North Carolina Medicaid reimbursement rates
143,093 current fee-for-service and managed-care rates from North Carolina Medicaid, across 89 services and 9 programs, normalized by code, provider level and unit. Each links to one of 284 official source documents.
Last retrieved 2026-10-02. History back to 1991-10-01.
- Current rates
- 143,093
- Services
- 89
- Programs
- 9
- Lines with a plan rule
- 17of 22 service lines
By industry
Applied behavior analysis (ABA)North Carolina rates, labor costs and changesBehavioral healthNorth Carolina rates, labor costs and changesHome healthNorth Carolina rates, labor costs and changesHome care & personal careNorth Carolina rates, labor costs and changesPrivate duty nursingNorth Carolina rates, labor costs and changesSkilled nursing facilitiesNorth Carolina rates, labor costs and changesHospiceNorth Carolina rates, labor costs and changesIntellectual & developmental disabilitiesNorth Carolina rates, labor costs and changesOutpatient therapy (PT, OT, speech)North Carolina rates, labor costs and changes
North Carolina rates by service
The median current rate for each service, like-for-like by unit. Follow a service to compare it with every other state.
| Service | Line | Median rate | Unit | Per hour | Variants |
|---|---|---|---|---|---|
| ABA assessment by a behavior analyst | ABA / autism services | $30.56 | 15 min | $122.24 | 11 |
| ABA assessment support by a technician | ABA / autism services | $61.73 | 15 min | $246.92 | 11 |
| ABA parent and caregiver training | ABA / autism services | $23.70 | 15 min | $94.80 | 11 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $32.22 | 15 min | $128.88 | 11 |
| Group ABA parent training (several families) | ABA / autism services | $11.51 | 15 min | $46.04 | 9 |
| Group ABA therapy led by a technician | ABA / autism services | $11.37 | 15 min | $45.48 | 11 |
| One-on-one ABA therapy by a technician | ABA / autism services | $20.81 | 15 min | $83.24 | 11 |
| Behavioral health services (fee schedule) | Behavioral health | $165.41 | — | $42.25 | 72 |
| Mental health assessment (non-physician) | Behavioral health | $19.81 | — | $85.36 | 16 |
| Mental health counseling | Behavioral health | $39.93 | day | — | 4 |
| Mental health service plan development | Behavioral health | $81.25 | per week | — | 5 |
| Multisystemic therapy for youth | Behavioral health | $46.55 | 15 min | $186.20 | 2 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $83.12 | — | $117.41 | 440 |
| Therapeutic behavioral services (daily rate) | Behavioral health | $158.20 | day | — | 2 |
| FQHC / RHC visit (PPS or APM rate) | Clinics (FQHC/RHC) | $125.41 | — | — | 3308 |
| Dental services | Dental | $169.76 | — | — | 1126 |
| Durable medical equipment | Equipment & supplies | $130.77 | — | $47.24 | 1067 |
| Enteral and parenteral nutrition | Equipment & supplies | $5.40 | — | — | 109 |
| Medical supplies | Equipment & supplies | $8.49 | — | — | 1304 |
| Orthotics and prosthetics | Equipment & supplies | $265.06 | — | $72.54 | 2410 |
| Adult day health (medical model) | Other home & community services | $43.06 | day | — | 2 |
| Case management / support coordination | Other home & community services | $22.90 | 15 min | $70.08 | 21 |
| Emergency response system monitoring | Other home & community services | $41.66 | month | — | 3 |
| Financial management services (self-direction) | Other home & community services | $107.42 | month | — | 2 |
| Home-delivered meals | Other home & community services | $7.70 | Each | — | 2 |
| Nursing assessment | Other home & community services | $87.09 | — | — | 4 |
| Nursing respite (RN or LPN) | Other home & community services | $13.00 | 15 min | $52.00 | 1 |
| Other waiver goods and services | Other home & community services | $10.57 | Each | — | 4 |
| Respite care (hourly) | Other home & community services | $7.85 | 15 min | $31.38 | 6 |
| Respite in a facility (daily) | Other home & community services | $219.57 | day | — | 3 |
| Self-direction coaching / supports broker | Other home & community services | $377.04 | month | — | 2 |
| Home health aide visit | Home health | $57.43 | 1 visit | — | 2 |
| Home health nurse visit (RN or LPN) | Home health | $109.55 | 1 visit | — | 6 |
| Home health occupational therapy | Home health | $120.56 | 1 visit | — | 1 |
| Home health physical therapy | Home health | $120.56 | 1 visit | — | 1 |
| Home health speech therapy | Home health | $120.56 | 1 visit | — | 1 |
| Home health therapy evaluation visit | Home health | $120.56 | 1visit | — | 4 |
| Home health visit (other or unspecified) | Home health | $3.19 | 1 visit | — | 66 |
| Hospice continuous home care (hourly) | Hospice | $66.94 | hour | — | 17 |
