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North Carolina Medicaid: Billing guidance for cell and gene therapy treatments
Act
immediately
Effective date
Feb 11, 2026
Identified
Jun 13, 2026
Summary
North Carolina Medicaid now participates in the Cell and Gene Therapy Access Model, requiring prior authorization for specific CGT treatments through UnitedHealthcare Community Plan. Providers must obtain prior auth before billing for listed CGT drugs or face claim denials.
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What to do
immediately · 3 steps
01Billing team must obtain prior authorization before providing any CGT treatments listed (Hemgenix, Luxturna, Elevidys, Roctavian, Zynteglo) to UnitedHealthcare Community Plan members in North Carolina.
02Use UnitedHealthcare Provider Portal for J1411, J3398, J1413, J1412, J3393, or call Optum Transplant Services at 888-802-1802 for Casgevy, Lenmeldys, Lyfgenia, Skysona, Zynteglo.
03Claims will be denied without prior authorization.
Codes mentioned
J1411J3398J1413J1412J3393
Original notice
North Carolina Medicaid: Billing guidance for cell and gene therapy treatments
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →North Carolina Medicaid: Billing guidance for cell and gene therapy treatmentsMediumEffective Feb 11, 2026 · State newsNorth Carolina Medicaid: Prior authorization updates for specialty pharmacy medicationsMediumEffective Dec 1, 2025 · State newsBrowse every UnitedHealthcare change in the policy list