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NC Division of Medical Assistance |
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Cost Asessments, Reports, and Settlements
The Department of Health and Human Services, Division of Medical Assistance (DMA) hereby 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.
Ambulance Services (CPT/HCPCS)
Ambulatory Surgical Centers (CPT/HCPCS)
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
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)
Independent Practitioner Services
Laboratory (CPT/HCPCS)
Local Educational Agencies (CPT/HCPCS)
Medicaid Crossover Percentage Payment Schedule
Nurse Midwife (CPT/HCPCS)
Nurse Practitioner and CRNA (CPT/HCPCS)
Optical Program (CPT/HCPCS)
Optometry Services (CPT/HCPCS)
Orthotic and Prosthetic Devices
Physician Assistant (CPT/HCPCS)
Physician Services (CPT/HCPCS)
Provisionally Licensed Professionals (CPT/HCPCS)
Podiatry Services (CPT/HCPCS)
Radiological/Imaging Services (CPT/HCPCS)
Rural Health Clinic (CPT/HCPCS)
Fee schedules that are not available online can be requested by completing and submitting the Fee Schedule Request Form. Choose an option below:
