NC DMA: Fee Schedules

Division of Medical Assistance
Providing access to high quality, medically necessary health care for eligible North Carolina residents through cost effective purchasing of health care services and products.

Medicaid for
North Carolinians

Health Choice for Children

Medicaid Providers

DMA
Publications

Fee Schedules

The rates listed in the online fee schedues 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 2005 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

Fee schedules that are not availalbe online can be requested by completing and submitting the Fee Schedule Request Form.

Announcements

Deferral of Rate Increases and the Reduction of Rates for Targeted Case Management

Quick Links

Calendars

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Adult Care Homes

Adobe Acrobat Format - updated 05/09/07
Microsoft Excel Format - updated 05/09/07

Ambulance Services (CPT / HCPCS)

Adobe Acrobat Format - updated 04/01/07
Microsoft Excel Format - updated 04/01/07
Adobe Acrobat Format - updated 06/01/05

Ambulatory Surgical Centers (CPT / HCPCS)

Adobe Acrobat Format - updated 10/01/07
Microsoft Excel Format - updated 10/01/07
Adobe Acrobat Format - updated 01/01/06
Microsoft Excel Format - updated 01/01/06

Adobe Acrobat Format - updated 10/22/08
Microsoft Excel Format - updated 10/22/08
Anesthesia Base Units - 2008

Behavioral Health Services

CAP-MR/DD Services

Comprehensive Waiver
- Adobe Acrobat Format - updated 10-28-08
- Microsoft Excel Format - updated 10-28-08
Supports Waiver

Adobe Acrobat Format - updated 10-28-08
Microsoft Excel Format - updated 10-28-08

Adobe Acrobat Format - updated 01/07/08
Microsoft Excel Format - updated 01/07/08
Adobe Acrobat Format - updated 05/31/07
Microsoft Excel Format - updated 05/31/07
Adobe Acrobat Format - updated 04/03/07
Microsoft Excel Format - updated 04/03/07
Adobe Acrobat Format - updated 03/01/07
Microsoft Excel Format - updated 03/01/07

Direct-Enrolled Behavioral Health Services

Certified Clinical Supervisor - updated 7/01/08
Licensed Clinical Addictions Specialist - updated 7/01/08
Nurse Practitioner - updated 7/01/08
Nurse Specialist - updated 7/01/08
Licensed Clinical Social Worker & Licensed Professional Counselor & Licensed Marriage and Family Therapist - updated 7/01/08
Licensed Psychological Associate - updated 7/01/08
Licensed Psychologist - updated 7/01/08

Enhanced Mental Health Services

Enhanced Mental Health Services - updated 9/24/08
Enhanced Mental Health Services - updated 6/10/08

Other Behavior Health Services

Level III and IV Residential Rates - effective 4/03/06
Mental Health Fee Schedule (LME) - updated 7/01/08
Mental Health Non-Licensed Clinician Fee Schedule
Revised Prospective Rates for Services SFY 2004-2005

Community Alternatives Programs (CAP)

CAP for Children (CAP/C)

Adobe Acrobat Format - updated 12/28/07
Microsoft Excel Format - updated 12/28/07

CAP/CHOICE

Adobe Acrobat Format - updated 12/28/07
Microsoft Excel Format - updated 12/28/07

CAP for Disabled Adults (CAP/DA)

Adobe Acrobat Format - updated 12/28/07
Microsoft Excel Format - updated 12/28/07

CAP/MR-DD

Comprehensive Waiver
- Adobe Acrobat Format - updated 10-28-08
- Microsoft Excel Format - updated 10-28-08
Supports Waiver

Adobe Acrobat Format - updated 10-28-08
Microsoft Excel Format - updated 10-28-08

Adobe Acrobat Format - updated 01/07/08
Microsoft Excel Format - updated 01/07/08
Adobe Acrobat Format - updated 05/31/07
Microsoft Excel Format - updated 05/31/07
Adobe Acrobat Format - updated 04/03/07
Microsoft Excel Format - updated 04/03/07
Adobe Acrobat Format - updated 03/01/07
Microsoft Excel Format - updated 03/01/07

Dental Services - updated 09/01/08

Durable Medical Equipment (DME)

Adobe Acrobat Format - updated 08/01/08
Microsoft Excel Format - updated 08/01/08
Adobe Acrobat Format - updated 04/09/08
Microsoft Excel Format - updated 04/09/08

Federally Qualified Health Center (CPT / HCPCS)

Adobe Acrobat Format - updated 01/01/08
Microsoft Excel Format - updated 01/01/08
Adobe Acrobat Format - updated 11/01/07
Microsoft Excel Format - updated 11/01/07
Adobe Acrobat Format - updated 07/01/06
Microsoft Excel Format - updated 07/01/06

