Physician Drugs: 1 Percent Rate Reduction

As required by the N.C. Session Law 2014-100, the N.C. Department of Health and Human Services (DHHS) submitted N.C. State Plan Amendment (SPA) 14-021 to the Centers for Medicare & Medicaid Services (CMS) requesting approval to implement a 1 percent rate reduction for Physician Drugs effective January 1, 2015. (See links below)

CMS approved SPA 14-021 on December 12, 2014.

Beginning August 19, 2015, NCTracks will reimburse all claims for Physician Drug Services rendered to Medicaid and N.C. Health Choice (NCHC) beneficiaries at the new reimbursement rate, which is equal to 1 percent less than the previous reimbursement rate.

Current fee schedules will be adjusted to reflect the 1 percent fee reduction and will be posted to the N.C. Division of Medical Assistance (DMA) website.

Claims with dates of service January 1, 2015, through the rate implementation date will be reprocessed at a later time. DMA will provide updates in future Medicaid bulletins.