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 96133 ‐ add on 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 12/1/2022
Behavioral Health Nurse Practitioners Physicians Physician Assistants
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
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 66.27 118.32 118.32 107.58 107.58 140.58 140.58
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
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 83.94 113.03 113.03
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. Service
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
Effective Date
Behavioral Health Nurse Practitioners Physicians Physician Assistants
Psychologists
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
12/1/2022
$ $ $ $ $ $ $ $ $ $
16.53 50.81 75.86 120.39 153.51 11.32 27.50 49.26 76.76 105.58
$
12.15 $
11.57
12/1/2022
$
23.48 $
22.36
12/1/2022 12/1/2022 12/1/2022 12/1/2022
$ $ $ $
81.13 27.30 45.58 68.68
$ $ $ $
77.03 26.00 43.41 65.41
99441 ‐ Telephone Evaluation and Management Service ‐ 5‐10 min
12/1/2022
$
27.30 $
26.00
99442 ‐ Telephone Evaluation and Management Service ‐ 11‐20 min
12/1/2022
$
45.58 $
43.41
99443 ‐ Telephone Evaluation and Management Service ‐ 21‐30 min
12/1/2022
$
68.68 $
65.41
99446 ‐ Interprofessional Tele/Internet/EHR Consultation, 5‐10 min
12/1/2022
$
16.76
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
Behavioral Health Nurse Practitioners Physicians Physician Assistants
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
Psychologists
Other Licensed Behavioral Health Clinicians