| Hospice end-of-life visit add-on (per hour) | Hospice | $66.93 | 15 min increments | — | 17 |
| Hospice general inpatient care (daily) | Hospice | $1,159.02 | day | — | 17 |
| Hospice inpatient respite (daily) | Hospice | $542.16 | day | — | 17 |
| Hospice routine home care (daily) | Hospice | $195.70 | — | — | 34 |
| IHS / tribal hospital stay (all-inclusive daily rate) | Hospital inpatient | $5,707.00 | — | — | 2 |
| Inpatient DRG pricing input (outlier, cost ratio, stay) | Hospital inpatient | $30.00 | — | — | 2591 |
| Inpatient DRG relative weight | Hospital inpatient | $1.62 | — | — | 807 |
| Inpatient hospital stay (DRG base rate) | Hospital inpatient | $10,623.86 | — | — | 199 |
| Inpatient hospital stay (per diem) | Hospital inpatient | $600.63 | day | — | 344 |
| Inpatient psychiatric stay (per day) | Hospital inpatient | $895.63 | — | — | 165 |
| IHS / tribal outpatient visit (all-inclusive rate) | Hospital outpatient | $826.00 | — | — | 2 |
| Outpatient payment adjustment factor | Hospital outpatient | $0.2071 | — | — | 159 |
| Surgery center facility fee (per procedure) | Hospital outpatient | $1,636.31 | — | — | 6 |
| ICF/IID stay (daily rate) | IDD services | $423.18 | — | — | 374 |
| Clinical lab tests | Lab & pathology | $21.25 | — | — | 28159 |
| Nursing home stay (daily rate) | Nursing facility | $327.09 | — | — | 891 |
| Swing-bed stay (hospital bed used for nursing-home care) | Nursing facility | $129.15 | day | — | 16 |
| Dialysis facility composite rate (per treatment) | Other | $60.09 | — | — | 1202 |
| Directed payment uniform increase (required MCO uplift) | Other | $34.29 | The specific uniform increase per service is provided in an attachment. EVV enhancements will be a 10% uniform increase. | — | 3 |
| Directed payment: required minimum or maximum level | Other | $87.50 | SNF: 95% of Medicare for the first 20 days of the admission and then 80% of Medicare for the remaining days of admission | — | 2 |
| Health plan payment rule (percent or lesser-of) | Other | $4.76 | $4.56 PMPM for all enrolled children ages 0-5 | — | 10 |
| Managed care minimum payment (percent of state fees) | Other | $100.00 | no less than one hundred percent (100%) of the Medicaid Fee-for-Service rate for the service or bundle | — | 16 |
| Coordinated caregiving (live-in caregiver support) | Personal care & attendant | $64.62 | day | — | 5 |
| Home health aide or nurse aide care (hourly) | Personal care & attendant | $6.42 | 15 min | $25.68 | 3 |
| Personal care / attendant care (hourly) | Personal care & attendant | $6.42 | 15 min | $25.68 | 24 |
| Physician-administered drugs (J-codes) | Pharmacy | $2.73 | — | — | 6896 |
| Private duty nursing (hourly shifts) | Private duty nursing | $13.00 | 15 min | $52.00 | 5 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $5.98 | 15 min | $23.92 | 7 |
| Anesthesia base units (per procedure) | Physician & professional | $90.00 | — | — | 325 |
| Physician and practitioner services (fee schedule) | Physician & professional | $377.18 | — | $79.16 | 73814 |
| Imaging and radiology | Radiology | $55.68 | — | — | 16302 |
| Nutrition counseling (dietitian) | Therapy (PT/OT/speech) | $23.07 | 15 min | $92.28 | 32 |
| Occupational therapy | Therapy (PT/OT/speech) | $23.85 | 15 min | $94.46 | 25 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $64.14 | — | — | 89 |
| Orthotic and prosthetic fitting and training | Therapy (PT/OT/speech) | $25.13 | 15 min | $100.52 | 50 |
| Other therapy services | Therapy (PT/OT/speech) | $9.35 | 15 min | $29.16 | 14 |
| Physical therapy | Therapy (PT/OT/speech) | $23.31 | 15 min | $93.24 | 35 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $66.11 | — | — | 89 |
| Speech-generating device evaluation | Therapy (PT/OT/speech) | $118.61 | — | — | 8 |
| Speech-generating device therapy | Therapy (PT/OT/speech) | $61.75 | — | — | 16 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $84.82 | — | — | 40 |
| Speech-language therapy | Therapy (PT/OT/speech) | $66.89 | — | — | 11 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $60.96 | — | — | 16 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $62.10 | — | — | 14 |
| Air ambulance transport | Transportation | $10,982.14 | — | — | 6 |
| Ambulance mileage | Transportation | $3.55 | mile | — | 3 |
| Ground ambulance transport | Transportation | $829.72 | — | — | 102 |
| Non-emergency medical transportation (NEMT) | Transportation | $474.00 | — | — | 1 |
| Eyeglasses and contact lenses | Vision & hearing | $229.53 | — | — | 24 |
| Hearing aids and hearing services | Vision & hearing | $58.71 | — | — | 16 |
Most-compared billing codes in North Carolina
