MedicaidReimbursementHigh impact
Rate Increase for Personal Care Services and the Community Alternatives Program
NC Medicaid - NCDHHS·NC · Geriatrics, Palliative Care, Occupational Therapy +1 more·Claims & Billing
Effective date
Aug 1, 2026
We identified it
Aug 1, 2026
Summary
Effective August 1, 2026, North Carolina Medicaid is implementing an 18% rate increase for all Personal Care Services (PCS) procedure codes across NC Medicaid Direct, CAP/C, CAP/DA, and CAP/CD programs. Billing teams must update fee schedules in their systems and ensure managed care plans load new rates within 45 days of DHB notification, with an additional 30-day claims reprocessing window.
Action Required
By August 1, 2026: Billing team must update all fee schedules in billing software to reflect the 18% rate increase for all PCS procedure codes listed in the policy (99509, S5125, S5135, S5150, S9122, T1004, T1019, T2027). Verify that rates match the new amounts specified (e.g., 99509 HA/HB from $5.96 to $7.03). For managed care claims, coordinate with contracted Standard Plans and Tailored Plans to ensure they load new rates within 45 calendar days of DHB notification. After August 1, 2026: Monitor for managed care claim reprocessing through September 30, 2026 (30-day reprocessing window). Verify that claims with dates of service on or after August 1, 2026 reflect the new rates. Document all rate changes in compliance records. Contact Medicaid.ProviderReimbursement@dhhs.nc.gov with questions. Failure to update rates may result in underbilling and lost revenue; failure to verify managed care plan compliance may result in claim denials.