Promulgation of New Clinical Coverage Policies and Amendment to Clinical Coverage Policy 8A Enhanced Mental Health and Substance Abuse Services.
Blog Entry List
Effective Jan. 1, 2026, The Acute Inpatient Hospital Services policy has been revised.
Coverage for Healthcare Common Procedure Coding System Code G0512 is end-dating effective Dec. 31, 2025.
Effective with date of service Jan. 1, 2026, new Current Procedure Terminology (CPT) codes have been added or deleted, and descriptions of some existing codes have been updated.
Effective for dates of service on or after Feb. 1, 2026, claims for certain drug testing procedure codes must include an individual ordering provider NPI.
Clinical Coverage Policy 1S-11 will include coverage for AlloMap® effective Jan. 1, 2026.
The 2026 initial training dates for Community Alternatives Program consumer direction are now available.
This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.
NC Medicaid is advising of a phased-in process for the reinstatement of non-emergency medical transportation rates to those in effect Sept. 30, 2025.
Effective Dec. 12, 2025, coverage for GLP-1s for the treatment of obesity will be reverted to the coverage available as of Sept. 30, 2025.
NC Medicaid is providing updated information to providers about the federal prohibitions on certain providers.
The new NC Medicaid Mental Health Parity website provides information on NC Medicaid compliance with federal mental health parity requirements.
Recent court rulings now require the North Carolina Department of Health and Human Services to reverse provider rate reductions and restore rates to their Sept. 30, 2025, levels.
NC Medicaid Managed Care plans may apply utilization edits and/or prior authorization criteria per the Food and Drug Administration label on drugs when the State has not established criteria and has not prohibited use of criteria.
NC Medicaid is providing updated information to providers about the federal prohibitions on certain providers.