Yes, NC Medicaid does cover dermatology in North Carolina when the care is medically necessary, including office visits, biopsies, removal of cancerous and precancerous lesions, light therapy for conditions like psoriasis and eczema, and wound repair. Copays are capped at $4 per visit, and no referral from a primary care provider is required. The harder question is practical: finding a dermatologist who both accepts Medicaid and is taking new patients.
What NC Medicaid Covers at the Dermatologist
Coverage runs across the standard diagnostic and treatment services a dermatologist provides. Under the reimbursement policy that applies to NC Medicaid dermatology claims, payable services include:
- Skin biopsies for diagnosis
- Removal of malignant and pre-malignant lesions, by excision or destruction
- Removal of benign lesions when the provider documents a medical reason (otherwise treated as cosmetic)
- Shaving and debridement of skin lesions
- Ultraviolet light treatment (actinotherapy) for acne, atopic dermatitis, and psoriasis
- Photochemotherapy (PUVA) for atopic dermatitis, lichen planus, psoriasis, and vitiligo
- Laser treatment for psoriasis and parapsoriasis
- Simple and intermediate wound repairs1AmeriHealth Caritas North Carolina. Dermatology Reimbursement Policy RPC.0112.1200
Cosmetic procedures are excluded. A benign mole removed because it looks unwanted is not covered; the same mole removed because it bleeds, catches on clothing, or shows worrying changes can be, provided the dermatologist documents the clinical reason.
What You’ll Pay
NC Medicaid charges no monthly premium. The copay for a dermatology visit, as with other doctor and outpatient visits, is capped at $4.2NC Medicaid. NC Medicaid Copays
You pay nothing at all if you fall into one of these groups:
- Members under 21
- Pregnant members, for pregnancy-related services
- Foster care members
- Members in institutional care
- Members in waiver programs such as NC Innovations, CAP/C, or CAP/DA
- Members seen at a Federally Qualified Health Center or Rural Health Clinic
- Federally recognized tribal members2NC Medicaid. NC Medicaid Copays
Do You Need a Referral?
No. NC Medicaid does not require a referral from a primary care provider to see a dermatologist, and claims will not be denied for lack of one.3NC Medicaid. Specialty Care Referrals NC Medicaid 2025 Update Some individual dermatology offices still ask for one as an office policy, so call ahead and ask.
If you’re enrolled in a managed care health plan, the dermatologist needs to be enrolled in NC Medicaid and in that plan’s network. Going out of network may require prior authorization from your plan. You can search for in-network dermatologists through the Provider and Health Plan Lookup Tool at ncmedicaidplans.gov,4NC Medicaid. Find a Doctor or call the NC Medicaid Contact Center at 888-245-0179 for help.
The Access Problem Is Real
Being covered and getting an appointment are not the same thing. A 2025 study from the Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill, drawing on interviews with people who enrolled through North Carolina’s December 2023 Medicaid expansion, found that beneficiaries saw specialists as reluctant to accept Medicaid and reported appointment waits considerably longer than those privately insured patients faced. Dermatologists were specifically named among the specialists people had tried to reach.5UNC Sheps Center. Medicaid Expansion Beneficiary Access Brief
A common frustration in those interviews: providers listed as in-network in a plan’s directory turned out not to be accepting new patients, or did not actually take that particular plan. When you call to schedule, confirm both pieces up front. Expect to call several offices.
Broader Coverage for Children Under 21
Children and young adults under 21 have wider coverage through the Early and Periodic Screening, Diagnostic, and Treatment benefit. Under EPSDT, NC Medicaid has to cover any dermatology service medically necessary to correct or treat a condition found during a screening exam, as long as the service is listed under Section 1905(a) of the Social Security Act and is not experimental. A dermatology service that would not be covered for an adult can still be approved for a child under EPSDT.6NC DHHS. Early Periodic Screening, Diagnostic and Treatment Medicaid Services for Children
Prior Authorization for Some Medications
Most dermatology prescriptions can be filled routinely, but certain drugs need prior authorization. Dupixent, a biologic prescribed for atopic dermatitis, is one that specifically requires prior approval.7NC Tracks. Pharmacy Prior Approval Forms The state also maintains prior authorization forms for broader categories relevant to skin disease, including immunomodulators, topical anti-inflammatory agents, and topical antihistamines. Providers submit requests by fax, phone, or through the NCTracks provider portal.
The complete list of drugs that need prior approval, along with the clinical criteria for each, lives on the NC Medicaid Preferred Drug List, which is updated periodically. The version in effect in early 2026 was revised that March.8NC Medicaid. Preferred Drug List
Teledermatology
NC Medicaid’s permanent telehealth policy pays for telehealth visits at the same rate as in-person care and lets patients be seen at home using any HIPAA-compliant device with audio and video. No prior authorization is required, and no initial in-person visit is required before a telehealth appointment.9NC Medicaid. Telehealth Program10Milbank Memorial Fund. Assessing the Impact of Medicaid Telehealth Policy Change on Equitable Access to Telehealth Services in North Carolina
Dermatology isn’t explicitly named on the state’s telehealth service list, but Clinical Coverage Policy 1H defines eligible services by billing code rather than by specialty, and it covers the standard outpatient evaluation and management codes a dermatologist bills for an office visit.11NC Medicaid. Clinical Coverage Policy 1H – Telehealth, Virtual Communications and Remote Patient Monitoring If you want a video dermatology visit, confirm with both your health plan and the dermatology office that the specific service will be covered before you book.