North Carolina Medicaid psychotherapy coverage: codes, telehealth and prior authorization
The short answerNC Medicaid does not require prior approval for outpatient behavioral health services under policy 8C. Associate-level professionals (LCMHCA, LMFTA, LCSWA) need a written service order from a physician, doctoral psychologist, NP or PA by the first treatment date. Telephonic-only services are limited to specific circumstances.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · North Carolina. Public policy, not the member's benefits.
North Carolina Medicaid
NC Medicaid Clinical Coverage Policy 8C, Outpatient Behavioral Health Services (amended January 1, 2025) · North Carolina
| 90785 | Listed [1] |
|---|---|
| 90791 | Listed [1] |
| 90832 | Listed [1] |
| 90834 | Listed [1] |
| 90837 | Listed [1] |
| 90846 | Listed (may not be used with 90785) [1] |
| 90847 | Listed (may not be used with 90785) [1] |
| 90853 | Listed [1] |
| Telehealth rules | Selected services (marked in Attachment A) can be delivered by telehealth following Policy 1-H, and some by telephonic audio-only when physical or behavioral health status, transportation or technology prevent in-person or telehealth. The same service by the same or a different attending provider on the same day is not allowed. [1] |
| Prior authorization | Medicaid shall not require prior approval for outpatient behavioral health services; the policy lists no utilization management. [1] |
| Referral | A written service order from a physician, doctoral licensed psychologist, NP or PA is required for associate-level professionals on or before the first date of treatment (excluding the initial assessment). Fully licensed professionals do not need a separate order. [1] |
| Who can bill | In addition to physicians, licensed psychologists, licensed psychological associates, LCMHCs, LCMHCAs, LCSWs, LCSWAs, LMFTs, LMFTAs, LCASs, LCASAs, PAs and NPs (including PMHNPs) can bill these services. [1] |
| Payment | Providers bill their usual and customary charges; rates are on the NC Medicaid website. NC Medicaid will not reimburse conversion therapy. A copayment may not be charged separately for 90785 or psychotherapy add-on codes; one copayment is allowed per office visit. [1] |
What North Carolina Medicaid's documents say
The table above has every field we found for North Carolina Medicaid, with numbered sources. In short:
- Prior authorization. Medicaid shall not require prior approval for outpatient behavioral health services; the policy lists no utilization management.
- Who can bill. In addition to physicians, licensed psychologists, licensed psychological associates, LCMHCs, LCMHCAs, LCSWs, LCSWAs, LMFTs, LMFTAs, LCASs, LCASAs, PAs and NPs (including PMHNPs) can bill these services.
- Telehealth rules. Selected services (marked in Attachment A) can be delivered by telehealth following Policy 1-H, and some by telephonic audio-only when physical or behavioral health status, transportation or technology prevent in-person or telehealth. The same service by the same or a different attending provider on the same day is not allowed.
- Codes. 90785, 90791, 90832, 90834, 90837, 90846, 90847 and 90853 are listed.
Check North Carolina Medicaid's claim against the row
Before the claim goes out, compare it with the row above: the code matches the session length you documented, the place of service and modifier fit a video or audio-only visit, and the rendering clinician's license is one the payer enrolls. The psychotherapy table compares Medicaid with every other payer we checked.