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Coverage and Limitations of Services

The Cancer Control Program covers up to 8 days of service for the diagnosis of cancer (inpatient or outpatient) per state fiscal year (July 1 through June 30) and up to 30 days of cancer treatment services (inpatient or outpatient) per state fiscal year. Follow-up services may be covered for up to 2 days if they fall within the 8- or 30-day limit. For maximum benefit to the patient, several services can be provided each day. Applications for in-patient diagnostic services must be accompanied by a written, signed statement from the attending physician stating the medical reason that inpatient services are required and why such services can not be performed on an outpatient basis.

* Coverage does not include treatment procedures that are palliative.
* Medications for the patient's use outside of the treatment facility or the doctor's office are not covered.
* Dental treatment is not covered except in cases of head and neck cancer and when necessary for the delivery of oncologic care.
* The Program will not cover late discharge fees, transportation, telephone calls, or other miscellaneous charges. Reimbursement for patient mileage is not an allowable charge.
* Cosmetic surgery will not be covered. This does not preclude the coverage of functional reconstructive surgery.
* Reconstructive surgery may only be covered for a patient when the Cancer Control Program paid for a treatment related to the same diagnosis.
* Treatment for patients suspected of having cervical intraepithelial neoplasia (CIN) should be performed in accordance with the guidelines of the American College of Obstetricians and Gynecologists (ACOG).
* Coverage includes both hospital and professional services. It can include short-term stays in hotel or motels when authorized treatment services are covered by the program and when the patient's residence is at least 50 miles from the medical facility providing the outpatient services. Reimbursement will be at the state rate for meals and lodging current at the time of service. Information on the current rate can be obtained from the Cancer Control Program.  
* Requests for inpatient diagnostic services must include justification as to why services can not be done on an outpatient basis.
   
  
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  Division of Public Health, North Carolina Department of Health and Human Services. All Rights Reserved.