Standard Rate Schedule: Non-Medicaid Clinician-Based Services Revised 11/01/2022 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 90791SR - In-Home Psychiatric Diagnostic Evaluation 90792 - PSYCHIATRIC DIAGNOSTIC EVAL W/ MED 90832 - PSYCHOTHERAPY 30 MN 90832SR - IN-HOME PSYCHOTHERAPY 60 MN 90833 - PSYCHOTHERAPY 30 MIN ADD ON TO E&M 90834 - PSYCHOTHERAPY 45 MN 90834SR - IN-HOME PSYCHOTHERAPY 60 MN 90836 - PSYCHOTHERAPY 45 MIN ADD ON TO E&M 90837 - PSYCHOTHERAPY 60 MN 90837SR - IN-HOME PSYCHOTHERAPY 60 MN 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 90846SR - In-home Family Ther W/O PT 90847 - FAMILY THER W/ PT 90847SR - In-home Family Ther W/ PT 90849 - MULTI-FAM GROUP 90853 - GROUP THER 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
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 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022 12/1/2022
Behavioral Health Physicians
Nurse Practitioners Physicians Assistant
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
4.03 122.71 132.48 101.51 48.20 63.74 30.55 64.10 98.11 52.77 96.26 132.48 88.28 122.60 107.43 70.08 136.88 88.22 136.88 36.00 36.00 10.11 132.53 66.27 118.32 118.32 107.58 107.58 140.58
3.84 90.58 132.48 93.81 35.15 63.74 28.60 55.29 98.11 50.02 85.91 132.48 83.31 108.90 94.92 64.82 136.88 78.74 136.88 36.00 36.00 8.49
Other Licensed Behavioral Health Clinicians
Psychologists
$ $ $
3.83 $ 116.33 $ 132.48 $
3.23 89.04 132.48
$ $
45.54 $ 63.74 $
34.18 63.74
$ $
60.65 $ 98.11 $
45.89 98.11
$ $
91.20 $ 132.48 $
69.57 132.48
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
116.22 102.05 66.32 136.88 83.56 136.88 36.00 36.00 8.58 116.16 53.20 93.07 93.07 101.00 83.94 113.03
97.08 85.94 55.06 136.88 69.58 136.88 36.00 36.00
$ $ $ $ $ $ $ $
Standard Rate Schedule: Non-Medicaid Clinician-Based Services Revised 11/01/2022 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
Nurse Practitioners Physicians Assistant
Psychologists
Service
Effective Date
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 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 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 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 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, 11-20 min 99448 - Interprofessional Tele/Internet/EHR Consultation, 21-30 min
12/1/2022
$
140.58
$
113.03
12/1/2022
$
53.79
$
41.97
12/1/2022
$
53.79
$
41.97
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
$ $ $ $ $ $ $ $ $ $
17.36 53.60 79.90 126.66 161.44 12.14 29.13 51.97 80.85 111.11
$ $ $ $ $ $ $ $ $ $
16.53 50.81 75.86 120.39 153.51 11.32 27.50 49.26 76.76 105.58
12/1/2022
$
12.15 $
11.57
12/1/2022
$
23.48 $
22.36
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
$ $ $ $ $ $ $ $ $ $
81.13 27.30 45.58 68.68 27.30 45.58 68.68 16.76 33.84 50.59
77.03 26.00 43.41 65.41 26.00 43.41 65.41
$ $ $ $ $ $ $
Other Licensed Behavioral Health Clinicians
Standard Rate Schedule: Non-Medicaid Clinician-Based Services Revised 11/01/2022 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
Effective Date
99449 - Interprofessional Tele/Internet/EHR Consultation, 31 or more min
12/1/2022
Behavioral Health Physicians
$
67.42
Nurse Practitioners Physicians Assistant
Psychologists
Other Licensed Behavioral Health Clinicians