Medicaid Clinical Coverage Policies and Provider Manuals

NCGS §108A-54.2 requires that the Department of Health and Human Services consult with and seek the advice of the Physician Advisory Group of the North Carolina Medical Society in developing new or amended Medicaid clinical coverage policies. Additionally, the law requires the Department to publish proposed new or amended clinical coverage policies on the Department's web site and accept oral and written comments. While all consultation and comments are considered, final approved Medicaid policies may or may not reflect this input. The Department has delegated to the DMA Division Director the authority to make the final decisions regarding clinical coverage policies.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) information is not included in all provider manuals.  For information about EPSDT, please refer to the Division's EPSDT Policy Instructions Update, effective 9/1/07, on the EPSDT Provider page.

Files below are in PDF format. The free Adobe Acrobat Reader (minimum 4.0) is required to view and print PDF files.

CPT codes, descriptors, and other data only are copyright 2006 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

Additional Medicaid Information:

• Laboratory Services - Provider Seminar Handout (38 KB Adobe Acrobat Reader)
• EPSDT Policy Instructions Update, August 17, 2007
• General and Special Medicaid Bulletins
• Proposed Clinical Coverage Policies

Updated July 15, 2008