Hospitals and Hospital Cost Reports

Inpatient Hospital Services 

Inpatient Hospital services are items and services ordinarily provided by the hospital for care and treatment of inpatients. Medically necessary and nonexperimental inpatient hospital services are available to eligible Medicaid customers within hospital utilization review guidelines. These services must be provided under the direction of a physician with privileges or a dentist in an institution maintained primarily for treatment and care of patients with disorders other than mental disease.

Outpatient Hospital Services 

Outpatient Hospital services are preventive, diagnostic, therapeutic, rehabilitative or relieving services or items furnished under the direction of a physician or dentist to a Medicaid beneficiary by an institution that is licensed or formally approved as a hospital. Outpatient hospital services are available to Medicaid customers who are not inpatients. 

Out-of-State Hospital Services

Out-of-State Hospital services are non-emergency clinical care services provided to a NC Medicaid beneficiary by a hospital located beyond the 40-mile radius of North Carolina’s border.

This service requires prior approval, except when:

  • An emergency arises from an accident or illness
  • The health of the individual would be endangered if treatment were postponed until the individual returned to North Carolina
  • The health of the individual would be endangered if travel were undertaken to return to North Carolina
  • The individual is a foster child who is a ward of North Carolina but resides beyond the 40-mile radius of North Carolina’s border

Emergency Medical Condition

An Emergency Medical Condition is the sudden onset of a medical condition that includes severe symptoms requiring immediate medical attention. Not receiving medical attention would result in:

  • Placing the patient’s health in jeopardy
  • Serious impairment to bodily functions
  • Serious dysfunction of any organ or body part

Financial Information

Cost Reports

Fee Schedules

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