Clinical Coverage/Medical Policy Updates
WellCare of North Carolina updates a select number of clinical coverage policies each month, ensuring the reviewal of all policies on an annual basis.
Authorization Rule Updates
2026
- Q1: Effective January 01, 2026 (PDF) - Revised 11/12/2025
- Q1: Effective February 01, 2026 (PDF)
Policy Updates
- WNC.CP.114 Enhanced Mental Health and Substance Abuse Services (PDF)
- WNC.CP.252 Acute Inpatient Hospital Services (PDF)
- WNC.CP.257 Special Ophthalmological Services (PDF)
- WNC.CP.285 Substance Abuse Intensive Outpatient Program SAIOP (PDF)
- WNC.CP.286 Substance Abuse Comprehensive Outpatient Treatment SACOT (PDF)
- WNC.CP.288 Clinically Managed Residential Withdrawal Management Services (ASAM 3.2 WM) (PDF)
- WNC.CP.202 Heart (Cardiac) Transplantation (PDF)
- WNC.CP.203 Kidney (Renal) Transplantation (PDF)
- WNC.CP.204 Liver Transplantation (PDF)
- WNC.CP.246 Small Bowel and Small Bowel_Liver and Multivisceral Transplants (PDF)
- WNC.CP.247 Pancreas Transplant (PDF)
- WNC.CP.248 Islet Cell Transplantation (PDF)
- WNC.CP.249 Lung Transplantation (PDF)
- WNC.CP.250 Heart_Lung Transplantation (PDF)
- WNC.CP.300 Casgevy Pharmacy Prior Approval Criteria (PDF)
- WNC.CP.301 Lyfgenia Pharmacy Prior Approval Criteria (PDF)
- WNC.CP.302 Zolgensma - Pharmacy Prior Approval Criteria (PDF)
- WNC.CP.102 Family Planning Service (PDF)
- WNC.CP.126 Urinary Incontinence Devices and Treatments (PDF)
- WNC.CP.129 Electric Tumor Treating Fields (PDF)
- WNC.CP.135 Homocysteine Testing (PDF)
- WNC.CP.152 Polymerase Chain Reaction Respiratory Viral Panel Testing (PDF)
- WNC.CP.162 Hyperhidrosis Treatments (PDF)
- WNC.CP.164 NICU Apnea Bradycardia Guidelines (PDF)
- WNC.CP.167 Neonatal Sepsis Management (PDF)
- WNC.CP.168 Neonatal Abstinence Syndrome Guidelines (PDF)
- WNC.CP.173 Testing for Select Genitourinary Conditions (PDF)
- WNC.CP.189 Rhinoplasty and or Septoplasty (PDF)
- WNC.CP.222 Skin Substitutes (PDF)
- WNC.CP.231 Peer Support Services (PDF)
- WNC.CP.259 In Lieu of Services (PDF)
- WNC.CP.269 Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing (PDF)
- WNC.CP.291 Outpatient Specialized Therapies (PDF)
- WNC.CP.297 Physical Health Clinical Policy Committee (PDF)