90785
Standard Rate Schedule: Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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.
Other
INTERACTIVE COMPLEXITY12/1/20224.03 $ $3.83 $3.23
Psychiatric Diagnostic Evaluation12/1/2022127.71 $ $121.33 $94.04
Enhanced Psychiatric Diagnostic Evaluation 12/1/2022 $175.00 $175.00 $175.00 90791SR
Home Psychiatric Diagnostic Evaluation 12/1/2022 $137.48 $137.48 $137.48 90792
In
PSYCHIATRIC DIAGNOSTIC EVAL W/ MED 12/1/2022 $106.51 90832
PSYCHOTHERAPY 30 MN 12/1/2022 $53.20 $50.54 $39.18 9083222
Specialty Psychotherapy, 30 min 12/1/2022 $75.48 $75.48 $75.48 90832SR
HOME PSYCHOTHERAPY 30 MN 12/1/2022 $68.74 $68.74 $68.74 90833
IN
PSYCHOTHERAPY 30 MIN ADD ON TO E&M 12/1/2022 $35.55 90834
PSYCHOTHERAPY 45 MN 12/1/2022 $69.10 $65.65 $50.89 9083422
90834SR
90834Z4
90836
90837
9083722
90837SR
90837Z4
Specialty Psychotherapy, 45 min 12/1/2022 $106.07 $106.07 $106.07
IN
HOME PSYCHOTHERAPY 45 MN 12/1/2022 $103.11 $103.11 $103.11
Equine assisted Psychotherapy, 45 min 12/1/2022 $86.51 $86.51 $86.51
PSYCHOTHERAPY 45 MIN ADD ON TO E&M 12/1/2022 $57.77
PSYCHOTHERAPY 60 MN 12/1/2022 $101.26 $96.20 $74.57
Specialty Psychotherapy, 60 min 12/1/2022 $145.00 $145.00 $145.00
IN HOME PSYCHOTHERAPY 60 MN 12/1/2022 $137.48 $137.48 $137.48
Equine assisted Psychotherapy, 60 min 12/1/2022 $126.77 $126.77 $126.77
PSYCHOTHERAPY 60 MIN ADD ON TO E&M12/1/202293.28 $ 90839
90838
PSYCHOTHER FOR CRISIS 60 MIN 12/1/2022 $127.60 $121.22 $102.08 90840
90846
PSYCHOTHER FOR CRISIS ADDÆL 30 MN 12/1/2022 $107.43 $102.05 $85.94
FAMILY THER W/O PT 12/1/2022 $75.08 $71.32 $60.06
9084622
90846SR
Service
Standard Rate Schedule:
Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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.
Effective Date
Behavioral Health Physicians Psychologists
Other Licensed Behavioral Health Clinicians
Specialty Family Therapy w/o Patient12/1/2022145.00 $ $145.00 $145.00
In home Family Ther W/O PT 12/1/2022 $136.88 $136.88 $136.88
FAMILY THER W/ PT 12/1/2022 $93.22 $88.56 $74.58
Specialty Family Therapy w/ Patient 12/1/2022 $160.00 $160.00 $160.00
In home Family Ther W/ PT 12/1/2022 $136.88 $136.88 $136.88
MULTI FAM GROUP 12/1/2022 $36.00 $36.00 $36.00
GROUP THER 12/1/2022 $36.00 $36.00 $36.00 9085322
Equine assisted Group Therapy 12/1/2022 $36.69 $36.69 $36.69
Specialty Group Therapy 12/1/2022 $62.68 $62.68 $62.68 90853Z4
ELECTROCONVULSIVE THERAPY 12/1/2022 $115.44
DEVEL TST LMT 12/1/2022 $10.11 $8.58 96112
DEVEL TST EXT 12/1/2022 $132.53 $116.16
add on DEVEL TST EXT 12/1/2022 $66.27 $53.20
NEUROBEHAV EXAM 12/1/2022 $118.32 $93.07
add on NEUROBEHAV EXAM 12/1/2022 $118.32 $93.07
PSYCH TESTING CLINICAL PSYCH 12/1/2022 $107.58 $101.00
add on PSYCH TESTING CLINICAL PSYCH 12/1/2022 $107.58 $83.94
NEUROPSYCH TST‐ CLIN PSYCH 12/1/2022 $140.58 $113.03
add on NEUROPSYCH TST
CLIN PSYCH 12/1/2022 $140.58 $113.03
PSYCH OR NEUROPSYCH TESTING CLINICAL PSYCH TST ADMIN AND SCORING 12/1/202253.79 $ $41.97
96137
Standard Rate Schedule:
Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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 Effective Date
add on PSYCH OR NEUROPSYCH TESTING CLINICAL
Behavioral Health Physicians Psychologists
PSYCH TST ADMIN AND SCORING 12/1/202253.79 $ $41.97
Other Licensed Behavioral Health Clinicians
Therapeutic prophylactic or diagnostic injection12/1/2022 $17.36 96374
96372
therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug 12/1/2022 $44.42 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) 12/1/2022 $19.26 99202
OP Visit New Pat, straightforward, 15 29 minutes12/1/2022 $58.60 99203
99204
99205
99211
99212
99213
99214
99215
99217
99218
OP Visit New Pat, low level, 30‐44 minutes 12/1/2022 $84.90
OP Visit New Pat, moderate, 45 59 minutes 12/1/2022 $131.66
OP Visit New Pat, high level, 60 74 minutes12/1/2022166.44 $
OP Visit Est Pat, presenting problem minimal 12/1/2022 $17.14
OP Visit Est Pat, straightforward, 10 19 minutes12/1/2022 $34.13
OP Visit Est Pat, low level, 20 29 minutes 12/1/2022 $56.97
OP Visit Est Pat, moderate, 30 39 minutes 12/1/2022 $85.85
OP Visit Est Pat, high level, 40‐54 minutes12/1/2022116.11 $
observation care discharge day management 12/1/2022 $62.45
initial observation, per day, low complexity 12/1/2022 $58.91
99219
99220
Service
Standard Rate Schedule:
Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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.
