As per the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS-1810-F) published on Aug. 6, 2024, the FY2025 hospice wage index has numerous updates based on the implementation of new Office of Management and Budget (OMB) labor market delineations.
These updates resulted in some counties (and county equivalents) that were previously considered urban shifting to now being considered rural, some counties (and county equivalents) that were previously considered rural shifting to now being considered urban, and the shift of some urban counties from one urban core based statistical area (CBSA) to a new or existing urban CBSA.
Effective Oct. 1, 2024, the affected counties are as follows:
| County Name | Old CBSA | Old 2024 CBSA Name | New CBSA | New 2025 CBSA Name |
|---|---|---|---|---|
Brunswick | 34820 | Myrtle Beach-Conway-North Myrtle Beach, SC-NC | 48900 | Wilmington, NC |
Craven | 35100 | New Bern, NC | 99934 | (Rural) North Carolina |
Granville | 20500 | Durham-Chapel Hill, NC | 50017 (new) | North Carolina |
Harnett | 22180 | Fayetteville, NC | 99934 | (Rural) North Carolina |
Haywood | 11700 | Asheville, NC | 50018 (new) | North Carolina |
Jones | 35100 | New Bern, NC | 99934 | (Rural) North Carolina |
Moore | 99934 | Rural North Carolina | 38240 (new) | Pinehurst-Southern Pines, NC |
Pamlico | 35100 | New Bern, NC | 99934 | (Rural) North Carolina |
Southampton | 47260 | Virginia Beach-Norfolk-Newport News, VA-NC | N/A
| VIRGINA |
Franklin City | 47620 | Virginia Beach-Norfolk-Newport News, VA-NC | N/A
| VIRGINA |
All providers should ensure that claims for the above-mentioned counties with dates of service through Sept. 30, 2024, are submitted with the 2024 (“Old”) CBSA codes. Claims with dates of service starting Oct. 1, 2024, should be billed with the 2025 (“New”) CBSA codes.
NCTracks system updates are currently in progress. Any NC Medicaid Direct claims submitted before updates take effect will be systematically reprocessed to reflect the Federal Fiscal Year 2025 fee schedule rate. Claims for newly created CBSAs 50017, 50018, and 38240 will need to be submitted after updates have been completed. Additional provider communication will be released at that time. All health plans have been advised of these changes. Providers should contact the individual health plans to confirm how they will be implementing these changes.
Contact
Provider Reimbursement, 919-527-7699
Health Plan Contacts and Resources