Rural Health Clinic
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N.C. DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH BENEFITS PHYSICIAN SERVICES FEE SCHEDULE PROVIDER SPECIALTY 075 TAXONOMY: 261QR1300X RURAL HEALTH CLINIC The inclusion of a rate on this table does not guarantee that a service is covered. Please refer to the Medicaid Billing Guide and the Medicaid and Health Choice Clinical Policies on the DMA Web Site. Providers should always bill their usual and customary charges. Please use the monthly Medicaid Bulletin for additions, changes, and deletions to this fee schedule. Please Note: Colored coded text changes (If Any) - Additions (BLUE) , End-Dated (RED) . Updated 6/30/2021 CODE MOD DESCRIPTION FACILITY NON-FACILITY 0001A IMMUNIZATION ADMINISTRATION BY INTRAMUSCULAR INJECTION OF SEVE 40.00 40.00 0002A IMMUNIZATION ADMINISTRATION BY INTRAMUSCULAR INJECTION OF SEVE 40.00 40.00 0011A IMMUNIZATION ADMINISTRATION BY INTRAMUSCULAR INJECTION OF SEVE 40.00 40.00 0012A IMMUNIZATION ADMINISTRATION BY INTRAMUSCULAR INJECTION OF SEVE 40.00 40.00 0031A IMMUNIZATION ADMINISTRATION BY INTRAMUSCULAR INJECTION OF SEVE 40.00 40.00 01996 DAILY HOSPITAL MANAGEMENT OF CONTINUOUS SPINAL DRUG ADMINIST 42.14 42.14 0225U INFECTIOUS DISEASE (BACTERIAL OR VIRAL RESPIRATORY TRACT INFECT 298.60 298.60 0226U SURROGATE VIRAL NEUTRALIZATION TEST (SVNT), SEVERE ACUTE RESP 42.28 42.28 0240U INFECTIOUS DISEASE (VIRAL RESPIRATORY TRACT INFECTION), PATHOGE 142.63 142.63 0241U INFECTIOUS DISEASE (VIRAL RESPIRATORY TRACT INFECTION), PATHOGE 142.63 142.63 10021 fine needle aspiration; without imaging guidance 56.68 108.77 10040 acne surgery (eg, marsupialization, opening or removal of 68.76 78.15 10060 drainage of abscess 72.94 84.15 10061 drainage of abscess 130.05 144.89 10080 incision and drainage of pilonidal cyst; 74.55 124.22 10081 incision and drainage of pilonidal cyst; 130.66 196.08 10120 incision and removal of foreign body, subcutaneous tissues; 71.53 102.72 10121 incision and removal of foreign body, subcutaneous tissues; 146.44 200.35 10140 drainage of blood effusion 93.45 118.28 10160 puncture aspiration of abscess, hematoma, bulla, or cyst 75.25 96.14 10180 incision and drainage, complex, postoperative wound infection 137.91 177.58 11000 surgical cleansing of skin 26.54 41.69 11001 debridement of extensive eczematous or infected skin; each additional 10% of 13.38 13.38 11004 debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing 475.29 475.29 11005 debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing 620.28 620.28 11006 debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing 586.88 586.88 11008 removal of prosthetic material or mesh, abdominal wall for necrotizing soft 223.60 223.60 11042 debridement; 37.98 57.66 11043 debridement; 184.60 210.35 11044 debridement; 254.01 287.33 11055 paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single 19.06 37.22 11056 paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); two to 26.88 45.65 11057 paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more 34.90 54.87 11200 removal of skin tags 53.04 62.43 11201 removal of skin tags, multiple fibrocutaneous tags, any area; each additional 13.53 14.75 11300 shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; 23.98 51.54 11301 shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; 40.77 71.05 11302 shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; 50.56 85.08 11303 shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; 59.30 99.89 11305 shaving of epidermal or dermal lesion, single lesion, scalp, 30.36 53.36 11306 shaving of lesion scalp/neck/hand/etc .6- 1.0 cm 45.98 73.84 11307 shaving of epidermal or dermal lesion, single lesion, scalp, 54.21 87.22 11308 shaving of epidermal or dermal lesion, single lesion, scalp, 65.22 98.23 11310 shaving of epidermal or dermal lesion, single lesion, face, 34.72 64.40 11311 shaving of epidermal or dermal lesion, single lesion, face, 50.86 82.05 11312 shaving of epidermal or dermal lesion, single lesion, face, 58.40 94.74 11313 shaving of epidermal or dermal lesion, single lesion, face, 78.13 118.71 11400 excision, benign lesion including margins, except skin tag (unless listed 57.90 87.57 11401 removal of skin lesion 77.22 108.11 11402 removal of skin lesion 85.52 120.66 11403 removal skin lesion 108.81 139.10 11404 amb surg exc ben lesions trunk arm legs 3.0 to 4.0 121.21 158.46 11406 amb surg exc ben lesion trunk arm leg over 4.0 cm 181.72 224.42 11420 excision, benign lesion including