NC Medicaid Rate Reductions Overview
In late September, the North Carolina Department of Health and Human Services Division of Health Benefits (NCDHHS DHB) announced NC Medicaid Rate Reductions effective Oct. 1, 2025. DHB implemented the cuts due to a shortfall in funding from the North Carolina General Assembly (NCGA). The reductions were necessary to maintain the NC Medicaid program with the current funding allocated to the Medicaid program by the NCGA.
Potential Updates From NCGA
The reductions are subject to change if the NCGA provides NC Medicaid with additional appropriations for service programs. If changes occur, updated information will be available on the NC Medicaid Provider Information page.
Partners’ Implementation Timeline
Partners Health Management and the other Local Management Entities/Managed Care Organizations (LME/MCOs) delayed implementing the cuts until Nov. 1, 2025. This delay was to help reduce the impact on providers.
Contact Information
For questions about the reductions and new rates:
Email: ClaimsDepartment@PartnersBHM.org.
For additional information on the reductions, read Partners Provider Alerts dated Sept. 30 and Oct. 31, 2025:
- Sept. 30, 2025: Partners to Implement Medicaid Rate Reductions in November
- Oct. 31, 2025: Update on Provider Rate Reduction Implementation
Services included in the rate reductions and the corresponding rate reduction percentage are listed below. They are also listed in the UPDATED: NC Medicaid Rate Reductions – Effective Oct. 1, 2025 bulletin.
The table below outlines the statewide Medicaid rate reductions by program area, as determined by the North Carolina Medicaid Fee Schedule updates effective Oct. 1, 2025.
Reductions by State Medicaid Fee Schedule (PDF)
| Reductions by State Medicaid Fee Schedule – Program | Applicable Reduction Percentage |
| Ambulance Services | 3% |
| Ambulatory Infusion Therapy Centers | Overlapping physician codes only – 8% |
| Ambulatory Surgical Centers | 10% |
| Anesthesiology Base Units | Anesthesiology codes – 10%
Overlapping physician codes – 8% |
| Auditory Implants | 3% |
| Children Developmental Services Agency (CDSA) | CDSA codes – 3%
Overlapping physician codes – 8% |
| Chiropractic Services | Chiropractic codes – 3%
Overlapping physician codes – 8% |
| Clinical Pharmacist Practitioner (CPP) | CPP codes – 3%
Overlapping physician codes – 8% |
| Community Alternatives Program | Personal Care-like Services – 8%
Non-Personal Care Services(PCS) codes – 3% |
| Dental | 3%
Ambulatory Service Center codes – 10% |
| Dialysis | 3% |
| Dietary and Nutritional Services | Dietary & Nutritional codes – 3%
Overlapping physician codes – 8% |
| Durable Medical Equipment | 3% |
| Enhanced Mental Health Services | 3% |
| Federally Qualified Health Centers | FQHC -3%
Overlapping physician codes – 8% |
| Freestanding Birth Center | 10% |
| Hearing Aid Program | 3% |
| HIV Case Management | 3% |
| Home Health Services | 3% |
| Home Infusion Therapy | 3% |
| Hospice | Room & Board (0658/0659) only – 10% |
| Hospital Outpatient Laboratory | 10% |
| Hospitals | 10% |
| Indian Tribal (I/T/U) Home Health | 3% |
| Indian Tribal (I/T/U) Pharmacy | 0% |
| Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) | 8% |
| Laboratory (Independent Diagnostic Testing Facilities) | Lab & X-ray codes – 3%
Overlapping physician codes – 8% |
| Local Health Departments (LHD) | LHD codes – 3%
Overlapping physician codes – 8% |
| NC Medicaid State Institutions | 8% |
| Nurse Midwives | 8% |
| Nurse Practitioner and Certified Registered Nurse Anesthetist (CRNA) | 8% |
| Nursing Facility Rates | 10% |
| Optical Program | 3% |
| Optometry Services | Optometry codes – 3%
Overlapping physician codes – 8% |
| Orthotics and Prosthetics | 3% |
| Other Behavioral Health Services | Research-Based Intensive Behavioral Health Treatment (RBI-BHT) (97151-97157) – 10%
Inpatient Behavioral Health – 8% Other – 8% |
| Outpatient Specialized Therapies | 3% |
| Personal Care Services | 8% |
| Pharmacy | 0% |
| Physician Administered Drug Program | 0% |
| Physician Assistant | 8% |
| Physician Services | ER (99281-99285) – 10%
Physician codes – 8% |
| Podiatry Services | 3% |
| Private Duty Nursing | 3% |
| Public Ambulance Provider Managed Care | 3% |
| Radiological/Imaging Services | 3% |
| Rural Health Clinic | RHC codes – 3%
Overlapping physician codes – 8% |
| Targeted Case Management | 3% |
| Vent Facility Rates | 10% |