dates, but they are not imminent.
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
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
- •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 in North Carolina
Reason
The changes are not imminent, but they include specific rate updates for future implementation.
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.
- •CPT codes 11005, 11006, 11008, 11042, 11043 included in PPS APM rate.
- •Procedures not separately reimbursable.
- •Applies to Rural Health Clinic Physician Services.
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, through June 30, 2026. It includes specific rates for various providers under the Rural Health Clinic PPS-APM/Well Child program.
Highlights
- •New fee schedule for NC Department of Health and Human Services.
- •Effective date: October 1, 2025.
- •End date: June 30, 2026.
- •Includes provider-specific PPS-APM rates.
Reason
The changes are relevant but not immediately urgent, as they take effect in 2025.
Watch items
Physician Administered Drug Program.xlsx
The document is a revised fee schedule for the Physician Administered Drug Program in North Carolina, effective May 27, 2026. It includes specific rate updates for drugs like Lemtrada and Xenpozyme, with effective dates ranging from 2025 to 2026.
Highlights
- •Revised PADP fee schedule effective May 27, 2026.
- •Includes rates for Lemtrada and Xenpozyme.
- •Effective dates for rates range from 2025 to 2026.
- •Providers should refer to Medicaid bulletins for updates.
Reason
The document contains future rate updates but lacks immediate urgency as the effective date is in 2026.
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 changes are not imminent, but they provide future rate information that may impact planning.
Watch items
FFS RHC PPS-APM.xlsx
The document outlines new fee-for-service rates for various providers effective from October 1, 2025, to June 30, 2026. It includes specific rates for rural health clinics and other medical centers.
Highlights
- •Effective date: 10/1/2025
- •End date: 6/30/2026
- •Provider-specific rates listed
- •Includes rural health clinics and medical centers
Reason
The document contains future rate changes but they are not immediately effective.
Watch items
Dialysis Provider Specific.xlsx
The document outlines a new dialysis fee schedule effective October 1, 2025, with specific rates for various providers. Rates are detailed for hemodialysis and peritoneal dialysis services.
Highlights
- •New dialysis fee schedule effective October 1, 2025.
- •Rates specified for hemodialysis and peritoneal dialysis.
- •Providers include Bio Medical Applications of NC, Total Renal Care of NC, and others.
- •Rates range from $140.58 to $144.6382 for hemodialysis.
Reason
The changes are not effective immediately, but they involve specific rate updates for dialysis services starting in 2025.
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 included but are not separately reimbursable as they are part of the PPS APM rate.
Highlights
- •New fee schedule for FQHC non-core services.
- •Effective date: October 1, 2025.
- •Includes CPT codes 11005, 11006, 11008, 11042, 11043.
- •Codes are not separately reimbursable.
Reason
The changes are relevant but not immediately urgent, with an effective date in the future.
Watch items
Hospital Provider Outpatient RCC.xlsx
The document outlines updated Medicaid outpatient rates for several hospitals in North Carolina, effective from October 1, 2025, to June 30, 2026. Notable changes include rate adjustments for specific hospitals and units.
Highlights
- •Effective date: October 1, 2025
- •End date: June 30, 2026
- •Rate change for Atrium Health Cabarrus: 0.125 to 0.1189625
- •New rates for DLP Rutherford Hospital and Forsyth Memorial Hospital
- •Includes provider appeal rights information
Reason
The document contains upcoming rate changes effective in 2025, but the changes are not immediate.
Watch items
MC FQHC Physician Services.xlsx
The document introduces a new fee schedule for Federally Qualified Health Center (FQHC) physician services effective October 1, 2025, for the state fiscal year 2026. Specific CPT codes related to debridement and removal of prosthetic material are included in the PPS APM rate and are not separately reimbursable.
Highlights
- •New FQHC fee schedule effective 10/1/2025.
- •Applies to state fiscal year 2026.
- •CPT codes 11005, 11006, 11008, 11042, 11043 included in PPS APM rate.
- •Codes not separately reimbursable.
Reason
The changes are relevant but not immediately urgent as they are effective in 2025.
Watch items
Low Impact (0)
No documents in this severity group.