North Carolina
highNC FEE Schedules
Run Date and Time
Jul 15, 2026
3m 18s
Run Metrics
Fee Schedule Impacts
Run summary
This run for North Carolina Medicaid / NC_FEE_SCHEDULES identified 0 changed documents and 24 newly discovered documents. 5 item(s) are high priority. 23 newly discovered item(s) appear current or upcoming.
High Impact (5)
Hospital DRG Base Rate.xlsx
The document outlines updated DRG base rates for North Carolina Medicaid, effective July 1, 2026, through June 30, 2027. It includes specific rate changes for several hospitals.
Highlights
- •DRG base rates updated for FY 2026-2027.
- •Effective date: July 1, 2026.
- •Includes rates for specific hospitals like DLP Harris Regional Hospital and Henderson County Hospital Corp.
- •Grouper version update to v44 effective October 1, 2026.
Reason
The document contains specific reimbursement-impacting rate changes effective soon.
Watch items
Hospital Rehab Per Diem.xlsx
The document outlines updated Medicaid rehab per diem rates for North Carolina hospitals, effective from July 1, 2026, to June 30, 2027. Specific rate changes are listed for several hospitals, indicating a reimbursement-impacting update.
Highlights
- •Rehab per diem rates updated for FY 2026.
- •Effective date: July 1, 2026, to June 30, 2027.
- •Rates specified for multiple hospitals.
- •Includes provider appeal rights information.
Reason
The document contains specific rate changes effective in the near future, impacting reimbursement.
Watch items
FFS RHC PPS-APM.xlsx
The document outlines a new fee schedule for the North Carolina Department of Health and Human Services, effective July 1, 2026, for various providers under the fee-for-service model. It includes specific PPS/APM rates for multiple providers.
Highlights
- •New fee schedule effective July 1, 2026.
- •Applies to fee-for-service rural health clinics.
- •Includes specific PPS/APM rates for providers.
- •Provider appeal rights referenced in administrative code.
Reason
The document contains specific rate changes effective soon, impacting reimbursement.
Watch items
Pharmacy Diabetic Testing CGM Condoms and Spermicides.xlsx
The document outlines updated fee schedules for diabetic testing supplies and continuous glucose monitors, effective from February 1, 2026. It includes specific rates for the Freestyle Libre 3 system sensor kit and reader.
Highlights
- •Revised fee schedule for diabetic testing supplies and CGMs.
- •Effective date for new rates: February 1, 2026.
- •Freestyle Libre 3 system sensor kit: $76.48 for 2 kits/28 days.
- •Freestyle Libre 3 reader: $70 for 1/365 days.
- •Freestyle Libre 2 plus sensor: $81.94 for 2/30 days.
Reason
The document includes specific rate changes effective soon, impacting reimbursement.
Watch items
Physician Administered Drug Program.xlsx
The document is a revised fee schedule for the Physician Administered Drug Program in North Carolina, effective June 11, 2026. It includes specific rates for drugs like Lemtrada and Xenpozyme, with effective dates ranging from May 2026 onward.
Highlights
- •Revised PADP fee schedule effective June 11, 2026.
- •Includes rates for Lemtrada and Xenpozyme.
- •Effective dates for rates start from May 2026.
Reason
The document contains new reimbursement rates effective soon, impacting billing and reimbursement.
Watch items
Medium Impact (17)
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. It includes specific CPT codes that are not separately reimbursable as they are included in the PPS APM rate.
Highlights
- •Effective date: July 1, 2026
- •CPT codes 11001, 11004, 11005, 11006, 11008, 11042 included in PPS APM rate
- •No separate reimbursement for listed CPT codes
- •Applies to rural health clinic physician services
Reason
The changes are relevant but not urgent as they are effective in 2026.
Watch items
NC Medicaid State Institutions.xlsx
The document outlines new Medicaid rates for state institutions in North Carolina, effective July 1, 2026. It includes specific rates for various facilities such as Black Mountain Neuro Medical Treatment and Broughton Hospital.
Highlights
- •New Medicaid rates effective 7/1/2026.
- •Includes rates for Black Mountain Neuro Medical Treatment and Broughton Hospital.
- •Rates are listed with provider names and NPI numbers.
Reason
The changes are not effective immediately, but they provide future rate information that may impact planning.
Watch items
Int. Care Facility (ICF-IID) Fee Schedule.xlsx
The document outlines a $34.29 rate increase effective July 1, 2025, for Medicaid direct fee-for-service claims in North Carolina. It also lists new NPIs and rates effective October 1, 2025, for various group homes.
Highlights
- •$34.29 rate increase effective July 1, 2025
- •New NPIs and rates effective October 1, 2025
- •Applies to Medicaid direct (FFS) claims
- •Includes specific group home rates
- •Managed care providers should contact contracted health plans
Reason
The changes are not immediate but involve future rate increases and new NPIs, requiring review for future planning.
