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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Fee Schedules

Announcements

The Department of Health and Human Services, Division of Medical Assistance (DMA) here by provides notice of its intent to amend the Reimbursement sections of Medicaid State Plan. To comply with SL 2011 - 145, section 10.37.(a)(6) and N.C. Gen. Stat. Section 108A-70.21(b1), DMA has submitted State Plan Amendments for the purpose of revising rate methodology language to reflect for SFY 2011 – 2012. Effective November 1, 2011 rates paid to North Carolina Medicaid and Health Choice services providers will be reduced by 2.67%. Nursing Homes will have their rate reductions effective July 1, 2011. Hospital providers will follow their normal rate update schedule of October 1, 2011 with the implementation of the DRG update. More detailed information will be posted on the DMA website under the heading of “What’s New” section at http://www.ncdhhs.gov/dma/provider/index.htm. Fee schedules previously posted on the website with the effective date of October 1, 2011 were removed and revised fee schedules have been posted to reflect the November 1, 2011 rate effective date. For questions concerning the reductions, please call DMA Finance Management at 919-647-8111.

The inclusion of a rate on these fee schedules does not guarantee that a service is covered. Please refer to the Medicaid Billing Guide and the Medicaid Clinical Coverage Policies and the Health Choice Clinical Coverage Policies.

The rates listed in the online fee schedules are current through the date of publication indicated on the fee schedule. Providers should review the general Medicaid bulletin for revisions, deletions, and additions to the fee schedules and for changes to services listed on these schedules.

These rates represent the maximum reimbursement rate. Providers are expected to bill their usual and customary charge.

CPT codes, descriptors, and other data only are copyright 2009 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.


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ACA Pseudo Medicare Fee Schedule (CPT/HCPCS)

Adult Care Homes

Ambulance Services (CPT/HCPCS)

Ambulatory Surgical Centers (CPT/HCPCS)

Anesthesia

Auditory Implant Parts

Behavioral Health Services

CAP-I/DD Services

Direct-Enrolled Behavioral Health Services

Enhanced Mental Health Services

Psychiatric Reduction Percentage Payment Schedule

Other Behavior Health Services

Chiropractic Services (CPT/HCPCS)

Community Alternatives Programs (CAP)

CAP for Children (CAP/C)

CAP/CHOICE

CAP for Disabled Adults (CAP/DA)

CAP-I/DD

Dental

General Dentist, Oral Surgeon, Pediatric Dentist, Periodontist, & Orthodontist

Physicians, FQHC, & RHC

All Dental Providers

Durable Medical Equipment (DME)

DME

Incontinence Supplies Revision

Federally Qualified Health Center (CPT/HCPCS)

Freestanding Birth Center Services (CPT/HCPCS)

Hearing Aid Program

HIV Case Management

Home Care

In-Home Care Services (Personal Care Services)

Private Duty Nursing

Home Health

Home Infusion Therapy

Hospice

Hospitals

ICF-MR Rates

Independent Practitioner Services

Multiple Independent Practitioners (CPT/HCPCS)

Occupational Therapy (CPT/HCPCS)

Physical Therapy (CPT/HCPCS)

Respiratory Therapy (CPT/HCPCS)

Speech Therapy & Audiology (CPT/HCPCS)

Laboratory (CPT/HCPCS)

Local Educational Agencies (CPT/HCPCS)

Medicaid Crossover Percentage Payment Schedule

  • Adobe Acrobat Format
  • Microsoft Excel Format

Nurse Midwife (CPT/HCPCS)

Nurse Practitioner and CRNA (CPT/HCPCS)

Nursing Facility Rates

Optical Program (CPT/HCPCS)

Optometry Services (CPT/HCPCS)

Orthotic and Prosthetic Devices

Personal Care Services

Physician Assistant (CPT/HCPCS)

Physician Drug Program

Physician Services (CPT/HCPCS)

Provisionally Licensed Professionals (CPT/HCPCS)

Podiatry Services (CPT/HCPCS)

Radiological/Imaging Services (CPT/HCPCS)

Rural Health Clinic (CPT/HCPCS)

Targeted Case Management

Vent Facility Rates

Fee schedules that are not available online can be requested by completing and submitting the Fee Schedule Request Form. Choose an option below:

 

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