Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes

Fee Schedule Effective Date
Ambulatory Surgical Center Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Assistive Care Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Behavior Analysis Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Behavioral Health Overlay Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Birth Center Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Child Health Services Targeted Case Management Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Community-Based Substance Abuse County Match Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Community Behavioral Health Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
County Health Department Certified Match Program Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Dental General Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for Medicaid Recipients
Under the Age of 21 Years
Promulgated Fee Schedule 1/1/2017
XLS
Early Intervention Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Emergency Transportation Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Hearing Services Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Home Health Visit Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Immunization Fee Schedule Promulgated Fee Schedule 10/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Independent Laboratory Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Injectable Medications Oncology Fee Schedule Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Licensed Midwife Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Medicaid Certified School Match Program Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Medical Foster Care Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Mental Health Targeted Case Management Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Occupational Therapy Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Outpatient Laboratory Fee Schedule
(Formerly titled Physician and Outpatient Laboratory Fee Schedule)
Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Personal Care Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Physical Therapy Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Physician Pediatric Surgery Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Practitioner Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Practitioner Laboratory Fee Schedule
(Formerly titled Physician and Outpatient Laboratory Fee Schedule)
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Prescribed Drug (Not Reviewed by the Pharmaceutical and Therapeutics Committee) Fee Schedule
(Formerly titled Injectable Medications Non-Oncology Fee Schedule)
Promulgated Fee Schedule 1/1/2018
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Prescribed Pediatric Extended Care Services Fee Schedule Promulgated Fee Schedule 1/1/2018
Private Duty Nursing Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Radiology Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
Respiratory Therapy Services Promulgated Fee Schedule 7/1/2017
*Updated Fee Schedule 1/1/2018
Specialized Therapeutic Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Speech-Language Pathology Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Targeted Case Management for Children at Risk of Abuse and Neglect Services Fee Schedule Promulgated Fee Schedule 1/1/2017
*Updated Fee Schedule 1/1/2018
Visual Services Fee Schedule Promulgated Fee Schedule 1/1/2017
XLS
*Updated Fee Schedule 1/1/2018
*Updated XLS 1/1/2018
*Fee Schedules not yet promulgated.

Billing Code Effective Date
County Health Department Billing Codes Promulgated Billing Code 1/1/2017
*Updated Billing Code 1/1/2018
Federally Qualified Health Center Billing Codes Promulgated Billing Code 1/1/2017
*Updated Billing Code 1/1/2018
Hospice Services Billing Codes Promulgated Billing Code 1/1/2017
*Updated Billing Code 1/1/2018
Hospital Outpatient Services Billing Codes Promulgated Billing Code 1/1/2017
*Updated Billing Code 1/1/2018
Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes Promulgated Billing Code 1/1/2017
*Updated Billing Code 1/1/2018
Nursing Facility Services Billing Codes Promulgated Billing Code 1/1/2017
*Updated Billing Code 1/1/2018
Rural Health Clinic Billing Codes Promulgated Billing Code 1/1/2017
*Updated Billing Code 1/1/2018
Statewide Inpatient Psychiatric Program Services Billing Codes Promulgated Billing Code 1/1/2017
*Updated Billing Code 1/1/2018
*Billing codes not yet promulgated.