Effective Date
Behavioral Health Physicians Psychologists
initial observation care, per day, moderate complexity12/1/202297.56 $
initial observation care, per day, high complexity12/1/2022 $136.82
Initial Hospital Care 30 Min 12/1/2022 $84.59 99222
99221
Initial Hospital Care Mod 50 Min 12/1/2022 $115.44 99223
Initial Hospital Care 70 Min 12/1/2022 $169.97 99224
subsequent observation care, per day, low complexity12/1/2022 $23.72 99225
subsequent observation care, per day, moderate complexity 12/1/202242.14 $ 99226
subsequent observation care, per day, high complexity12/1/2022 $63.00 99231
Subsequent Hospital 15 Min 12/1/2022 $34.93 99232
Subsequent Hospital 25 Min 12/1/2022 $62.96 99233
99234
99235
99236
Subsequent Hospital 35 Min 12/1/2022 $90.16
Observation/Inpat Low 12/1/2022 $119.33
Hosp/Obs 1 Day Mod Sev 12/1/2022 $156.75
Hosp/Obs 1 Day High Sev 12/1/2022 $194.83
Hospital Discharge 30 12/1/2022 $62.24 99239
99238
Hospital Discharge > 30 Min12/1/202290.46 $ 99241
99241U4
outpt. consult, minor‐ phys time approx 15 min.12/1/2022 $40.72
Physician Consult ‐ Brief 12/1/2022 $55.00
Other Licensed Behavioral Health CliniciansService
99242
99242U4
99243
99244
99245
99251
99252
99253
99254
99255
99281
99282
99283
99284
outpt. consult, moderate
Physician Consult
outpt. consult, severe
Standard Rate Schedule:
Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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.
Effective Date
Behavioral Health Physicians Psychologists
phys time approx 30 min.12/1/202276.28 $
Intermediate 12/1/2022 $90.00
phys time approx 40 min.12/1/2022 $104.91
outpt. consult, severe‐ phys time approx 60 min.12/1/2022 $155.82
outpt. consult, severe
initial inpt consult
initial inpt consult
phys time approx 80 min.12/1/2022 $191.51
phys time approx 20 min. 12/1/2022 $41.58
phys time approx 40 min. 12/1/2022 $64.42
initial inpt consult‐ phys time approx 55 min. 12/1/2022 $97.80
initial inpt consult‐ phys time approx 80 min. 12/1/2022 $141.46
initial inpt consult‐ phys time approx 110 min. 12/1/2022 $172.36
er visit, minor 12/1/2022 $17.35
er visit, low severity 12/1/2022 $33.75
er visit, moderate severity 12/1/2022 $52.30
er visit, high severity 12/1/2022 $97.92
emergency department visit for the evaluation and management of a patient, 12/1/2022 $145.57
99285
99291
critical care, evaluation and management of the critically ill or critically 12/1/2022 $236.89
99292
critical care, 30‐74 min Add 30 Min 12/1/2022 $107.43
initial nursing facility care, per day, for the evaluation and management of 12/1/202275.37 $
99304
99305
Init Nursing Fac Care 35 Min 12/1/2022 $105.38
Other Licensed Behavioral Health CliniciansService
Standard Rate Schedule:
Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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.
