Official confirmation regarding the Aetna State Health Plan (SHP) fee schedule changes effective January 1, 2026.
According to Aetna’s provider information, the Clear Pricing Project (CPP)—the unique Aetna SHP fee schedule—is ending on December 31, 2025. Effective January 1, 2026, you will remain in-network for State Health Plan members at your standard Aetna contracted rates.
You can find this confirmed on Aetna’s provider site here: Clear Pricing Project (CPP) information from Aetna:
https://www.aetna.com/health-care-professionals/north-carolina-state-health-plan/nc-shp-clear-pricing-project.html Aetna
And reiterated on Aetna’s NC SHP overview for providers: NC State Health Plan Network Updates:
https://www.aetna.com/health-care-professionals/north-carolina-state-health-plan.html Aetna
These resources state that the CPP ends December 31, 2025 and that providers will be paid at their Aetna network rates beginning January 1, 2026.
Summary:
- Copays will increase from $26 / $36 to $42 / $62, effective January 1, 2026.
- The separate Aetna State Health Plan fee schedule will be discontinued.
- Claims will transition to the standard Aetna fee schedule.
- CPT code S8990 will no longer be covered under Aetna SHP.
Are your patients educated on the changes happening with their SHP plan?