Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS.
Service
90785 - INTERACTIVE COMPLEXITY 90791 - Psychiatric Diagnostic Evaluation 90791HI - Enhanced Psychiatric Diagnostic Evaluation 90791SR - In-Home Psychiatric Diagnostic Evaluation 90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/ MED 90832 - PSYCHOTHERAPY 30 MN 9083222 - Specialty Psychotherapy, 30 min 90832SR - IN-HOME PSYCHOTHERAPY 30 MN 90833 - PSYCHOTHERAPY 30 MIN ADD ON TO E&M 90834 - PSYCHOTHERAPY 45 MN 9083422 - Specialty Psychotherapy, 45 min 90834SR - IN-HOME PSYCHOTHERAPY 45 MN 90834Z4 - Equine-assisted Psychotherapy, 45 min 90836 - PSYCHOTHERAPY 45 MIN ADD ON TO E&M 90837 - PSYCHOTHERAPY 60 MN 9083722 - Specialty Psychotherapy, 60 min 90837SR - IN-HOME PSYCHOTHERAPY 60 MN 90837Z4 - Equine-assisted Psychotherapy, 60 min 90838 - PSYCHOTHERAPY 60 MIN ADD ON TO E&M 90839 - PSYCHOTHER FOR CRISIS 60 MIN 90840 - PSYCHOTHER FOR CRISIS ADDÆL 30 MN 90846 - FAMILY THER W/O PT 9084622 - Specialty Family Therapy w/o Patient
Behavioral Health Physicians
Effective Date
12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
4.03 127.71 175.00 137.48 106.51 53.20 75.48 68.74 35.55 69.10 106.07 103.11 86.51 57.77 101.26 145.00 137.48 126.77 93.28 127.60 107.43 75.08 145.00
Other Licensed Behavioral Health Clinicians
Psychologists
$ $ $ $
3.83 121.33 175.00 137.48
$ $ $ $
3.23 102.17 175.00 137.48
$ $ $
50.54 $ 75.48 $ 68.74 $
42.56 75.48 68.74
$ $ $ $
65.65 106.07 103.11 86.51
$ $ $ $
55.28 106.07 103.11 86.51
$ $ $ $
96.20 145.00 137.48 126.77
$ $ $ $
81.01 145.00 137.48 126.77
$ $ $ $
121.22 102.05 71.32 145.00
$ $ $ $
102.08 85.94 60.06 145.00
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS. Behavioral Health Physicians
Service
Effective Date
90846SR - In-home Family Ther W/O PT 90847 - FAMILY THER W/ PT 9084722 - Specialty Family Therapy w/ Patient 90847SR - In-home Family Ther W/ PT 90849 - MULTI-FAM GROUP 90853 - GROUP THER 9085322 - Specialty Group Therapy 90853Z4 - Equine-assisted Group Therapy 90870 - ELECTROCONVULSIVE THERAPY 96110 - DEVEL TST LMT 96112 - DEVEL TST EXT 96113 - add on DEVEL TST EXT 96116 - NEUROBEHAV EXAM 96121 - add on NEUROBEHAV EXAM 96130 - PSYCH TESTING CLINICAL PSYCH 96131 - add on PSYCH TESTING CLINICAL PSYCH 96132 - NEUROPSYCH TST- CLIN PSYCH 96133 - add on NEUROPSYCH TST- CLIN PSYCH 96136 - PSYCH OR NEUROPSYCH TESTING CLINICAL PSYCH TST ADMIN AND SCORING 96137 - add on PSYCH OR NEUROPSYCH TESTING CLINICAL PSYCH TST ADMIN AND SCORING 96372 - Therapeutic prophylactic or diagnostic injection
12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
136.88 93.22 160.00 136.88 36.00 36.00 62.68 36.69 115.44 10.11 132.53 66.27 118.32 118.32 107.58 107.58 140.58 140.58
12/1/2022
Other Licensed Behavioral Health Clinicians
Psychologists
$ $ $ $ $ $ $ $
136.88 88.56 160.00 136.88 36.00 36.00 62.68 36.69
$ $ $ $ $ $ $ $ $
8.58 116.16 53.20 93.07 93.07 101.00 83.94 113.03 113.03
$
53.79 $
41.97
12/1/2022
$
53.79 $
41.97
12/1/2022
$
17.36
$ $ $ $ $ $ $ $
136.88 74.58 160.00 136.88 36.00 36.00 62.68 36.69
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS.
