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North Carolina Medicaid: Don't delay well-child visits
Act
immediately
Effective date
Not stated in the notice
Identified
Sep 2, 2026
Summary
North Carolina Medicaid now allows scheduling of 2-year well-child visits before the child's second birthday with full reimbursement, and clarifies that well-care visits for ages 3–21 do not require 365-day spacing but are covered per calendar year. This timing change is critical for meeting immunization compliance (CIS Combo 10) and well-care quality measures.
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What to do
immediately · 6 steps
01Billing team must update scheduling and billing workflows to reflect that 2-year well-child visits (CPT 99382, 99392) can be scheduled and billed BEFORE the child's second birthday for UnitedHealthcare Community Plan of North Carolina members.
02Update encounter forms and billing system validation rules to remove any restrictions preventing pre-birthday scheduling.
03Provide guidance to front desk/scheduling staff that these visits are fully reimbursable prior to the birthday.
04Additionally, update billing software and staff training to clarify that well-child visits for ages 3–21 (CPT 99383, 99384, 99385, 99393, 99394, 99395) no longer require 365-day spacing and are covered per calendar year.
05Use modifier EP when applicable for EPSDT-eligible ages 0–20.
06Ensure clinical staff understand the immunization compliance deadline (vaccines must be completed by second birthday to count toward CIS Combo 10 measures) to support early scheduling.
Codes mentioned
9938199382993839938499385993919939299393993949939599461G0438G0439S0302S0610S0612S0613
Original notice
North Carolina Medicaid: Don't delay well-child visits
uhcprovider.com · Always check the source before changing claims.