Cleveland County Health Department
To Assure, enhance, and protect the health of our citizens through education and prevention.
   
Carolina Community Health Partnership

Medicaid 24 Visit Limit

What does it mean?

Medicaid has set limits on the number of visits a person can make for medical care in one year to 24 visits.

Who is eligible?

  • Persons under 21 years of age have Unlimited medical visits
  • Persons 21 years of age and older are limited to 24 medical visits per year based on State Fiscal Year (7/1/06 - 6/30/07)
  • Visits paid by Medicare that are also billed to Medicaid DO NOT count toward the 24 visits.

What services count as a medical visit?

The following services count as a visit towards the 24 visit limit:

  • visits to your primary care doctor (includes both sick visits and physicals)
  • visits to a psychiatrist
  • visits to a chiropractor
  • visits to a eye doctor
  • visits to a podiatrist (foot doctor)
  • visits to a specialist when referred by your primary care doctor
  • visits by your primary care doctor to you while in the hospital
  • X-ray services (except for radiation therapy or x-rays taken the same day as the doctor visit)
  • family planning visits(patients over 21 years of age)
  • outpatient hospital services, except emergency room visits
  • pharmacy management

The following services do not count as a visit toward your 24 visit limit:

  • physical therapy visits
  • mental health facility visits
  • dental visits
  • visits to the emergency room
  • doctor visits to nursing home residents
  • home health and hospice visits
  • outpatient lab services or work done by an independent lab
  • pregnancy and prenatal visits

If you are going to any doctor more than twice a month, you may exceed your 24 visits allowed by Medicaid for the year. Your doctor's office can bill you for visits aver the 24 visit limit. Use your doctor's office visits wisely and carefully to avoid this situation.

Resources
- Medical Home Brochure (Adult)
- Medical Home Brochure (Children)
- Information for Medicaid Consumer

TACC

Need transportation services to your appointment? Contact the Department of Social Services to qualify @ 704 487-0669

Medical Home

A Medical Home is the one place you and your child go for all their health care needs:

  • Checkups
  • Sick visits
  • Accidents
  • Special health needs
  • Immunizations (Shot)

A Medical Home is a doctor's office, community clinic, or a local health department. The staff there knows you, your child, and your health history.

Why do you and your child need a Medical Home?

You want to take your family to someone you know and trust. A Medical Home offers the very best care. Because the staff knows you and your child, they can:

  • make sure you get the checkups, screenings, and shots you need to stay well
  • work with you in planning your care
  • tell you about community programs and resources that may be helpful
  • help you locate the right specialists and equipment for you and your child

Then when you or your child is sick or hurt...

You have someone to call for help! The staff at the Medical Home can tell you if you should:

  • treat your child or yourself at home. (they will tell you how)
  • come to the doctor's office. (they will make an appointment for you)
  • go to the emergency room. (the emergency room is for true emergencies - times when children may lose their life or risk their health without immediate treatment. it is rare when children need to be seen in the emergency room
Please Remember to contact your Doctor BEFORE YOU GO TO THE EMERGENCY ROOM if possible...