Effective Date
initial nursing facility care, per day, for the evaluation and management of a 12/1/2022135.41 $ 99307
99306
subsequent nursing facility care, per day, for the evaluation and management of 12/1/2022 $37.19
99308
subsequent nursing facility care, per day, for the evaluation and management of 12/1/2022 $56.87 99309
subsequent nursing facility care, per day, for the evaluation and management of 12/1/2022 $75.43
99310
subsequent nursing facility care, per day, for the evaluation and management of 12/1/2022 $111.53
99315
nursing facility discharge day management; 30 minutes or less 12/1/2022 $54.42
99316
nursing facility discharge day management; 30 minutes or less more than 30 12/1/2022 $71.11
99318
evaluation and management of a patient involving an annual nursing facility 12/1/2022 $78.86
99324
domiciliary or rest home visit for the evaluation and management of a new 12/1/2022 $50.56
99325
domiciliary or rest home visit for the evaluation and management of a new 12/1/2022 $73.64
99326
domiciliary or rest home visit for the evaluation and management of a new 12/1/2022 $121.75
Behavioral Health Physicians Psychologists Other Licensed Behavioral Health CliniciansService
Standard Rate Schedule:
Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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.
Effective Date
domiciliary or rest home visit for the evaluation and management of a new 12/1/2022158.80 $
99327
99328
domiciliary or rest home visit for the evaluation and management of a new 12/1/2022 $186.94
99334
domiciliary or rest home visit for the evaluation and management of an 12/1/2022 $52.11 99335
domiciliary or rest home visit for the evaluation and management of an 12/1/202280.71 $
99336
domiciliary or rest home visit for the evaluation and management of an 12/1/2022 $113.66
99337
domiciliary or rest home visit for the evaluation and management of an 12/1/2022 $163.32
99341
home visit for the evaluation and management of a new patient, which requires 12/1/2022 $50.56 99342
home visit for the evaluation and management of a new patient, which requires 12/1/2022 $73.64
99343
home visit for the evaluation and management of a new patient, which requires 12/1/2022 $118.59
99344
home visit for the evaluation and management of a new patient, which requires 12/1/2022 $155.68
99345
home visit for the evaluation and management of a new patient, which requires 12/1/2022187.26 $
Behavioral Health Physicians Psychologists Other Licensed Behavioral Health CliniciansService
Standard Rate Schedule:
Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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.
Effective Date
home visit for the evaluation and management of an established patient, which 12/1/202249.34 $
99347
99348
home visit for the evaluation and management of an established patient, which 12/1/2022 $74.50 99349
home visit for the evaluation and management of an established patient, which 12/1/2022 $108.48 99350
home visit for the evaluation and management of an established patient, which 12/1/2022 $151.24
Prolonged MD Serv except Office(60 min) 12/1/2022 $86.13 99355
99354
Prolng MD Serv except Office(Add 30min) 12/1/2022 $85.27 99356
Prolng MD Serv IP or observ (Add 30min) 12/1/2022 $79.20
Prolng MD Serv IP or observ (60min) 12/1/2022 $78.66 99357
99406
smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes, up to 10 minutes 12/1/2022 $12.15
99407 ‐ smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes 12/1/2022 $23.48
99408
alcohol and/or substance (other than tobacco) abuse structured screening (eg. audit, dast) and brief intervention (sbi) services; 15‐ 30 minutes 12/1/2022 $31.30
99409 ‐ alcohol and/or substance (other than tobacco) abuse structured screening (eg. audit, dast) and brief intervention (sbi) services; greater than 30 minutes 12/1/202261.53 $
Behavioral Health Physicians Psychologists Other Licensed Behavioral Health Clinicians99417
Service
Standard Rate Schedule:
Medicaid 1915(b) Clinician-Based Services
Revised 11/01/2022
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.
Effective Date
Behavioral Health Physicians Psychologists
Prolonged Office or other OP (15 min)12/1/202286.13 $
Other Licensed Behavioral Health Clinicians
99421
Online Digital E/M Service, 5 10 min 12/1/2022 $27.30 99422
Online Digital E/M Service, 21 or more min 12/1/2022 $68.68
Online Digital E/M Service, 11 20 min 12/1/2022 $45.58 99423
99441
Telephone Evaluation and Management Service
5 10 min 12/1/2022 $27.30
99442
Telephone Evaluation and Management Service
11 20 min 12/1/2022 $45.58
99443
Telephone Evaluation and Management Service
21 30 min 12/1/2022 $68.68
99446
Interprofessional Tele/Internet/EHR Consultation, 5 10 min 12/1/2022 $16.76
99447
Interprofessional Tele/Internet/EHR Consultation, 11 20 min 12/1/2022 $33.84
99448
Interprofessional Tele/Internet/EHR Consultation, 21
30 min 12/1/2022 $50.59
99449
Interprofessional Tele/Internet/EHR Consultation, 31 or more min 12/1/2022 $67.42
G2012
Brief Virtual Check
in by Prescriber, 5
10 minutes12/1/2022 $27.30