North Carolina Will Let Providers in Large Counties Add MRI Scanners Without Certificate-of-Need Review Starting November 21, 2026

Providers in North Carolina counties with more than 125,000 residents under the 2020 decennial census will be able to acquire MRI scanners without certificate-of-need (CON) approval starting November 21, 2026, under a law enacted in March 2023. For imaging groups and health systems in the state’s larger markets, adding a magnet will no longer depend on a state need determination and a competitive review.

The law itself isn’t new. The North Carolina General Assembly passed Session Law 2023-7 in March 2023, and it was signed March 27, 2023, as part of the state’s Medicaid expansion, according to a McGuireWoods client alert on the 2023 CON reforms. The news is the effective date.

The stakes are clearest in Wake County, where a Raleigh imaging group’s vendor declined to renew the service agreement for a scanner in 2025, and the group asked the state for a way to replace it. State staff recommended against a special exception, partly because the exemption was only months away.

What changes on November 21

Today, North Carolina regulates MRI largely through its definition of a “diagnostic center.” The codified CON statute, N.C.G.S. Chapter 131E, Article 9, labels the current version of that definition “Effective until November 21, 2026.” The version that replaces it adds this language:

“No facility, program, or provider, including but not limited to, physicians’ offices, clinical laboratories, radiology centers, or mobile diagnostic programs, shall be deemed a diagnostic center solely by virtue of having a magnetic resonance imaging scanner in a county with a population of greater than 125,000 according to the 2020 federal decennial census or any subsequent federal decennial census.”

According to the North Carolina Division of Health Service Regulation’s Technology and Equipment Committee agency report on the Raleigh Radiology petition, providers in qualifying counties will be able to acquire an MRI “without CON approval and without regard to a need determination” in the State Medical Facilities Plan (SMFP).

The consulting firm RPC goes a step further. Its summary of North Carolina’s CON program, updated in August 2026, says MRI scanners in qualifying counties are also “removed from the definition of major medical equipment and are no longer subject to CON review.”

The exemption is narrow. It covers MRI, in large counties. The diagnostic-center definition’s $3 million threshold still applies to other equipment, and smaller counties keep the existing rules for MRI as well.

A 2023 law with a payment-based clock

When the bill passed, McGuireWoods described the MRI change as taking effect “Three Years After the First HASP-Directed Payment,” a trigger tied to the Medicaid expansion’s financing rather than a fixed date. The statute text and the state agency report give that date as November 21, 2026, and the RPC summary agrees.

Wake County MRI capacity under CON

The agency report counts Wake County’s planning inventory at 36.54 fixed-equivalent MRI scanners: 22 existing fixed scanners, 5 approved but not yet issued, and 9.54 fixed equivalents contributed by mobile units. The Proposed 2026 SMFP produced a need determination for one more fixed scanner.

That’s how the CON process works: the state projects need, identifies a set number of scanners, and providers compete for them. In the 2025 SMFP cycle, Raleigh Radiology–Holly Springs, Duke Imaging Garner and Raleigh Radiology–Blue Ridge all applied for the one Wake scanner.

Raleigh Radiology, Akumin and a legacy scanner

The petition behind the agency report didn’t start as a policy fight. It started with a contract. Akumin decided not to renew its service agreement for a “legacy” scanner at Raleigh Radiology–Blue Ridge when that agreement expired in November 2025.

Raleigh Radiology asked the state for one of two remedies: a Wake-only policy for legacy scanners, or a restricted need determination. State staff “recommends denial of the petition.” Part of the staff’s reasoning was timing. Even an application filed in January 2026, staff noted, would have produced a scanner only about three months before the exemption took effect.

That timing shows what the CON gate meant in practice: a provider facing the end of a scanner service agreement had no quick legal route to a replacement through the need-determination process.

Legacy scanners and the exemption

Legacy scanners complicate the picture. The agency counts 20 fixed legacy scanners statewide, while noting it can’t count them with certainty. Nineteen sit in counties that will become exempt, and one is in Wilson County, which falls below the population threshold. Legacy owners already replace or relocate those units without a CON, so the exemption’s main effect is on adding scanners, not on keeping existing ones.

Lists of qualifying counties differ on Pitt County

The agency report’s table lists Pitt County among the counties where MRI will become exempt. The 2023 McGuireWoods list of counties over 125,000 leaves Pitt out. Both describe the same 2020-census threshold, yet the two lists conflict on Pitt.

What comes after the exemption

There’s no data yet on scanner counts, wait times or prices under the exemption, because it hasn’t taken effect. Any claim that it will lower costs or widen access is a prediction, and so is any claim that it will flood large counties with underused magnets.

What the date does create is a before-and-after line in the state’s largest imaging markets, with Wake County’s inventory as a documented starting point. The November 21 date turns the broad argument over CON laws into something North Carolina can measure.

About the sources: The effective date and statutory language come from the codified statute and the state agency staff report. The McGuireWoods alert and the RPC summary are secondary descriptions that agree with those documents.