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

Fee Schedules

Announcements

The 3% fee reduction in accordance with North Carolina Session Law 2013-360, Section 12H.18(b) was implemented on March 2, 2015. The reduction was announced in the January, 2014 Medicaid Bulletin article titled 3 Percent Rate Reduction.

3% rate reduction for Primary Care Physician who attested for Affordable Care Act (ACA) Enhanced Payments

  • Subject to the 3% fee reduction enacted under Session Law 2013 – 360
  • The reduction was effective Jan. 1, 2015 and was implemented March 2, 2015.
  • NCTracks will reprocess claims from Jan. 1, 2015 through March 1, 2015 at a later date.

3% rate reduction for Physician Services (physicians, midwives, nurse practitioners, physician assistants and certified registered nurse assistants)

  • Subject to the 3% fee reduction enacted under Session Law 2013 – 360
  • The reduction was effective Jan. 1, 2014 and was implemented March 2, 2015.
  • NCTracks will reprocess claims from Jan. 1, 2014 through March 1, 2015 at a later date.

Frequently Asked Questions (FAQ)

Q - Are physicians in North Carolina still receiving ACA Enhanced Payments?

No, enhanced payments ended for all services provided on or after January 1, 2015.

Q - Why did the 3% fee reduction not apply to ACA primary care physicians until Jan. 1, 2015, when it applied to all other services effective Jan. 1, 2014?

North Carolina Session Law 2013 – 360 instructed that ACA primary care physicians were to be exempt from the 3% rate reduction until Jan. 1, 2015. Current fee schedules have been adjusted to reflect the 3% fee reduction and have been posted to the DMA website. DMA will alert providers through Medicaid bulletins, NCTracks email blasts and in the NCTracks provider portal as more information is available.

REMINDER

Pending Centers for Medicare & Medicaid Services (CMS) approval, all providers will be subject to a 1% fee schedule reduction effective January 1, 2015 as enacted by Session Law 2014 – 100.


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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

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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