Watch items
Hospital Provider Outpatient RCC.xlsx
The document outlines updated Medicaid outpatient rates for various hospitals in North Carolina, effective from July 1, 2026, to June 30, 2027. These updates include specific rate changes for several hospitals, indicating reimbursement-impacting changes.
Highlights
- •Effective date: July 1, 2026 - June 30, 2027
- •Rate updates for multiple hospitals
- •Includes provider appeal rights information
- •Specific rates listed for each hospital
Reason
The changes are not effective immediately but involve reimbursement-impacting updates for the next fiscal year.
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.
- •Covers services in hospital inpatient/outpatient settings.
- •Effective date: 2026-07-01 to 2027-06-30.
Reason
The changes are relevant but not immediately urgent, with an effective date in 2026.
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 in 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 changes are not effective immediately, but they include specific rate updates for the upcoming period.
Watch items
Hospital Psych Per Diem.xlsx
The document outlines a new psych per diem fee schedule effective from July 1, 2026, to June 30, 2027, with a base rate of $895.63. It specifies that LME/MCOs and PHPs must reimburse providers at this rate unless an alternative arrangement is agreed upon after October 1, 2025.
Highlights
- •New psych per diem fee schedule effective July 1, 2026.
- •Base rate set at $895.63 per diem.
- •Applies to North Carolina Department of Health and Human Services.
- •LME/MCOs and PHPs must reimburse at 100% of base rate unless otherwise agreed.
- •Effective through June 30, 2027.
Reason
The changes are not effective immediately, but they involve future reimbursement rates.
Watch items
Dialysis Provider Specific.xlsx
The document outlines a non-published fee schedule for dialysis facilities, effective from October 1, 2025. It includes specific rates for various dialysis services by provider.
Highlights
- •Fee schedule for dialysis facilities effective October 1, 2025.
- •Includes rates for hemodialysis and peritoneal dialysis.
- •Providers listed with specific NPI numbers and rates.
- •Document revised on June 10, 2026.
Reason
The changes are not immediately effective but are relevant for future 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 procedures 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.
- •Procedures 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
Hospital Swing Bed Per Diem.xlsx
The document outlines a new swing bed per diem fee schedule effective from July 1, 2026, to June 30, 2027, with a rate of $129.15 for several hospitals in North Carolina.
Highlights
- •New swing bed per diem fee schedule.
- •Effective dates: July 1, 2026 - June 30, 2027.
- •Rate: $129.15 for specified hospitals.
- •Applies to Medicare defined swing bed units.
Reason
The changes are not effective immediately, but they involve future reimbursement rates.
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 effective October 1, 2025.
- •Includes CPT codes: 10021, 10030, 10035, 10036, 10040, 10060, 10061, 10080, 10081.
- •Rates for procedures like 'drainage of skin abscess' and 'acne surgery' updated.
- •Effective dates range from 2025-10-01 to 9999-12-31.
Reason
Changes are relevant but effective in the future, not immediately urgent.
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. Several services are included in the PPS APM rate and are not separately reimbursable.
Highlights
- •New fee schedule for rural health clinic non-core services.
- •Effective date: July 1, 2026.
- •Applies to state fiscal year 2027.
- •Services included in PPS APM rate, not separately reimbursable.
Reason
The changes are relevant but not immediately urgent, as they take effect in 2026.
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
MC FQHC Physician Services.xlsx
The document introduces a new fee schedule for the North Carolina Medicaid program, effective July 1, 2026, for Federally Qualified Health Center (FQHC) physician services. Several CPT codes are included but are not separately reimbursable as they are part of the PPS APM rate.
Highlights
- •New fee schedule for FQHC physician services.
- •Effective date: July 1, 2026.
- •Several CPT codes included but not separately reimbursable.
- •Applies to North Carolina Medicaid program.
Reason
The changes are relevant but not urgent as they are effective in 2026.
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 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 immediately urgent, with an effective date in 2026.
Watch items
Public Ambulance Provider Managed Care.xlsx
The document outlines a new fee schedule for public ambulance providers in North Carolina, effective July 1, 2026. It includes cost-based rates for various counties and specifies HCPCS codes for billable ground and air transport services.
Highlights
- •Effective date: July 1, 2026
- •Applies to in-network public ambulance providers
- •Cost-based rates established for each provider
- •Includes HCPCS codes: A0426, A0427, A0428, A0429, A0433, T2003, A0430, A0431
- •Rate floor set for managed care
Reason
The changes are not effective immediately, but they involve significant future reimbursement updates.
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 guides for coverage details.
Reason
The changes are relevant but not immediately urgent, as they are effective in 2025.
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 in North Carolina
Reason
The effective date is far in the future, reducing urgency for immediate review.
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 final rate.
- •Specific facilities and their rates are listed.
- •Provider appeal rights are referenced in administrative code 10a ncac 22j.0102.
Reason
The effective date is far in the future, reducing urgency for immediate review.
Watch items