Where North Carolina ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | North Carolina | All-state median | Rank |
|---|---|---|---|---|
| 10004 | Physician and practitioner services (fee schedule) | $36.98 | $35.52 | 8 of 19 |
| 10005 | Physician and practitioner services (fee schedule) | $62.62 | $60.63 | 9 of 19 |
| 10006 | Physician and practitioner services (fee schedule) | $42.67 | $39.90 | 7 of 19 |
| 10007 | Physician and practitioner services (fee schedule) | $80.39 | $76.74 | 9 of 19 |
| 10008 | Physician and practitioner services (fee schedule) | $52.43 | $46.94 | 7 of 19 |
| 10009 | Physician and practitioner services (fee schedule) | $97.58 | $93.03 | 9 of 19 |
| 10010 | Physician and practitioner services (fee schedule) | $71.32 | $65.32 | 7 of 19 |
| 10021 | Physician and practitioner services (fee schedule) | $52.36 | $49.77 | 9 of 19 |
| 10030 | Physician and practitioner services (fee schedule) | $126.07 | $119.43 | 6 of 19 |
| 10035 | Physician and practitioner services (fee schedule) | $74.46 | $70.26 | 8 of 19 |
| 10036 | Physician and practitioner services (fee schedule) | $37.49 | $35.41 | 9 of 19 |
| 10060 | Physician and practitioner services (fee schedule) | $67.39 | $76.16 | 12 of 19 |
| 10061 | Physician and practitioner services (fee schedule) | $120.14 | $129.16 | 13 of 19 |
| 10080 | Physician and practitioner services (fee schedule) | $68.87 | $78.73 | 12 of 19 |
| 10081 | Physician and practitioner services (fee schedule) | $120.71 | $127.86 | 12 of 19 |
| 10120 | Physician and practitioner services (fee schedule) | $66.08 | $77.44 | 14 of 19 |
| 10121 | Physician and practitioner services (fee schedule) | $135.29 | $135.29 | 10 of 19 |
| 10140 | Physician and practitioner services (fee schedule) | $86.33 | $86.45 | 11 of 19 |
| 10160 | Physician and practitioner services (fee schedule) | $69.52 | $69.52 | 10 of 19 |
| 10180 | Physician and practitioner services (fee schedule) | $127.40 | $148.10 | 13 of 19 |
| 11000 | Physician and practitioner services (fee schedule) | $24.52 | $24.52 | 10 of 19 |
| 11001 | Physician and practitioner services (fee schedule) | $12.36 | $12.36 | 10 of 19 |
| 11004 | Physician and practitioner services (fee schedule) | $439.08 | $437.21 | 8 of 19 |
| 11005 | Physician and practitioner services (fee schedule) | $573.02 | $573.02 | 10 of 19 |
| 11006 | Physician and practitioner services (fee schedule) | $542.16 | $542.16 | 10 of 19 |
| 11008 | Physician and practitioner services (fee schedule) | $206.56 | $206.56 | 10 of 19 |
| 11010 | Physician and practitioner services (fee schedule) | $209.04 | $225.24 | 12 of 19 |
| 11011 | Physician and practitioner services (fee schedule) | $225.43 | $229.46 | 11 of 19 |
| 11012 | Physician and practitioner services (fee schedule) | $326.26 | $326.26 | 10 of 19 |
| 11042 | Physician and practitioner services (fee schedule) | $35.08 | $50.80 | 15 of 19 |
| 11043 | Physician and practitioner services (fee schedule) | $170.54 | $134.21 | 4 of 19 |
| 11044 | Physician and practitioner services (fee schedule) | $234.65 | $182.12 | 3 of 19 |
| 11055 | Physician and practitioner services (fee schedule) | $17.61 | $14.80 | 7 of 19 |
| 11056 | Physician and practitioner services (fee schedule) | $24.83 | $20.38 | 8 of 19 |
| 11057 | Physician and practitioner services (fee schedule) | $32.24 | $26.13 | 7 of 19 |
| 11102 | Physician and practitioner services (fee schedule) | $33.65 | $32.23 | 9 of 19 |
| 11103 | Physician and practitioner services (fee schedule) | $19.49 | $18.65 | 9 of 19 |
| 11104 | Physician and practitioner services (fee schedule) | $42.23 | $40.43 | 9 of 19 |
| 11105 | Physician and practitioner services (fee schedule) | $23.03 | $22.05 | 8 of 19 |
| 11106 | Physician and practitioner services (fee schedule) | $51.34 | $49.21 | 8 of 19 |
Managed care in North Carolina
15 plans on record, 5 state-directed payment records, 1,905 published capitation cells.
Who sets the rate, line by line →Recent rate changes and notices
Frequently asked questions
Where does North Carolina publish its Medicaid fee schedules?
North Carolina publishes rates across 284 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does North Carolina publish?
143,093 rates are current across 89 services and 9 programs, with 573,651 versions on record since 1991-10-01.
Do North Carolina Medicaid managed-care plans pay the fee schedule?
For 17 of 22 service lines, plan contracts or state law set a rule plans must follow (a floor, a state-set rate or a required pass-through). For the rest, plans negotiate. See the managed-care page for each line's rule and citation.
Other states
Your North Carolina rate cardYour codes, what North Carolina pays, what plans must pay, and every change in 2026.