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Medicaid B - Dialectical Behavior Therapy (DBT)

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About

Coverage

Medicaid B

Diagnosis Group(s)

Mental Health, Substance Use

Age Group(s)

18-20, Adult, Child

Authorization

Submission Requirements

  • Unmanaged benefit limited to scope in provider network contract

Service Definition Authorization Parameters

  • 52 Individual sessions and 52 Group sessions annually
  • Ages 12 and up

Authorization Guidelines

Locus Level

1 2 3 4 5 6
Green check Green check Green check

Calocus Level

1 2 3 4 5 6
Green check Green check

Service Codes & Descriptions

  • 90837 22 Z3 - DBT Ind Therapy
  • 90837 22 Z3 CR - DBT Ind Therapy
  • 90837 22 Z3 GT - DBT Ind Therapy
  • 90837 22 Z3 GT CR- DBT Ind Therapy
  • 90853 22 Z3 - DBT Group Therapy
  • 90853 22 Z3 CR - DBT Group Therapy
  • 90853 22 Z3 GT - DBT Group Therapy
  • 90853 22 Z3 GT CR- DBT Group Therapy

Full Service Definition

<a target="_blank" href="https://medicaid.ncdhhs.gov/media/10107/open">Download PDF</a>

Alliance Statement of Work