Service
96374 - therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug 96375 - therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary service) 99202 - OP Visit New Pat, straightforward, 15-29 minutes 99203 - OP Visit New Pat, low level, 30-44 minutes 99204 - OP Visit New Pat, moderate, 45-59 minutes 99205 - OP Visit New Pat, high level, 60-74 minutes 99211 - OP Visit Est Pat, presenting problem minimal 99212 - OP Visit Est Pat, straightforward, 10-19 minutes 99213 - OP Visit Est Pat, low level, 20-29 minutes 99214 - OP Visit Est Pat, moderate, 30-39 minutes 99215 - OP Visit Est Pat, high level, 40-54 minutes 99217 - observation care discharge day management 99218 - initial observation, per day, low complexity
Behavioral Health Physicians
Effective Date
12/1/2022
$
44.42
12/1/2022
$
19.26
12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022
$ $ $ $ $ $ $ $ $ $ $
58.60 84.90 131.66 166.44 17.14 34.13 56.97 85.85 116.11 62.45 58.91
99219 - initial observation care, per day, moderate complexity
12/1/2022
$
97.56
99220 - initial observation care, per day, high complexity 99221 - Initial Hospital Care 30 Min 99222 - Initial Hospital Care-Mod-50 Min
12/1/2022 12/1/2022 12/1/2022
$ $ $
136.82 84.59 115.44
Psychologists
Other Licensed Behavioral Health Clinicians
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS.
Service
Behavioral Health Physicians
Effective Date
99223 - Initial Hospital Care-70 Min
12/1/2022
$
169.97
99224 - subsequent observation care, per day, low complexity
12/1/2022
$
23.72
99225 - subsequent observation care, per day, moderate complexity
12/1/2022
$
42.14
99226 - subsequent observation care, per day, high complexity
12/1/2022
$
63.00
99231 - Subsequent Hospital 15 Min 99232 - Subsequent Hospital 25 Min 99233 - Subsequent Hospital 35 Min 99234 - Observation/Inpat Low 99235 - Hosp/Obs 1-Day Mod Sev 99236 - Hosp/Obs 1-Day High Sev 99238 - Hospital Discharge 30 99239 - Hospital Discharge > 30 Min 99241 - outpt. consult, minor- phys time approx 15 min. 99241U4 - Physician Consult - Brief 99242 - outpt. consult, moderate- phys time approx 30 min. 99242U4 - Physician Consult - Intermediate 99243 - outpt. consult, severe- phys time approx 40 min. 99244 - outpt. consult, severe- phys time approx 60 min. 99245 - outpt. consult, severe- phys time approx 80 min. 99251 - initial inpt consult- phys time approx 20 min.
12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
34.93 62.96 90.16 119.33 156.75 194.83 62.24 90.46 40.72 55.00 76.28 90.00 104.91 155.82 191.51 41.58
Psychologists
Other Licensed Behavioral Health Clinicians
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS. Behavioral Health Physicians
Service
Effective Date
99252 - initial inpt consult- phys time approx 40 min. 99253 - initial inpt consult- phys time approx 55 min. 99254 - initial inpt consult- phys time approx 80 min. 99255 - initial inpt consult- phys time approx 110 min. 99281 - er visit, minor 99282 - er visit, low severity 99283 - er visit, moderate severity 99284 - er visit, high severity 99285 - emergency department visit for the evaluation and management of a patient, 99291 - critical care, evaluation and management of the critically ill or critically 99292 - critical care, 30-74 min Add 30 Min 99304 - initial nursing facility care, per day, for the evaluation and management of 99305 - Init Nursing Fac Care 35 Min 99306 - initial nursing facility care, per day, for the evaluation and management of a 99307 - subsequent nursing facility care, per day, for the evaluation and management of 99308 - subsequent nursing facility care, per day, for the evaluation and management of
12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022
$ $ $ $ $ $ $ $
64.42 97.80 141.46 172.36 17.35 33.75 52.30 97.92
12/1/2022
$
145.57
12/1/2022
$
236.89
12/1/2022
$
107.43
12/1/2022
$
75.37
12/1/2022
$
105.38
12/1/2022
$
135.41
12/1/2022
$
37.19
12/1/2022
$
56.87
Psychologists
Other Licensed Behavioral Health Clinicians
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS.
