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NC Medicaid »   Home

Physician Clinical Coverage Policies

Files

1A-2.pdf

1A-2, Preventive Medicine Annual Health Assessment

PDF • 291.79 KB - December 04, 2019

1A-3.pdf

1A-3, Noninvasive Pulse Oximetry

PDF • 284.61 KB - December 04, 2019

1A-4.pdf

1A-4, Cochlear and Auditory Brainstem Implants

PDF • 328.74 KB - March 15, 2021

1A-5.pdf

1A-5, Child Medical Evaluation and Medical Team Conference for Child Maltreatment

PDF • 357.04 KB - May 18, 2021

1A-6.pdf

1A-6, Invasive Electrical Bone Growth Stimulation

PDF • 310.98 KB - December 04, 2019

1A-7.pdf

1A-7, Neonatal and Pediatric Critical and Intensive Care Services

PDF • 302.29 KB - December 04, 2019

1A-8.pdf

1A-8, Hyperbaric Oxygenation Therapy

PDF • 372.08 KB - December 04, 2019

1A-9.pdf

1A-9, Blepharoplasty/Blepharoptosis (Eyelid Repair)

PDF • 299.8 KB - December 05, 2019

1A-11.pdf

1A-11, Extracorporeal Shock Wave Lithotripsy

PDF • 285.94 KB - December 05, 2019

1A-12.pdf

1A-12, Breast Surgeries

PDF • 359 KB - February 01, 2021

1A-13.pdf

1A-13, Ocular Photodynamic Therapy

PDF • 303.17 KB - August 04, 2020

1A-14.pdf

1A-14, Surgery for Ambiguous Genitalia

PDF • 284.6 KB - December 05, 2019

1A-15.pdf

1A-15, Surgery for Clinically Severe or Morbid Obesity

PDF • 397.21 KB - March 15, 2019

1A-16.pdf

1A-16, Surgery of the Lingual Frenulum

PDF • 302.2 KB - December 05, 2019

1A-17.pdf

1A-17, Stereotactic Pallidotomy

PDF • 288.25 KB - December 05, 2019

1A-19.pdf

1A-19, Transcranial Doppler Studies

PDF • 300.19 KB - February 01, 2021

1A-20.pdf

1A-20, Sleep Studies and Polysomnography Services

PDF • 403.98 KB - May 12, 2021

1A-21.pdf

1A-21, Endovascular Repair of Aortic Aneurysm

PDF • 294.73 KB - December 05, 2019

1A-22.pdf

Medically Necessary Circumcision

PDF • 318.84 KB - June 16, 2021

1A-23.pdf

1A-23, Physician Fluoride Varnish Services

PDF • 3.58 MB - December 05, 2019

1A-24.pdf

1A-24, Diabetes Outpatient Self-Management Education

PDF • 332.94 KB - March 19, 2021

1A-25.pdf

1A-25, Spinal Cord Stimulation

PDF • 301.09 KB - December 05, 2019

1A-26.pdf

1A-26, Deep Brain Stimulation

PDF • 294.21 KB - September 15, 2020

1A-27.pdf

1A-27, Electrodiagnostic Studies

PDF • 309.01 KB - September 15, 2020

1A-28.pdf

1A-28, Visual Evoked Potential (VEP)

PDF • 301.15 KB - September 15, 2020

1A-30.pdf

1A-30, Spinal Surgeries

PDF • 394.77 KB - August 14, 2020

1A-31.pdf

1A-31, Wireless Capsule Endoscopy

PDF • 298.84 KB - January 04, 2022

1A-32.pdf

1A-32, Tympanometry and Acoustic Reflex Testing

PDF • 287.36 KB - December 05, 2019

1A-33.pdf

1A-33, Vagus Nerve Stimulation for the Treatment of Seizures

PDF • 290.89 KB - September 15, 2020

1A-34.pdf

1A-34, Dialysis Services

PDF • 367.54 KB - December 02, 2020

1A-36.pdf

1A-36, Implantable Bone Conduction Hearing Aids (BAHA)

PDF • 306.45 KB - December 12, 2019

1A-38.pdf

1A-38, Special Services: After Hours

PDF • 284.19 KB - March 15, 2019

1A-39.pdf

1A-39, Routine Costs in Clinical Trial Services for Life Threatening Conditions

PDF • 318.74 KB - December 12, 2019

1A-40.pdf

1A-40, Fecal Microbiota Transplantation

PDF • 289.94 KB - December 12, 2019

1A-41.pdf

1A-41- Office Based Opioid Treatment: Use of Buprenorphine and Buprenorphine-Naloxone

PDF • 395.27 KB - July 01, 2021

1A-42.pdf

1A-42, Balloon Ostial Dilation

PDF • 298.17 KB - December 12, 2019

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Contact Information

NC Medicaid
Division of Health Benefits

2501 Mail Service Center
Raleigh, NC 27699-2501
 
NC Medicaid Contact Center
Phone: 888-245-0179
Monday-Friday 8 a.m. to 5 p.m.
Closed on State holidays. 
 
Visit RelayNC for information about TTY services. 
 
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https://medicaid.ncdhhs.gov/physician-clinical-coverage-policies