2026 Current Procedure Terminology Code Update

This bulletin is related to NC Medicaid Direct.

Effective with date of service Jan. 1, 2026, the American Medical Association (AMA) has added new CPT codes, deleted others, and changed the descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2026 edition of Current Procedural Terminology, published by the AMA. Providers should note the full descriptions as well as all associated parenthetical information published in this edition when selecting a code for billing services to NC Medicaid.

New CPT codes that are covered by NC Medicaid are effective with date of service Jan. 1, 2026. Claims submitted with deleted codes will be denied for dates of service on or after Jan. 1, 2026. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code(s).

Note: NC Medicaid did not elect to cover any new HCPCS codes for 2026, except those related to pharmacy services. The Pharmacy Section will notify providers when new drug codes are added to NCTracks.

Note: All Category II and III Codes are not covered.

A bulletin article will be released listing the new codes that will be separately reimbursable by Ambulatory Surgery Centers (ASC) when that information is released by the Centers for Medicare & Medicaid Services (CMS) in January 2026.

The State and NCTracks (GDIT) are in the process of completing system updates to align our policies with CPT code changes (new codes, covered and non-covered, as well as the end-dated codes), to ensure that claims billed with the new codes will process and pay correctly.

Until this process is completed, claims submitted with new covered codes will pend for “no fee on file.” These pended claims will recycle and pay when the system work is completed. No additional action will be required by providers. This process will also be applicable to the Medicare crossover claims.

To maintain cash flow, when appropriate, providers may wish to split claims and bill new codes on a separate claim. This will ensure that only claims billed with the new procedure codes are pended for processing.

Contact

NCTracks Contact Center 800-688-6696