North Carolina
highNC FEE Schedules
Run Date and Time
Sep 15, 2026
3m 42s
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. 6 item(s) are high priority. 20 newly discovered item(s) appear current or upcoming.
High Impact (6)
Physician Assistant Fee Schedule.xlsx
The document introduces a new fee schedule for physician assistants 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 assistants effective 2025-10-01.
- •Includes rates for procedures like acne surgery and abscess drainage.
- •References ACA-defined taxonomy rates and PADP fee schedule.
- •Effective dates range from 2025-10-01 to 9999-12-31.
Reason
The document contains specific rate changes effective soon, 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 multiple 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
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 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 listed do not guarantee service coverage.
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 10/1/2025.
- •3% rate reduction for multiple services.
- •8% reduction for overlapping personal care services.
- •Providers must bill usual and customary charges.
- •Previous rates end-dated as of 9/30/2025.
Reason
The document includes imminent rate reductions effective October 1, 2025, 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 a behavioral health rate increase. Additionally, new rates for specific 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 CPT codes 10021, 10030, 10035, 10036, 10040, 10060, 10061.
Reason
The document includes upcoming rate changes and effective dates that impact reimbursement.
Watch items
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 various hospitals and notes the 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
Medium Impact (16)
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 fiscal year 2027. It includes specific rates for various providers under the Rural Health Clinic PPS-APM/Well Child program.
Highlights
- •New fee schedule for fiscal year 2027.
- •Effective date: July 1, 2026.
- •Includes provider-specific PPS APM rates.
- •Applies to Rural Health Clinic PPS-APM/Well Child program.
- •Updated on August 26, 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. 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.'
- •Rates are subject to change based on NDC.
Reason
The changes are relevant but not urgent as they are effective in 2025.
Watch items
Ambulatory Surgical Centers.xlsx
The document is a revised fee schedule for Ambulatory Surgical Centers in North Carolina, effective October 1, 2025, with rates for specific procedure codes provided.
Highlights
- •Revised fee schedule for Ambulatory Surgical Centers.
- •Effective date: October 1, 2025.
- •Includes procedure codes 10030, 11443, 11444, 11446, 11450, 11451.
- •Facility and non-facility rates are specified.
- •Modifier 'sg' is used for fee-for-service.
Reason
The document contains upcoming rate changes effective in 2025, but the effective date is not imminent.
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 lists new rates for various procedures, such as 'drainage of skin abscess' and 'acne surgery.'
Highlights
- •New rates effective October 1, 2025.
- •Includes procedures like 'drainage of skin abscess' and 'acne surgery'.
- •Rates listed for CPT codes 10021, 10030, 10035, 10036, 10040, 10060, 10061, 10080, 10081.
Reason
The changes are relevant but not immediately urgent, as they take effect in 2025.
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
- •New rates effective 10/1/2025 for hospital outpatient lab services.
- •Rates are 146.38% of Medicaid direct FFS rates.
- •Draft rates pending CMS approval.
- •Applies to managed care services under NC Medicaid.
Reason
The changes are not effective immediately and are pending approval, but they are relevant for future planning.
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. 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, to September 30, 2026
- •Current inpatient RCC rates based on DRG Grouper V43.1
- •Transition to DRG Grouper V44 on October 1, 2026
- •Specific rates listed for multiple hospitals
Reason
The document is current but changes are not immediately effective, and it primarily lists rates without immediate impact.
Watch items
Hospital Psych Per Diem.xlsx
The document outlines the psych per diem fee schedule for North Carolina Medicaid, effective from July 1, 2026, to June 30, 2027, with a base rate of $895.63. Providers must reimburse at least 100% of this rate unless an alternative arrangement is agreed upon.
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
- •Providers must reimburse at least 100% of the base rate
- •Alternative reimbursement arrangements allowed post-October 1, 2025
Reason
The document is current but effective in the future, indicating a need for awareness but not immediate action.
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. It includes specific rates for various facilities, impacting reimbursement for Medicaid long-term care services.
Highlights
- •New SNF fee schedule effective July 1, 2026.
- •Covers Medicaid long-term care rates.
- •Includes specific rates for facilities like Abbotts Creek and Abernethy Laurels.
- •Effective period: July 1, 2026, to September 30, 2026.
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) with an effective date of July 1, 2026, and outlines specific reimbursement rates for services performed in hospital settings.
Highlights
- •New FQHC fee schedule effective 7/1/2026.
- •Provider-specific PPS/APM rate: $438.99.
- •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
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
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.
Reason
The changes are relevant but not immediately urgent, as the effective date is in the future.
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 the fiscal year 2027. It includes specific PPS/APM rates for various providers.
Highlights
- •New fee schedule for fiscal year 2027.
- •Effective date: July 1, 2026.
- •Includes specific PPS/APM rates for providers.
- •Provider appeal rights referenced in administrative code.
Reason
The changes are relevant but not immediately 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 performed in hospital settings.
Highlights
- •New FQHC PPS/APM fee schedule effective 7/1/2026.
- •Applies to state fiscal year 2027.
- •Specific rates for Advance Community Health Inc. included.
- •Reimbursement details for hospital services under taxonomy 193200000x.
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 procedure codes 92557, 92567, 92568, 92570, 92571, 92572, 92576, 92579.
Reason
The changes are relevant but not immediately urgent, as they take effect in 2025.
Watch items
Local Education Agencies.xlsx
The document provides a fee schedule update for North Carolina's Medicaid services, including specific rates for various procedures with effective dates ranging from 2022 to 2026.
Highlights
- •New fee schedule for North Carolina Medicaid services.
- •Includes rates for procedures like cast applications and psychiatric evaluations.
- •Effective dates range from 2022-04-01 to 2026-07-01.
- •Rates provided for both facility and non-facility settings.
Reason
The document includes specific rates and effective dates, but many are not imminent, reducing urgency.
Watch items
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 NC Medicaid.
- •Effective dates: July 1, 2026 - June 30, 2027.
- •Includes specific rates for hospitals like Atrium Health Cabarrus and AdventHealth Hendersonville.
- •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
Low Impact (0)
No documents in this severity group.