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NC Department of Health and Human Services
NC Division of
Medical Assistance

Medicaid & N.C. Health Choice
Clinical Coverage Policies and Provider Manuals

Effective October 1, 2015, DMA's clinical coverage policies were amended to add ICD-10 codes where applicable. The ICD-9 versions of these policies, which were in effect through September 30, 2015, can be referenced here.

Program-Specific Clinical Coverage Policies


Facility Services

Community Based Services

Dental Program

Medical Equipment

Vision Services

Hearing Aid Services

Behavioral Health

Pharmacy Services

Specialized Therapies

Transplants and Transplant-Related Services

Targeted Case Management

Auditory Implant External Parts

No Longer Active Policies

  • For a listing of No Longer Active Policies go here.


Prior approval (PA) may be required for some services, products or procedures to verify documentation of medical necessity.

The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), as amended by the Health Care and Education Recovery Act of 2010 (P.L. 111-152), together referred to as the Affordable Care Act (ACA) requires state Medicaid programs to be compliant with the National Correct Coding Initiative (NCCI) in claims processing by March 31, 2011.  DMA has implemented the NCCI for all Medicaid and NCHC claims. Each provider shall comply with NCCI methodologies and can access information about NCCI and its impact on claims processing.

Unless directed otherwise, institutional claims must be billed in accordance with the National Uniform Billing Guidelines.  All claims must comply with National Coding Guidelines. Ready NC Connect NC