Service
99309 - subsequent nursing facility care, per day, for the evaluation and management of 99310 - subsequent nursing facility care, per day, for the evaluation and management of 99315 - nursing facility discharge day management; 30 minutes or less 99316 - nursing facility discharge day management; 30 minutes or less more than 30 99318 - evaluation and management of a patient involving an annual nursing facility 99324 - domiciliary or rest home visit for the evaluation and management of a new 99325 - domiciliary or rest home visit for the evaluation and management of a new 99326 - domiciliary or rest home visit for the evaluation and management of a new 99327 - domiciliary or rest home visit for the evaluation and management of a new 99328 - domiciliary or rest home visit for the evaluation and management of a new 99334 - domiciliary or rest home visit for the evaluation and management of an
Behavioral Health Physicians
Effective Date
12/1/2022
$
75.43
12/1/2022
$
111.53
12/1/2022
$
54.42
12/1/2022
$
71.11
12/1/2022
$
78.86
12/1/2022
$
50.56
12/1/2022
$
73.64
12/1/2022
$
121.75
12/1/2022
$
158.80
12/1/2022
$
186.94
12/1/2022
$
52.11
Psychologists
Other Licensed Behavioral Health Clinicians
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS.
Service
99335 - domiciliary or rest home visit for the evaluation and management of an 99336 - domiciliary or rest home visit for the evaluation and management of an 99337 - domiciliary or rest home visit for the evaluation and management of an 99341 - home visit for the evaluation and management of a new patient, which requires 99342 - home visit for the evaluation and management of a new patient, which requires 99343 - home visit for the evaluation and management of a new patient, which requires 99344 - home visit for the evaluation and management of a new patient, which requires 99345 - home visit for the evaluation and management of a new patient, which requires 99347 - home visit for the evaluation and management of an established patient, which 99348 - home visit for the evaluation and management of an established patient, which 99349 - home visit for the evaluation and management of an established patient, which
Behavioral Health Physicians
Effective Date
12/1/2022
$
80.71
12/1/2022
$
113.66
12/1/2022
$
163.32
12/1/2022
$
50.56
12/1/2022
$
73.64
12/1/2022
$
118.59
12/1/2022
$
155.68
12/1/2022
$
187.26
12/1/2022
$
49.34
12/1/2022
$
74.50
12/1/2022
$
108.48
Psychologists
Other Licensed Behavioral Health Clinicians
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS.
Service
99350 - home visit for the evaluation and management of an established patient, which 99354 - Prolonged MD Serv except Office(60 min) 99355 - Prolng MD Serv except Office(Add 30min) 99356 - Prolng MD Serv IP or observ (60min) 99357 - Prolng MD Serv IP or observ (Add 30min) 99406 - smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes, up to 10 minutes 99407 - smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes 99408 - alcohol and/or substance (other than tobacco) abuse structured screening (eg. audit, dast) and brief intervention (sbi) services; 15- 30 minutes 99409 - alcohol and/or substance (other than tobacco) abuse structured screening (eg. audit, dast) and brief intervention (sbi) services; greater than 30 minutes 99417 - Prolonged Office or other OP (15 min) 99421 - Online Digital E/M Service, 5-10 min 99422 - Online Digital E/M Service, 11-20 min 99423 - Online Digital E/M Service, 21 or more min 99441 - Telephone Evaluation and Management Service - 5-10 min
Behavioral Health Physicians
Effective Date
12/1/2022
$
151.24
12/1/2022 12/1/2022 12/1/2022 12/1/2022
$ $ $ $
86.13 85.27 78.66 79.20
12/1/2022
$
12.15
12/1/2022
$
23.48
12/1/2022
$
31.30
12/1/2022
$
61.53
12/1/2022 12/1/2022 12/1/2022 12/1/2022
$ $ $ $
86.13 27.30 45.58 68.68
12/1/2022
$
27.30
Psychologists
Other Licensed Behavioral Health Clinicians
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services Revised 03/02/2023 For Nurse Practitioner and Physician Assistant rates see: NC Medicaid Fee Schedules: Nurse Practitioner
Physician Assistant
For qualifying telehealth (GT modifier) and telephonic (KX modifiers) services, see NC Medicaid Clinical Coverage Policy 8C. "Other licensed behavioral health clinicians" includes: LCSW, LCMHC, LMFT, LCAS, CNS, CSAC, and CCS.
Service
99442 - Telephone Evaluation and Management Service - 11-20 min 99443 - Telephone Evaluation and Management Service - 21-30 min 99446 - Interprofessional Tele/Internet/EHR Consultation, 5-10 min 99447 - Interprofessional Tele/Internet/EHR Consultation, 1120 min 99448 - Interprofessional Tele/Internet/EHR Consultation, 2130 min 99449 - Interprofessional Tele/Internet/EHR Consultation, 31 or more min G2012 - Brief Virtual Check-in by Prescriber, 5-10 minutes
Behavioral Health Physicians
Effective Date
12/1/2022
$
45.58
12/1/2022
$
68.68
12/1/2022
$
16.76
12/1/2022
$
33.84
12/1/2022
$
50.59
12/1/2022
$
67.42
12/1/2022
$
27.30
Psychologists
Other Licensed Behavioral Health Clinicians