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North Carolina Medicaid: Billing guidance for cell and gene therapy treatments
Act
immediately
Effective date
Feb 11, 2026
Identified
Mar 1, 2026
Summary
North Carolina Medicaid now allows providers to participate in the Cell and Gene Therapy (CGT) Access Model, providing eligible Medicaid enrollees access to cell and gene therapy treatments at reduced costs. Prior authorization is required for all CGT treatments through UnitedHealthcare Community Plan, with specific billing procedures for different drug therapies.
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What to do
immediately · 4 steps
01Billing team must obtain prior authorization before providing any CGT treatments to UnitedHealthcare Community Plan members.
02For drugs J1411 (Hemgenix), J3398 (Luxturna), J1413 (Elevidys), J1412 (Roctavian), and J3393 (Zynteglo), submit prior auth requests through UnitedHealthcare Provider Portal.
03For Casgevy, LenmeldyTM, Lyfgenia, Skysona, and Zynteglo, contact Optum Transplant Services at 888-802-1802.
04Do not bill members for services provided without prior authorization as claims will be denied.
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