CurrentUnitedHealthcarePolicy CSNC.MP.017.08
Private Duty Nursing Services (for North Carolina Only)
This UnitedHealthcare Medical Policy governs Private Duty Nursing (PDN) services for members in North Carolina and defers detailed medical necessity criteria to North Carolina Medicaid Clinical Coverage Policies for beneficiaries age 21+ and under 21. It provides applicable CPT/HCPCS code reference and related policy links.
Policy Summary
PayerUnitedHealthcare
PolicyPrivate Duty Nursing Services (for North Carolina Only)
Policy CodePolicy CSNC.MP.017.08
Change TypeApplicable codes revised; related policy list updated
Effective DateNov 1, 2025
Next Review Date
Key ActionProviders must follow the referenced North Carolina Medicaid Clinical Coverage Policies (3G-1 for age 21+ and 3G-2 for under 21) to determine medical necessity and document eligibility per those policies.
SourceLink
POLICY UPDATE CHANGES
Removed HCPCS codes S9123, S9124, and T1002 from Applicable Codes effective 11/01/2025.
Removed reference link to Home Hemodialysis (for North Carolina Only) policy (retired May 1, 2026) as of 05/01/2026.
Archived previous policy version CSNC.MP.017.07 on 11/01/2025.
1Referenced Procedure Codes Remaining
3Procedure Codes Removed
2Referenced External Clinical Policies