MedicaidReimbursementHigh impact
Updates to Rate Increase for Personal Care Services and the Community Alternatives Program
NC Medicaid - NCDHHS·NC · Occupational Therapy, Physical Therapy, Palliative Care·Claims & Billing
Effective date
Aug 1, 2026
We identified it
Aug 5, 2026
Summary
Effective August 1, 2026, NC Medicaid is applying an 18% rate increase across all Personal Care Services (PCS) procedure codes for NC Medicaid Direct, CAP/C, CAP/DA, and CAP/CD programs. This replaces the previous July 31, 2026 bulletin and also applies to PCS furnished through NC Medicaid Managed Care (Standard Plans and Tailored Plans). Billing teams must update fee schedules in their systems and ensure claims reflect the new rates.
Action Required
By September 15, 2026 (45 days from DHB notification): Billing team must update all fee schedules in the billing system to reflect the 18% rate increase for all applicable PCS codes listed in the policy. Update rates for codes 99509, S5125, S5135, S5150, S9122, T1004, T1019, and T2027 across NC Medicaid Direct, CAP/C, CAP/DA, and CAP/CD programs. For NC Medicaid Managed Care contracts (Standard Plans and Tailored Plans), coordinate with health plans to ensure they load the new rates within their 45-day window. Before October 15, 2026 (30 days after rate load deadline): Billing team must reprocess all claims with dates of service on or after August 1, 2026 to ensure they reflect the new increased rates. Verify the revised fee schedules posted at https://ncdhhs.servicenowservices.com/fee_schedules match your system updates. Failure to update rates will result in underpayment of claims and potential compliance issues. Contact Medicaid.ProviderReimbursement@dhhs.nc.gov with questions.