Hearing Aids and Implants

Cochlear Implants

Adobe Acrobat Format - updated 03/01/08
Microsoft Excel Format - updated 03/01/08

Hearing Aid Programs

Adobe Acrobat Format - updated 07/18/08
Microsoft Excel Format - updated 07/18/08
Adobe Acrobat Format - updated 01/01/07
Microsoft Excel Format - updated 01/01/07

Adobe Acrobat Format - updated 09/01/08
Microsoft Excel Format - updated 09/01/08
Adobe Acrobat Format - updated 01/02/08
Microsoft Excel Format - updated 01/02/08

Adobe Acrobat Format - updated 09/01/08
Micorsoft Excel Format - updated 09/01/08
Adobe Acrobat Format - updated 02/27/08
Micorsoft Excel Format - updated 02/27/08

Home Infusion Therapy

Adobe Acrobat Format - updated 01/02/08
Microsoft Excel Format - updated 01/02/08
Adobe Acrobat Format - updated 09/01/08
Microsoft Excel Format - updated 09/01/08

Adobe Acrobat Format - updated 12/04/07
Microsoft Excel Format - updated 12/04/07

Independent Practitioner Services

Multiple Independent Practitioners

Adobe Acrobat Format - updated 01/01/08
Microsoft Excel Format - updated 01/01/08
Adobe Acrobat Format - updated 05/14/07
Microsoft Excel Format - updated 05/14/07
Adobe Acrobat Format - updated 07/01/06
Microsoft Excel Format - updated 07/01/06

Occupational Therapy

Adobe Acrobat Format - updated 01/01/08
Microsoft Excel Format - updated 01/01/08
Adobe Acrobat Format - updated 05/14/07
Microsoft Excel Format - updated 05/14/07
Adobe Acrobat Format - updated 07/01/06
Microsoft Excel Format - updated 07/01/06

Physical Therapy

Adobe Acrobat Format - updated 01/01/08
Microsoft Excel Format - updated 01/01/08
Adobe Acrobat Format - updated 05/14/07
Microsoft Excel Format - updated 05/14/07
Adobe Acrobat Format - updated 07/01/06
Microsoft Excel Format - updated 07/01/06

Respiratory Therapy

Adobe Acrobat Format - updated 01/01/08
Microsoft Excel Format - updated 01/01/08
Adobe Acrobat Format - updated 05/14/07
Microsoft Excel Format - updated 05/14/07
Adobe Acrobat Format - updated 07/01/06
Microsoft Excel Format - updated 07/01/06

Speech Therapy & Audiology

Adobe Acrobat Format - updated 01/01/08
Microsoft Excel Format - updated 01/01/08
Adobe Acrobat Format - updated 05/14/07
Microsoft Excel Format - updated 05/14/07
Adobe Acrobat Format - updated 07/01/06
Microsoft Excel Format - updated 07/01/06

Local Educational Agencies (CPT / HCPCS)

Adobe Acrobat Format - updated 08/27/08
Microsoft Excel Format - updated 08/27/08

Medicaid Crossover Percentage Payment Schedule

Nursing Facility Rates

Adobe Acrobat Format- updated 10/01/08
Microsoft Excel Format- updated 10/01/08

Optical Program (CPT / HCPCS)

Adobe Acrobat Format - updated 01/01/08
Microsoft Excel Format - updated 01/01/08
Adobe Acrobat Format - updated 01/01/07
Microsoft Excel Format - updated 01/01/07

Orthotic and Prosthetic Devices

Adobe Acrobat Format - updated 05/01/08
Microsoft Excel Format - updated 05/01/08

Physician Drug Program

Adobe Acrobat Format - updated 10/09/08
Microsoft Excel Format - updated 10/09/08
Adobe Acrobat Format - updated 08/01/08
Microsoft Excel Format - updated 08/01/08
Adobe Acrobat Format - updated 05/01/08
Microsoft Excel Format - updated 05/01/08
Adobe Acrobat Format - updated 02/21/08
Microsoft Excel Format - updated 02/21/08

Physician Services (CPT / HCPCS)

Adobe Acrobat Format - updated 10/17/08
Microsoft Excel Format - updated 10/17/08
Adobe Acrobat Format - updated 11/01/07
Microsoft Excel Format - updated 11/01/07
Adobe Acrobat Format - updated 07/01/06
Microsoft Excel Format - updated 07/01/06

Rural Health Clinic (CPT / HCPCS)

Adobe Acrobat Format - updated 01/01/08
Microsoft Excel Format - updated 01/01/08
Adobe Acrobat Format - updated 11/01/07
Microsoft Excel Format - updated 11/01/07
Adobe Acrobat Format - updated 07/01/06
Microsoft Excel Format - updated 07/01/06

Updated November 6, 2008