margins, except skin tag (unless listed 62.77 88.81 11421 removal of skin lesion 84.97 115.56 11422 removal of skin lesion 102.46 129.11 11423 amb surg exc ben lesion scalp neck hand 2.0 to 3.0 119.67 150.56 11424 amb surg exc ben lesion scalp neck hand 3.0 to 4.0 138.09 173.83 11426 amb surg exc ben lesion scalp neck hand over 4.0 211.34 250.11 11440 excision, other benign lesion including margins (unless listed elsewhere), 75.02 97.14 11441 removal of skin lesion 98.74 123.57 11442 excision, other benign lesion including margins (unless listed elsewhere), 110.25 139.32 11443 amb surg exc ben lesion face ears nose 2.0 to 3.0 136.52 167.71 11444 amb surg exc ben lesion face ears nose 3.0 to 4.0 175.39 212.04 11446 excision, other benign lesion (unless listed elsewhere), face, 248.62 289.51 11450 exc skin for hidradenitis primary suture/axillary. 180.72 263.99 11451 exc skin for hidradenitis w other closure/axillary 239.12 345.71 11462 exc skin for hidradenitis w prim suture/inguinal 173.71 260.32 11463 exc skin for hidradenitis w oth closure/inguinal 243.86 355.31 11470 exc skin for hidradenitis w primary closure 205.96 290.14 11471 exc skin for hidradenitis with other closure 259.46 365.15 11600 removal of skin lesion 87.42 135.26 11601 removal of skin lesion 113.14 167.35 11602 removal of skin lesion 124.53 183.89 11603 excision malignant lesion truck arms or legs diame 148.22 209.39 11604 amb surg excision malignant lesion 3.0 to 4.0 cm 162.92 231.37 11606 amb surg excision malignant lesion over 4.0 cm 241.95 326.74 11620 removal of skin lesion 88.75 138.11 11621 removal of skin lesion 114.38 168.88 11622 removal of skin lesion 131.95 191.31 11623 excision malignant lesion diameter 2 to 3 cm. 162.78 223.95 11624 amb surg exc malignant lesion 3.0 to 4.0 scalp etc 185.17 252.09 11626 amb surg exc malignant lesion 4.0 scalp neck 231.91 307.31 11640 removal of skin lesion 93.48 144.35 11641 removal of skin lesion 122.08 177.81 11642 removal of skin lesion 144.11 205.28 11643 amb surg exc malignant lesion face ears 2.0 to 3.0 180.22 242.00 11644 amb surg exc malignant lesion face ears 3.0 to 4.0 224.74 298.94 11646 amb surg exc malignant lesion face ears over 4.0 316.51 394.95 11720 debridement of nail(s) by any method(s); one to five 14.03 24.02 11721 debridement of nail(s) by any method(s); six or more 23.97 34.58 11730 removal of nail 48.60 76.17 11732 avulsion of nail plate, partial or complete, simple; each additional nail plate 25.26 35.55 11740 evacuation of subungual hematoma 25.05 34.45 11750 removal of nail bed 138.25 164.90 11755 biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral 68.81 102.42 11760 reconstruction of nail bed 102.77 153.04 11762 reconstruction of nail bed 158.77 206.91 11765 wedge excision of skin of nail fold (eg, for ingrown toenail) 52.76 96.99 11770 amb surg exc pilonidal cyst/sinus simple 139.28 197.42 11771 amb surg exc pilonidal cyst/sinus extensive 322.58 406.16 11772 amb surg exc pilonidal cyst/sinus complicated 420.22 492.89 11900 injection into skin lesions 25.01 43.18 11901 injection, intralesional; 38.92 54.98 11960 insertion of tissue expender. 710.46 710.46 11970 replacement of tissue expander with permanent prosthesis 467.48 467.48 11971 removal of tissue expander(s) without insertion of prosthesis 230.44 344.61 11976 removal, implantable contraceptive capsule 79.29 116.83 11980 subcutaneous hormone pellet (implantation of estradiol and/or testosterone) 66.60 83.25 11981 insert drug implant drevice 67.91 103.75 11982 remove drug implant device 82.86 119.58 11983 remove/insert drug implant 151.73 186.10 12001 repair of recent wound 81.84 113.02 12002 amb surg simple repair superficial wound 2.5-7.5 90.81 120.50 12004 simple rep superf wds sca neck axil ext gen tru/ex 106.82 142.24 12005 amb surg simple repair superficial wound 12.5-20.0 133.20 177.42 12006 amb surg simple repair superficial wound 20.0-30.0 168.33 220.41 12007 amb surg simple repair superficial wound over 30.0 192.40 249.64 12011 amb surg simple repair superficial wound 2.5 cm 84.61 120.04 12013 amb surg simple repair superficial wound 2.5-5.0 96.50 132.53 12014 amb surg simple repair superficial wound 5.0-7.5 116.25 156.53 12015 amb surg simple repair superficial wound 7.5-12.5 145.93 196.81 12016 amb surg simple repair superficial wound 12.5-20.0 178.16 235.40 12017 amb surg simple repair superficial wound 20.0-30.0 212.13 212.13 12018 amb surg simple repair superficial wound over 30.0 262.19 262.19 12020 treatment of superficial wound dehiscence.