NC Medicaid

Innovations Waiver Providers Must Add 39 Services and Accreditation by April 20

NC Medicaid is updating the Provider Permission Matrix (PPM) for taxonomy 251S00000X to add 39 new Innovations Waiver Service options for Intellectually and Developmentally Disabled (I/DD) service providers. Beginning April 20, 2026, providers must report national accreditation when selecting these services. Providers currently using the single Community/Behavioral Health service must migrate to a new Innovations Waiver Service and report accreditation by April 20, 2027, or lose reimbursement eligibility.

Quarterly Provider Update: Provider Directory API Launch, Accreditation Updates, Webinar Schedule

NC Medicaid announces the launch of its Provider Directory API per CMS-9115-F interoperability requirements, making network provider information publicly accessible. Behavioral health providers are reminded of national accreditation requirements per NC Gen Stat § 122C-81. Enrolled providers must disclose adverse actions against licenses, certifications, or accreditations within 30 calendar days under NC Gen Stat 108C-4.

80 New ICD-10-PCS Codes Effective April 1, 2026

CMS has released 80 new ICD-10-PCS procedure codes effective April 1, 2026. NC Medicaid Direct and NC Medicaid Managed Care providers must use these codes for discharges and patient encounters from April 1, 2026 through September 30, 2026. The complete code list is available on the CMS ICD-10 webpage.